Giorgos Tsetis: When you want to solve an issue, you must first thoroughly understand the problem. A lot of times, especially in the pharma world, everybody is trying to identify the magic pill that targets a single trigger. But, that's the exact reason there hasn't been a drug that holistically and indefinitely ends the problem. You can't zero in on one specific trait or symptom, you really have to solve for the many causes. When it comes to hair loss for men and women, there are several causes that disrupt the natural hair growth cycle. Basic vitamins and minerals only act as a temporary bandaid for hair health deficiencies, which is simply not enough. Hair loss and thinning hair means your body is imbalanced and there's something off, because hair follicles are mini organs.

It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.
If, however, you aren’t so sure that any of the causes listed above are a problem for you, then a good place to start may be to talk with your healthcare provider about testing. It is important to learn the root cause – especially if dealing with infertility – because that which is causing hair thinning and shedding may also be contributing to your inability to conceive.

A. Steroids are not for female pattern hair loss but are sometimes used for alopecia areata (spotty hair loss that is different than hair loss due to genetics and aging). Laser combs? There are some reports that low-level light therapy could stimulate hair growth in some people. It's something to try when people feel like they have no other good options. At $350, it's expensive and I'm not sure it's worth the money, but it is safe. 

It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.
If you’ve gotten through this list and still don’t know what’s going on, it’s time to talk to your doc. Unfortunately, madarosis–typically used to mean the loss of eyelashes, but also referring to the loss of brows–may be due to many, many things, including a number of vision and life-threatening conditions, like herpes zoster, leprosy, HIV/AIDS, trachoma, malignant eyelid tumors, discoid lupus, scleroderma, and hypothyroidism (Khong, Casson, Huilgal, Selva; Survey of Opthamology, 2006). Brow and lash loss are both indicators of underlying diseases, so yes get to your doc stat.
Giorgos Tsetis: In the beginning, we left three factories because we didn't feel confident that they could do the job at our standard. These type of factories are sourcing the ingredients for you, but you have no clue where these ingredients are coming from. You don't know the efficacy, if they're clinically tested, and what about absorption? As a company, we decided to identify these root triggers that play a role in disrupting the hair growth cycle, then rigorously tested how we can target them and what specific ingredients solve for each trigger. Then, we developed individual partnerships with top suppliers all over the world that specialized in single ingredients that actually have that efficacy. We decided to source our own ingredients because we wanted to control the entire process. At least nine of the ten companies we consulted with said we couldn't do that, because the ingredients we chose to use were incredibly expensive. That's one main reason others can't do the work we do. For example, we purchase our primary ingredient for $600 per kilo, and you can buy the standard version of that ingredient in China for $30 per kilo. Same ingredients, but ours is clinically tested and proven to be effective. We only use patented ingredients, which made others think we're crazy, but creating the absolute best product is our top priority.
The Hair Wellness Group’s mission is to provide each client with a personal experience that will leave them “Uplifted” and “ Inspired”. Our unique approach integrates wellness, relaxation, and beauty into one’s lifestyle at all levels. We call this the “Total Approach”. The Hair Wellness Group educates, empowers, and enriches the lifestyle of all seeking optimum results in hair restoration, hair replacement, and scalp rejuvenation.
Estrogen and combined oral contraceptive (COC) drugs with estrogen or progestogen have been reported as effective, but data are limited (Adenuga et al., 2012, Raudrant and Rabe, 2003, Scheinfeld, 2008). They are thought to function through several mechanisms. Both components of COC drugs increase the levels of sex-hormone-binding globulin (Schindler, 2013). They also send negative feedback signals that suppress the hypothalamic secretion of gonadotropin and releases the hormone and pituitary secretion of the luteinizing and follicle-stimulating hormones, which results in a decreased androgen production (Gilman et al., 1990, Varothai and Bergfeld, 2014). These actions decrease androgen secretion from the ovary and the quantity of free, biologically active androgens, which reduces their effects on the hair follicles (Schindler, 2013). Our practice when prescribing COC drugs is a combination of ethinyl estradiol 20 mcg plus drospirenone 3 mg. Drospirenone is an analogue of spironolactone. This treatment combination is approved by the FDA for the treatment of acne but not alopecia.
Hormone Replacement Therapy: You may be advised to go for hormone replacement therapy or may take supplementary estrogen in case your doctor suspects that the hair loss is caused because of low or lack of estrogen hormone. These supplements may either be taken orally or may be applied topically to the skin as a gel. However it must be mentioned that not all women are benefited with this type of treatment for low estrogen levels causing hair loss.
Well, maybe that’s a new adage from instagram, but it’s true all the same: eyebrows are the essential defining feature of every woman’s face. That’s exactly why eyebrow loss can feel like a death sentence to the beauty-conscious woman. With thick, lush eyebrows in style, eyebrow loss can feel more traumatizing than ever. Hair one day, gone the next!
It’s common for women to experience shedding hair after pregnancy. Usually, this is in response to estrogen levels returning to normal, shedding the extra hair grown during pregnancy. Usually, the hair will return to the same thickness it was before you got pregnant. New moms who are not breastfeeding should consider taking hair growth vitamins post-pregnancy too to balance out their hair growth cycle.

