Offices in Chevy Chase, MD and Stafford, VA
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Men’s Hair Loss

Why am I Balding?

Over 40 million men suffer from hair loss, 40% of men have noticeable hair loss by age 35 and 65% by age 60.

For many men, hair loss is inevitable.  It is a hereditary condition that increases with age. These genes may be passed from either the maternal or paternal side.

Other reasons include:

  • hormonal changes
  • stress
  • illness
  • poor nutrition

Not Causes:

  • Frequent shampooing
  • The wearing of hats
  • Poor circulation

Androgentic alopecia, or pattern baldness, is the leading cause of hair loss in men and women.  In this condition, hormones combined with a hereditary predisposition produce thinning hair and pattern baldness.

Less common causes of hair loss include:

  • high fever
  • severe infection
  • diet
  • certain medications
  • birth control pills
  • thyroid disease
  • childbirth
  • cancer treatments.

During the consultation, the cause of your hair loss will be evaluated, followed by a discussion of available of treatment options.

Male pattern baldness usually begins with a receding hairline and thinning at the crown, and continues to progress over a lifetime.  Female pattern baldness usually consists of thinning across the top of the scalp with preservation of the frontal hairline.  Although the ultimate degree of baldness cannot be accurately predicted, the age of onset and the family history are important factors.

Restoring Lost Hair

Follicular-unit micrografting is a procedure during which literally thousands of follicles are redistributed into the thinning or balding areas.  Each micrograft contains a single “Follicular-unit” consisting of one to three (or rarely four) hair follicles.  Follicular-unit grafts are then carefully implanted into the bald or thinning “recipient” areas.  Meticulous artistic and technical skill is required to design an appropriate hairline, as well as ensure the appropriate angle, orientation and position of each transplanted hair.  Follicular-unit micrografting creates a result that defies detection and is never, ever “pluggy.”

Topical and oral medications may benefit some people with early-to-moderate hair loss and may also be combined with follicular-unit micrografting.  The use of medications to stop or slow down the hair loss process can be discussed during your consultation.  Hair pieces, wigs, or weaves are difficult to maintain, and may present an unnatural appearance.  While these solutions are acceptable for some people, hair transplantation using follicular-unit micrografts can provide a more natural look permanently.


Classification of Hair Loss in Men

Norwood Classification


The Norwood classification, published in 1975 by Dr. O’tar Norwood, is the most widely used classification for hair loss in men. It defines two major patterns and several less common types (see the chart below). In the regular Norwood pattern, two areas of hair loss–a bitemporal recession and thinning crown–gradually enlarge and coalesce until the entire front, top and crown (vertex) of the scalp are bald.

Class I represents an adolescent or juvenile hairline and is not actually balding. The adolescent hairline generally rests on the upper brow crease.
Class II indicates a progression to the adult or mature hairline that sits a finger’s breath (1.5cm) above the upper brow crease, with some temporal recession. This also does not represent balding.
Class III is the earliest stage of male hair loss. It is characterized by a deepening temporal recession.
Class III Vertex represents early hair loss in the crown (vertex).
Class IV is characterized by further frontal hair loss and enlargement of vertex, but there is still a solid band of hair across top separating front and vertex.
Class V the bald areas in the front and crown continue to enlarge and the bridge of hair separating the two areas begins to break down.
Class VI occurs when the connecting bridge of hair disappears leaving a single large bald area on the front and top of the scalp. The hair on the sides of the scalp remains relatively high.
Class VII patients have extensive hair loss with only a wreath of hair remaining in the back and sides of the scalp.

Norwood Class A
The Norwood Class A patterns are characterized by a front to back progression of hair loss. Norwood Class A’s lack the connecting bridge across the top of the scalp and generally have more limited hair loss in the crown, even when advanced.
The Norwood Class A patterns are less common than the regular pattern (<10%), but are significant because of the fact that, since the hair loss is most dramatic in the front, the patients look very bald even when the hair loss is minimal. Men with Class A hair loss often seek surgical hair restoration early, as the frontal bald area is not generally responsive to medication and the dense donor area contrasts and accentuates the baldness on top. Fortunately, Class A patients are excellent candidates for hair transplantation.

Diffuse Patterned and Unpatterned Alopecia

Two other types of genetic hair loss in men not often considered by doctors, “Diffuse Patterned Alopecia” and “Diffuse Unpatterned Alopecia,” pose a significant challenge both in diagnosis and in patient management. Understanding these conditions is crucial to the evaluation of hair loss in both men and women, particularly those that are young when the diagnoses may be easily missed, as they may indicate that a patient is not a candidate for surgery. (Bernstein and Rassman “Follicular Transplantation: Patient Evaluation and Surgical Planning”)
Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia manifested as diffuse thinning in the front, top and crown, with a stable permanent zone. In DPA, the entire top of the scalp gradually miniaturizes (thins) without passing through the typical Norwood stages. Diffuse Unpatterned Alopecia (DUPA) is also androgenetic, but lacks a stable permanent zone and affects men much less often than DPA. DUPA tends to advance faster than DPA and end up in a horseshoe pattern resembling the Norwood class VII. However, unlike the Norwood VII, the DUPA horseshoe can look almost transparent due to the low density of the back and sides. Differentiating between DPA and DUPA is very important because DPA patients often make good transplant candidates, whereas DUPA patients almost never do, as they eventually have extensive hair loss without a stable zone for harvesting.
The progression of male hair loss in Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA). In DUPA, the sides thin significantly as well.
Donor area of a patient who will evolve into DUPA and whose diagnosis is not readily apparent at the age of 27.

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5530 Wisconsin Avenue, Suite 818, Chevy Chase, MD 20815

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2071 Jefferson Davis Highway, Stafford, VA 22554