What are the common signs of balding?

Dr Asim Shahmalak is one of the UK’s leading hair transplant surgeons. He runs Crown Clinic in Manchester and also has consulting rooms in Harley Street.

He is well known for his celebrity clients including the Coronation Street star Jack P Shepherd, the model Calum Best and the TV doctor Christian Jessen.

What are common signs of balding?

Hair loss (alopecia) can affect just your scalp or your entire body, and it can be temporary or permanent. It can be the result of heredity, hormonal changes, medical conditions or a normal part of ageing. Signs and symptoms of hair loss may include:

* Gradual thinning on top of head. This is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair. An increasingly common hair loss pattern in older women is a receding hairline (frontal fibrosing alopecia).

* Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on the scalp, beard or eyebrows. Your skin may become itchy or painful before the hair falls out.

* Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning but is temporary.

* Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.

What causes balding?

Male Pattern baldness, medically known as androgenetic alopecia, is overwhelmingly caused by your genes. It is a myth that the baldness gene passes down more commonly on the mother’s side – both sides of the family can cause it. Yes, there are lots of other causes for hair loss, but none of the others is nearly as significant as the hereditary cause.

The other main factor causing balding is age. Around a third of men are suffering from hair loss by the time they reach their 30s. This rises to 40% by their 40s and around half of men have suffered baldness by their 50s. There are other factors and a few include:

* Stress – severe physical stress (like surgery) or severe psychological stress (like a death in the family) can cause profound changes in the body and lead to telogen effluvium, a shedding of the hair. The good news is that the hair may well go back when the stress goes away.

* Vitamin/mineral deficiency – red blood cells are important because they carry oxygen to nearly every cell in the body, helping those cells maintain normal function. Deficiencies in other nutrients such as vitamin B and protein are thought to contribute to hair loss as well.

* Medication – we all know chemotherapy can lead to hair loss but lots of other drugs can also make your hair fall out. These include anti-thyroid medications, hormonal therapies and anti-convulsants (for epilepsy).

* Trichotillomania – this is an obsessive compulsive disorder in which sufferers rip out their hair.

How is balding different to hair loss?

Hair loss can often be temporary, possibly caused by a medical condition, and the hair will grow back whereas balding is permanent and can only be rectified by proven medication or hair transplant surgery. It’s normal to lose hair. We can lose between 50 and 100 hairs a day, often without noticing. Hair loss is not usually anything to be worried about, but occasionally it can be a sign of a medical condition. Types of temporary hair can be triggered by a number of factors including:

An illness


Cancer treatment

Weight loss

Iron deficiency

Permanent hair loss, or balding, is called male and female pattern baldness.

How is balding different in males versus females?

In women, hair loss more often involves a general thinning across the entire scalp. Known as diffuse thinning, most women affected lose a lot of their hair volume, making their scalp more visible. In general, the hair remains intact, but in some rarer cases women with hair loss may experience a receding hairline. But more commonly, female hair loss starts in the central area of the scalp and then spreads outwards if it is left untreated.

As with men, the most common cause of female hair loss is genetics. If you have female pattern baldness on the mother or father’s side of the family, there is a greater risk of it happening to the next generation of women in the family. This hereditary hair loss is permanent as opposed to the temporary thinning of the hair which can be caused by other factors such as pregnancy, stress, poor diet and menopause.

Permanent hair loss tends to happen differently in women to men.

Whereas men typically tend to first start losing their hair in the crown area or in the hairline at the front of the scalp and then go on to develop bald patches, in women hair loss manifests itself through general thinning rather than more noticeable bald patches.

Hair loss tends to be subtler in women than it is in men. Hair may also fall out in large clumps during brushing and showering.

This kind of thinning hair, while not as immediately noticeable as male pattern baldness, can still undermine a women’s self-confidence and age her appearance appreciably. It is why so many women seek permanent remedies for permanent hair thinning/hair loss. Around 10% of Dr Shahmalak’s clients at Crown Clinic are women.

Below are the most common causes of hair thinning particularly in women.

* Androgenetic Alopecia – hereditary pattern hair loss with a typical pattern of diffuse thinning over the central scalp. It is the most common type of hair loss. It occurs in about 20% of women.

* Alopecia Areata – a recurrent disease of unknown cause that results in patchy loss of hair from the scalp and/or eyebrows.

* Telogen Effluvium – a condition that causes shedding of hair over the entire scalp; it may be chronic but may also be acute following a stressful event such as high fever, sever dietary deficiency, and chronic blood loss from heavy menstruation.

* Loose Anagen Syndrome – a condition that causes hair to shed before its normal growth cycle is completed. Hair can be pulled out by normal combing or brushing.

* Traction Alopecia – tight braiding and corn-rowing can, over time, cause permanent damage to hair and scalp and result in hair loss.

Chemicals – some chemicals used in hair styling can, over time, cause permanent damage to hair and scalp and result in hair loss.

* Trichotillomania – (compulsive hair plucking) – a person feels compelled to pluck hair in regular or bizarre patterns, resulting over time in traction alopecia and permanent hair loss.

* Scarring Alopecia – hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top of the scalp and occurs predominantly in women. The condition frequently occurs in Afro-Caribbean women and is believed to be associated with persistent tight braiding or “corn-rowing” of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring.

* Hypothyroidism – thyroid deficiency can be associated with thinning, patchy hair loss.

* Pregnancy – hormonal changes and stress of pregnancy may cause temporary hair loss

* Menopause – due to hormonal changes in a women’s body from the age of 45 onwards

* Stress – this cause cause temporary hair loss

* Poor diet – another cause of temporary hair loss

* Medicine – cancer treatments such as chemotherapy can cause cause the temporary loss of hair.

Hair loss in women is surprisingly common. Around 40% of women will suffer from hair loss at some point in their lives – for instance during pregnancy or the menopause. But unlike with men, hair loss in women is often temporary and the hair will eventually grow back.

However, permanent hair loss is still a relatively common problem in women and is largely for hereditary reasons.