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At any time, approximately 90 per cent of hairs on the scalp are in the growth phase while the other 10 per cent are in the resting phase. The growth phase lasts on average around four to five years, after which, the follicle enters the resting phase, which lasts around two to four months. At the end of the resting phase, the hair falls out naturally and is replaced by new hair. Consequently, some hair loss is a natural part of the hair growth cycle.

On a typical day, around 50 to 150 scalp hairs are lost. Baldness results when hair loss occurs at an abnormally high rate; when hair replacement occurs at an abnormally slow rate; or when normal hairs are replaced by thinner, shorter ones.

About 95 per cent of all cases of hair loss are the result of androgenetic alopecia (known as male pattern baldness in men). Approximately 25 per cent of men begin balding by the age of 30 and two thirds by the age of 60. Male pattern baldness occurs in a characteristic fashion on the scalp with hair loss generally beginning at the temples and the top of the head towards the back, causing a receding hairline and a bald spot. Hair loss may continue until the two areas are joined, creating a horseshoe-shaped area of hair on the sides and the back of the head.

As is suggested by its medical name (androgenetic alopecia), male pattern baldness seems to involve both hormonal (androgen) and genetic factors. Many different types of hormones play a role in the regulation of scalp hair, but the hormones with the largest effect are the androgens. Testosterone and its more potent derivative dihydrotestosterone (DHT) are responsible for increasing the size of the hair follicles in areas such as the beard and underarm during puberty, but can also cause hair follicles in the scalp to decrease in size later in life. These contrasting responses to DHT may be explained by genetic differences in the individual hair follicles. Similarly, in men who are balding, genetically determined characteristics of hair follicles in the scalp may cause the follicles to be more likely to degrade in the presence of androgens. Hair follicles become miniaturized and the hair consequently becomes thinner and shorter. The growing phase of the growth cycle becomes progressively shorter, which means more hairs are shed. Although the follicles still have an adequate blood supply, they continue to shrink and some eventually die.

Alopecia Areata is a specific type of hair loss that involves the shedding of hair in small patches on the scalp or other parts of the body. This form of alopecia is thought to be caused when the immune system attacks the hair follicles. We do not know why the immune system attacks the hair follicles in this way but it could be triggered by stress.

Alopecia areata normally results in small clumps of hair falling out which may not re-grow for 12 months. Sometimes the hair does not grow back with the same pigmentation. It is not unusual for the hair to grow back white. In rare cases the alopecia affects the whole of the scalp. Approximately 10% of people who have this type of hair loss will not re-grow hair and this is usually the case where there is a family history of alopecia areata or the person has an autoimmune disorder.

Alopecia totalis is where the person loses all of the hair on his or her scalp. It is not clear what causes this but it is thought that it could be triggered by an autoimmune disorder or stress.

Alopecia Universalis

Alopecia universalis describes when a person is unable to grow any hair at all on their body or scalp. It can strike its victims at any age and is thought to be the result of an autoimmune disorder. This disorder appears to affect less than 1 person in 100,000.

Traction alopecia occurs when excessive strain is put on the hair shafts, usually through braiding. Prolonged traction of the hair can lead to permanent damage, with the hair refusing to re-grow.

Telogen effluvium describes a temporary thinning of the hair on the scalp. It is not known what causes telogen effluvium but it is probably caused by more hairs being in the shedding part of the cycle than the growing cycle. Telogen effluvium is therefore temporary as the hairs will normally re-grow.

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