Home / Hair Loss / Basics of Hair Loss and Restoration


We have recently made an update article with the latest hair loss treatments: Best hair loss treatments of 2021.
Hair loss is a very common condition that will affect most men and women at some point of their lives. Hair loss is caused by gradual miniaturization of the hair follicles under these influence of multiple complex biochemical pathways in genetically sensitive individuals. We know that males must possess the hormone Dihydrotestosterone (DHT) to have hair loss. We know that castrated males will not lose their hair unless exposed to exogenous sources of testosterone. We know that products which retard the formation of Dihydrotestosterone delay the hair loss process and sometimes temporarily reverse it. These products do not always work and their results do not appear to be permanent.


A common problem for men (80%) and women (50%), hair loss happens from any number of factors. These include hormonal imbalances, levels of stress, lack of proper nutrients, and numerous diseases. For most people, though, hair loss is through what doctors call androgenetic alopecia. Aging is also a factor. Three things trigger the occurrence of androgenetic alopecia:
  • A genetic predisposition to balding
  • An increased presence of male hormones
  • Time displacement between androgens and their effect on hair follicles

Presently, chances of balding are impossible to guess. For example, the presence of balding in the mother or father’s side of the family does not always indicate an individual will experience hair loss surgery. However, the chances of a male going bald are high if he winds up with a receding hairline before his thirties and happens to have a father who is balding. In this way, accurate predictions of balding, its rate, and its direction are difficult to make.

We do our utmost to anticipate balding and plan procedures in accordance. The complex and uncertain nature of balding is the most important factor for planning hair restoration via surgical means. Producing the best results may require multiple procedures, vigorous donor harvesting, or other factors.


Fortunately, only the top of the scalp is affected by androgenic alopecia in typical male pattern baldness and the Ludwig pattern of hair loss in women. Male pattern baldness typically appears in receding hairline or empty bald spot on top of the scalp while female hair loss at crown mostly gets visible thinning over that area and sometimes throughout the scalp including the hairline. The back and side are sparred. The hairs from the back and sides can be moved to any region on the body and continue to grow. The hairs on the top will still fall out no matter where they are move on the body. This is the principle of “donor dominance” and means that the donor hairs retain their characteristics no matter where they are relocated to. This is fortunate to individuals seeking hair restoration surgery. We can transplant these non-affected hairs to any part of the scalp and they will grow for the remainder of a person’s life unaffected by the DHT.


Individuals inherit the gene for hair loss from either their mother or father. Sometimes one must trace the gene far back in their family history to identify the “culprit”. Often times the gene may have come from one’s mother’s, mother’s, mothers, father. It is difficult to trace this sort of inheritance because the gene for typical male pattern baldness does not express itself in women. We tend to see typical male pattern baldness in women who are exposed to exogenous sources of testosterone or those who have a hyper-androgen state such as an adrenal tumor. Hair loss does occur in women, however, but the pattern is different. We typically call this pattern the Ludwig pattern of hair loss. There are other patterns of hair loss in women particularly. One common pattern is the generalized thinning pattern, which we call DUPA (diffuse unpatented alopecia). Women who present with a Ludwig pattern or DUPA often have a family history of hair loss from their mother. While hair loss in men is stalled by Propecia (finasteride) it does not appear to work in women. Rogaine (minoxidil) works in both men and women so it must have a slightly different mechanism of action. All of these slightly different patterns make the study of hair loss and its treatment rather complex. There is still much we need to uncover in the science of hair loss for both men and women.


Healthy men and women produce androgenic hormones. These often are called “male” hormones. Such chemicals include testosterone, androstenedione, and DHT, also known as dihydrotestosterone. The products of both male and female reproductive organs, these hormones are integral to both sexes in variant amounts. Their levels within someone are responsible for the classification of genders, with androgenic hormonal levels obviously much higher in males.

Pattern baldness occurs through the exposure of hair follicles to high concentrations of DHT. Such exposure takes place through high concentrations of the 5-alpha-reductase enzyme in the hair follicles’ sebaceous glands. The 5-alpha-reductase enzyme is responsible for the conversion of testosterone to DHT in these glands. This conversion to DHT causes hair loss.


Curbing the effects of this enzyme is possible through Propecia (finasteride), one of many hair loss treatments available on the market. Propecia and similar products work to prohibit the activity of the 5-alpha-reductase enzyme, thus reducing the DHT concentration in hair follicles.


As mentioned earlier, balding is a process that occurs at any age, and various speeds, depending on the genetics of an individual. Hair loss begins anywhere from one’s early twenties onward. The rate of hair loss is also unpredictable. Some experience rapid hair loss within months while others experience it gradually.

Forhair only creates hair loss treatment plans only after closely analyzing your rate and hair loss pattern. There also, however, is what specialists call the “permanent” zone. This is a u-shaped portion of the head along the back and sides of the scalp. Theoretically unaffected by the telogen phase, this area is often ideal for graft harvesting.


Hair grows at its own cycle. The medical world calls this period the anagen phase or the active growth of hair. Time plays a huge part in hair loss. Aging often combines with a genetic predisposal to hair loss and exposure to DHT. Follicles shedding hair strands, resultantly, cease renewing themselves as scalp hair. This leads to the infrequency of the anagen phase. As the active hair growth phase lessens, the hair loses color and becomes shorter and finer -a process called the miniaturization. Such miniaturization does not mean hair loss, however, though hair thinning becomes more noticeable. This is because thinner, lighter strands enable light to more easily reach the bare scalp.


