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Understanding Hair Loss

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Understanding Hair Loss

Androgenetic Alopecia, is also known as Male Pattern Baldness or, simply, hair Loss.

This is the most common type of hair loss in men. This process is mediated by the Genetic Code.

This is something that we inherit from our parents, from both sides and from multiple generations back.

It’s a complex pattern of inheritance, so you can’t say it comes from your father’s side or mother’s side exclusively.

"With Dr Nel you will receive a direct, straight talking, no nonsense and clear explanation of the process and the science behind it, as well as which medical treatments are required for the best results (this is not always told or emphasized by all clinics)  And It's definitely not a pressure type sales approach." - Rob

Androgenetic Alopecia Causes Terminal Miniaturised Vellus Hairs

Hair follicles are commonly divided into 3 categories

1) Terminal Hairs

• These are the hairs visible on your scalp
• 60-84 microns in diameter
• Terminal hair is ‘healthy hair’
• You need to maximize the caliber of your terminal hairs in order to maximize the total hair volume and achieve the best possible aesthetic impact.

2) Miniaturised Hairs

• Miniaturized hairs are hairs from terminal hair follicles that have been affected by DHT, causing thinner hair shafts.
• 30-60 microns in diameter
• Miniaturized and Vellus hairs (<30 microns) will not make a major impact on your scalp, as they will not be as visible.
• Even if your scalp was covered with a million Vellus hairs, it will look like down, you will almost not see the hair.

3) Vellus Hairs

• Vellus hairs are fine, short and barely noticeable
• Less than 30 microns in diameter

Examples of Vellus hairs are the hairs on the back of your hands. You will notice a lot of very small fine hair follicles, and you almost need a magnifying glass to see them.


A hair transplant involves the transplantation of hair follicles harvested from the donor area on the patient’s scalp, to the area where hair loss has occurred (recipient area).

Therefore there needs to be an adequate supply of healthy Terminal hair follicles for harvesting and for transplanting to help create the appearance of a fuller head of hair.

What Causes Androgenetic Alopecia?

There is a process called ‘miniaturization’ where your hair follicles get smaller in caliber and length over time and that is the effect of Androgenetic Alopecia. This is what causes the appearance of hair loss.

How Does This Happen?

The male hormone Testosterone is converted by the enzyme 5 Alpha Reductase to DHT which has an affinity to bind with Androgen Receptors which are located on some of the hair follicles. Some people have a lot of these receptors and at a young age, they will look like the graphic VII below although they might only be in their early 20’s.

Other people have very few of these receptors and at 80 years of age, they will still have a full head of hair similar to graphic II below.

Most people are somewhere in-between these extremes such as seen on a natural Bell-shaped curve which is the ‘Normal Curve’ distribution below.

Typical Hair Loss Rates

Norwood Hamilton Scale Comparison Chart Hair Loss Rates Miniaturization Process

On the Normal Curve, above you will see that approximately 64% of males will be in the light grey area, 15% of males will be in the darker areas to the right and left of the center area of the Bell-Shaped Curve.

Then the dark small areas on the far left and far right represent the small percentage of men who lose hair in their early 20’s and those who don’t lose hair even in their 80’s and older.

The Miniaturization Process

When male hormones bind with the Androgen Receptors there is a reaction in the nucleus of the cell that triggers the miniaturization process.

This diminishes the energy supply (ATP) to the cells and the oxygen gradient drops.

Over time the follicle does not get enough nutrients to grow becoming smaller and smaller. This process is called miniaturization.

The follicles lose their caliber and become shorter. This is what causes the appearance of hair loss.

There is actual loss of hair volume and the consequence over time is that the scalp becomes more visible.
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