Resources
Understanding Hair Loss
Hair loss is rarely a single condition — it is a spectrum of causes, patterns, and progression rates. Understanding yours is the first step toward reclaiming it.
What is happening to your hair?
At any given time, roughly 85–90% of your hair follicles are actively growing in a phase called anagen, while the remainder are resting or shedding in the telogen phase. The average person sheds 50 to 100 hairs per day — a normal part of this cycle. Hair loss becomes a clinical concern when this cycle is disrupted: follicles miniaturize, shed without replacement, or are permanently damaged.
The nature of the disruption — genetic, hormonal, autoimmune, physical, or systemic — determines which type of hair loss you are experiencing, which treatments will work, and how much of the lost density can realistically be restored.
Both Dr. Truesdale and Dr. Drummond conduct thorough scalp analyses at every consultation. Correctly identifying the type and stage of hair loss is the foundation of every effective treatment plan at Crown Hair Institute.
The Science
Common causes of hair loss
Androgenetic Alopecia
Male & Female Pattern Hair Loss
The most common cause of hair loss in both men and women, affecting roughly 50% of men by age 50 and up to 40% of women during their lifetimes. It is driven by a genetic sensitivity to dihydrotestosterone (DHT), a metabolite of testosterone. Over time, DHT gradually miniaturizes susceptible hair follicles, causing them to produce shorter, finer hairs until they stop producing hair entirely. The pattern of loss follows predictable paths — the Norwood scale for men, the Ludwig scale for women — based on which follicles carry the receptor sensitivity.
Alopecia Areata
Autoimmune Hair Loss
An autoimmune condition where the body's immune system mistakenly attacks healthy hair follicles, causing round patches of sudden hair loss. It can affect the scalp, eyebrows, beard, and body hair. In most cases the follicles are not permanently destroyed, meaning regrowth is possible. Alopecia totalis (complete scalp loss) and alopecia universalis (complete body hair loss) are more advanced forms. Treatment options include corticosteroid injections, topical immunotherapy, and newer JAK inhibitor medications.
Traction Alopecia
Tension-Induced Loss
Repeated, prolonged tension on hair follicles from tight hairstyles — braids, locs, weaves, extensions, tight ponytails — gradually damages follicles along the hairline and temples. In early stages, changing styling habits can allow full recovery. In advanced cases where follicles have been permanently scarred, hair transplantation can restore the affected hairline. Dr. Truesdale specializes in traction alopecia restoration, a procedure that requires particular expertise with curly and coily hair types.
Telogen Effluvium
Stress & Systemic Shock
A temporary, diffuse form of hair loss triggered by physiological or psychological stress. Surgery, illness, rapid weight loss, childbirth, nutritional deficiencies, or severe emotional stress can push large numbers of hair follicles prematurely into the telogen (resting/shedding) phase. Shedding typically begins two to three months after the triggering event and usually resolves on its own within six to twelve months once the underlying cause is addressed.
Scarring Alopecias
Cicatricial Hair Loss
A group of rare disorders that permanently destroy hair follicles and replace them with scar tissue. These include lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and dissecting cellulitis. Because follicles are irreversibly destroyed, early diagnosis and treatment to halt progression is critical. Once the condition is stabilized and inactive, hair transplantation may be considered to restore affected areas, though outcomes depend on individual circumstances and require careful evaluation.
Medical & Medication-Related
Thyroid, Hormonal, and Drug-Induced Loss
Several medical conditions and medications cause hair loss as a side effect. Thyroid disorders — both hypothyroidism and hyperthyroidism — are a common and often overlooked cause of diffuse shedding. Iron deficiency anemia, polycystic ovary syndrome (PCOS), and lupus can also contribute. Chemotherapy drugs cause widespread hair loss through their effect on rapidly dividing cells. In most medication-related cases, hair regrows once the underlying condition is treated or the medication is changed.
