Hair loss: answers to the most frequently asked questions

Short answer: Hair loss in men is usually hereditary, often begins before the age of thirty and then gradually worsens. In many cases, it can be readily recognised and treated if you start in time.

Hair loss is one of the most common complaints among men, but it also raises many questions: is this normal, is it down to stress, and what can you do about it yourself? This article addresses the most frequently asked questions, from how common it is to when you should consult a doctor.

How common is hair loss?

Hair loss in men is very common and clearly increases with age. Research into the prevalence of androgenetic alopecia shows that the condition increases significantly with age: a considerable proportion of men already show signs of it by around the age of thirty, rising to the majority in later life. The fact that it is so common does not mean it does not deserve attention: early detection offers the best chance of influencing its progression.

What are the most common causes of hair loss?

The most common form in men is androgenetic alopecia, in which hair follicles gradually become more sensitive to a hormone derived from testosterone. Preclinical research into the effect of this hormone on the androgen receptor illustrates how hair follicles can gradually shrink, or miniaturise, causing hair to regrow thinner and shorter until it eventually stops growing altogether.

In addition, there are other forms of hair loss, such as temporary hair loss caused by stress or illness, and less common autoimmune-related forms. These differ from the hereditary form in that they often resolve spontaneously once the underlying cause has been removed.

Is hair loss always hereditary?

No, but heredity is the most common cause in men. In hereditary hair loss, a combination of genes plays a role in determining how sensitive hair follicles are to hormonal influences, and this predisposition can be inherited from either parent. Non-hereditary forms also exist, for example due to a lack of nutrients, thyroid problems or a major life event, but these usually follow a different pattern to the gradual, symmetrical thinning associated with hereditary hair loss.

At what age does hair loss usually start?

Hereditary hair loss can begin as early as the late teenage years, although it is barely noticeable at that stage. It usually only becomes noticeable in your twenties or thirties, when the hairline recedes slightly or the crown thins out. Trichoscopic examination of the progression pattern of male pattern hair loss confirms the characteristic pattern described in the Norwood classification, a scale that divides the progression into clearly recognisable stages. The earlier in this process you begin treatment, the more hair is usually preserved.

Can stress cause hair loss?

Yes, stress can trigger a temporary form of hair loss, regardless of genetic predisposition. In cases of stress-related hair loss, hair follicles enter their resting phase prematurely, resulting in a noticeably greater amount of hair falling out than usual a few months later. This type of hair loss is usually temporary and resolves itself once the underlying period of stress has passed, in contrast to the gradual, permanent thinning associated with hereditary hair loss.

What is the difference between normal hair loss and alopecia?

Everyone loses a small number of hairs every day as part of the natural hair cycle, and that is perfectly normal. Alopecia involves a structural reduction in hair density that goes beyond this natural cycle, with a recognisable pattern such as a receding hairline or a thinning crown. The difference, therefore, lies not in the number of hairs that fall out in a day, but in whether, in the longer term, fewer hairs actually grow back.

Does hair loss stop on its own?

That depends very much on the type. Temporary hair loss caused by stress, illness or a deficiency usually resolves itself once the cause has been addressed. Hereditary hair loss, on the other hand, is progressive in nature and does not resolve on its own: without a targeted approach, hair density will gradually continue to decrease in accordance with the Norwood pattern mentioned earlier.

When should I see a doctor about hair loss?

It is advisable to consult a doctor as soon as you notice early signs of hair loss and the hair loss does not seem to stop of its own accord, or when sudden, localised bald patches appear that do not fit the usual pattern. The latter may, in fact, indicate a cause other than the hereditary form. According to the Farmacotherapeutisch Kompas, a thorough medical history is essential for determining the type of hair loss, which in turn directly determines the appropriate course of treatment.

What treatments are available for hair loss?

For hereditary hair loss, there are medical treatments that can be prescribed under a doctor’s supervision and which target the underlying hormonal or circulatory mechanisms. A network meta-analysis comparing the effectiveness of a topical vasodilator with that of a hormone-targeting tablet shows that both mechanisms of action can effectively slow hair loss, provided they are used consistently and over the long term. The most appropriate approach depends on the stage and type of hair loss, and should ideally be discussed with a doctor.

Is there anything I can do myself before I seek help?

Yes, although the options for hereditary hair loss are more limited than is often thought. Getting enough sleep, eating a balanced diet and minimising prolonged stress support a healthy hair growth cycle, but they do not reverse hereditary hair loss. Shampoo, sunlight, headwear and hair gel have no proven effect on hair loss, however persistent these myths may be. In the event of persistent or increasing hair loss, a doctor remains the best person to determine the type and discuss an appropriate course of action.

Need help with hair loss?

Persistent hair loss is no cause for panic, but it is a good reason to have the type and cause diagnosed. A systematic review and meta-analysis of the psychosocial impact of hair loss in men shows that it affects many men’s self-image and self-confidence, suggesting that the issue deserves more attention than the taboo surrounding it often suggests. A doctor can determine whether the condition is hereditary and which medical treatment is appropriate. Would you like to know how Fellos can help you with this? Click here.

Frequently Asked Questions

Is my hair loss normal, or should I be worried?

A gradually receding hairline or thinning crown in adulthood is usually due to hereditary hair loss and is not, in itself, a cause for concern. However, sudden, localised bald patches or extreme hair loss over a short period of time are reasons to consult a doctor.

Can hair lost due to stress grow back completely?

Yes, stress-related hair loss is usually temporary, and the hair generally grows back within a few months of the stressor being removed. If you are unsure or if the symptoms persist, it is advisable to see your GP.

Does it help to wash my hair more often, or actually less often?

There is no proven link between how often you wash your hair and hereditary hair loss. This myth persists, but there is no scientific evidence to support a connection.

At what age is it advisable to take action against hair loss?

The earlier in the process you start, the more hair is usually preserved, so it is advisable to discuss this with a doctor as soon as the first noticeable signs appear. Waiting until hair loss is well advanced often makes treatment less effective.

Is a consultation at Fellos compulsory before I can do anything about hair loss?

The medical treatments offered by Fellos require an online consultation with a doctor, during which the symptoms and the type of hair loss are assessed. This is the standard procedure for prescribed medical treatment.

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