As you start to look at treatments for hair loss, it’s really important to know where
the breakdown of the hair growth cycle is occurring. In order to do that, you need
to know what normal looks like. When we are born, we are born with about a
hundred to 150,000 follicles on our head that are actively going to grow throughout
our lifetime. This hair cycle is in constant transformation as any other living system,
and there’s different phases to this growth cycle that are undergoing
transformation at any particular time. And you’re going to have hair follicles in
various stages at different points throughout our life.

When you start here at the top, the antigen, which is actually the active growth
phase, it’s actually where we have the majority of our hair at any given time, about
80% to 90% of the hair follicles, and it’s really in that grow within phase and it’s
really what determines our hair length. This phase actually lasts a long time, about
three to six years on average. After you go through this active growth phase, then
the hair transitions into this catagen phase, which only about 5% of our hair is in at
any one point, and it’s really when the hair follicle starts to shrink and it’s really
starting to prepare itself to separate from the dermal papilla, which is then going to
allow it to shed. Then that phase takes about two to three weeks.

Once it starts to shrink and it moves into the telogen phase, which then becomes
what we call the resting phase, and that’s … You have about 5% to 10% of your
hairs in that phase. It’s really now separated from the follicle and it’s getting ready
to shed. Then they move into the exogen phase, where the hair actually shut on a
regular basis, and then it starts the whole cycle over. You can see you as the hair is
shedding in the exogen phase, there’s actually a small matrix at the base that is
now starting to form the new hair that’s ready to kind of take its place. When
you’re in that exogen phase, that’s where we’re losing hair and shedding hair.

On average, normal hair loss is about 50 to 150 hairs per day. If it gets to exceed
that, that is obviously problematic and you’re gonna not be able to keep up with
normal renewal, and then patients are going to start to notice thinning hair or hair
loss, which is going to be problematic. Now, if you kind of were thinking and
listening about the different phases and the timeframe, so if you think the anagen
is three to six years, but then if you take catagen, telogen and exogen phase, those
three phases alone, on average, take about three to four months.

Whenever you start treatments for hair loss, you need to give it at least three to
four months to see any kind of improvement. Unfortunately, patients these days,
which is getting worse, are certainly are looking for things to occur much more
rapidly, but we have to teach that patience is a virtue concept, because whatever
we do, even the best therapies, are still going to take a minimum of 90 to 120 days
to show any noticeable benefit, and they have to kind of stay the course. As we
start to talk about hair loss too, it’s important to kind of address some of the myths
that are out there.

Probably the number one myth is that patients think that they’re shampooing too
much and that they should shampoo very, very little, and that will help with hair
loss. But actually shampooing is actually, in particular, when we start to talk about
androgenic hair loss from too much 5 DHT in the scalp, actually shampooing
removes that hormone and actually helps with hair loss. Patients often say, well,
I’m not going to shampoo cause I’m worried every time I shampoo, it’s going to
come out and I’m going to have worsening hair loss, but it’s really important to get
some of the chemical derivatives that may be sitting on the hair and scalp that are
causing it. Shampooing too much should not cause hair loss.

Stress will cause permanent hair loss. Actually, stress typically does not. It’s usually
temporary while the stressor is in place. But stress does a lot of horrible things to
our body, as you know, not only from adrenal problems or weight gain and various
other things, but also can lead to hair loss. But if the stress can be removed, that
can certainly come back. Patients also worry that if they shave the hair, it’s going to
grow back twice as thick and/or darker. Actually, that is a falsehood. Usually, when
they shave, it becomes an optical illusion, because instead of the hair coming out
with the fine tip that usually is at the top, then you cut it, it actually creates a
greater diameter because it’s cutting it shorter in the base, which creates the
illusion that the hair is actually twice as thick, but it’s actually not.