Toppik on 3 November 2014

For those people who have just begun to lose their hair, the signs are obvious and the question invariably the same: ‘Why am I going bald?’.

You begin to notice more hairs on your pillow in the morning.

As you lean over your desk and run your hands through your hair, you see more hair than you usually do drop onto the pages in front of you. Or maybe it’s the white vanity basin at home, which seems to collect an inordinate number of hairs per day. Invariably you notice a slightly higher hairline or a thinner crown in a photo from the last family get-together. And again you probably ask yourself, ‘Why am I going bald?’.

It was Hippocrates who first made the connection between hair loss and male hormones. He noted that eunuchs did not go through the balding process but, instead, maintained a head of hair essentially as good as the day they lost their manhood. He theorised that due to the loss of the testicles there was a lack of ‘hot blood’ in the body. It was this ‘hot blood’ that burnt the hair follicles on top of the scalp. The term ‘hot blood’ probably referred to sex drive. It took us almost 2,400 years to realise how correct Hippocrates was.

In the 1950s, a psychiatrist by the name of Dr Hamilton was working in a mental institution and was astounded to see a severely bald identical twin visit his institutionalised brother, who had a complete head of hair. What Dr Hamilton observed was contrary to accepted medical beliefs: being identical twins, their hair loss pattern should have been exactly the same. It struck Dr Hamilton that there must be some outside factor attributable to the incarcerated twin retaining a full head of hair. He discovered that the critical difference was that the institutionalised twin had been castrated some years before, as was a common practice for inmates of such institutions. Castration was performed as some sort of misguided treatment, and it did seem to reduce the frustration of inmates who had no release for their sexual urges.

To conform his theory that the male hormone testosterone was responsible for hair loss, Dr Hamilton administered testosterone injections to the castrated twin.

Within a matter of months he was as bald as his brother.

In an attempt to reverse the hair loss Dr Hamilton ceased treatment, but the hair did not grow back. Once the follicles had been killed off by the male hormone, they were not able to be resurrected.

It is important to note that had this individual not had a history of hair loss in his family, i.e. his twin brother had not been bald, normal doses of testosterone injections would not have induced hair loss.

Androgenetic Alopecia

What I have described above is the most common form of hair loss in both males and females. It has the scientific name androgenetic alopecia:

Andro – for the male hormone

Genetic – for the inherited balding gene

Alo – loss of

Pecia – hair

‘Androgenetic alopecia’ therefore means the loss of hair induced by the genes and the male hormone.

We now know that hair loss is caused by two factors working in conjunction:

  • Genetics: To experience hair loss an individual must inherit, from at least one parent, the balding gene. It can come from either parent, and it can come from the father’s side whilst he himself does not suffer from hair loss. When we receive our genetic makeup from our parents at the time of conception, those of us that receive the balding gene grow hairs on the front, top and crown of the scalp with a use-by-date attached to them. At a certain age they are programmed to wither and die.
  • Testosterone: The male body is constantly producing testosterone. An enzyme in the body known as 5 alpha reductase reduces this hormone down to a more potent form called dihydrotestosterone (DHT). It is DHT that acts upon those hair follicles genetically programmed to die and essentially acts as the messenger of death.

DHT Testosterone

As you go through the male pattern baldness process, the hair on top of your head changes.

  • 1. Shorter anagen or growing phase: A shorter growing phase means that the hair can only grow to a certain length before shedding and a new and generally weaker and finer hair grows.
  • 2. Hair lies flat to the scalp: As hair becomes progressively weaker, it loses its ability to stand up and add volume.
  • 3. Hair is less pigmented: The weaker, finer hair is unable to carry as many pigment cells as the thicker and stronger hair, and adds little to your overall appearance.
  • 4. Hair shaft is significantly finer than hair shafts on the side of your head: As part of the shorter growing phase, the hair that is produced is significantly finer than the previous one.

