Hair shedding affects both men and women equally. Seeing more hair in the hairbrush, on the shower floor, or down the drain can be upsetting. Every day, we see patients who are concerned about whether or not they are permanently losing their hair. Patients we see frequently describe their situation with terms like hair shedding, hair thinning, hair loss, and hair fall. I’ll go over these terms to help you understand them, as well as situations where there is a risk of long-term hair loss and treatments I recommend in my practice.
I’ve been in practice for over 25 years in Manhattan and Long Island. Throughout my career, I have assisted patients with genetic pattern hair loss with surgical hair transplants and medical therapies such as finasteride and minoxidil. In 2011, I discovered a remarkable side effect of acellular matrix with PRP, the wound healing materials we used to improve our hair transplant surgical results, which resulted in reactivation of hair growth and thickening of thinning hair. Based on my findings with various formulations and techniques, I created the TrichoStem Hair Regeneration system for male and female pattern hair loss. TrichoStem Hair Regeneration Centers was founded to help make this treatment system more geographically accessible. Patients from all over the world visit our offices for TrichStem Hair Regeneration.
How do I know if I’m shedding too much hair?
The possibility of permanent hair loss is the most common concern for people who experience hair shedding. According to the medical literature, it is normal to shed 50-100 hairs a day. This is usually not perceivable because of the rate of hair regrowth.
Stages of Hair Growth
Individual hairs grow continuously for 2-6 years in a period called the anagen phase. Approximately 88-90% of your hair follicles are in the anagen phase, which means that the majority of your hair is growing and visible at any given time. Hair eventually stops growing, but only about 8-10% of hairs do so.
When hair stops growing, it enters a brief transitional phase known as catagen, during which the hair shaft begins to separate from the hair follicle or root. This transitional period lasts approximately four weeks.
The hair then sheds in a phase called telogen. Telogen is also the resting phase where the follicle doesn’t produce hair for about 3-4 months. After the telogen phase, the hair growth cycle starts again with the anagen phase, and hair grows from the same follicle.
Hair Shedding vs Hair Loss (or Hair Fall)
Higher than normal hair shedding when 200 or more hairs are shed per day, is frequently associated with temporary hair loss conditions. Hair shedding can be caused by hormonal effects from oral contraceptives, or hormonal changes before and after childbirth, for example. In general, shed hair remains viable with a hair follicle that is still intact and functional, allowing the hair to grow back. Telogen effluvium is a common type of hair shedding.
Telogen effluvium is commonly caused by a stressful event that occurred 2-5 months prior to hair shedding. Events that cause telogen effluvium are frequently extremely stressful, such as general anesthesia, extensive surgery, a death in the family, divorce, or hospitalization. Chronic telogen effluvium is a condition that primarily affects women, and is not directly related to a single stressful event.
Chronic telogen effluvium is distinguished by consistent and significant hair shedding, as well as some relative stability in density and overall scalp coverage. There is no direct treatment for telogen effluvium, so you must simply wait for the shed hair to regrow.
Hair shedding is common in both men and women undergoing cancer treatment because chemotherapy causes a halt in the active growth phase, which is known as anagen effluvium. Hair usually grows back after chemotherapy, so intervention is rarely required. Some patients have reported that their hair quality never returned to pre-chemotherapy levels.
Hair Thinning vs Hair Shedding
Hair thinning is defined as a progression in which hair density decreases, and individual hairs grow back thinner after normal shedding. If left untreated, the hair follicle eventually miniaturizes, then disappears. Scalp sensitivity to dihydrotestosterone, or DHT, is a contributing factor to hair thinning in men with male pattern hair loss. Another aspect of male pattern hair loss is the possibility of a genetically programmed limitation on the number, and duration of hair growth cycles. The drug finasteride is used to reduce DHT in the bloodstream to slow progressive hair thinning.
Finasteride allows for prolongation of the hair growth cycle, but it has limited value in the stimulation of hair growth. Further, we’ve observed many patients who’ve been on finasteride for over 15 years, but still progressively lost a significant volume of hair. This doesn’t mean that the finasteride didn’t work, it just means that there are other variables which cause hair loss to continue in spite of the drug. More than likely, they would have had much less hair if they weren’t on finasteride.
Female pattern hair loss is far more common than is commonly assumed. Affecting 50% or more of women over 50, there may be an association with estrogen deficiency, as well as genetic factors. Female pattern hair loss is diffuse, resulting in a decrease in hair density and a widening of the hair part, which is referred to as a “Christmas tree” pattern.
The term “hair fall” is commonly used in South Asian countries to mean awareness of hair loss, which can refer to hair shedding, or genetic pattern hair loss. Although “hair fall” more accurately describes hair shedding, people who say “hair fall” are often describing the progressive hair thinning associated with genetic pattern hair loss, or androgenetic alopecia.
As previously stated, I developed a treatment for male and female pattern hair loss based on observations of improved scalp coverage during hair transplant in areas not transplanted when we used PRP or platelet rich plasma with ACell’s acellular matrix. Since 2011, I’ve been combining these materials, and developing algorithms, which I’ve refined over time based on the responses I’ve received. TrichoStem Hair Regeneration is not just an injection treatment. I create customized treatment plans for male and female pattern hair loss patients based on the patient’s gender, age, age of onset of hair loss, degree of hair loss, and any prior medical treatments used for hair loss.
Although a large percentage of our patients have done well for over 5 years with only one treatment session, patients who have moderate to advanced hair loss may receive an additional treatment 15-24 months after the first to maximize scalp coverage. Sustained hair growth, and thicker hair has been seen for 3-5 years, or even more with this approach. Our patients don’t need to come in for injections every month or every three months for the treatment to be effective. We follow our patients with standardized digital photography and microscope photos every 3 to 6 months for the duration of the treatment plan, and yearly thereafter. We have achieved visible and long-term improvement in hair thickness, density, and coverage in over 99% of our patients.
My hair is falling out from the root, what can I do?
It is common for people to think that their hair follicles are being lost with hair shedding. It is a common mistake that a white bulb at the end of a shed hair shaft is the root or the hair follicle, and when they see it, they have permanently lost that hair. The white bulb commonly seen with shed hair is actually keratin, or dead skin, with the hair follicle remaining in place to regrow a new hair strand. Pattern hair loss, or androgenetic alopecia/ androgenic alopecia is when the shed hair grows back progressively thinner, and there is delay in regrowth of new hair because hair growth cycles are limited.
Recommendations for Proper Hair Loss Treatment
When it comes to hair loss, proper diagnosis and management can make a significant difference in your long-term outlook. People are being sold hair loss treatments in which the practitioner or vendor makes no commitment to your long-term management. If you’re experiencing hair loss and considering a procedure, look for a doctor who will conduct a thorough evaluation, show you before and after photos of their patients, and provide you with a rational treatment plan that you can trust. I hope you found this information helpful.