People lose hair for many reasons, but the most common is male pattern hair loss. Some females also exhibit a version of this as they age called female androgentic alopecia. The cause for this type of hair loss is genetic. Most people have close relatives who have also lost hair in a similar fashion. Often beginning in the late teens, male pattern baldness manifests itself has as a patterned loss of hair in the crown and front of the scalp. As the balding crown widens and the hairline recedes men pass through stages of thinning hair and into baldness. Women generally exhibit genetic hair loss by diffuse thinning rather than in a patterned fashion as men do.

Note in the following image that before this man has a clip to attach his hairpiece and very little hair. After, note the natural hair line and a full head of hair:

The first step for a person who is losing hair, is to be sure of its cause. Dermatologists are especially trained to diagnose and treat hair disorders. Hair loss may be due to internal factors such as those caused by thyroid disease, which must be diagnosed. If there is an internal problem present the hair loss is merely a symptom of a more important problem which needs to be addressed. Specific blood tests can be used to determine if the hair loss is part of a more important disorder. Many individuals presume that their hair loss comes from lack of vitamins, improper shampoos, or grooming techniques. These are very rare causes.

After a diagnosis of the type of hair loss is made, the proper treatment can be selected. Many individuals fall prey to clever advertising techniques, which promise restoration of hair by taking certain medications or applying certain lotions or shampoos to the scalp. These are fraudulent and have been going on for thousands of years.

There are only two medications which have been FDA approved for treating hair loss. One is Rogaine or minoxidil, which originally was developed as a blood pressure medication. When applied in a liquid form to the scalp this can reduce hair loss and occasionally grow small amounts of new hair. Propecia (finesteride) was specifically developed to block the enzyme which is presumed to lead to hair loss. Propecia can be effective in slowing down hair loss, but only occasionally grows significant amounts of new hair.

If a person wishes to gain a noticeable amount of new hair he or she will either have to purchase a hairpiece or undergo hair transplantation. Hairpieces are sold under a variety of names. Consumers should be very careful because some companies advertise in a way that is quite deceptive. Hairpieces are fashioned of human hair, which is attached to the scalp. Hairpieces fall apart in time and must be replaced and this process can be quite expensive. Hairpieces are best suited for men or women with significant baldness who are poor candidates for hair transplantation.

Hair transplantation is a procedure that was developed by dermatologists in the late 1950's. This technique involves transplanting hair follicles from the back of the scalp where the hair is thicker into the front of the scalp and the crown where balding is present. Hair transplantation has gradually become a very refined procedure. In the early days large "plugs" of hair were transplanted which left an unrefined pluggy appearance to the transplanted hair. Modern techniques however are based on the use of very small or follicular grafts containing from 1-3 hair follicles. These small grafts are placed to resemble the growth of normal hair. Because the grafts are so small and the result is so subtle, it is very difficult to tell that a patient's hair has been transplanted. Often even the barber is unaware that the patient had undergone this procedure.

The hair to be transplanted is obtained from a strip of hair-bearing scalp obtained from the back of the head. Once the strip is removed, the area is carefully sutured leaving only a small hairline scar. This eventual scar is nearly impossible to see unless the head is shaved. This removed strip is then subdivided into tiny individual little grafts containing between 1-3 hairs. These are then placed into punctures in the scalp in a precise fashion. The grafts are held in by clotted blood. The process takes several hours but most patients are quite comfortable during hair transplantation due to advances in local anesthesia. Postoperatively, the patient wears a dressing for one day and can drive or do minor chores wearing a hat the following day. Anywhere from a few hundred to well over a thousand hairs can be transplanted effectively during one procedure. Although some doctors have advocated even larger transplantations, there is evidence that transplanting too many hairs at one time results in poor growth and loss of many of the grafts. A conservative approach limiting the amount of hairs transplanted to 1500 or less provides excellent growth with most grafts surviving.

Most men or women undergo hair transplantation at least two times to achieve the best results. Severe cases of baldness may require several procedures. Additionally men with significant loss of hair in the crown area may benefit from a scalp reduction in which some of the balding scalp is removed and the scalp is "reduced" in size. Once sufficiently reduced, hair transplantation can be used to cover the remaining balding scalp and the scar. Each person must be carefully evaluated according to the severity of baldness, the color and thickness of hair, and other factors in order to achieve the best results.

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