Hair loss (alopecia): causes and what to do?

Hair loss (alopecia): causes and what to do?

Solid and full hair is synonymous with youth and attractiveness – for many, the psychological stress when the hair falls out is correspondingly great. In Germany, every second man and at least every tenth woman is affected by hair loss (alopecia), whether it is due to hereditary or pathological hair loss. Hopes are often high that “miracle cures” and other therapies can stop hair loss. Hair transplantation is considered to be permanently effective. But there are also different, at least temporarily, effective means.

hair growth and hair loss

Our hair consists of keratin, so it is initially nothing more than horn threads with pigments – yet it is our most beautiful natural jewellery. Humans have between 100,000 and 150,000 hairs on their heads, between 80 and 100 of which fall out and grow back daily.

Human scalp hair does not stop growing at a certain length but grows about an inch per month. A hair can grow for around seven years before it falls out and then rises again. Unfortunately, this is not the case for everyone. Hair loss – alopecia – is a common problem.

Anyone who loses over 100 hairs daily over a long period suffers from this disorder. Two different forms are distinguished: hereditary and pathological hair loss. Both occur in both men and women – albeit with different frequencies.


Genetic hair loss

The hormonal hereditary hair loss – the so-called androgenetic alopecia – is the most common form of hair loss, mainly affecting men. The cause is the “male genes”, which ensure that the hair follicles of many males react more and more sensitively to the hormone dihydrotestosterone (DHT) with age. This androgen is a male sex hormone that is often responsible for the thinning splendour on the head, the growth of the beard, and the male-typical growth on the chest and in the pubic area.

The increasing sensitivity to DHT with age is genetically programmed and reduces the hair follicle’s size – the factual structure surrounding the hair bulb. The hair follicle itself is surrounded by an outer and an inner hair root sheath. If the hair root sheath finally dies off, the hair falls out and no longer grows back.

Hereditary hair loss begins at the receding hairline.

The changes in hair growth usually begin in the third decade of life. Typically, they start insidiously at the “receding hairline”. These grow backwards, and later, the tonsure area of ​​the back of the head is also affected. The loss continues for years until only a more or less scanty fringe of hair remains. This form of hair loss in men is typical.

However, women can also be affected as they produce DHT (although to a much lesser extent than men). The affected women often show a more masculine hair type overall. Hair loss in men ultimately leads to baldness, while in women, the hair on their head only thins.

Different regions of the head are sensitive to DHT differently. For example, the hair in the crown at the back of the head is not sharp. Therefore, hair is always taken from this area and transplanted onto the top of the head in hair transplants.


Disease-related hair loss – circular hair loss

In the case of circular hair loss (alopecia areata), round, bald areas usually form on different parts of the head. The cause of the circular hair loss is an autoimmune reaction of the body against the hair follicles. In Germany, around one million people are affected. At the beginning of the disease, the hair initially loses its pigment and turns grey. Circular or oval bald spots on the scalp are characteristic. In the edge area of ​​these spots, one finds the distinct club hairs, which are only half a centimetre long and a little pigmented; occasionally, they end up split.

The back of the head and the lateral region of the hairy head are mainly affected; eyelashes, beard and the rest of the body hair are less common . Very rarely, there is a complete loss of body hair – this particular case is referred to as alopecia universalis. However, the bald spots are not painful and do not itch.

Other causes of hair loss

Metabolic diseases, medication and iron deficiency, hormonal disorders and extreme mental stress can also negatively affect hair metabolism and lead to so-called diffuse hair loss. In rare cases, malnutrition can also cause hair loss.

Finally, there is physiological hair loss. It is rare and occurs after pregnancy or during menopause, which is related to a sudden drop in the female hormone estrogen. When estrogen levels return to normal, hair loss usually stops.

Stop hair loss – what helps?

A dermatologist should be consulted before resorting to all conceivable means to stimulate hair growth. There are many reasons for hair loss, and underlying organic disorders should be ruled out. Treating hair loss is often difficult. In the case of hereditary hair loss, there are now remedies that can be used to stop hair loss in some instances.

However, hair follicles that have once shrunk or died cannot be “revived” – miracle cures that promise to let new hair sprout on a bald head promise more than they can keep.


hair transplants

If the hair is slowly thinning, bald spots can disappear with a hair transplant. Nevertheless, you should be aware that you cannot restore the hair of your youth with a hair transplant. A severe bald head surrounded by a smaller fringe of hair can never again be covered with the hair density of an 18-year-old. In addition, you need a lot of patience for a hair transplant because the newly implanted hair falls out a short time before it begins to grow back tentatively.