Androgenetic alopecia, commonly called male or female pattern baldness, was only partially understood until the last few decades. For many years, scientists thought that androgenetic alopecia was caused by the predominance of the male sex hormone, testosterone, which women also have in trace amounts under normal conditions. While testosterone is at the core of the balding process, DHT is thought to be the main culprit.

So, if you have a similar paranoia—fear not! Losing strands is totally normal. But Dr. Wexler is quick to add that things like over-tweezing (it causes scarring to the follicles), waxing, severe weight-loss, stress, excessive touching, hormonal changes, and auto immune disease can cause irregular brow hair loss. If you believe your case may be extreme, it's best to see a specialist.


The majority of women with androgenic alopecia have diffuse thinning on all areas of the scalp. Men on the other hand, rarely have diffuse thinning but instead have more distinct patterns of baldness. Some women may have a combination of two pattern types. Androgenic alopecia in women is due to the action of androgens, male hormones that are typically present in only small amounts. Androgenic alopecia can be caused by a variety of factors tied to the actions of hormones, including, ovarian cysts, the taking of high androgen index birth control pills, pregnancy, and menopause. Just like in men the hormone DHT appears to be at least partially to blame for the miniaturization of hair follicles in women suffering with female pattern baldness. Heredity plays a major factor in the disease.
Giorgos Tsetis: I am an entrepreneur and have an engineering background that allows me to think in strategic ways to solve complex problems. Of course, I did have this very personal experience. But, to be honest with you, getting into this category wasn't directly a choice, it felt more like destiny. I say that, because their are literally millions who suffer from what I was suffering from. Aside from being a model, I owned an engineering company in New York, and business was steadily growing. The tipping point came when I found out the University of Washington published research that said my issue could cause permanent sexual dysfunction without the specific drug I was taking. That's when I panicked, reached out to my business partner and dear friend, and we begun to dig deeper into the issue. As we started diving deep, we recognized there was a tremendous white space.
Male pattern baldness is connected to the male sex hormone androgen. So naturally, reducing your stress levels will also reduce the risk of suffering from the different symptoms that stress cause. You can reduce stress by practicing mindfulness and yoga. You can also cut down on work and make sure to get enough sleep. Minimize your exposure to negative people or experiences. Spending time in nature and exercising also contribute greatly to your mental health.
Take extra care in looking after your hair. Use a gentle, nourishing shampoo (we love Bumble and Bumble Gentle Shampoo) to promote good condition and prevent breakage. Try using a silk or satin pillowcase. Avoid harsh styling products and techniques that apply heat to the hair (blow drying, curling irons etc) as these can cause more damage to fragile hair.
Some medications have side effects that include hair loss. Talk to your doctor if you are experiencing significant hair loss and you think that your medication might be the cause. Your doctor might be able to switch you over to another type of medicine without any reported side effects. Don’t stop taking your medications until you’ve spoken with your doctor, as this could be dangerous for your health.
Giorgos Tsetis: Another reason Unilever was inspired to partner with us is that we really target three channels. Direct-to-consumer is one, then we target physician channels and salon channels; which are the hardest to convince. There's liability involved, so there's no doctor in the world who is going to recommend or endorse a product they don't believe in. We have about 350-400 physicians currently selling the product. A large amount of these doctors are thought-leaders or experts in the space, so they are known to speak about this issue on a world stage when it comes to new innovations. We also have each of the top 20 hair salons in the country carrying the product. There's a ton of celebrities who use the product as well. It is a premium product, but we've still made it affordable for people. When you look at other products on the market, our price point is comparable. We're also working on special programs for people in need who can't normally afford the product. If somebody is motivated, serious and really needs it -- we work to make sure they can get the product, and seek to serve as many people as possible.
Liver support: is necessary to eliminate unneeded wastes from the body. Everything we take in is processed through the liver and toxins are broken down into water soluble byproducts so they can be moved into the intestine and pulled into the stool for elimination. Foods like cruciferous vegetables (kale, broccoli, collard greens) and lemon support the liver detox pathways. Herbs like milk thistle, dandelion root, and burdock root help to support  liver cleansing. 

