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Hair Loss/I don't get it


QUESTION: I have always measured my ponytail circumference to keep a check on my hair density.  Even when I was shedding a lot over 120 per day, my measurement stayed the same. Now since my last baby (1.5 years ago) my ponytail went up a tiny bit with her, but now it's gone down, past the normal by 1/4" and I dont get it because I'm not shedding over 100 per day.  I'm very distraught as I just don't get it. Any ideas?

ANSWER:  Many patients and doctors fail to realize that each hair only has a predetermined number of hair cycles and that varies from site to site over the scalp as well as the rest of the body. On the scalp the hairs grow for about 5 years, fall out and restart again. That is a life cycle. When we see male or female pattern baldness it is because the hairs which had fewer life cycles are not growing back..
 In my book "Hair Loss Answers" which can be read for free on my website I describe a patient who developed malaria at age 22 and in one year used up 10 life cycles and was bald in a year.

   In your situation I believe you may have noticed thinning due to the stress of delivery and other causes of stress resulting in your inherited normal thinning on the top and back of your head showing up as a thinner ponytail. There are treatments for this explained in Chapter 9
 Here in Chapter 3 is a description of the how and why of inherited female pattern loss:
Normal hair follicles go through a growth cycle (described in the previous chapter) that lasts roughly four to six years, ending with the hair shaft being shed, and a brief resting period after which the growth cycle starts over again with a new hair beginning to grow from the hair follicle.

But hair follicles that are sensitive to DHT, and that receive the DHT message to shut down, begin to have shorter anagen (growth) phases. The DHT circulating in the blood seems to signal these sensitive hair follicles to stop growing hair before the normal growth phase would have ended. Instead of four to six years, the growth cycle shortens to three to four years, and then one to two years, and eventually the hair follicles affected by DHT simply stop producing new hairs altogether, and stay in a sort of telogen (resting) phase. As the growth phase of the follicles becomes shorter, the hairs grown by those follicles do not grow as long as they once did.

Scalp hairs grow approximately one-half inch per month, which works out to about six inches per year. If the growth phase of a follicle is six years long, the hair grown by that follicle could reach thirty-six inches in length if it were not cut. But if the growth phase shortens to two years, the maximum length of the hair would be only twelve inches. Eventually, as the anagen phase continues to shorten, the hairs produced by the hair follicle may only grow out an inch or less before they are shed.

It is believed that each hair follicle is genetically programmed for a limited number of growth cycles. The shorter the duration of each cycle, the sooner a particular hair follicle goes through all of its growth cycles and stops producing a new hair.

For example, if a particular hair follicle is programmed to have twenty complete growth cycles, each lasting an average of five years, then that hair follicle will continue producing new hairs for 100 years (twenty growth cycles at five years each). But if that hair follicle is sensitive to DHT circulating in the blood, the growth cycles will begin to shorten, and the follicle’s twenty-cycle life may only last until age fifty, or forty, or thirty. And some hair follicles are programmed to have fewer than twenty growth cycles, which is why some men start showing frontal hairline recession before age twenty, while other DHT-sensitive follicles continue growing hairs until age thirty or age forty.

But there’s more bad news for those who have inherited pattern hair loss. DHT affects sensitive hair follicles in another way as well: it results in thinner and less pigmented strands of hair. Normally, a hair follicle shrinks in size after the anagen (growth) phase, and the hair shaft falls out during the catagen or telogen phase. As the follicle begins a new anagen phase, it grows back to its original size, and it produces a new hair of normal thickness.

There is evidence that hair follicles that are sensitive to DHT do not return to their full size after the telogen phase. In each successive growth cycle, the hair follicles become smaller and smaller. This is significant because the hairs produced by these miniaturized hair follicles are themselves thinner and less pigmented than normal hairs. Over time the affected hair follicles only produce nearly transparent “peach fuzz” hairs instead of full size normally colored hairs. And finally they produce no new hairs at all.

So DHT affects sensitive hair follicles two ways: first, it shortens the hair growth cycle, which “ages” the hair follicles. Second, it causes miniaturization of the hair follicles. The result of these two effects are shorter hairs, increasingly finer and less pigmented hairs, and eventually less hair altogether.

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QUESTION: so you're saying that this is only going to get worse??  
I'm not going to use minoxidil but how can I find a doctor that will give me a topical mix of things like you had mentioned, with zinc salts/progesteron/etc.  

And spironolactone, can it reverse any of the hair loss on it's own?? And do most women see results after taking it?

Your original question was "do you have any ideas?".  I have directed you to a source where you can learn about how and why we all thin as we get older and some with inherited patterned loss. You need to look at your family to see to what degree they thin out and the timing or when they thin to get some idea of the when and how much loss you will experience. To that , you need to determine whether stressful events such as deliver or surgeries or illnesses may be a factor in making your specific inherited pattern show up earlier  than it would without those stresses. I do not know where you live and who the local hair specialist may be but your dermatologist should be a good start in finding a hair loss specialist. Most dermatologists do treat acne and female pattern hair loss with spironolactone but you should speak to yours about this.
Appendix – Sources for More Information
• American Academy of Dermatology
1567 Maple Ave Evanston IL 60201 312-869-3954 www (Information on dermatology, including hair loss.)
• American Academy of Cosmetic Surgery
159 East Live Oak Ave #204 Arcadia CA 91006 818-447-1579 www (Information on various hair restoration procedures.)
• American Society for Dermatologic Surgery
5550 M eadowbrook Dr. Suite 120 Rolling M eadows, IL 60008 847-956-0900 www .asds-net .org
(A good source for dermatologic and hair restoration surgeons)
• American Hair Loss Council
100 Independence P lace #207 800-274-8717 www (Good source for hairpiece and wig information.)
• International Society of Hair Restoration Surgery
www (Source for hair restoration surgeons worldwide)

Hair Loss

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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