Hair Loss Concerns: Decoding Thinning at the Crown
We’ve all been there: that moment of dawning realization when you notice that your hair isn’t as full as it used to be, especially at the crown. The top of your head is a surprisingly common battleground for hair loss. It can be a gut-punch feeling, a sudden vulnerability, and the beginning of a frantic search for solutions. Whether the hair loss you're experiencing is due to genetics or a reversible condition, knowing how to tell the difference will guide you on what to do next.
Hair Stylists, Trichologists, Dermatologists, and Primary Care Physicians may all play a role in your diagnosis, care, and management of hair loss. There are various methods and protocols for regrowing hair or slowing the rate of hair loss, such as in the instance of Androgenic Alopecia (genetic hair loss). From medicinal treatments to homeopathic remedies, there are countless options for almost everyone. Regardless of the cause, it’s important to remember it takes time to notice regrowth once the root cause is addressed. There aren’t any overnight, magic solutions, but with patience and consistency, you will see results.
Understanding the Crown: Why It’s a Hotspot for Hair Loss
The scalp is a complex structure composed of multiple layers, including the epidermis, dermis and hypodermis, each playing a crucial role in hair growth. Within the dermis reside hair follicles, the specialized structures that encase the hair root. This root is the actively growing portion of the hair and is composed primarily of keratinocytes, cells that are responsible for producing keratin, the fibrous protein building block of hair.
The crown has a unique vulnerability to hair loss triggers and is most commonly the first place someone notices thinning. It is an area of our scalp that is highly responsive to changes in the body which leads to an increased sensitivity in the hair follicles there. With Androgenic Alopecia (genetic hair loss), there is a sensitivity to the hormone Dihydrotestosterone (DHT).
Hair is the second fastest dividing cell within our body, after the skin and intestinal tract cells. Under the right conditions, our hair will grow healthy and uninterrupted. The moment another part of our body demands resources, our body deems our hair as non-essential and diverts the essentials to where they are needed more. The most vulnerable areas to change, such as the crown, will be noticed first.
Androgenic Alopecia (Genetic Hair Loss)
Androgenic Alopecia (AGA) is a genetic hair loss disorder, also known as Male or Female Pattern Baldness. For both men and women, AGA is caused by a genetic predisposition because of variations in the Androgen Receptor (AR) gene. The AR gene is responsible for determining how readily hair follicles respond to Dihydrotestosterone (DHT).
As you age, your levels of DHT rise. High levels of DHT can cause hair follicles to shrink, leading to thinning and eventually baldness. When DHT binds to hair follicle receptors, it disrupts the hair’s growth cycle. The hair’s anagen (growth) phase is shortened and its telogen (resting) phase is lengthened. Prolonged exposure to elevated DHT levels can cause hair follicles to stop producing hair and become dormant.
Androgenic Alopecia is a progressive condition with such little hair loss at first that it isn’t until the front hairline is affected do people search for answers. The condition affects both men and women but the pattern of hair loss differs. For men, hair loss begins above the temples before receding into the characteristic “M” shape. Hair will then begin to thin at the crown, leading to partial or complete baldness. In women, hair typically thins diffusely at the crown and causes a widening of the part. The front hairline is usually retained and hair loss rarely leads to total baldness.
A medical professional, such as your primary care physician or dermatologist, will be the only one who can make an official diagnosis of AGA. Oftentimes a review of your family medical history and a visual exam, with or without a trichoscope, can be enough for a diagnosis. Other times blood tests or a biopsy of the scalp may be needed to rule out other causes.
There are currently only two FDA-approved medicinal treatments for AGA, topical minoxidil and oral finasteride. Topical minoxidil (Rogaine) is an over-the-counter product that comes as a foam or liquid and it is often recommended to use the 5% solution. It is generally well tolerated but can cause temporary hair shedding, scalp irritation and changes in hair texture. Unwanted hair growth is possible so ensure to use minoxidil only in places you wish to regrow. In rare cases, it can contribute to a fast heartbeat. Minoxidil works to relax the smooth muscles in blood vessels around hair follicles. This allows increased blood flow to deliver more nutrients to the follicles, stimulating hair growth. This helps to extend the hair growth phase and shorten the resting phase. Ultimately, it promotes hair growth and potentially thickens any existing hair. The time it takes to notice results and the effectiveness will vary between individuals.