Classification for Men
The Norwood Scale
The Hamilton-Norwood Scale is the most widely used classification system for male pattern hair loss. Introduced in the 1950s and refined by Dr. O'Tar Norwood in 1975, it describes seven progressive stages that guide diagnosis, treatment planning, and graft estimation for hair transplant surgery.
Stage I
Minimal or no recession of the hairline. Generally considered a mature hairline with no clinical hair loss.
Stage II
Slight recession at the temples. Still largely cosmetic. Early intervention with medication can slow progression.
Stage III
Deep temporal recession — the classic 'M-shaped' hairline. This is typically when patients first consider treatment.
Stage III Vertex
Recession at the temples plus the beginning of thinning at the crown. Two fronts of loss developing simultaneously.
Stage IV
More severe frontal loss with a larger bare area at the crown. A band of hair still separates the two zones.
Stage V
The two areas of loss begin to merge. The separating bridge of hair is narrower and sparser.
Stage VI
The frontal and crown areas have merged into a single large bald zone. Only a horseshoe of hair remains on the sides and back.
Stage VII
The most advanced stage. Only a narrow band of hair remains around the sides and back of the head.
Stages III–IV are the most common presentation at initial consultation. Most candidates for surgical restoration are Norwood III through VI with adequate donor hair supply.
Classification for Women
The Ludwig Scale
Female pattern hair loss presents differently from men — rather than a receding hairline, women typically experience diffuse thinning across the crown and top of the scalp. The Ludwig Scale, developed in 1977, classifies this pattern into three grades. The frontal hairline is often preserved even in advanced stages, which is why many women are surprised to learn how much density they have actually lost.
Grade I
Mild thinning on the top of the scalp. The part is noticeably wider but the scalp is not fully visible. Early intervention is most effective at this stage.
Grade II
Moderate thinning with clearly visible scalp through the top and crown area. The hairline at the front remains largely intact.
Grade III
Severe, diffuse thinning across the top of the scalp with near-complete loss on the crown. The frontal hairline may still be preserved.
Important: Women with hair loss should always be evaluated for underlying medical causes — thyroid dysfunction, iron deficiency, PCOS, and hormonal imbalances — before pursuing surgical options. Dr. Truesdale performs a comprehensive consultation that includes reviewing lab work and health history to rule out reversible systemic causes.
Know the Signs
When to seek treatment
Hair loss is always easier to treat at earlier stages, when more follicles are still alive and viable. The window for non-surgical intervention — medications, PRP, exosomes — is wider when hair is thinning than when it has been absent for years. Many patients wait too long because they assume nothing can be done. If you are experiencing any of the following, it is worth speaking with a specialist.
- ✓Noticeable widening of your part line
- ✓More hair than usual collecting in your shower drain or on your pillow
- ✓A receding hairline at the temples or frontal scalp
- ✓Visible scalp through the top of your hair in bright light
- ✓Patchy or sudden hair loss anywhere on the scalp
- ✓Persistent scalp itching, burning, or tenderness accompanying shedding
- ✓Thinning that has been progressing for more than three to six months
The Rule of Early Action
Every year of delay narrows your options
Once follicles fully miniaturize and close, they cannot be revived. Medications like finasteride and minoxidil work best when there is still active — if weakened — follicular activity. PRP and exosome therapy require living follicles to stimulate. Surgical hair transplantation is highly effective at many stages, but the available donor supply and optimal coverage depend heavily on timing.
The sooner you understand what is happening to your hair, the more tools remain available to you.
Not sure where to start?
Take our 2-minute hair loss quiz
Our guided quiz assesses your loss pattern, timeline, and goals — and gives you a personalized overview of which treatments may be appropriate for you.
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A detailed side-by-side comparison of the two main hair transplant techniques, including scarring, recovery, and graft yield.
Read moreHair loss quiz
Answer a few questions about your pattern and history to get a personalized overview of your options.
Read moreTake the First Step
A free discovery call answers everything
Dr. Truesdale and Dr. Drummond provide a thorough scalp analysis, determine your Norwood or Ludwig stage, and walk you through every realistic option — no pressure, no obligation.