The hairs that grow at the front, top and crown are the ones programmed at conception for some people to be susceptible to the effects of DHT at a certain age. The hairs that are produced at the back and side of the head are resistant to the effects of the DHT and will continue to grow for a lifetime. This, in effect, explains one of the basic principles of hair transplantation. The hairs that grow at the back and sides of the head are the ones that are used in hair transplantation. Because they will not be affected by the male hormone, they can be transferred to anywhere in the body and will continue to grow regardless of DHT levels.

Hair Loss and Diet

It appears evident that diet has very little effect on androgenetic alopecia. While proteins, vitamins and minerals are essential for normal hair growth, a lack of these will not induce androgenetic alopecia, but may in some cases cause a diffuse thinning as the body directs its vital resources away from hair growth to survival. The crash dieter can at times experience this form of diffuse thinning. Normal hair growth will resume within a few months of returning to a normal diet.

Hair Loss and Diet

It has also been suggested that red meat may increase the levels of testosterone in the body, subsequently resulting in an increase in androgenetic alopecia. Researchers have noted that since World War II there has been an increase in baldness among Japanese men. They suggest that this could be traced back to changes in diet – to a more Westernised diet, with higher consumption of animal fat – n the years since 1945. This hypothesis is based on a link between this kind of diet and the higher sebum production. However, the change in androgen level as a result of red meat consumption is so small as to be relatively insignificant.


Diet will not induce androgenetic alopecia. Treatments purporting to supply nutrients to the hair shaft and aid the growing process should be looked upon with some scepticism.

Hair Loss and Smoking

The results of research into this question seems to suggest the following findings.

Hair Loss and SmokingAs has already been pointed out, a major factor in male pattern baldness seems to be the conversion of testosterone into DHT. DHT is the chemical that attacks the hair follicles, shrinking them and ultimately destroying their capacity to produce healthy scalp hair.

In one study, involving over 1200 middle-aged men, DHT levels were between 9 and 18 per cent higher among smokers than non-smokers. The study did not look specifically at hair loss, but given the role that DHT is known to play, the results suggest that it is highly likely that smoking may result in hair loss.

In summary, it seems fair to conclude the following:

  • If you DO NOT have a genetic predisposition to hair loss, smoking will not make your hair fall out.
  • If you DO have a genetic predisposition to hair loss, stopping smoking won’t stop your hair falling out but may well slow the process.

Hair Loss and Blood Supply

All sorts of myths are associated with hair loss and blood supply. Don’t wear a cap or you will cut off the blood supply to your scalp! Stand on your head for five minutes a day and improve the circulation! All interesting theories, and all are baseless.

The hair has withered and died under the influence of DHT. Wearing a cap or massaging the scalp will not affect the amount of DHT that arrives at the follicles. Thirty-five years of hair transplant surgery has shown this to be true, with grafts performed in the 1960s to the top of the scalp growing just as well to this day as the hair at the back and sides.

Hair Loss and Hygiene

Sebum is secreted by the sebaceous gland, which is located near the hair follicle. This surface sebum can be high in testosterone and, more importantly, DHT, which, it has been theorised, may re-enter the follicle and induce or exacerbate androgenetic alopecia. Daily shampooing is likely to be beneficial in reducing surface levels of DHT.

Many treatments are based on this theory, but any shampoo from a supermarket will fulfil the role of removing surface sebum.

Hair Loss and Clogged Pores

This is another of those plausible theories suggested to people just before they are asked to pay for some special lotion to flush out those clogged pores and induce marvellous, luscious hair. We have all had ingrowing hairs. This phenomenon occurs where a hair literally punches its way through skin where there’s no opening for it, quite often causing a pimple. It is hard, then, to believe that a clogged pore could stop the hair growing.

Hair Loss and Ethnic Background

It has become apparent to me over the years that there are certain ethnic hair loss traits. Particularly Greeks, but Southern European males and females in general, appear to suffer from hair loss more than people from other geographical areas.


  • Hair loss is caused by a combination of two factors: family history or inherited genes, and the male hormone.
  • Only the hair at the front, top and crown is affected by male pattern baldness, with a ring of DHT-resistant hairs found at the back and sides of the scalp.
  • A number of myths, and some widely-held community beliefs regarding hair loss and its causes (and solutions), have no basis in fact.