Oral finasteride is by prescription only and is not commonly prescribed due to the potential side effects. It may cause decreased fertility in men, decreased libido, and may be a cause of a high-grade prostate cancer. It does have a high success rate of hair regrowth and halted worsening of loss among men in clinical studies. Finasteride works by inhibiting the enzyme 5-alpha reductase, which prevents testosterone from converting into DHT. Lowering the levels of DHT in the scalp helps to prevent further loss and can promote regrowth in susceptible individuals. It is not generally recommended for women but it is considered a viable option for some, particularly those over 50 and when monitored by a healthcare professional.
There are other options to consider that would need to be discussed with a dermatologist or hair transplant specialist. Additional treatments may include PRP (platelet-rich plasma) Therapy, laser therapy and hair plug transplants. Regardless of which direction you decide to take to regrow your hair, consistency is crucial. With topical treatments, the moment you discontinue use, hair loss will resume. Always consult with a medical professional before using any product for hair loss, including over-the-counter items.
Telogen Effluvium: A Different Story
A very common cause of hair loss is Telogen Effluvium, characterized by diffuse, and often non-severe, shedding of the hair. It is a form of nonscarring alopecia and is defined as a temporary cause because once the underlying issue(s) is resolved, hair will regrow. It is a reactive process triggered by many things, making Telogen Effluvium a commonly diagnosed disorder.
Physical or emotional stress, medications, illnesses, nutritional deficiencies or imbalances, and hormonal changes can all disrupt the hair growth cycle. Viral illnesses, severe infection, even chronic illnesses can trigger episodes of Telogen Effluvium. Oftentimes people who have major surgery will experience this hair loss a few weeks after the operation. This is due to the physical stress the body experienced from the surgery and even the effects of being under anesthesia. Telogen Effluvium is triggered when stressors cause a large number of hair follicles that are in the growing phase to abruptly enter the resting phase.
Postpartum hair loss is the most recognizable form of Telogen Effluvium and is the reason this disorder is experienced by more women than men. A decrease in estrogen, hypothyroidism, or any other hormonal imbalances have all been linked to this type of hair loss. Nutritional deficiencies such as iron deficiency, low protein intake and crash dieting, and ingestion of heavy metals and excess vitamin A are also common causes. Some examples of medications that have been linked to Telogen Effluvium include beta-blockers, retinoids, anticoagulants, and some immunizations.
The biggest difference in recognizing Telogen Effluvium from Androgenic Alopecia would be in the pattern of hair loss. Hair loss will be experienced diffusely throughout the scalp instead of distinct areas. It can sometimes be more pronounced at the crown because of the follicle sensitivity but will still be noticeably diffuse throughout. This hair loss disorder is not recognized immediately after being triggered and can go undetected for up to three months. This is because the resting phase is lengthened and the person doesn’t notice the halted growth. Once the affected hair follicles re-enter the growing phase, the strands that had been caught in the resting phase begin to be pushed out, resulting in noticeable shedding.
Getting a diagnosis of Telogen Effluvium is a fairly simple process. Sometimes an older photo versus a current photo can suffice in a proper diagnosis. If the person is being evaluated during the shedding phase, a “pull test” will be beneficial. A pull test is when you run your fingers through the hair, with a gentle pull, and four or more hair strands fall out with each pass through. However, after the shedding phase has passed, the pull test could yield normal results. An examination of the scalp under a trichoscope may reveal an increased percentage of short anagen hairs, and no scarring should be present.
If more serious underlying conditions are suspected, your doctor or dermatologist may order a scalp biopsy or various blood tests. As far as treatments go, once the causative event has been appropriately treated, no further action is necessary. In theory, Minoxidil should work to promote hair recovery in Telogen Effluvium. Unfortunately it has not been clinically proven to be effective. With time and nutritional support, it is possible to have a complete recovery without additional treatments.
