• Over 80 million men and women in the United States suffer with hereditary hair loss, as well as experience male-pattern baldness, female-pattern baldness and androgenetic alopecia. Many hair loss cases unique and deriving from other medical issues. It’s imperative to understand the causes of balding and find treatment options that are safe, affordable and provide the maximum aesthetics results, especially for hair loss for women over 50

    ZestNow: As you know this is a very emotional issue for women. What are the possible causes of female hair loss?

    Dr. D: Not all hair loss is the same.  Hair loss is in itself a symptom and not a diagnosis. There are many things that can cause hair loss, and the remedy, or treatments, vary depending on the cause. Here are some of the most common forms of hair loss:

    Androgenic Alopecia – The most common cause of hair loss in both men and woman, androgenic alopecia is often termed patterned hair loss, where the growth phase of a hair (the Anagen phase) is shortened resulting in a collection of very fine colorless hairs referred to as vellus hairs. This process is characterized by loss of pigment (melanin) of the hair, and progressive hair miniaturization in girth and length of the hair shaft resulting in a thinning or bald appearance.

    Treatment for Androgenic Alopecia in women is limited to the use of a topical medication containing Minoxidil (2%) and hair restoration surgery.  If a talented ethical surgeon performs the surgery, the aesthetic results can be quite fulfilling.

    Scarring Alopecia (AKA Cicatrical Alopecia  is a form of permanent hair loss in which the follicles are actually destroyed due to surrounding inflammation within the scalp and replaced by scar tissue during the healing and recovery phase. Although this type of hair loss disorder will be diagnosed in only 3-5 percent of hair loss cases, there are many types of scarring alopecia, with different causes. Treatments for this type of hair loss are aimed at preventing destruction of the follicles by quelling the inflammatory process and minimize scar formation.

    Telogen effluvium is a term used to signify hair shedding of club hairs when a disproportionate number of actively growing (anagen) hair follicles are prematurely shifted into their resting (telogen) phase resulting in hair thinning. Fortunately, Telogen Effluvium does not cause permanent destruction to the hair follicles, and most will see recovery of the lost hair after the inciting event is over or removed.

    Alopecia Areata occurs when one’s immune system mistakenly attacks hair follicles, resulting in semi-round discrete patches of hair loss or noticeably thin patches with broken off hairs termed “exclamation point” hair. This form of hair loss is usually non-permanent, as the patches of hair typically re-grow in 6 to twelve months.  However, up to ten percent of cases may only partially re-grow with thinner finer hair or not at all.

    Various medical diseases can contribute to female hair loss, and are worth mentioning. Some of them are:  thyroid disease (Hypothyroidism, and Hyperthyroidism,) Iron deficiency anemia, polycystic ovarian disease and discoid lupus.

    Believe it or not, the daily routine of styling and treatment we subject our hair to, can in itself cause hair loss.  Although not all of this is true hair loss, but rather breakage, it can render our hair with lack luster shine and volume. Permanents, straightening, blow drying, bleaching, keratin treatments, Brazilian treatments, coloring (especially permanent color two shades darker than one’s native hair) and even excessive sun exposure will damage hair if done frequently. Pulling and traction on the hair itself can actually cause the follicles to be killed if done on continual bases.  Examples of this would be continual use of hair   extensions, fastened tightly to strands of hair, or wearing hair in tight braids for extended periods of time.

    ZN: Which of these conditions are most likely to occur after 50?

    Dr. D: Roughly 50% of women by the age of 50 or older, experience some form of hair loss. By far the most common form of hair loss in women 50 years and older is Androgenic Alopecia, aka: Female patterned Hair loss (FPHL).  This form of hair loss is genetically inherited and affects 80%-85% of women who have hair loss 50 years and older. : Effluvium is another form of hair loss commonly seen in women 50 years and older.  The Chronic Idiopathic form of Telogen Effluvium is especially more dominant in middle-aged women.

    ZN: What warning signs shall we look for?

    Dr. D: In general it is normal to lose fifty to one hundred hairs per day without any cumulative hair loss. If you notice that you are losing more, or losing more frequently, definitely seek medical help for further diagnosis. Other signs to watch for with respect
    to their specific hair disorders include:

    Fine, colorless, miniaturized vellus hairs replacing normal healthy fully-grown hair, resulting in patterned hair loss could be Androgenic Alopecia..

    Small patches of hair loss that expand over time.  Itching, burning, pustules; with color changes to the scalp in red, violet and yellow hues.  A waxy very shinny appearance to the scalp and loss of the native pores in the lesion. This could be Scarring Alopecia..