You will need to check with your health insurance company to find out if hormone replacement therapy will be fully or partially covered, or how much your copayment will be. If you don't have health insurance, costs can still vary greatly depending on the type of medication you get, and whether you take brand name or generic drugs. Prices may range from as little as about $7 per month to as high as $150 a month for hormone replacement therapy.

It is known that estrogen plays a great role in reducing bodily hair, in promoting the growth of the hair on your head, controlling height, reducing the muscle mass, promoting the breast growth, keeping the skin smooth, keeping away from wrinkles, regulating menstrual cycle in women, preventing fatigue, keeping away depression etc. From all these it can be known that estrogen hormone is important for the overall health of an individual.
There can be any number of different factors contributing to your hair loss. If you’re reading this and thinking, “well I have that and that, and am going through that,” then you may already have an idea of what is a contributing cause for you. You may already be doing much of what is suggested here and may learn of additional ideas to consider trying.
Amalie Beauty Inc. and its materials are not intended to treat, diagnose, cure, or prevent any disease. 
All material on Amalie is provided for educational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, exercise, or other health program.

It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.


When compared with no treatment, patients who received ethinyl estradiol 50 μg and cyproterone acetate 2 mg with cyproterone acetate 20 mg on days 5 to 20 of the menstrual cycle for 1 year had a significant increase in their percentage of anagen hairs with trends toward a larger shaft diameter of full anagen hairs and a decreased number of hairs that were less than 40 microns (Peereboom-Wynia et al., 1989). A 12-month randomized control trial of 66 women compared treatment with topical minoxidil 2% plus an oral contraceptive (ethinyl estradiol 30 μg + gestodene 75 μg) with treatment with cyproterone acetate 50 mg plus an oral contraceptive (ethinyl estradiol 35 μg + cyproterone acetate 2 mg) and demonstrated that treatment with cyproterone was more effective in hyderandrogenic patients but otherwise less effective (Vexiau et al., 2002). Side effects of cyproterone acetate include weight gain, breast tenderness, and a decreased libido (Kelly et al., 2016). Hepatotoxicity and development of multiple meningiomas may occur when doses exceed 25 mg daily (Medicines and Healthcare products Regulatory Agency, 2009). Cyproterone acetate is used widely in Europe and Canada, either in an isolated form or in combination with ethinyl estradiol, but it is only available in the United States as an orphan drug for the treatment of hirsutism (Carmina and Lobo, 2003, Jurzyk et al., 1992, Kelly et al., 2016). Cyproterone acetate is classified as pregnancy category X.
The complex actions of genetics, DHT, shifting of hormone ratios and age-related volume loss can commonly occur in women in their 40’s and 50’s. However, just like in men, genetic hair loss can appear at all ages after puberty.  In fact, hair loss occurs with relatively high frequency even in women in their 20’s and 30’s. The majority of women with female pattern hair loss initially develop diffuse thinning over the front and top of the scalp, while maintaining the frontal hairline. This thinning may present with a widening through the central part line while others may present initially with either episodic or continuous hair shedding, prior to any noticeable decrease in hair volume. In addition, thinning may also be seen throughout the scalp, including the temple areas as well as the back and sides.
Cut the fast-food diet and start getting some whole food in your life. The less processed the better; as my mom says “as close to nature as possible.” Healthy skin and hair start with a healthy diet. Aim for a diet rich in Vitamin C, Vitamin A, Vitamin E, B Vitamins, lean protein and Essential Fatty Acids. EFAs can be found in walnuts, salmon, flax seed, and most seeds. EFAs have been shown to increase prostaglandin production in those with a deficiency; prostaglandin is what prompts your lashes and brows to grow.
When a woman is experiencing hair loss and has PCOS, spironolactone is often prescribed and it can be helpful but it’s important as well to address all these other issues when it comes to PCOS related hair loss. It’s also important to know that there is only a mild correlation of elevated testosterone on a blood test and hair loss. This is likely due to the hypersensitivity of the follicle to androgens in PCOS. Basically we get an exaggerated reaction from a smaller amount of testosterone.