In the case of pathological hair loss, a hair transplant is not advisable because there are not enough well-developed donor hair roots. The transplantation method is particularly successful in the case of androgenetic alopecia.

How does a hair transplant work?

In a hair transplant, hair from the back of the head is transplanted into the bald areas, e.g. B. in the receding hairline. Only the existing hair at the back of the head is used to fill up the hair in the thinned areas. The donor hair on the back of the head should also be robust and thick, and the hair loss should not be too extensive. You will get a good result with naturally strong and healthy hair roots.

It becomes more complicated if the donor hair quality improves, i.e., fragile and soft hair grows on the back of the head. Healthy and strong hair roots are then isolated from the neck and redistributed if possible. Incidentally, hair from another person cannot be used for a hair transplant because the immune system would reject it.

Different methods of hair transplantation

One method of hair transplantation is skin island transplantation:  In several treatment steps, hairy skin islands are punched out in the back of the head under local anaesthesia and replanted in appropriately prepared recipient areas in the hairless scalp area. However, this often results in tufts of hair growing on the transplanted islands of hair, which looks unnatural.

The mini and micrograft technique is the most common form of hair transplantation. A micro-graft contains one to two hairs with a diameter of 0.7 to 0.9 mm; a mini-graft includes three to five hairs with a 1.0 to 1.2 mm diameter. Up to 1,500 of these transplants are used per treatment. With these tiny skin islands, it is possible to create a natural hairline in the forehead area, where a slow, rather inconspicuous transition from hairless to hairy skin is guaranteed. Many grafts can be placed in one session under local anaesthesia. Several treatment steps can be carried out one after the other to fill in more significant hairless regions.


implementation of the transplant

Depending on the technique, tiny slits are cut into the skin, or small holes are punched or drilled in the hair transplant; sometimes, a laser is also used. While slits can push the implanted hair out again when they grow together, the wound area is more significant in the case of punched holes. The heat can damage tissue with lasers, making it difficult for the hair to grow back. On the other hand, less blood flows when using a laser.

The usual outpatient operation lasts between two and four hours. After the hair transplant, it is entirely normal for the transplanted hair to fall out again. After about three months, however, new hair is produced. The bald area will be overgrown without complications after nine to twelve months.

Hair transplant cost

Before a hair transplant, the patient should be advised in detail. Above all, it must be apparent where the limits and risks of a hair transplant lie and how high the operation costs are. In most cases, the patient has to bear the costs themselves. There are exceptions in the event of an accident – e.g. burn scars on the scalp, which are usually covered by health insurance.

The hair transplant cost is onerous to estimate as it varies from person to person. Depending on the doctor and clinic, a graft costs between 1 and 3 EUR, so it can quickly add up to 3,000 and 6,000 EUR or even more. To fill the receding hairline, you must reckon with around 2,000 EUR.

artificial hair implantation

With this method, differently coloured artificial hair made of synthetic fibres is inserted into the scalp using a special needle. But within a year, you must reckon with a breaking off of about ten per cent and more of the artificial hair. In addition, the risk of a bacterial infection is increased, and a foreign body rejection reaction with inflammatory hardening of the scalp can often occur. Doctors advise against this method.


Drug treatment for hair loss

Hair loss can also be treated with medication.

hair loss in men

The active ingredient finasteride has been approved in Germany for genetic hair loss in men since 1999. Finasteride selectively inhibits the enzyme that converts the male hormone testosterone into DHT (dihydrotestosterone). The finasteride tablets are taken orally once a day. The drug must be used continuously throughout 3 to 6 months to see any benefit.

Rarely, taking finasteride can cause side effects such as reduced desire or erectile dysfunction. The remedy is unsuitable for women, as a positive effect on hormonal hair loss has not been proven. In addition, fetal damage cannot be ruled out in pregnant women.

hair loss in women

For women – and, of course, also for men – there is a preparation against hair loss that can be applied to the scalp or taken as a tablet. It contains minoxidil and has been approved in Germany since 2004. As a side effect, increased body hair was observed in some patients after ingestion.

Men should also not take finasteride before adulthood, as DHT plays a role in the formation of male sexual characteristics. The following applies: If you have a fully developed bald head or a prominent receding hairline, only small successes are possible with finasteride. In the case of mild and moderate hair loss, however, finasteride is a therapy option to stop the hair loss at least.


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