When To See A Professional
Sometimes both Androgenic Alopecia and Telogen Effluvium can occur at the same time. It is important to reach out to a medical professional when experiencing any kind of hair loss. The earlier you can receive a diagnosis, the sooner you can have an action plan to manage it. Since management needs to be a well-balanced holistic approach, it is common to consult with two or more professionals during your treatment.
It is best to consult with a Dermatologist for any scalp related issues and to get an official diagnosis of Androgenic Alopecia or Telogen Effluvium. A dermatologist can prescribe the appropriate oral and topical medications, offer specialized treatments, and work alongside other professionals in your team to put you on the path to recovery.
Your Primary Care Physician may not be well versed in all things hair and scalp care, not like a Dermatologist will be. However, it is often recommended to have blood work drawn to check for nutritional deficiencies or hormonal imbalances and your PCP would be best suited for those tests. Your doctor can also help in diagnosing other conditions that may interfere with your treatments and success rates.
Adding a certified Trichologist to your team can be very helpful, particularly those who are also Cosmetologists. A Trichologist receives specialized training in the study of scalp and hair health. The majority of these professionals are not licensed cosmetologists, but rather those in the medical field who choose to study only the medical aspects of hair and scalp health. Trichologists are able to recognize various hair and scalp disorders and refer to the proper medical professional for diagnosing. They will perform an in-depth scalp analysis and can personalize advice and specialized treatments. If your Trichologist is also a Cosmetologist, they can provide services that the others cannot, such as hair extensions, wig assistance and haircuts to help camouflage hair loss.
Red flags to watch out for that need immediate medical attention would be rapid hair loss, scalp pain, inflammation, wounds, oozing, or any other abrupt and sudden concerning symptom that involves the scalp and hair. Remember, the sooner you address your hair loss concerns, the sooner you will have relief.
Questions To Ask Your Hairstylist/Trichologist
For your Hairstylist:
Are there any signs of scalp issues you've noticed?
Are there styling techniques or products I should avoid?
Can you recommend a dermatologist or trichologist?
For your Trichologist:
What type of hair loss am I experiencing?
What are the treatment options available?
What can I expect in terms of hair regrowth?
What lifestyle changes can I make to support hair health?
Lifestyle Tips for Healthy Hair
Proper nutrition will always be a large contributing factor in healing any issue we may have within our bodies, our hair is no exception. As any doctor will tell you, make sure you maintain a well-balanced diet. A diet rich in protein, iron, zinc, vitamin D, and other vital vitamins and minerals, will assist you in regrowing strong, healthy hair.
Stress management cannot be stressed enough - it is imperative to keep your stress levels as low as you possibly can. No one is ever going to be free from life’s stressors but managing how your mind and body react to them makes all the difference. Incorporating small changes into your routine such as journaling, meditation, walking/exercising or confiding in a therapist are great ways to help yourself.
Being gentle in the ways that you care for and style your hair is an important habit to adopt. Avoid harsh chemicals or styling, tight hairstyles, and excessive heat. Invest in quality hair care and learn what products are best for you specifically.
There are many supplements on the market today that specifically target hair regrowth. Not everyone going through hair loss will benefit from these kinds of supplements. For example, unless you are already pretty deficient in Biotin, it isn’t going to have any hair growth benefits for you. It is very important to discuss any and all supplements with your doctor. Just as having a deficiency can cause hair loss, so can having an overabundance.
Whenever you’re trying to decode what your hair loss is trying to tell you, ask yourself “what is the hair loss pattern?. How suddenly have I noticed the hair loss?” Being able to answer those two questions will put you on the right track to managing your hair loss. Adopting a holistic approach to your beauty and wellness has all over and long lasting positive impacts. Take the time to be consistent, invest in the proper products, and most importantly have the patience with yourself to see your management plan through. There are so many solutions to hair loss, it is just a matter of discovering what works for you.