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Hair thinning can be understood as a reduction in hair density caused by having fewer hair strands or by hair becoming increasingly fine or fragile. It is entirely involuntary and has a wide variety of causes including genetic predisposition, hormonal imbalances, environmental factors and an unhealthy scalp.

There is currently no way to instigate permanent re-growth of hair that has been lost through genetic or hormonal causes. However, it is widely regarded that with early detection, professional consultation and specialist products, the effects of hair thinning can be reduced or delayed. If the cause is reversible, such as an underlying medical condition, it is possible to stop hair thinning by treating the deficiency. There are also several measures sufferers can take to give hair a thicker appearance and to create an optimum scalp environment for new hair to grow and thrive.

Hormonal causes
Hormone imbalances play a substantial role in thinning, and can be inherited from either parent. This is especially true of the most common types of thinning: male and female pattern baldness (androgenetic alopecia). High levels of androgens, and their bi-product DHT (dihydrotestosterone), cause thinning by contributing to a process known as ‘miniaturization’.

Follicular miniaturization occurs when, as the result of various causes, the hair follicle begins to deteriorate. As a consequence, the hair’s growth phase (anagen) is shortened, and young, unpigmented vellus hair is prevented from growing and maturing into the deeply-rooted and pigmented terminal hair that makes up 90 per cent of the hair on our heads. In time, hair becomes thinner and its overall volume is reduced until, finally, the follicle falls dormant and ceases producing hair completely.

Temporary hormonal changes, such as those experienced during puberty, during and after pregnancy and during the menopause can also contribute to hair thinning.

Lifestyle
Stress has been shown to restrict the blood supply to capillaries, inhibiting oxygen and nutrient uptake to hair follicles and inhibiting hair growth. Studies have shown that poor nutrition, limited food intake, and deficiencies in biotin, iron, protein or zinc can cause thinning, as can a diet high in animal fats (often found in fast food and Vitamin A. Air and water pollutants, as well as minerals in water and the phototoxic effects of sunlight, can cause thinning by aging the scalp skin and damaging hair.

Health
Temporary or permanent hair loss can be caused by several medications, including those for blood pressure, diabetes, heart disease, cholesterol and specific chemotherapies. Any that affect the body’s hormone balance can have a pronounced effect, and these include the contraceptive pill, hormone replacement therapy, steroids and acne medication. Hypothyroidism or hyperthyroidism (an under- or overactive thyroid) and the side effects of the medications used to treat either condition can cause hair loss, as can poor circulation, which deprives hair of nutrients.

Aging
Gradual thinning of hair with age is a natural condition known as involutional alopecia. The is caused by an increasing number of hair follicles switching from the growth, or anagen phase, into a resting phase, or telogen phase, so remaining hairs become shorter and fewer in number. The American Hair Loss Association predicts that 85 per cent of men will have experienced significant hair thinning by the time they reach 50.

Scalp environment
An unhealthy scalp environment can play a significant role in hair thinning by contributing to miniaturization or causing damage. Air and water pollutants, environmental toxins, conventional styling products and excessive amounts of sebum have the potential to build up on the scalp. This debris can block hair follicle and cause their deterioration and consequent miniaturization of hair. It can also physically restrict hair growth or damage the hair cuticle, leading to hair that is weakened and easily broken off before its natural lifecycle has ended.

Demodex folliculorum
This microscopic mite feeds on the sebum produced by the sebaceous glands, denying hair essential nutrients and causing thinning. Demodex folliculorum is not present on every scalp, and is more likely to live in an excessively oily scalp environment.

Breakage
Rigorous brushing and heat styling, rough scalp massage and pulling, twisting or binding hair too tightly can damage the cuticle, the hard outer casing of the hair. This causes individual strands to become weak and break off, reducing overall hair volume.

Excessive daily hair loss
It is generally accepted that each person has between 100,000 and 150,000 hairs on their head (blondes have the most, followed by brunettes and redheads). Advice about how many strands it is normal to lose per day varies, but recent studies suggest an average of 100. In order to maintain a normal volume it must be replaced at the same rate. The first signs of hair thinning that people will often notice are more hairs than usual left in their hairbrush after brushing, or in the basin after shampooing. Styling can also reveal areas of thinning, such as a wider parting or thinning crown.

