Baldness

The natural history of balding

The natural history of balding is how it first appears, the different ways it progresses, and how it affects the different regions of the head.  Being aware of this, allows one to be a more informed hair loss patient, with more realistic expectations of any hair loss treatment. 

People are born with varying amounts of soft, fine baby hair, which is vellus in nature.  As we age, most of our hair becomes the more robust terminal type.  It may change in pigmentation, becoming darker, or it may become curly, wavy and coarser.  

After puberty, one has an adolescent hairline for a few years.  It is fairly low and flat spread across the forehead.  As men progress through their twenties, given that there is no balding, the hairline assumes the "mature" look, with slight frontal-temporal recessions, which impart a concave appearance to the hair line on each side, with a lower peak in the middle.  This "mature" hairline is not considered balding.  

Later, there may be front-to-back hair loss, hair loss beginning in front and at the crown simultaneously, or sometimes isolated vertex or crown hair loss (i.e. the "bald spot") The hair loss patterns, rate of hair loss and age at which it occurs are highly unpredictable.  

Women can experience a similar hair loss pattern.  However, they more often keep their frontal hairline, but have thinning on the top of the scalp.  

Hair Thinning

Hair can be described as thin, fine, or thinning.  Even though these terms are often used interchangeably, they each have a different definition.

Thin hair

This term means that there are physically a smaller number of hair follicles on the scalp.  Blondes normally have the most hairs, around 140,000, with redheads having only about 90,000.

Fine hair

This term relates to the actual diameter of the hair strands, which are normally smaller, making it appear ‘fine’.  Hairs that are coarse have wider, ‘thicker’ hairs.

Thinning hair

When hair is thinning, it means that the scalp is in the process of losing hair.  There could be many reasons, but the most common cause is hereditary hair loss (androgenetic alopecia).