    Shedding of greater than one hundred club hairs per day from an inciting event stressor. This could be Telogen Efflluvium described above with ecovery of the lost hair after the inciting event is over or removed.

    Semi round discrete patches of hair loss, with central clearing of hair and possibly some broken off ”exclamation point hair” are visible. This may be caused by Alopecia Areata.

    ZN: One of our members noticed seasonal hair shedding on her dogs and asks if this is true for us as well.

    Dr. D: Although there is no hard scientific evidence to indicate there is seasonal issues and hair loss, I do see in my own practice, anecdotal evidence of complaints of increased hair shedding; especially when the seasons change from summer into fall. I feel that this form of hair loss may be associated with a Telogen Effluvium, and does not necessarily mean that the hair is
    permanently lost, but likely to regrow in 6 – 12 months

    ZN: Can you explain why hair is affected by chemotherapy? Does the hair always come back and how long does it take?

    Dr. D: Chemotherapy targets cancer cells because they have a faster growth rate than most normal cells of our body. Our hair cells (found in the matrix of the hair bulb) also have a fast growth rate and are therefore also targeted by chemotherapy. Once these cells are affected, they stop producing the normal hair cells, and hair growth stops abruptly. Hair re-growth typically happens after chemotherapy treatment is completed, though not always.  What determines re-growth is the exact type and duration of treatment prescribed, for the particular type of cancer the chemotherapy is meant to eradicate. The hair typically begins to regrow in 10 to 12 months.

    ZN: Will the regrown hair be different?

    Dr. D: The texture, volume and sometimes color can all be the same or different after re-growth.  Sometimes, the hair may return wavier, with a slightly lighter shade of color or no pigment at all. The fullness of the re-grown hair may be the same or slightly thinner. The determining factor to re-growth is the actual type, dosage and duration of the chemotherapy used along with the actual physiological affect it had on certain cells of the hair that is responsible for the physical characteristics of the hair.

    ZN: What other conditions might create hair loss?

    Dr. D: Other causes of hair loss might include: Exposure to toxins and heavy metals and chemical burns, radiation to the scalp, genetic and/or other medical causes are also typical.

    ZN: What can be done to restore lost hair?

    Dr. D: Although the primary goal is to prevent hair loss in the first place, hair can be restored in part or whole with the use of medications and cosmetic surgery.  Minoxidil for women is a topical medication that can help stabilize, prevent and in some cases recover lost hair.  Its use needs to be maintained on a daily basis in order to retain the benefit. With the advent of advanced modern day Hair Restoration Surgery women can permanently replace a large portion of lost hair. I personally have treated thousands of men and women with natural pleasing aesthetic results.

    ZN: What other alternatives are there?

    Dr. D: Besides the scientifically proven results of Minoxidil and Hair Restoration Surgery, there are many proprietary products on the market that claim hair re-growth without substantiated evidence.

    Two alternatives that are growing in popularity are Laser therapy and Platelet Rich Plasma injections (PRP).

    Although the mechanism of laser therapy in the role of hair re-growth is not known, it is believed to aid in repair of the scalp tissue and up regulates hair growth.  Platelet Rich Plasma (PRP)- is a process where a patient’s own blood is drawn, spun down in a centrifuge, and the Platelet Rich Layer is re-injected into the scalp. I have begun to see positive effects with PRP either as a stand-alone procedure or in conjunction with hair restoration surgery in my practice.

    ZN: Dr. Dorin, thank you for sharing your information on such an important topic.

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    Article by: Dr Robert Dorin

    Robert Dorin, D.O. ACOFP is New York City’s hair restoration surgeon and co-partner of True & DorinHair Loss Doctors with over 10 years of experience in the field of hair restoration. Personally affected by hair loss and a patient of hair restoration surgery himself, Dr. Dorin has a knowledgeable understanding of hair loss from both sides of the industry, providing immense knowledge in the field. True & Dorin are the first to practice True &Dorin Strip Procedure and True & Dorin Extraction Procedure, two groundbreaking surgeries requiring minimal discomfort and optimal scalp repair.   Dr Dorin is a Diplomate of the American Board of Hair Restoration Surgery, board certified in Family Practice and a member of the following: International Society of Hair Restoration Surgeons (ISHRS), Coalition of Independent Hair Restoration Physicians, International Alliance of Hair Restoration Surgeons (IAHRS), AOA, ACOFP, and New York State Osteopathic Medical Society.

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