Women using oestrogen supplementation or taking birth control pills will also experience hair loss when they cease supplying their body with extra oestrogen. These forms of hair loss may be temporary but this, however, does not mean that there is no link between oestrogen and permanent hair loss. Scientists have noted up to 30 hormones that could play a role in female pattern hair loss – the genetic kind of hair loss – and oestrogen, whilst poorly explored, may be one of them. It’s alright if the excess hairs are the ones that are lost but when normal hair falls out, there’s a problem.
It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.
This is most commonly found in women wearing ponytails, tight braids or any hairstyles that typically pull on hair with excessive force. In addition, rigorous brushing, heat styling and rough scalp massage can damage the cuticle, the hard outer casing of the hair. This causes individual strands to become weak and break off, reducing overall hair volume.

There’s no doubt that estrogen and hair loss are connected, but there are certain factors that determine how much of an effect estrogen levels have on your hair. As one of the main visible measures of your health, hair growth is often one of the first areas affected when hormones are off-balance. Let’s take a look at the links between estrogen hormonal imbalance and hair loss.
Giorgos Tsetis: Hair loss completely shattered my confidence, and losing your confidence in modeling isn't a good thing. It was a very high price to pay. For eight years I was struggling, trying different solutions, searching for answers, not knowing what was going on. It was exhausting to say the least. So, when I made the decision to close down my company and started working on Nutrafol, people really thought I was crazy. They wondered why I was taking the chance of getting into this industry. To me, it wasn't really a choice, because there was nothing on the market that was healthy, accessible and helping the other 80 million people who are effected in the United States. We wanted to help ourselves, but really help others by making a valuable product that addressed an unsolved issue.
Trichotillomania is a hair pulling disorder associated with anxiety, stress, depression, boredom and frustration. It is where a person manually removes hairs with their finger, either a few strands throughout the day or sometimes many strands at one time during an emotional outburst. This behavior is usually a means of coping with stress or emotional turmoil. However, it can sometimes become a habit that is difficult to break. The eyebrows is a commonly targeted area as is the scalp.
Another cause of eyebrow hair loss is genetic predisposition. Many patients naturally have thinner eyebrows that run in their family. This is one of the biggest reasons patients seek our services. Medical conditions such as hypothyroidism, eczema, and alopecia areata (spot baldness) can also lead to brow hair falling out. It’s important to determine the cause of your condition to find an effective treatment.
Certainly when those testosterone levels rise, DHT is even more of a problem. DHT levels can be elevated and be within what doctors consider "normal range" on a blood test, but they may be high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even regular levels of chemicals, including hormones.
Furthermore, Penn dermatopathologists developed an even more advanced method called the HoVert technique for diagnosing hair loss and other disorders from a scalp biopsy. The technique uses a unique horizontal and vertical testing approach that provides a greater amount of information to the referring dermatologist than standard industry longitudinal scalp biopsies.
You may have thought you were one up on men in the biological war but not only testosterone-strong males experience hair loss. In fact (and unfairly), up to 50% of women will experience some form of hair loss in their lifetime. You might have heard that pregnancy, the contraceptive pill and menopause are possible causes of hair loss, but are they really? Well, yes and no. An understanding of why female hair loss happens and what role estrogen plays in hair growth may help to make this answer clearer.
When a woman is experiencing hair loss and has PCOS, spironolactone is often prescribed and it can be helpful but it’s important as well to address all these other issues when it comes to PCOS related hair loss. It’s also important to know that there is only a mild correlation of elevated testosterone on a blood test and hair loss. This is likely due to the hypersensitivity of the follicle to androgens in PCOS. Basically we get an exaggerated reaction from a smaller amount of testosterone.
Another cause of eyebrow hair loss is genetic predisposition. Many patients naturally have thinner eyebrows that run in their family. This is one of the biggest reasons patients seek our services. Medical conditions such as hypothyroidism, eczema, and alopecia areata (spot baldness) can also lead to brow hair falling out. It’s important to determine the cause of your condition to find an effective treatment. 