Skin conditions
A substantially blemished face, back and limbs could point to cystic acne. The most severe form of the condition, cystic acne arises from the same hormonal imbalances that cause hair loss, and is associated with DHT production. Seborrheic dermatitis, a condition in which an excessive amount of sebum is produced and builds up on the scalp (looking like an adult cradle cap), is also a symptom of hormonal imbalances, as is an excessively oily or dry scalp. Both can cause hair thinning.

Body hair
Excessive body hair in men is an indication that hair thinning of the head might occur. Studies have shown that if a man has complete chest hair, he is around 50% more likely to become bald, increasing to 90% if he has total body hair. In women, excessive body hair (hirsutism) or a sudden appearance of body hair may indicate the same hormonal imbalances that cause hair loss.

Noticing thinning
Hair stylists can play an important role in diagnosing thinning. In many cases, they will be the first person to notice the problem, and they can often recommend a solution based on the specific needs of their client.

Testing
There are two types of identification tests for female pattern baldness: the Ludwig Scale and the Savin Scale. Both track the progress of diffused thinning, which typically begins on the crown of the head behind the hairline, and becomes gradually more pronounced. For male pattern baldness, the Norwood Scale tracks the progress of a receding hairline and/or a thinning crown, through to a horseshoe-shaped ring of hair around the head and on to total baldness.

Medical consultation
In almost all cases of thinning, and especially in cases of severe hair loss, it is recommended to seek advice from a doctor or dermatologist. Many types of thinning have an underlying genetic or health-related cause, which a qualified professional will be able to diagnose.

Treating the scalp
As an extension of facial skin, effective cleansing and moisturizing of the scalp can help keep follicles open and create an optimum environment for healthy hair to grow and mature, preventing miniaturization and controlling thinning. Certain products on the market are specially designed to remove the styling build-up, environmental pollutants and excess sebum that block follicles and inhibit hair growth, and nourish the scalp skin and hair to reduce breakage and promote health.

Medication
A variety of medications have been proven to slow hair thinning, help grow new hair or enlarge existing hairs to create better coverage. Most require long-term use as, if stopped, hair loss returns. Some treatments are topical, and activated by being sprayed or rubbed into the scalp, while others are taken in pill form. One of the most popular medications, corticosteroids, are either injected into the scalp, taken in pill form or applied in an ointment, and are used especially to treat patchy hair loss. Other treatments include UVA light therapy and immunotherapy.

Surgical treatments
Hair transplant surgery was developed during the 1950s. Usually carried out under local anaesthetic, a surgeon will move healthy hair from the back and sides of the head to areas of thinning, helping to restore a natural look. The procedure can take anything between four and eight hours, and additional sessions can be carried out to make hair even thicker. Transplanted hair falls out within a few weeks, but regrows permanently within months. A decision to proceed with medication or hair restoration should always be made in consultation with a medical professional.

Background
Perhaps unsurprisingly, hair thinning causes stress for sufferers, a fact which can be attributed to the psychology of appearance. Although societal interest in appearance has a long history, this particular branch of psychology came into its own during the 1960s and has gained momentum as messages associating physical attractiveness with success and happiness grow more prevalent. In 1984, psychologist Dr. Stephen L. Franzoi and Dr. Stephanie A. Shields developed the Body Esteem Scale, which aims to achieve a comprehensive overview about how participants feel about their bodies (including their hair), and is still used today.

Emotional reactions
The psychology of hair thinning is a complex issue. Hair is considered an essential part of overall identity: especially for women, for whom it often represents femininity and attractiveness. Men typically associate a full head of hair with youth and vigor. Although they may be aware of pattern baldness in their family, many are uncomfortable talking about the issue. Hair thinning is therefore a sensitive issue for both sexes. For sufferers, it can represent a loss of control and feelings of isolation. People experiencing hair thinning often find themselves in a situation where their physical appearance is at odds with their own self-image, and commonly worry that they appear older than they are or less attractive to others.

Coping with and treating the problem
There are three main ways that men and women typically cope with hair thinning. The first is compensation: taking extra care in their appearance to create a more positive body image. The second is camouflage: wearing wigs, hairpieces or headwear, shaving the head or styling to detract from thinning. Finally, many experience compulsive behavior – constantly checking their appearance and seeking reassurance.