. Frequently Asked Questions  
Answers by Dr Kevin Alexander
What is the difference between normal and abnormal hair loss ?

Everybody loses at least 100 hairs per day due to the body's natural need to replace old hairs with new ones. In fact, the old hair is usually prompted to fall out only when it is pushed out by the new hair growing through. In certain instances, natural hair loss may become excessive, for example following severe emotional or physical trauma ,(as in the case of an operation), or following a hormonal stress,(as is the case post pregnancy ). These are all temporary conditions of increased hair loss and providing there is no other underlying problem, like an inherited tendency to alopecia androgenetica, the problem usually corrects itself within a few weeks. True hair loss, leading to a permanent thinning of the scalp hair or even bald spots, means that there is an underlying inherited or pathological condition and I will cover these in the next question.

What are the main and other causes of hair loss?

By far the most common condition leading to permanent hair thinning in both men and women is the inherited condition of alopecia androgenetica (male or female pattern baldness, as the case may be). This is  a condition which can be inherited from the maternal as well as the paternal side of the family and can go back six generations. It is a complex pattern of inheritance which can skip generations and often, people who have inherited the condition, do not know of anyone else in their family  who is similarly afflicted. Approximately 95 % of all men and women seeking help for hair loss, have alopecia androgenetica. 

Another , less common cause of  hair loss is a condition known as Alopecia Areata. In this condition, the body fails to recognize it's own hair follicles as belonging to itself and mounts an antibody attack on its own hair follicles. This leads to a sudden and dramatic loss of hair which can occur overnight and  usually starts in patches. This condition could spread to involve the entire head (Alopecia Totalis) or even the entire body (Alopecia Universalis). 

Other causes of hair loss would include Thyroid gland problems, iron deficiency anemia, fungal scalp infections, specific hormonal problems and there are numerous other less common causes.

Are males or females more prone to hair loss? 

With every hair loss condition other than alopecia androgenetica (male or female pattern baldness), the  incidence between the sexes is equal. In alopecia androgenetica, the inheritance of the trait is equal in both men and women, but due to the fact that this condition involves the interaction with an inherited receptor of the male hormone Dihydrotestosterone (DHT), (which in men is found in quantities four hundred times that which is found in women), the severity of the condition is far worse in men. In women it is more slowly progressive and involves a diffuse thinning of the hair virtually all over the head (except maybe at the base of the skull). Post -menopausally, the balancing effect of oestrogen on the male hormones is lost and the condition tends to accelerate. In men with this condition, the hairs on the sides and back of the head are spared, and the hair is  lost only on top. 

Does diet influence hair loss? 

Yes, but not to the extent that most people  believe. The hair requires certain minerals, vitamins and nutrients which are generally found in most well-balanced diets (for e.g.. zinc, calcium, iron, folic acid, biotin). Of these, iron is the most important, but you need to be extremely deficient in iron before this translates into actual, visible hair loss. On the other hand, overdosing with Vitamin A in supplement form, could eventually lead to hair loss. Very few cases of hair loss are caused by diet alone , and so altering one's diet and treating the condition with hair vitamin supplementation or other natural remedies is unlikely to be successful. 

Can hair loss be treated, and if so how? 

Yes, there has been a recent 'revolution' in terms of medical treatment (i.e. prescription tablets and lotions) for hair loss in both men and women. We are now seeing results with medical treatments which , a few years ago, were thought to be impossible to achieve. 

We  have safe and effective drugs which are specific to gender, for example the new male anti-baldness pill Propecia, which cannot be given to women, but can grow hair back in 66 % of men and prevent further loss in 83% . We also have a female-specific anti-baldness pill which should not be given to males. The prescription lotions which we use, can be safely given to either sex. 

Here at Dr Alexander's Hair Loss Clinic in Bedfordview, Johannesburg, treatment for the most common hair loss condition, alopecia androgenetica (i.e. male and female pattern baldness), would involve the use of these new tablets and lotions, whereas treatment for a condition such as Alopecia areata, would involve a short course of intrascalp injections together with a topical lotion. 

All of these medicines have a sound scientific basis for working ,and have been extensively tested in Clinical drug trials worldwide, where they have been found to be effective and to be safe to use. 

Is hair loss common?

Hair loss, or more specifically alopecia androgenetica (male or female pattern baldness), is extremely common in both men and women. Roughly  70-80 % of men and 40-50% of women will experience some form of hair thinning from this condition in their lifetime. 

In women, the condition is usually not as severe , and is therefore not as noticeable as it is in men, but it is still very common. Women are also able to hide the condition better by wearing their hair up with clips etc.

Fifty percent of the patients that I treat at my  Hair Loss Clinic are women. The
psychological and emotional impact of hair loss on a woman can be totally devastating.

Is hair loss common among children? 

