Hair Loss Guide

Over 80% of men and over 25% of women around the world are affected by hair loss, most of which is the result of genetics, hormones, or pattern hair loss. In this article, the causes and effective treatment options for hormonal hair loss are discussed.

What is Hair Loss?

Most people experience hair loss at some point in their lives. The most common cause is a pattern baldness which is also referred to as androgenetic alopecia. This type of hair loss may affect all hairs all over the body or may only affect the hairs on the head.

Elderly people are most affected by hair loss. Normally, human hair loses 50-100 hair strands a day. Since there are more than a hundred thousand hair strands on the head, this daily hair loss is

Usually, the new hair will grow back and replace the lost hair, but this is not always true. Hair loss usually begins and progresses gradually over the years but can develop rapidly.

Hair growth can be divided into 3 phases: growth phase (Anagen phase), transition phase (Catagen phase) and resting or loss phase (Telogen effluvium phase).

The growth phase comprises about 85% of the total hair on the head. This phase lasts about 2-6 years. The hair actively grows longer and thicker in this phase.

In transition phase, the hair undergoes the regeneration process. At this phase, cell division stops and the hair follicles are no longer supplied with nutrients and begin to shrink. This phase usually lasts about two weeks and ends when hair follicle is keratinized and ready for the final phase, the loss phase. The metabolic activity of the hair follicle is stopped during this phase, causing the hair to die and eventually fall out.

For approximately 3 months and until new hair is formed, this process affects approximately 8% to 14% of the total hair on the head. The regrowing hair sheds the existing hair from the follicle causing the hair to fall out. The hair will begin to enter its life cycle again starting from the growth stage.

Female Androgenetic Alopecia

Hereditary hair loss or androgenetic alopecia, can also occur in women. Although women are less affected, this type of hair loss is more common and usually begins with thinning and shedding of hair around the crown.

Congenital hair loss in women may begin as early as the age of 30. However, hair thinning is usually noticeable during menopause when the hair follicles are sensitive and respond to the hormonal changes.

This is especially true in the central region, where the scalp becomes more visible, though complete head baldness is extremely rare in women. Unfortunately, conventional remedies such as shampoos or dietary changes cannot help with hereditary hair loss.

Alopecia Areata

Circular hair loss or alopecia areata, is one of the most common hair loss problem caused by inflammation. This type of hair loss often occurs in episodes and is accompanied by other symptoms such as pain or itching in the affected area.

The exact cause of alopecia areata has not yet been identified. This type of hair loss is not age-related and can happen to anyone, whether young or old, both men and weman.

However, some factors are known to be associated with the development of this type of hair loss. Immune system disorders are the most important factor contributing to hair loss.

In this form of hair loss, there is a local inflammatory reaction which limits hair growth and leads to hair loss until the formation of bald, round patches on the head. Other parts of the body such as eyebrows or mustaches can also be affected by this condition.

Another important factor that plays a role in the development of the disease is genetic predisposition, and circular hair loss is more common in people with family history.

Additionally, this type of hair loss may be the result of stress in some cases. For example, accident or loss of a loved one can lead to circular hair loss. Malnutrition or harmful environmental factors are also the causes of this type of hair loss.

Diffuse Hair Loss

Diffuse hair loss does not affect only a certain area on the head, but hair on the entire head becomes thinner. It is usually noticeable about 3-4 months after the onset of symptoms.

Alopecia areata is usually noticeable when combing or washing the hair and the scalp becomes more visible through thinning hair. It can be caused by a variety of reasons, from illness such as thyroid disorders, infectious diseases, vitamin deficiency, to severe stress, hormonal changes or medications.

Possible Causes of Diffuse Hair Loss are As Follows:


Diffuse hair loss can be caused by the following diseases:

  • Thyroid dysfunction, such as hypothyroidism or hyperthyroidism
  • Infectious diseases
  • Venereal diseases such as syphilis
  • Chronic intestinal diseases, such as ulcerative colitis and Crohn’s disease.
  • Cancer
  • Eating disorders such as bulimia and anorexia
  • Diabetes
  • Systemic Lupus Erythematosus (SLE)


The following medications can cause diffuse hair loss:

  • Chemotherapy with cytostatic agents
  • Painkillers
  • ACE inhibitors and beta-blockers, such as antihypertensivs
  • Hypolipidaemic agents
  • Thyroid medications
  • Heparin (anticoagulant)
  • Antibiotics

Radiotherapy and Radiation Accidents

Radiotherapy and radiation accidents can lead to diffuse.

  • Hair loss after exposure to ionizing radiation (8 Gray)
  • Hair usually grows back after about 2 months.
  • A radiation dose above 8 Gray can lead to permanent hair loss

       External circumstances

The following external circumstances can lead to diffuse hair loss:

  • Abnormally high stress
  • Surgery, general anesthesia

       Hormonal changes

         Hormonal changes are the relevant factors contributing to diffuse hair loss.

