Rapid Screening for Hair Loss (Thinning)

What is the cause of thinning… the most common cause of female hair loss?

Twenty five percent of healthy women will develop scalp hair thinning in their lifetime. It will not become visible until 50% of the hair is gone. Contrary to common belief, thinning is not the result of hairs falling out.  It’s caused by a progressive reduction in the hair’s diameter and length. As the hair diameter gets smaller and smaller, the underlying skin becomes more and more visible. Eventually the hair vanishes and a hairless area appears. The process starts 15 to 20 years before the underlying skin becomes visible.  If detected early, treatment success approaches 100%.


What is the cause of thinning?

The majority of women with thinning have a positive family history of hair loss in their family.  But 10% of women with thinning have a hormone imbalance.  If the diagnosis of thinning is established, a hormonal imbalance should be ruled out with several blood tests.  Thinning should not be confused with shedding.  Shedding is the somewhat abrupt loss of full-sized hairs, and is much more common.  Shedding can be caused by iron deficiency, thyroid abnormalities, fever, childbirth, the discontinuation of birth control pills, or the side effect of certain medications.


How is thinning detected?

A rapid screening test is all that is required.  The test determines if miniaturized hairs are present.  We use a state-of-the-art micro-imaging system to examine your scalp hairs… very close up.  A magnified photo of your scalp surface is taken.  In the absence of thinning, all hairs have normal-sized diameters.   In the presence of thinning, miniaturized hairs with small diameters are seen between the full-sized hairs.  If thinning is detected by the screening exam, a more comprehensive hormone evaluation is recommended.


Will thinning get worse if untreated?

In men, thinning will get worse 100% of the time… rapidly in some, more slowly in others.  Thinning is what leads to male pattern baldness.  On the other hand, reliable predictive data is not available for women — simply because precise measuring technologies were not available until this year.  Fortunately in women, the progression is much slower and less severe.  In women, the hair thins, but the forehead does not enlarge.  An actual bald spot, with no hair, does not result.






If the diagnosis of thinning is established, what is the next step?

The next step would be a more formal hair loss evaluation.  Hormone studies would be generally performed.  Although 90% of women with thinning are otherwise healthy, about 10% with thinning have hormone imbalance.  If the top of the head indicates thinning, other areas of the scalp would be evaluated as well.  A small percentage of women with thinning have miniaturization over the entire scalp and not just on top.  Hair shaft structure should be examined, and the average hair diameter calculated.





Micro-image of early thinning

Note the variation in hair diameter… some are large, many are intermediate and some are very thin.  In the absence of thinning, all diameters would be full-sized and large. NOTE: The patient in this photograph has NO visible hair loss.


Can the severity of thinning be measured?

Yes, with cross section trichometry (CST).  CST is a new technology that enables us to help patients like never before.  Physicians no longer take imprecise photos or count the number of hairs in a magnified field to see if a patient is better or worse.  Counting the actual number of hairs within an area of scalp has only limited value; the measurement of hair diameter must be performed as well.  With CST we can simultaneously measure both the hair diameter and the number of hairs per centimeter of scalp.  No hairs are cut.  Any changes in hair diameter and/or changes in the number of hairs, are displayed as a single CST “score.”  CST can quantify the severity of your loss and establish a baseline value for the treatment that follows.


Can the rate of worsening be measured?

Yes. By tracking the CST value over a period of time, the percent worsening per year can be easily calculated.



What are the treatments for thinning?

Although hundreds of preparations promise to grow hair, Hevia Cosmetic Dermatology provides only those that are medically proven to work, FDA-approved, and FDA-pending. These include treatments that range from minoxidil, enhanced minoxidil preparations, finasteride, dietary supplements, several forms of laser, and combination treatments as well.  Most treatments are performed by the patient at home; a few are administered by our technicians in the office.


How well do they work?

FDA-approved treatments are medically proven, and work surprisingly well!  If thinning is arrested or stabilized, the treatment is considered a success.  A large percentage of patients who receive treatment actually re-grow their lost hair and enjoy an increase in their hair diameter. A patient’s response is not only determined by the treatment; but it’s also determined by genetic makeup.  Most patients respond better to one treatment than they do to another.  It is a bit unpredictable. Some patients benefit from a combination of treatments.


Can the response to treatment be measured?

With CST, we can precisely measure your response to any treatment we’ve prescribed.  If your hair “score” does not sufficiently improve, your treatment can be altered, or the dosage adjusted.  There is no guesswork.  Your hair loss management is precise and scientific.  The success (or failure) of treatment can be authenticated and proven.  Until this year, precise hair measurement was simply not possible.


Can the treatment for thinning be postponed?

Yes.  Those patients who choose no treatment can be re-examined and their CST re-measured at 6 to 12 month intervals.  Any stabilization or worsening can be easily detected by a change in their CST score. Certainly an annual worsening of 13% would have a greater significance than a worsening of 2%.


If the thinning is not getting worse,  should it be treated?

It’s probably a good idea.  Women with thinning have less than 100% of their original hair mass. Because the miniaturized hairs have smaller diameters, the entire hair mass behaves differently than it would were all the hairs full-sized.  Reduced hair mass translates to less body, volume, more fly-away, and more breakage. Medically proven treatments will inhibit further miniaturization, increase the diameter of the hairs, and maintain the follicles in their active growing phase.  With treatment, your hair will become fuller, longer, stronger, healthier, and behave significantly better.


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