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EDUCATIONAL GUIDE

What Causes Hair Loss

An educational overview of the most common types of hair loss — what drives them and how they differ.

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THE MOST COMMON CAUSE

Androgenetic Alopecia

Androgenetic alopecia (AGA) is the most common form of hair loss in both men and women. In men it is often called male-pattern baldness; in women, female-pattern hair loss. It accounts for the vast majority of hair transplant candidates.
The underlying mechanism is hormonal. Dihydrotestosterone (DHT) — a byproduct of testosterone — binds to hair follicles in genetically susceptible areas of the scalp and causes them to progressively miniaturize. Over time, the miniaturized follicles produce hair that is finer, shorter, and eventually dormant.
The key fact about AGA is that it is genetically predetermined. The follicles in certain parts of the scalp — typically the front, top, and crown — carry sensitivity to DHT that follicles in the back and sides do not. This is why the back and sides of the scalp are used as donor areas in hair transplant surgery: those follicles retain their DHT resistance when moved to another location.

MEASURING THE PATTERN

Norwood and Ludwig

Hair loss professionals use standardized scales to describe the pattern and extent of AGA.
The Norwood Scale (men) runs from Norwood I (no significant loss) to Norwood VII (extensive loss limited to a narrow band on the back and sides). Most transplant candidates present at Norwood III through VI.
The Ludwig Scale (women) measures diffuse thinning across the crown from Ludwig I (mild) to Ludwig III (severe). Female-pattern hair loss tends to present as diffuse thinning rather than recession.
These scales are useful as communication tools. The actual severity of loss — and what is achievable with surgical or non-surgical treatment — is best assessed in a direct evaluation, not by self-staging.

OTHER CAUSES

Other Common Causes

Not all hair loss is androgenetic alopecia. Several other causes are worth understanding, both because they require different treatment approaches and because they affect candidacy for hair transplant surgery.

Traction Alopecia

Caused by repeated mechanical tension on the hair shaft — tight ponytails, braids, extensions, and certain professional styling practices. The follicles can be damaged over time by the sustained pull. In early stages, traction alopecia may resolve when the source of tension is removed. In later stages, the follicular damage may be permanent.

Telogen Effluvium

A widespread, temporary form of hair shedding triggered by significant physiological stress — major illness, surgery, significant weight loss, childbirth, or nutritional deficiency. The hair follicles shift prematurely from the growth phase (anagen) into the resting/shedding phase (telogen). The shedding typically begins two to four months after the triggering event and resolves as the underlying cause is addressed. Most patients experience full regrowth within six to twelve months.

Alopecia Areata

An autoimmune condition in which the immune system attacks hair follicles, causing patchy hair loss. It can affect the scalp, face, and body. The course is unpredictable — some patients experience spontaneous regrowth; others progress to more extensive loss. Hair transplant surgery is generally not appropriate for alopecia areata because the autoimmune activity may affect transplanted follicles as well.

WHY IT MATTERS

Why Diagnosis Matters Before Treatment

The right treatment depends on an accurate diagnosis. A patient with telogen effluvium needs to address the underlying cause, not undergo surgery. A patient with alopecia areata needs immunological management, not a hair transplant. A patient with early-stage AGA may benefit from non-surgical management before surgery becomes appropriate.
Dr. Alexander evaluates each patient individually. The consultation is where he determines what type of hair loss you have, what is driving it, and what the appropriate response is for your specific situation.

Understanding what is causing hair loss is the first step. Understanding what can be done about it is the next one.

Schedule a complimentary consultation with Dr. Alexander. He evaluates the cause, the pattern, and the options — and gives you an honest assessment of what is realistic for your case.
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