Hair loss is uncommon among children because the commonest form of  hair loss i.e. alopecia androgenetica, (male and female pattern baldness), is only seen in the late teens at it's earliest. The less common conditions of alopecia areata , totalis and even universalis do occur in children.

I have successfully treated children with all of these conditions from as young as five years of age, but success rates in alopecia totalis and universalis, both here and overseas, tend to be low, whereas with alopecia areata, the success rate is quite high. 

Children are also more commonly afflicted than adults with the scalp fungal infection Tinea Capitis. This is a fairly straightforward condition to treat once you have identified the causative fungus. 

Are there any preventative measures that can be taken to avoid hair loss, and if so what?

Unfortunately, there is not much that one can do to prevent the occurrence of either alopecia androgenetica (male and female pattern baldness), nor alopecia areata, although both these conditions are now treatable.

Obviously, the less common causes of hair loss such as iron deficiency and Thyroid gland problems can be prevented if these conditions are remedied early, as hair loss is usually a late sign of these conditions.

Another preventative measure would be to ensure, in terms of one's vitamin supplementation, not to overdose with vitamin A. 

Do chemicals used for hair treatments in salons cause hair loss? 

Usually not. Most causes of hair loss work their effect at the level of the hair follicle, and unless a chemical is able to penetrate through to the level of the follicle, it is unlikely to cause hair loss. Most chemicals used in hair treatments exhibit their effect in terms of the condition of the hair above the level of the scalp. 

Perming and straightening lotions are not generally recommended as they may denature the protein structure of the hair at the follicle base, and this may lead to permanent damage at the level of the follicle.

At what stage, if any, would you suggest a patient undergo hair replacement/ transplant? 

I would say that one should only consider hair replacement or hair transplant after you have tried medical treatment for at least one year and discover that you are one of the few unfortunate individuals in whom it has not been successful . If it is at all possible to get your own natural hair back, this is obviously the best solution and the most socially acceptable manner to deal with the problem. Most of our patients are proud to tell their friends and colleagues about their successful medical treatment for their hair loss problem. Success rates
with medical treatments are now extremely high. 

If however, medical treatment does fail, then I certainly don't believe in just leaving the problem and suffering the loss of confidence that comes with an embarrassing hair loss problem. If I have a patient in this position, I would normally suggest referring him or her to an expert in either hair replacement or hair transplant surgery. 

How do hair replacements/transplants work and for how long do they last? Are they very noticeable? Do they require special treatment? 

In a hair transplant, hairs are taken from a donor site at the back of one's own head and transplanted to the area of balding. This procedure is not generally successful in women as the donor site is usually not as clearly defined as it is in men. The donor site is then stitched closed and the scar is covered with the overlaying hair.

A micro-follicular hair transplant would be noticeable under close scrutiny as there is a minimum distance required between the implants, so to create more density, 3-6 hairs are implanted into each apparent root, giving the appearance of 'hair tufts'. From a reasonable distance away, this would not be noticeable. 

The main problem with regard to hair transplantation is in terms of the amount of hair which needs to be transplanted. If you are looking to cover a large area of bald scalp with thick hair, this is unlikely to be achieved by means of hair transplant due to the expense, the limited amount of donor hair available, and the fact that the transplanted hairs have to be spaced a certain distance apart. Remember that the average human head contains about 120 000 hairs. 

The best results with transplant surgery are seen when one has a small area of thinning hair which one would like to "fill up", or if one wants to create a more defined hair line when one is receding in front. Often, one can use both medical treatment and transplant surgery concurrently to get the best possible result. 

It is generally advisable, even if a man undergoes transplant surgery, that he should continue using the anti-baldness tablet Propecia to prevent further thinning of susceptible hairs and to give himself the best opportunity for hair regrowth. 

In hair replacement, a hair-piece, made from either real human hair or artificial fibre is secured to the scalp by various methods. In some instances, your existing scalp hair may need to be shaved . These hair pieces can last anything from one to three years ,depending on the care by which they are handled. There are certain centers who are experts in developing  virtually undetectable hair pieces at a price, and other centers where the hair piece may be cheaper , but will be more obvious. Hair replacement always requires special follow-up aftercare treatment in terms of  hair cuts, styling and re-securing to the scalp. This may become quite expensive in the long term. 

by Dr Kevin Alexander

1. Wash regularly with good quality shampoos and conditioners.

2. Avoid styles that put a strain on the hair such as braiding and hair extensions.
    Avoid the habit of pulling your own hair.

3. Have your serum Thyroid hormone levels and iron levels checked annually.

4. Avoid straightening or perming your hair with strong chemical lotions.

5. Brush your hair in different directions on a regular basis.

6. If you notice hair loss or thinning, do not ignore the problem. Contact a
    professional who specialises in dealing with these problems.