Hair loss stages

Male pattern baldness (androgenetic alopecia) is responsible for 95% of all hair loss in men. This hereditary condition is caused by the hormone dihydrotestosterone (DHT), which causes healthy hair follicles to shrink and the hairs attached to them to consequently fall out. When considering treatment (oral or topical medications) for your hair loss, it is important to establish how far your hair loss has progressed. The Norwood scale is often used by clinicians to characterize hair loss progression.

Norwood hair loss type 1

This type describes the least amount of hair loss. Consider this normal unless you have a family history of male pattern baldness. Monitor your situation to determine if your hair loss develops into stage 2.

Norwood hair loss type 2

This type describes a small amount of hair loss. There is a good chance that, with treatment, you can regain most or all your lost hair. Consult a doctor to verify that your hair loss is caused by male pattern baldness.

Norwood hair loss type 3

This type describes a small to moderate amount of hair loss. A combination therapy may be helpful if your frontal hair line is being stubborn in growing back. Hair transplantation may also be considered.

Norwood hair loss type 4

This type describes a moderate amount of hair loss. At this level, there is no guarantee that using all the treatments listed will bring back almost all your hair. At this level of hair loss, you may not restore a satisfactory amount of hair since not everyone responds favorably to these treatment options. Hair transplantation may also be considered.

 Norwood hair loss type 5

This type describes a moderate to large amount of hair loss. At this level, there is no guarantee that using all the treatments listed will bring back a large amount of hair. A hair transplant may be the best option if you want to regain most or all of your hair. Consult your doctor to discuss treatment options.

Norwood hair loss type 6

This type describes a large amount of hair loss. There is no guarantee that using oral or topical treatments will bring back a large amount of hair. At this level, a hair transplant may be the most effective option for your hair loss. Consult your doctor to discuss treatment options.

Norwood hair loss type 7

This type describes the highest amount of hair loss with the least chance of regaining a large amount of lost hair. Consult your doctor to discuss treatment options.

Treatments for male pattern baldness include Rogaine® (generic name: minoxidil) 2% or 5%,¹ Rogaine in combination with Retin-A 0.025%,² and Propecia® (generic name: finasteride).³ Where hair loss has progressed to a higher stage, these treatments will not restore a full head of hair, but allow one to climb back into a lesser stage of the Norwood scale. For example, with stage 6 hair loss, a reasonable outcome with treatment is a return to stage 4 or 5. Hair transplantation may also be considered at early-mid stages of hair loss. Consult your doctor for treatment options that are best suited to your needs.

Article by: Dr. M. Cernea, Mediprobe Research Inc.

References

1. Goren A,Shapiro J,Roberts J, McCoy J, Desai N, Zarrab Z, Pietrzak A, Lotti T. 2015. Clinical utility and validity of minoxidil response testing in androgenetic alopecia.” Dermatol Ther 28 (1): 13–6.

2. Ferry JJ, Forbes KK, VanderLugt JT, Szpunar GJ. 1990. Influence of tretinoin on the percutaneous absorption of minoxidil from an aqueous topical solution. Clin Pharmacol Ther 47 (4): 439-46.

3.Varothai S, Bergfeld WF. 2014. Androgenetic alopecia: an evidence-based treatment update. American journal of clinical dermatology 15 (3): 217–30.

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Why is my hair falling out?

Although it seems popular to believe that the main cause of hair loss is our toddlers, or perhaps it’s the teenagers, (and clinical research does corroborate stress as a trigger in some cases (1,2)), hair loss can be a symptom of multiple diseases/disorders.

Like the blades of grass that carpet the golf course, our hair is rooted into our scalp. Specifically, hair grows from the hair follicle. Moreover it has been estimated that anywhere from 250,000 to 500,000 hair follicles exist on the human scalp (3). Each of those follicles often contains multiple strands of hair. It is when the hair follicle is no longer functioning properly that hair loss can occur.

Though there can be many causes, male pattern baldness is probably a familiar term. An approximated 70% of men and 40% of women will be affected at some point throughout life (3). Changes in hormones can promote the shrinking of the scalp hair follicle until it gradually ceases to produce hair (4). The result is an increase in facial hair and a decrease in hair on the scalp. Men may notice a hairline recession at the temples and top of the head while women are more likely to experience a general thinning throughout that progressively increases with age.

But there are many other reasons for hair loss. If this description does not sound like you, alopecia areata is another condition resulting in hair loss and affects approximately 2% of the population (5). In this case, it is the immune system that attacks the hair follicle. Even more frustrating, the immune system selectively targets actively-growing coloured hair, leaving the older, gray hairs behind (6). More extreme than male pattern baldness, variations of alopecia areata can cause patchy hair loss on the scalp, complete loss of scalp hair or complete loss of all hair throughout the body.

Overall, although the root cause of your hair loss might not be simple or straight forward, your team at Sure Hair can help identify your situation and discuss the options best for you.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. McElwee KJ, Gilhar A, Tobin DJ, Ramot Y, Sundberg JP, Nakamura M, et al. What causes alopecia areata? Exp Dermatol. 2013 Sep;22(9):609–26.
2. Peters EMJ, Liotiri S, Bodó E, Hagen E, Bíró T, Arck PC, et al. Probing the effects of stress mediators on the human hair follicle: substance P holds central position. Am J Pathol. 2007 Dec;171(6):1872–86.
3. Santos Z, Avci P, Hamblin MR. Drug discovery for alopecia: gone today, hair tomorrow. Expert Opin Drug Discov. 2015 Mar;10(3):269–92.
4. Kaufman KD. Androgens and alopecia. Mol Cell Endocrinol. 2002 Dec 30;198(1-2):89–95.
5. Gilhar A, Etzioni A, Paus R. Alopecia areata. N Engl J Med. 2012 Apr 19;366(16):1515–25.
6. Paus R, Slominski A, Czarnetzki BM. Is alopecia areata an autoimmune-response against melanogenesis-related proteins, exposed by abnormal MHC class I expression in the anagen hair bulb? Yale J Biol Med. 1993 Dec;66(6):541–54.

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