By Dr. Cole, FUE Hair Transplant Pioneer

Hair Loss Causes & Treatments


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.


hair loss and restoration

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:

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

Affected areas of hair loss


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.

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:

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.


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.

Hair restoration consultation


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.

Hair loss products


was the first pill approved by the FDA to grow hair. Patients will primarily use it to stabilize hair loss. About 8 in 10 people maintain their current hair; 1 in 10 will experience reduced hair loss, and another 1 in 10 will see no results.

is still an uncommon treatment option but research indicates it delivers superior results with significantly fewer side effects. Formulas vary by source, so patients should expect results will vary too. Contact us to learn more about where to obtain this treatment.

works in a similar way to Propecia, though it blocks both types of 5 alpha-reductase. Yet to be approved by the FDA for hair loss, the product does show promise in re-growing hair. Adovart tends to last longer for hair loss but also results in lengthier side effects.

can be very effective, but it is also messy and oily. Clinical studies indicate that around 40% of men begin regrowing hair after prolonged use. Forhair recommends that patients use the 5% variety as it affects more people and encourages better results.

shampoo is available as a 1% solution over the counter and 2% by prescription. It is effective as Rogaine in treating hair loss. Additionally, its properties also decrease the inflammation of hair follicles -a common effect of pattern baldness. Patients typically shampoo it into their hair for 5 to 10 minutes before rinsing.

shampoo also claims to reverse thinning hair. Our experience is that it does not offer any clinical advantage nor to do anything positive for the consumer. The product claims to inhibit the 5AR enzymes but lacks the consistency of finasteride.

extract reduces your body’s DHT production and, as a result, may reduce hair loss. A small percentage even begins regrowing some hair. One study indicates that saw palmetto is also similar to finasteride: taking the extract regularly is effective as reducing the prostate size as 5mg of finasteride. However, there are currently no studies that clinically contrasts the extract’s and Propecia’s effectiveness for hair loss.

is an essential vitamin for healthy hair. A deficiency in the mineral can lead to hair loss and dullness. In fact, some research shows that zinc deficiency is worse than testosterone-derived DHT, a major facet of pattern baldness for both sexes.

is an exciting new product that stimulates hair growth and density. A principle signaling system within the epidermis, WNT is crucial for developing and maintaining hair follicles. Effective for men and women, patients can take Deltacrin WNT along with 5-ARIs and DHT inhibitors like Propecia and Rogaine.

is the first available treatment that enables patients to topically activate WNT channels. It is also among the first treatments equally effective for both males and females. Those that apply it enjoy a 7% increase in hair density and a 10% increase in hair diameter within 60 days.

are perfect for hair maintenance, growth, and post-procedure recovery. The hair care line includes a wealth of natural ingredients, including DHT inhibitors and antioxidants, that promote excellent hair. Hair Cycle also has a number of products, including shampoo, conditioner, and hair styling products. Those that undergo hair restoration procedures will also want to use the Post Surgical Gel and/or Hair Transplant Kit.


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.

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.

hair treatment procedure

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.

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.

What's Your Next Step?

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