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No. The donor area can have up to 50% of hairs removed before it starts to show. With a normal head of hair this means that up to 10,000 hairs can be taken for transplantation.

Of course. The transplanted hair will grow beneath a wig as does normal hair. Some people prefer to continue wearing a wig until the transplanted hair has grown to a decent length.

There is no reason at all why you cannot have a hair transplantation at any time of year which suits you.
Hair has always been very important to women, more so than to men. This is the reason vast industries have devoted huge resources to developing numerous products aimed at making women's hair even more beautiful. Consequently, it can be extremely worrying for a woman to discover that she is losing some of her precious hair. Many women start by trying to conceal the fact they are suffering from hair loss but this does nothing to rectify the situation. Hair loss will continue whilst the cause of hair loss still exists. Identifying this cause and treating it where possible is vital.

Hair loss in women is on the increase and is now affecting younger women. Studies have shown that 60% of women suffering hair loss are under 40 years old. Together with the loss of their hair, women are often suffering emotionally, stressed, depressed and with low self respect, all of which can compound the problem.

For many years, unfortunately, doctors believed that hair loss in women had exactly the same causes as baldness in men. But research has proved that women's and men's hair loss and baldness are different. With recent developments, there is now greater understanding, there are tests, treatments and help available. There is no need to hide the problem.

What causes hair loss in women?
The normal life cycle of hair is a period of growth at a rate of 1-2 centimetres per month for a period of about 6 years. Hair will normally continue lengthening until it reaches its genetically predetermined length. It then goes through a resting period (telogen phase) after which it falls out. At the same time, a new hair will have started to grow from the follicle and will repeat the process. This cycle will normally continue for our lifetime. Every day some old hairs fall out and new ones start to grow.

When this cycle is interrupted, abnormal hair loss may occur, sometimes temporarily, sometimes permanently. The different causes of hair loss have different names and need different treatments: Androgenetic Alopecia; Traction Alopecia; Telogen Effluvium; Alopecia Areata; Alopecia Totalis; Alopecia Universalis.

It is important to establish the real cause of hair loss before making any decisions about treatments. Understanding a bit about the different causes and effects can help to identify the reasons for your own hair loss. It is also helpful to establish exactly where your hair loss has occurred and what stage of hair loss you have reached - see Stages of hair loss.

There are some tests which can be carried out medically to help your search to establish the cause of hair loss. They may not positively identify a cause but might help by eliminating causes and narrowing your search. Blood tests can be used to check the following:-

Hormone levels including androstenedione, DHEA, follicular stimulating hormone, leutinising hormone, prolactin and testosterone
Serum iron, serum ferritin and TIBC (total iron binding capacity)
Thyroid levels (T3, T4, TSH)
CBC (complete blood count)

There are other physical tests a doctor can perform. The density of hair can be measured with a densitometer, the strength of hair roots can be assessed by pulling the hair and a tiny area of scalp can be removed and examined microscopically to help establish the cause of hair loss.

The types of female hair loss are:

Androgenetic Alopecia
The most common type of hair loss in women is similar to androgenetic alopecia in men but there are some important differences which need to be understood. Age, though a major factor in male androgenetic alopecia, is not always a factor for women - hair loss can occur at any age from the teens upward. More importantly, events affecting hormones in the body may lead to noticeable hair loss, for example childbirth, menopause, dramatic loss of weight, major surgery, strong emotional of body stress etc. Whereas male androgenetic alopecia is purely a result of the effects of the male hormone testosterone, female androgenetic alopecia also results from the effects of other hormones.

There are differences too in the places affected by hair loss. Unlike the male equivalent, female androgenetic alopecia leaves the front line intact. Instead, hair thins from the centre parting along the top of the head, gradually enlarging the area of hair loss from the centre line.

The mechanism of androgenetic hair loss is the same in both sexes. Androgens are a group of hormones which include testosterone (the male hormone which also exists in women but in smaller quantities) and which circulate throughout the body in the blood stream. In susceptible individuals, an enzyme called 5 alpha-reductase is present in increased quantities in the hair follicle and metabolises testosterone into the more destructive form, DHT (dihydrotestosterone). DHT has a progressive effect on the capacity of the follicle to produce hair and, through a process of miniaturisation, the follicle produces shorter, thinner and less pigmented hairs in shorter growth cycles until it ultimately ceases hair production irreversibly. All of these hormones and enzymes are present (and necessary) in all of us. It is the relative levels and genetic susceptibility which changes a normal, healthy head of hair into a condition of hair loss.

