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Hair Restoration Answers

Does Frequent Combing Cause Hair Loss?

Q: Is it ill-advised to comb one’s hair more than twice a day, especially hair that has been transplanted? Will frequent combing induce hair loss? — G.K. ~ Paramus, N.J.

A: Combing or brushing one’s hair does not cause hair loss – no matter how many times a day you do it. However, constant traction with braids or hair extensions can cause hair loss and this loss can be permanent.

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Going Bald. Do You Perform a Test for LPP (Lichen Planopilaris)?

Q: Hi Dr. Bernstein, I am a 30 year old man with a balding crown. I’m 99.9% sure its male pattern baldness (I’m currently on Propecia and Rogaine). I recently read about how people going bald are getting tested for LPP (lichen planopilaris). Do you perform this test? — F.L., Scarsdale, NY

A: Lichen Planopilaris (believed to be a type of autoimmune disease) occurs more frequently in women than in men and more commonly in African-Americans than in Caucasians. The variation that could be confused with androgenic alopecia in men is central centrifugal cicatricial alopecia (or CCCA). While definitive testing would involve a scalp biopsy, this is rarely necessary as the doctor can easily tell by just examining you with the naked eye using magnification (densitometry).

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Can Hair Loss be Caused by Weight Lifting and Increase in Testosterone Levels?

Q: My son, 25 years old, is seeing hair loss around the hairline. According to your website, he is probably a stage II. He may have a little hair loss at the vertex; right now it is hard to tell. He is very muscular and loves weight lifting, but no drug enhancement. Is there a relationship between weight lifting and hair loss, since I have read that weight lifting increases testosterone levels? — G.S., Pleasantville, NY

A: Yes, weight lifting does increase testosterone, which in turn increases DHT. This can accelerate hair loss, although the effect is generally very slight.

Rather than modify his exercise program, your son may want to consider taking finasteride (Propecia). This requires a doctor’s prescription.

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Hair Restoration Answers

Can Stress Cause Diffuse Unpatterned Hair Loss (DUPA)?

Q: Can stress produce diffuse unpatterned hair loss (DUPA), or was it bound to happen anyway? — D.D., Park Slope, Brooklyn

A: Both DPA (diffuse patterned hair loss) and DUPA (diffuse unpatterned hair loss) are genetic conditions, unrelated to stress and would have happened anyway. These types of hair loss are characterized by a high percentage of mininiaturized hair in broad areas of the scalp. See the Classification of Hair Loss in Men and Classification of Hair Loss in Women pages on the Bernstein Medical – Center for Hair Restoration website for more information on this topic.

In contrast, stress generally presents as increased hair shedding, a reversible condition referred to as telogen effluvium. It is called this because the normal growing hair is shifted to a resting (telogen) phase before it temporarily falls out. Increased miniaturization is not associated with telogen effluvium.

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Can Stress Cause Hair Loss or is that a Myth?

Q: I’ve been dealing with daily mental stress for the past few months. I’ve noticed that during that time, I’ve experienced a lot of frontal hair loss and thinning. I thought stress was a myth for causing hair loss. — R.P., Upper East Side, Manhattan

A: Stress may cause temporary shedding, but it generally does not affect the long-term course of genetic hair loss.

It seems that women’s hair is affected by stress more commonly than men’s hair, but the reason is not clear.

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Is Hair Loss in Men Caused by Elevated Testosterone Levels?

Q: I was told that if men have a lot of testosterone that that’s when they lose hair. Is this true? — Y.B., Lake Forest, Illinois

A: Although androgenetic hair loss is dependent upon normal levels of testosterone, it is not due to increased testosterone. It is caused by a sensitivity of the follicles to normal levels of testosterone.

So someone that is bald doesn’t have extra levels of male hormones and is not necessarily over-sexed.

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What Causes Common Hair Loss or Baldness?

Q: I know that I am going to be bald because my father is bald and I am losing my hair just like him. What actually causes this kind of hair loss? — J.P., Paradise Valley, Arizona

A: Although there are many different causes, the overwhelming number of people that have hair loss have what is referred to as “patterned hair loss” or “androgenetic alopecia.”

In men, it is due to a hormone called DHT, which is a by-product of testosterone produced by the action of the enzyme 5-alpha reductase. This enzyme is inhibited by the hair loss medication Propecia. See the causes of hair loss in men page on the Bernstein Medical – Center for Hair Restoration website for more information.

In women, the mechanism is a little bit more complex as another enzyme, aromatase, is involved in the metabolic pathway. See the causes of hair loss in women page on the Bernstein Medical – Center for Hair Restoration website for more information.

We know that the inheritance comes from both the mother’s and father’s side, although the actual genes causing hair loss in men and women have not yet been identified. Statistically, the inheritance from the maternal side appears to be a bit stronger, but the reason for this is unknown.

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