Hair cells are some of the fastest growing cells in our body. However, for some people, it doesn’t grow fast enough leaving them bald after a certain age. Do we have genes to blame for this phenomenon or can it be thyroid hair loss? Let’s take a closer look and differentiate these two potential causes.

Why is this an important topic for conversation?

It is to understand the hair loss problem better and the type of treatment that is appropriate. You don’t want to shell thousands on hair transplant cost when your condition only needs pharmacological intervention. It does pay to be aware, and it will save you from a lot of frustration and wasted effort.

Androgenetic Alopecia

Androgenetic alopecia (AGA), commonly known as female or male pattern baldness, is a condition characterized by a progressive hair loss, especially of the scalp hair. It comes with distinctive patterns in women versus that of men, but in both genders, the scalp hair is the area that is severely affected. Over time, the hairline recedes forming a characteristic “M” shape. In some cases hair thinning may also start at the crown (the top portion of the head), progressing to partial to complete baldness. However, this condition rarely leads to total baldness in women.

Causes

Research found that this kind of hair loss is related to hormones, particularly an androgen called dihydrotestosterone (DHT), which is a more potent form of testosterone. Androgens play an important role for normal sexual development in males before birth and during puberty. These hormones also holds important functions in both sexes, such as regulating hair growth and sex drive.

DHT has many roles too, such as the development of the penis and prostate gland. This is why it is also linked to benign prostatic hyperplasia (BPH), or prostate enlargement, and prostate cancer.

In men, the enzyme 5-alpha-reductase (5-AR) converts testosterone into DHT in the testes and prostate. Up to 10 percent of testosterone is converted into DHT under normal conditions. However, when things go awry and DHT formation goes overboard, is when the hair starts to get affected. Increased levels of androgens in the hair follicles can lead to a shorter hair growth cycle. It stunts its growth and it creates thinner strands. Additionally, there is also a delay in the growth of new hair to replace those that have shed.

In men, androgenetic alopecia can start as early as a person’s teens and the risk increases with age. In women, this kind of hair loss is most likely to occur after menopause.

Symptoms

You will notice more hairs fall on the pillow, the shower, or on your comb. However, when checking these symptoms you must take other factors into consideration because there are other reasons why people lose more hair than usual, such as childbirth, medications, or a serious illness.

In men, hair loss usually starts at the temples and the crown. It then progresses in an M-shaped pattern. In advanced stages, only a small rim of hair that lines the side and back of the scalp remains. In women, hair loss tends to be more diffused and better hidden. It affects the top of the head and down the middle, while the hairs along the temples and forehead remains normal.

Diagnosis

Androgenetic alopecia is usually diagnosed by its pattern and history of a similar type of hair loss affecting family members. A thorough and standardized diagnostic approach is an essential step in developing a successful therapeutic concept.

Treatment

Hair loss of this nature has the following treatments:

• Medications

Minoxidil (Rogaine) or Finasteride (Propecia) are the two popular medications that prevent hair loss and promote new hair growth. However, this effect can be quite unpredictable from one person to the next.

• Scalp Reduction

This procedure involves the surgical removal of strips of bald skin to decrease the size of a bald spot.

• Hair Flaps

Using a strip of skin which contains good hair growth, it is excised from a less cosmetically important area to a more prominent one like the head. This has been considered an outdated hair restoration method because it can result in permanent shock loss (loss of some or a significant amount of existing hair) and extreme scarring.

• Hair Transplants

A hair transplant procedure is considered the last resort in hair restoration. There are two different approaches to this treatment and these are, the Follicular Unit Transplantation (FUT) and the Follicular Unit Extraction (FUE). FUT is more invasive and more prone to scarring because it involves incisions to remove a piece of scalp which contains the donor hairs. FUE, on the other hand, is less invasive because it uses a punch tool to remove the grafts directly from the scalp. These techniques can harvest a number of grafts that could go by the thousands, making it a time-consuming process, but often a successful one at best.

