Understanding Hair Loss

When performed by an experienced physician, a hair transplant surgery can produce life long results that are so natural that even hair stylists cannot detect them. Choosing the best hair restoration procedure and physician is critical to your hair restoration success.

How Hair Grows

The portion of the hair that we can see is called the shaft. Each shaft of hair protrudes from its follicle, which is a tube-like pouch just below the surface of the skin. The hair is attached to the base of the follicle by the hair root, which is where the hair actually grows and where it is nourished by blood capillaries. Like the rest of the body, hairs are made of cells. As new cells form at its root, the hair is gradually pushed further and further out of the follicle. The cells at the base of each hair are close to the blood capillaries, and are living.

As they get pushed further away from the base of the follicle they no longer have any nourishment, and so they die. As they die, they are transformed into a hard protein called keratin. So, each hair we see above the skin is dead protein. It is the follicle, which lies deep in the skin, that is essential in growing hair. Also, the thickness of each hair depends on the size of the follicle from which it is growing.

Hair growth is not a continuous process: it has several stages…


The first phase is the growing stage. Hair grows at about 1 cm each month, and this phase can last between 2 and 5 years.


As this phase begins the bulb detaches from the blood supply and the hair shaft is pushed up.


This is followed by a resting stage, during which there is no growth. This phase lasts about 5 months. At the end of the resting phase, the hair is shed, and the follicle starts to grow a new one. At any moment, about 90% of the hair follicles of the scalp are growing hairs in the first phase; only about 10% are in the resting phase. If a follicle is destroyed for any reason, no new hair will grow from it.

How Baldness Occurs

If any of the stages of hair growth are disrupted, the individual may become bald. For example, if follicles shut down (meaning that they stay in the resting phase, and then shed the hair) instead of growing new hairs, there will be less hair on the head. Another reason might be interference with the formation of new hair cells at the root during the growing phase. If follicles have been destroyed (i.e., a burn, loss of layered skin or trauma), there will be baldness in that area. An individual can also look bald if the hairs are growing but are so fragile that they break just as they emerge from the follicle.

Recently, scientists at Columbia University in New York announced the discovery of a gene that appears to be the ‘master switch’ for hair growth. They found the gene after comparing the genes of hairless mice belonging to a mutant breed, and comparing the genes of 11 members of a family who had lost all their hair. This discovery is a step towards understanding how the hair follicle works and how baldness happens, and may lead to effective treatments becoming available in the future.

Psychology of Hair Loss, Prevention and Re-growth

Hair forms a vital element of an individual’s physical appearance. Changes in the hair, including its loss, can have correspondingly profound effects on interpersonal reactions and on self image. Studies that have specifically addressed the psychosocial impact of hair loss in men have shown that men with visible hair loss are perceived as older, weaker, and less physically attractive than their non-balding counterparts. Not surprisingly, such adverse social stereotyping of individuals with hair loss has a considerable impact on the self image, and therefore on the quality of life, of men with AGA. Studies confirm that the negative self-perception of hair loss by others is reflected in the psychological responses of balding men to their own condition. Using standard psychological tests, men with AGA report experiencing distress about their hair loss, feeling less physically attractive, and having greater body image dissatisfaction than their non-balding peers.

Given that many men are strongly motivated to seek help with their AGA, the treatment objectives may variously include the prevention of further hair loss, the maintenance of existing hair, the re-growth and retention of lost hair, or any combination of the three. In most cases, however, prevention and maintenance are the most realistic therapeutic options. In this context, it must be recognized that there is frequently a disparity between what the physician assumes are the patient’s needs or requirements, and what the patient actually expects. Although there is a lack of rigorous scientific studies of men’s attitudes towards re-growth of their lost hair as compared to the prevention of further hair loss, some indications are available in the literature. For example, in a study in which men with AGA completed the Hair Loss Effects Questionnaire (HLEQ), a high proportion gave responses that were directed towards a future rather than a present state: 93% worried about how much hair they would lose, 87% reported trying to estimate if they were losing more hair, and 8o% tried to imagine how they would look with more hair loss. Cash has also reported that balding men who anticipated more hair loss in the future experienced significantly greater negative events and cognitive preoccupation, and were also less satisfied with their hair and overall appearance than men who anticipated minimal future hair loss.

Some anecdotal evidence, based on market research among 2200 men with at least some degree of hair loss, strongly supports the importance of prevention rather than re-growth to the patient. Thus, when asked directly whether they were more concerned about the amount of hair they currently had (i.e. re-growth) or the rate at which they were losing it (i.e. prevention), most respondents (61%) were equally concerned about the two; of those expressing a greater concern for one or the other, two-thirds were more concerned with prevention and one-third with re-growth Although the ideal for most of the men involved in this research would clearly be a hair treatment that produced both re-growth and prevention, slightly more respondents thought that prevention (43%) rather than re-growth (34%) was essential in a hair loss treatment.

Therefore, it seems that many men are more anxious to prevent further hair loss in the future than they are to re-grow the hair they have already lost. Nonetheless, physicians may incorrectly believe that the patient will only be satisfied with overt re-growth, when in fact he would be content with retaining his remaining hair. This is an important point because secondary prevention, that is the prevention of further loss, is currently a more realistic treatment goal for the physician to offer. This is demonstrated by the drug treatments that have been or are now available.

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