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.

Take the Hair Loss Quiz

Continue Your Research

Learn more

Which treatment is right for me?

A guide to deciding between surgical and non-surgical options based on your hair loss stage, goals, and health.

FUE vs. FUT: What's the difference?

A detailed side-by-side comparison of the two main hair transplant techniques, including scarring, recovery, and graft yield.

Hair loss quiz

Answer a few questions about your pattern and history to get a personalized overview of your options.

Take the First Step

A free discovery call is the first step

Our Office Manager will discuss your goals, walk you through our process, and share an approximate price range if you submit photos beforehand. At your $100 consultation, Dr. Truesdale or Dr. Drummond provides a thorough scalp analysis, determines your Norwood or Ludwig stage, and walks you through every realistic option — no pressure, no obligation.

Book Free Discovery Call Call/Text (323) 947-2126