  • Some women may experience hormonal changes about 2-4 months after giving birth. This is caused by estrogen deficiency, as the concentration of this hormone decreases after childbirth and excessive hair growth during pregnancy falls out. Hair loss may also be increased under stress.
  • Taking or discontinuing birth control medications, such as oral contraceptives.
  • Menopause, especially in the early stage


         Malnutrition can lead to diffuse hair loss.

  • Unhealthy nutrition
  • Radical diets
  • Protein or iron deficiency
  • Deficiencies in vitamins, biotin, or zinc, which are rare.

As there are many possible causes, it is difficult to determine the cause of hair loss on your own. It is recommended that, you should consult a doctor for proper diagnosis and treatment.


There are a number of factors that are mistakenly believed to be the causes of hair loss.

  • Hair washing: Frequent washing your hair does not increase hair loss.
  • Wearing a Hat: Wearing a hat or cap does not increase hair loss.
  • Exposure to sunlight: More exposure to sunlight does not lead to hair loss.
  • Masturbation: Masturbating has nothing to do with hair loss.
  • High testosterone level: A naturally high testosterone level does not result in increased hair loss.
  • Mother’s genetic material: Mother’s genetic material does not specifically contribute to hair loss.

Treatment Options

Although it is difficult to treat androgenetic alopecia, it can be solved by hair transplantation. The effective methods for treating and analyzing hair loss are as follows:

         Lifestyle change

  • The risk of hair loss can be minimized through dietary adjustments
  • Increase exercise
  • Avoid stress
  • Mediterranean diet with a lot of vegetables, fish, nuts and olive oil is effective for hair loss
  • Quit smoking
  • Weight loss
  • Hair contains keratin, which consisting of a large amount of protein. Therefore, increasing protein intake can help prevent hair loss.
  • Protein-rich foods, vegetable proteins (potatoes, grains, soybeans) are more beneficial for hair loss than animal proteins (meat, eggs, cheese).
  • Vitamin A (spinach, butter, carrot, broccoli) can promote hair growth.

You may use active ingredients such as Baicapil to promote hair growth.

Food Supplements

In general, taking multivitamin supplements may help with hair loss problems. These supplements help with vitamin balance such as vitamin A, vitamin B1, vitamin B12, vitamin C and vitamin D3, as well as minerals.

Vitamin D deficiency can disrupt the hair cycle and increase hair loss. Those who do not get enough vitamin D from sunlight, which helps the production of vitamin D, should take dietary supplements. A study in 2018 found that vitamin D is associated with androgenetic alopecia. Therefore, treating vitamin D deficiency can help with hair regrowth. Please consult your doctor about vitamin D intake at 800–1000 IU per day.

Biotin, which is also referred to as vitamin B7 or vitamin H, is important for metabolic processes. Biotin helps to strengthen hair and nails. You can take dietary supplements to provide your hair and nails with all the essential nutrients, such as zinc, to make it stronger and look shiny and healthy.

Zinc keeps the scalp healthy and prevents testosterone from converting into dihydrotestosterone because it acts as a natural blocker of DHT blocker, a hormone that responsible in atrophy of the hair follicles in androgenetic alopecia.

Saw palmetto products are about as effective as 5 mg of finasteride. Saw palmetto extract can decrease DHT level, thereby increasing testosterone level. Additionally, more broccoli and pumpkin seed oil should be included to the diet to enhance the effectiveness of saw palmetto extract.

Ginseng is considered a medicinal herb with restorative properties and a nutrient for hair. When applied externally, the nutrients reach from the scalp through the hair roots to the tips and can produce the same effect when used as a supplement. Caffeine can be used to enhance the effects of ginseng.

To date, there has not been scientifically proven that supplements are effective for hair loss problems. Therefore, it is questionable whether these products actually help with hair loss problem. However, it is not hurt to take additional supplements as they will not have negative effects on the body and immune system.

Hair Care

Although there are many shampoos such as Alpesin are specially designed for hair loss, gentle baby shampoos can also be used. For people with oily hair, you should wash your hair less often, use a mild shampoo, dry your hair with a towel and avoid rubbing it too hard.

Many hair styling products can also contribute to hair loss. For example, coloring products, bleaching, hairspray and hair extensions, or the regular use of straighteners and hair dryers can increase the shedding effect. You should ensure the temperature is kept low and the hair is completely dry when using heated appliances such as a straightener or curling iron.

You may massage your scalp with a natural oil such as coconut or olive oil because these oils have a stimulating effect on hair follicles. The oil should be left on overnight and then washed off the next morning. According to a review in 2018, researchers believe that coconut oil can prevent hair damage caused by improper care and UV exposure. In addition, head massage is also a useful method for increasing scalp blood circulation. A study in 2016 found that only four minutes of scalp massage a day for 24 weeks can deliver a positive effect.