Shedding is a natural part of hair growth. In fact, most people lose between 50 and 100 strands a day. Specialists call this the telogen phase, or resting phase. Regular hair follicles begin growing new strands after three months or so. However, the number of hair follicles entering the telogen phase increase over time. More follicles in the telogen phase than the anagen phase greatly increase the chance of balding. Such hair loss typically happens on the front, crown, and top of the scalp. Telogen hairs are fragile, making them easy to pull from the scalp via combs or other physical contacts. Strands may even be noticeable in the bathroom drain after showering. Seeing this happen can be quite frightening for individuals, especially those unsure if the hair loss signifies a disease or other medical condition.


The age of onset varies from one individual to another. Men who begin to lose their hair at a younger age will typically have a much greater degree of hair loss than men who begin losing their hair later in life. For this reason, it is best for men to avoid hair restoration surgery at a minimum until their 23rd birthday. Even then surgical solutions are far riskier than with much more mature men. Well informed men less than 23 years of age are sometimes candidates for hair restoration surgery, but the overall plan should be much more conservative for these men.

The age of onset and rate of hair loss is hard to predict. However, the spread of baldness and thinning occurs in many ways and affects specific parts of the head. Hair loss patterns aside from male and female pattern baldness, or androgenetic alopecia, include:

  • Alopecia Areata -It occurs in patches all over the head and is often easy to cover
  • Triangular alopecia -A static series of patches that typically arise in childhood
  • Alopecia Universalis -An advanced form of alopecia areata, where hair loss occurs over the entire body
  • Cicatricial alopecias -Scarring of scalp areas with active follicles, preventing their growth as a result of rare disorders, burns, infections, and other causes
  • “Toxic” alopecias -Location unspecific, often the result of chemotherapy or low activity in the thyroid or pituitary glands
  • Diffuse alopecias -A widespread thinning of hair that may even affect the “permanent” zone

The onset and progression of androgenetic alopecia are usually obvious. We will analyze its pattern, spread, and rate. Our conclusions about your hair loss combine patient input and medical data to find the best solution. Other hair loss patterns usually require further investigation. We strongly recommend scalp biopsies, physical examinations, and lab tests to identify other types of balding.


In summation, balding can affect both men and women at different ages and different rates. Balding happens through many things. Most frequently, though, it happens through an increase in male hormones. DHT is often the main culprit. High levels of DHT often lead to hair miniaturization. The hair growth cycle often happens faster too.

We fully appreciate our patients’ goals and concerns at Forhair. The Southeast’s leading hair replacement surgery clinic, our consultations always explore your best options. Even effective procedures, if done in haste, can lead to disappointing results due to a spread in thinning or balding spots. This is particularly true for patients in the early phases of balding or thinning. We will fully consider such circumstances, and whatever else, when designing your personal hair restoration plan.



Many products are on the market to promote healthy hair, reduce hair loss, or speed the post-surgical recovery course. Most of these treatments’ effectiveness varies from person to person. However, their positive effect is prolific enough to warrant most people’s use of these products. Be sure to consult with a physician before starting a regimen as negative side effects are possible. Overall, though, most patients have everything to gain by using a hair restoration treatment.


Self-administered hair loss treatments are plentiful and, usually, effective. While such products can work, however, new outpatient treatments are pushing the bar further. Three are particularly noteworthy.
  • ACell -ACell is a cellular matrix treatment that stimulates stem cells to hasten recovery, if injected in the scalp, by activating dormant follicular stem cells.
  • CRP -A treatment derived from the patient’s own blood, CRP contains growth factors and cytokines that stimulate follicular stem cells.
  • Stem Cell Therapy -An emerging treatment that uses the patient’s follicle stem cells to generate unprecedented results.

Effective standalone, these treatments also complement each other. ACell prolongs the effects of CRP, for instance, while Stem Cell Therapy can increase hair count that then CRP effects. Each is also ideal for post-procedure recovery. They particularly augment Forhair’s innovative Cole Isolation Technique (CIT®). The only version of Follicular Unit Extraction (FUE) to leave stem cell remnants, CIT® offers a chance for donor areas to regenerate follicles. Undergoing ACell, CRP, or Stem Cell Therapy with CIT® significantly increases follicular recovery in donor areas, hair growth, and thickness. As part of a transplant or treatments unto themselves, CRP, ACell, and Stem Cell Therapy show marked results for patients. Those less viable for transplants particularly benefit from these options.

Forhair is actively researching improvements to these treatments. CRP, for instance, results from removing unnecessary biological matter from PRP treatments. This considerably increases each dose’s amount of growth factors. In turn, this encourages even more stimulation of stem cells for faster growth, thicker growth.


There are numerous hair loss treatments available. Patients often take a combination of the above products to maximize hair retention and growth. Selecting the right treatments, though, is critical for both patient health and treatment effectiveness. Consulting with a hair restoration specialist offers several advantages when selecting treatments.
  • Efficacy -A hair loss treatment’s effectiveness depends on both the patient’s hair loss type and several other factors -even only 8 in 10 men taking Propecia will retain their current hair
  • Side Effects -Just as with a hair loss treatment’s effectiveness, side effects depend on the person
  • Conjunction -Some hair loss treatments complement each other while others do not.

At Forhair we know what hair loss products are effective. Expect us to thoroughly consider your goals and health. Further, we never recommend hair loss treatments that can hurt our patients -no hair restoration specialist should. Instead, we aim to recommend hair restoration treatments that best fit your individual needs and characteristics. For instance, it is common for patients to both undergo CRP+ACell and take Propecia. Contact us today for a consultation that includes hair treatment recommendations to maximize your hair retention and density.

Contact Us

This field is for validation purposes and should be left unchanged.