It is known that during pregnancy, because of an increased level of estrogen, there is a tremendous growth of new hair. However, during menopause it is noticeable that the reduced level of estrogen hormone tends to cause hair loss. When the estrogen hormone levels tend to drop, the hair follicles fall under the influence of the male sex hormone or the testosterone, which cause the shortening of the growth phase of hair. Subsequently there is a noticeable hair loss. This hair loss caused due to the drop down of estrogen levels may cause patchy hair loss or complete baldness.
Hormones are cyclical. Testosterone levels in some men drop by 10 percent each decade after thirty. Women's hormone levels decline as menopause approaches and drop sharply during menopause and beyond. The cyclic nature of both our hair and hormones is one reason hair loss can increase in the short term even when you are experiencing a long-term slowdown of hair loss (and a long-term increase in hair growth) while on a treatment that controls hair loss.

Giorgos Tsetis: I am an entrepreneur and have an engineering background that allows me to think in strategic ways to solve complex problems. Of course, I did have this very personal experience. But, to be honest with you, getting into this category wasn't directly a choice, it felt more like destiny. I say that, because their are literally millions who suffer from what I was suffering from. Aside from being a model, I owned an engineering company in New York, and business was steadily growing. The tipping point came when I found out the University of Washington published research that said my issue could cause permanent sexual dysfunction without the specific drug I was taking. That's when I panicked, reached out to my business partner and dear friend, and we begun to dig deeper into the issue. As we started diving deep, we recognized there was a tremendous white space.
These are only a few of the common myths heard by physicians and other hair loss specialists on a daily basis. The American Hair Loss Council suggests that you first have your hair loss diagnosed by a competent dermatologist who sees hair loss patients on a regular basis. Once you know the diagnosis you will have a better understanding of exactly which treatment option may be best for you.
Most women with pattern hair loss don't get a receding hairline or bald spot on top of the scalp as is common in men. Instead, there is visible thinning over the crown. In men and women, hairs are miniaturized because of a shortened growth cycle where the hair stays on the head for a shorter period of time. These wispy hairs, which resemble forearm hairs, do not achieve their usual length.
You basically have two major choices here: hormone replacement therapy (HRT) or phytotherapy (herbal remedies). You may wish there were more options, but there really are not. You can of course take other approaches to treating hair loss, but if low estrogen levels are one of the major causes of your hair loss, the results you will see treating the problem through other means are going to be quite limited if you are failing to treat the cause.
Low iron and low B12 can arise from a variety of causes including autoimmunity, poor intake, depletion due to medications (i.e. antacids) or bad digestion and are common causes of hair loss. But other common nutrient deficiencies can arise as part of a less than stellar diet low in zinc, protein (especially the amino acid lysine) or a deficiency of vitamin B6 (a very common issue with women taking hormones like the birth control pill). Low vitamin D has also been linked to excessive hair loss as has excessive vitamin A intake (less common.)
Scurf refers to the scales and greasy crusts that accumulate along the hair shaft and indicates the presence of seborrhea.[26,27] Collarettes are composed of hard fibrinous scales[25,28] surrounding each individual eyelash. They travel upward along with the growth of the lashes and are indicative of staphylococcal infection. Sleeves or cylindrical dandruff comprise scales that form a cuff around the lash root and are connected with it, in contrast to greasy scales which are not connected to the lash root.[29] Sleeves indicate infestation with Demodex folliculorum.
What’s more likely is that telogen effluvium is at play (again). In addition to hormone fluctuations, this type of hair loss happens when there is a drastic dip in protein in the diet or sudden weight loss. For example, if you are sick and can only consume liquids for a month. “If you have protein levels that drop dramatically, your hair follicles go into hibernation, and you can see sudden acute hair loss that shows up three to six months later,” says Dr. Katta. 

