The most common forms of temporary hair loss include telogen effluvium, alopecia areata and androgenic hair loss, which is commonly known as female and male patterned hair loss (typically experienced later in life). There are different types of alopecias with their own causes and symptoms. All forms of alopecia can be divided into one of two categories, it is either a temporary, or non-scarring (non-cicatricial) form of alopecia, which can be reversed with topical and oral medications, or permanent scarring alopecia (cicatricial). Considering there are so many forms of alopecia, it is necessary to specify which condition you are referring to when delving into what the condition is.

Female pattern hair loss

This common form of alopecia mostly affects women. The pattern aspect of it lies in the manner the hair recedes. It typically thins around the crown, with the front of the hairline remaining healthy. Individual hairs will appear shorter and thinner prior to falling out.

Male pattern hair loss

In contrast to female pattern hair loss, male pattern hair loss starts with a receding hairline, the crown generally being affected last. This is the most common form of hair loss for men, affecting half of the male population over the age of 50.

What causes androgenic hair loss?

Female pattern hair loss

FPHL is caused by a change in hormones combined with genetic factors, meaning it is hereditary. When androgen (a group of hormones) rise to higher levels, it affects certain follicles (typically around the crown). Conditions like PCOS (polycystic ovarian syndrome) are also caused by the elevated hormone levels and present symptoms such as acne, infertility, irregular menstruation cycles, and increased facial hair. The follicles produce thinner and smaller hairs which tend to become lighter until they eventually stop producing the hairs altogether.

Male pattern hair loss

Like FPHL, MPHL is also caused by a mixture of genetic factors and hormones. One hormone, in particular, dihydrotestosterone, affect the follicles on the scalp in the same way that FPHL is affected by hormones. The follicles start to produce hairs that are smaller, thinner, daintier and lighter in colour. Eventually, the follicles stop producing hair altogether. Also like FPHL, MPHL can be hereditary.

The symptoms of androgenic hair loss

Female pattern hair loss

Female pattern hair loss is most commonly experienced in a woman’s 50s or 60s and occasionally as early as 30s or 40s, generally later than men. There aren’t usually any scalp symptoms that are associated with androgenic hair loss. These changes take place very slowly, the hair can be lost over a few decades, sometimes even slower, but nonetheless, the condition can be very upsetting. FPHL can have profound psychological effects which reverberate throughout a person’s life.

Male pattern hair loss

Male pattern hair loss can occur anytime after puberty and no other symptoms, other than the thinning of hair, are usually experienced. The hairline may slowly thin and recede which can have a marked psychological effect, once again, affecting every area of life by undermining self-confidence.  

The treatments for androgenic hair loss

Female pattern hair loss

Topical treatments: A minoxidil solution may be effective at slowing the progress of the condition. It is applied to the scalp with a dropper. It may take up to 6 months of treatment before any effect is noticed, in fact, it may cause further hair loss during the first 2 – 8 weeks of use before taking effect.

Oral medications may be prescribed to counteract the effects of dihydrotestosterone by blocking it. There are a number of different medications which all achieve this, and they show promising results. Careful consideration is required prior to use as this treatment is not safe during pregnancy or lactation.

Male pattern hair loss

For men, the same treatments apply as for FPHL. Men can also use finasteride tablets, one of the medications that block dihydrotestosterone (the hormone responsible for follicle size reduction). This treatment is done over a period of 3 – 6 months.

Who gets hair loss?

Some forms of alopecia, like alopecia areata and telogen effluvium can occur to anyone at almost any age. Other forms of areata, like androgenic hair loss tends to happen to people older than 40 or 50 years of age, although male pattern hair loss can occur at any point after puberty. A genetic predisposition certainly plays an important role. Proper hair care can prevent hair loss as some forms of alopecia are linked to tight hairstyles, like braids and weaves.

Hair loss and scalp disorders with Dr. Nokubonga Khoza.

Our hair loss and scalp disorders consultation take about 20-30 minutes. Only conditions relating to the scalp will be discussed during this session. All patients are expected to fill out a pre-assessment form on arrival to the practice. There are many causes of hair loss and scalp disorders and surprisingly they can look similar. Dr. Khoza’s primary goal is to provide the highest level of care when it comes to skin and scalp disorders. Our hair consults focus is on proper diagnosis, non-surgical management, counselling and preventing further disease progression.

During the consultation, Dr. Khoza will review the patients past medical history, medication, hair grooming practices, and styling. She will examine the scalp with the use of dermoscopy and take relevant pictures. Should there be a need; Dr. Khoza may order blood tests, take hair samples and perform a scalp biopsy. Dr Khoza performs the following in-office procedures for hair loss; Platelet rich plasma, micro-needling and intralesional injections.

Please note all procedures are scheduled for a separate appointment and are not performed on the same day as the initial consultation.

Estimated time for procedures:

1. Scalp biopsy – 20 minutes
2. Intralesional scalp injections – 10 minutes
3. Micro-needling – 30 minutes
4. Platelet Rich Plasma – 1hour

How to prepare for your consultation with Dr. Khoza for androgenic hair loss

1. Take careful note of your symptoms. It is important to give Dr. Khoza an accurate description of what you have been experiencing. Has the hair been falling out gradually? Has it been only in certain patches, or has it been a constant and ongoing “loss” from all over the scalp?
2. Think of any changes in your life that may coincide with the hair loss. Have you been taking a new medication, or have you stopped using a medication? Have you changed your level of physical activity? Have you gone through any major stresses, changed your diet, started or stopped taking any vitamins, or used a new hair or skin product, like shampoo?
3. Be prepared for questions. Dr. Khoza will also want to know if hair loss runs in your family, and if so, at what age did your relatives experience hair loss for the first time?
4. Dr. Khoza will examine your scalp during the consultation. Sebum, or oil, can sometimes play an important role in hair loss, so it may be advised to avoid washing your hair for a day or two prior to the appointment.
5. Bring a list of medications used in the last two years.
6. Bring latest bloods if you have done any in the last six months.
7. It always helps to bring all current hair and scalp products.
8. Bring old photos up to 5 years prior if possible.
9. Keep a positive outlook.