Women suffering androgenetic alopecia usually have higher than normal levels of androgens in their blood. Another characteristic is that they usually have raised levels of 5 alpha-reductase particularly in the tissues of the top of the head. Sometimes there are outward indications too like abnormal periods, pimples and more hair generally on the body. Unfortunately there is no easy way to establish positively that hair loss is due to androgenetic alopecia. The best method is to eliminate all of the other possible causes before making any conclusions.

Therapy: Hair loss through androgenetic alopecia is permanent. Hair will never grow back. If a significant area of the head is affected by hair loss the remedy is hair transplantation in the same way as for men. There is, however, a significant difference between transplanting hair in women and hair in men. The process of implantation can cause shock to the surrounding follicles resulting in temporary loss of hair (telogen effluvium). The affected surrounding follicles start growing new hair right away but there is a period immediately after transplantation when it might appear that hair loss has continued. After 4-8 months the hairs have re-grown and the benefits of transplantation become obvious. There is no way of predicting which people are likely to suffer the effect of post-transplant follicular shock but it occurs in 5-10% of men and in 40-50% of women.

Traction Alopecia
This is a preventable form of hair loss caused by the strain of constantly pulling the hair back for long periods of time. Women with plaits or braids or a pony tail are the most at risk from this form of hair loss. The constant tension upon the hair results in a thinning of the roots and eventual and irreversible hair loss. Unlike androgenetic alopecia, the areas most affected by this form of hair loss are the temples and the front line.

Therapy: Hair loss through traction alopecia is permanent. The remedy is hair transplantation in the areas of hair loss, see above.

Telogen Effluvium
A short-term, reversible, form of hair loss caused primarily by stress. Women's hair appears to be more sensitive to the effects of stress, both physical and psychological, than men's hair. Telogen is the resting phase of the growth cycle. Normally, 10% of the hairs on the head at any one time are in this phase which lasts for about 3 months. When the body suffers shock or is put under stress or suffers severe malnutrition it stops making new hair, thus conserving its limited resources. Consequently, a greater percentage of hair is put into the resting phase and fallen hair is not replaced. This type of hair loss occurs from any area of the head. Instead of the normal loss of about 100 hairs, up to 400 hairs could be lost daily. Sometimes the hair is lost from the back and top of the head and is not very obvious. In some cases, the hair loss becomes apparent weeks or months after the event which triggered the condition. Hair can continue to fall for a period of months.

Acute Telogen Effluvium occurs suddenly with hair falling quickly without any apparent reason. This could have been caused by sudden physical stress or high fever.

Another variant is Chronic Telogen Effluvium where hair loss continues for months or even years after the triggering event. There are numerous possible causes of this type of hair loss: anaemia; childbirth; sudden weight loss; a prolonged course of hormone pills or oral contraceptives; under-active thyroid; high fever; major surgery; psychological stress. The condition can also develop into androgenetic alopecia if the person is genetically susceptible.

Therapy: Hair loss through telogen effluvium is usually reversible. Often hair re-grows naturally after the cause of stress has been removed. As long as the incident which caused the condition is no longer significant, hair re-growth can often be aided by dermatological treatment.

Alopecia Areata
A relatively rare and little-understood form of hair loss. It can occur in children or adults and results in patches of the scalp losing hair totally and suddenly, leaving circular areas of smooth bare skin. The surrounding hair is also affected by a narrowing of the hair at the root (exclamation point hair). There is often a family history of this type of alopecia.

In some cases the condition develops into Alopecia Totalis where all hair is lost from the head. In the most serious cases Alopecia Universalis can result in the loss of hair from the whole body, face and head too.

There is still uncertainty about exactly what triggers this type of hair loss. One of the causes of alopecia areata is thought to be a malfunction of the immune system whereby incorrect signals are sent to the hair follicles instructing them to stop generating new hair. Factors which are associated with this form of hair loss are allergic reactions, emotional stress, bacterial infections, genetic susceptibility and prolonged exposure to some medications particularly through chemotherapy.

Therapy: Hair loss is often temporary. In many cases hair grows back in time but dermatological treatments like cortisone can also help.

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