Hair lotions containing Alfatradiol can help decrease the proportion of hair in Anagen phase, as Alfatradiol is an active ingredient with protective effect on the hair follicles. Alfatradiol hair lotions can be applied to wet or dry hair.

In other words, hair loss cannot be effectively prevented only by hair care. These methods may protect and provide good care for hair, but they have little stimulating effect on hair growth. However, in the case of androgenetic alopecia, the only effective treatment is medical procedure.

Hiding or Embracing Hair Loss

Some people choose to hide their hair loss by using a wig, toupee, extensions, or comb-over. These methods are effective for a short period of time, but they become less effective as the hair loss progresses. Celebrities who use comb-over to hide their hair fall include Donald Trump and Nicolas Cage.

Another option is to embrace hair loss problem, which can often be achieved by shaving the entire head. As hair is a symbol of femininity, this method is more popular among men. Celebrities who shave their heads to embrace their hair loss problem include Michael Jordan, Dwayne Johnson and Ben Kingsley.

Medical Treatments

For people with androgenetic alopecia or patients undergoing chemotherapy, low-level laser therapy can be used to increase their hair density. This method is also referred to as red light therapy which can promote stem cell stimulation. However, multiple sessions of treatments may be required to show results in case of conventional laser devices.

Commercial minoxidil drops or topical solutions are effective in treating hair loss in about two-thirds of patients. These liquid or foam products should be applied to your scalp daily. The common side effects of minoxidil include scalp irritation and acne in the area where these products are applied. An irregular heartbeat and blurred vision may also occur, which are rare complications.

  • Finasteride can slow down the progression of hair loss and also has an ability to promote new hair growth. Finasteride is effective in men under 60. Women who are or are expected to becoming pregnant should avoid taking or coming into contact with this medication.

    Micro needling is an increasingly popular facial treatment method. This process produces a similar effect as a hair loss treatment, wherein the skin responds to the “micro-injuries” caused by fine needles. Micro needling stimulates the healing process and hair production. It therefore stimulates the production of proteins in the epidermal cells, contributing to regeneration of hair follicles. The hair grows back again after about 4-6 treatments,

    The injection of platelet-rich plasma (PRP) stimulates hair growth in balding area. In PRP, platelets from patient’s are separate via centrifugation and are then injected into the scalp.

    Regardless of the cause, mesotherapy can be used for all types of hair loss. This method can increase hair regrowth when the hair follicles are still alive by using a solution containing natural ingredients. While this method is effective, extra caution is required in people with severe allergic reactions.

    Ingestion of anti-androgens or estrogens may be helpful in progressive hair loss. Consultation with a doctor is required as anti-androgens also pose the similar side effects like other hormonal therapies.

    Hair transplantation involves the transfer of hair from healthy area to the balding area. It is the effective method for people with androgenetic alopecia and can provide permanent results without severe side effects.


Medical treatments are most effective in preventing progression of hair loss or in regenerating hair in the balding area. While they are very helpful, these methods come with high costs and may have some side effects. The most effective and scientific proven treatments for hair loss are minoxidil, finasteride and hair transplantation.


Is it possible to stop male androgenetic alopecia?

The use of finasteride and minoxidil can prevent the progression of male androgenetic alopecia in many patients. However, the hair loss symptoms resume when medication is discontinued.

Which products can solve hair loss in women?

Minoxidil and hair transplantation are ideal methods for hair loss in women. Minoxidil is to be applied to the affected area in the morning and evening. However, finasteride is not an effective treatment for female hair loss.

What are the causes of baldness in men?

The primary cause of male androgenetic alopecia is DHT, a hormone responsible for shrinkage and atrophy of hair follicles.

What are the causes of hair loss in women?

Congenital hair loss is the most common type of hair loss in women. However, diffuse hair loss or circular hair loss can also be observed. Hair loss in women may be caused by genetics, improper diet or stress.

Dr. Suthida Arayametee

– Doctor of Medicine, Chiang Mai University

– Grad.Dip.Clin.Sci.(Radiology), Chiang Mai University

– Diploma in Practical Dermatology, Cardiff University, UK

  • Certificate of completion: Fundamental of Platelet Rich Plasma (PRP) Therapy Training Course
  • Certificate of attendance: Implanter Workshop for Hair Transplantation, Faculty of Medicine Siriraj Hospital
  • Certificate of Completion: Medical Weight Management Specialist, School of Antiaging and Regenerative Medicine, Mae Fah Luang University
  • Certificate of attendance RELIFE Master Network Module 3 Advance Workshop for Thread Lifting (Definisse Free Floating)
  • Certificate of attendance Mid-Face Correction & Enhancement using thread, botulinum toxin, filler Workshop by No 1 Trainer
  • Certificate of attendance: RELIFE Master Network Module 2 Advance Workshop for thread Lifting (Definisse Double thread technique with 23-cm-thread)
  • Certificate of attendance: 9th ITCAM Hands-on Cadaveric Dissection of Toxin and Filler Injections and Thread Lift
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