Taking estrogen supplements as part of a hormone replacement therapy regime has its effects on your hair as well. Women can treat a type of hair loss called androgenic alopecia, associated with low estrogen and progesterone, by replacing these hormones artificially. Dosages of synthetic estrogen should be monitored regularly -- abnormal hair growth is a possible side effect of one kind of hormone replacement therapy, called esterified estrogens.
Toxic alopecia occurs when there is a disruption of hair growth in the anagen phase. This usually occurs following chemotherapy and radiotherapy.[94] Radiotherapy for various types of ocular tumors, eyelid and choroidal tumors have been reported to produce madarosis.[95–97] Hair loss due to radiation is usually reversible, but may be permanent when the dose of radiation is in the range of 50 to 60 Gy.[94]
Furthermore, Penn dermatopathologists developed an even more advanced method called the HoVert technique for diagnosing hair loss and other disorders from a scalp biopsy. The technique uses a unique horizontal and vertical testing approach that provides a greater amount of information to the referring dermatologist than standard industry longitudinal scalp biopsies.
The photo included here shows an example of one condition which could affect the eyebrows, eyelashes, facial hair and pubic hair. This is a type of thinning hair found in women that are regularly seen at Sussex Trichology in West Sussex. These symptoms obviously cause the sufferer much distress as the appearance has dramatically altered the hairline since the eyebrows define the face. Shuna Hammocks, our Consultant Trichologist, is able to diagnose your condition and discuss it at length and then design a treatment plan for you. It may be suggested that you attend the clinic for hair treatments which involve a combination of creams, steam and massage.
Everyone’s hair loss is different. Which is why, at Hair Club, we don’t provide a one-size-fits-all solution to restore your hair. Instead, we consult one-on-one with you to understand what’s needed to fit your taste and lifestyle. Only then will we custom tailor a solution that works best for you, so you can get the results you want. It’s what we’ve done for 600,000+ satisfied clients. It’s what we’ll proudly do for you.
Contrary to popular belief, hair does not grow continuously but actually grows in cycles. It starts at the follicles which are embedded in the skin and the visible part, the shaft, is a consequence of active growth at the follicles over time. The living part of the hair in the skin has blood and nerve supply while the hair shaft is made up of dead cells and protein and does not have a blood or nerve supply. Therefore it can be easily cut without any bleeding or pain.
Despite the name androgenetic alopecia, the exact role of hormones is uncertain. It is well known that androgens affect the growth of the scalp and body hair and even Hippocrates observed 2,400 years ago that eunuchs did not experience baldness (Yip et al., 2011). However, hyperandrogenism cannot be the only pathophysiologic mechanism for FPHL because the majority of women with FPHL neither have abnormal androgen levels nor do they demonstrate signs or symptoms of androgen excess (Atanaskova Mesinkovska and Bergfeld, 2013, Schmidt and Shinkai, 2015, Yip et al., 2011). Furthermore, cases have been reported in which FPHL developed in patients with complete androgen insensitivity syndrome or hypopituitarism with no detectable androgen levels (Cousen and Messenger, 2010, Orme et al., 1999).

Madarosis is a clinical sign that has become pathognomonic of leprosy in countries like India. However, this apparently benign clinical sign has wider ramifications in many systemic and dermatological disorders. Hence, establishing a proper diagnosis and appropriate management is mandatory. Though management of the primary disease results in regrowth of eyebrows and eyelashes, many require surgical management. Thus, the management of a patient with madarosis requires a coordinated effort from the dermatologist, ophthalmologist, internist, and reconstructive surgeon.

×