One thing worth noting about androgenetic alopecia is that it is progressive and it creates permanent results. Treatments would either have to be maintained or it has to give long-lasting results like what you can get out of a hair transplant.

Thyroid Hair Loss

The thyroid gland is a butterfly shaped gland that is positioned in front of the lower neck. It lies along the front of the windpipe and just below the Adam’s apple. Such a small body part plays an important role by producing various hormones that are released into the bloodstream and  responsible for different body functions.

Hypothyroidism (an underactive thyroid) and hyperthyroidism (overproduction of thyroid hormones) are just two of the different thyroid diseases. Severe and prolonged hypothyroidism and hyperthyroidism can eventually cause hair loss. It can affect the entire scalp with the scalp hair becoming uniformly sparse. However, thyroid hair loss can only become apparent several months after the onset of the disease itself.

Causes

The best way to address thyroid hair loss is to look at the root cause of hyperthyroidism and hypothyroidism. With proper diagnosis, an appropriate treatment can be provided, which will ultimately address the hair loss issue.

• Hyperthyroidism

The most common cause of hyperthyroidism is the autoimmune disorder Grave’s disease. It is where the body makes an antibody called thyroid stimulating immunoglobulin (TSI) that causes the thyroid gland to make too much thyroid hormone. This disease runs in families and it is more common in women who also display a significant amount of hair loss.

Toxic nodular or multinodular goiter can also result in hyperthyroidism, where nodules or lumps cause the thyroid hormone to produce excessive amounts of thyroid hormones. High iodine consumption and Thyroiditis (inflammation of the thyroid gland) can also result in the same problem.  

• Hypothyroidism 

Different causes behind hypothyroidism include autoimmune disease (Hashimoto’s thyroiditis), hyperthyroidism treatment, thyroid surgery (the partial or total removal can halt or diminish hormone production), Radiation therapy, and medications.

In lesser instances, hypothyroidism can be caused by a pituitary disorder, a congenital disease (a defective thyroid or no thyroid gland), pregnancy, and iodine deficiency.

Diagnosis

With hyperthyroidism diagnosis can be confirmed through blood tests that measure the levels of TSH (Thyroid Stimulating Hormone) in the blood.A diagnosis for hypothyroidism is done along with routine annual physical examinations since this is mostly common among older women. The same blood test will also be done because this can determine a condition called subclinical hypothyroidism which usually doesn’t have any obvious signs and symptoms, so, it may not necessarily reflect on your hair.

Treatment

One thing promising about thyroid hair loss is that it is temporary. You have to address the thyroid problem to fix the accompanying symptoms.

Hyperthyroidism can be treated using anti-thyroid drugs (methimazole and propylthiouracil), radioactive iodine treatment, and the surgical removal of gland. However, there are rare cases where anti-thyroid drugs, such as carbimazole and propylthiouracil can cause diffuse hair loss. Hence, it can be difficult to tell whether the hair loss is due to the effects of the thyroid overactivity or anti-thyroid drugs. There is a high probability that anti-thyroid drugs are not the cause and you can find other alternative treatments while you sort it out. Radioiodine is one treatment that does not cause hair loss.

For hypothyroidism, the standard treatment involves the daily use of synthetic thyroid hormone levothyroxine (Levothroid, Synthroid, etc).

So, whether the cause of your hair loss is genetic or as a result of a disease process, the most important step is proper diagnosis. Androgenetic alopecia is a progressive condition that lead to permanent baldness, while thyroid hair loss is reversible with proper treatment of the underlying causes.

If you are unsure of the kind of hair loss you are experiencing now, talk to your GP or approach a hair loss expert right away so you can already undergo the proper diagnostic tests. The earlier you address the problem, the better your chances with hair restoration.

For more questions, talk to Dr. Daood today of the Sydney Hair Transplant Clinic.