Hair Loss

Condition Basics

What is hair loss?

Hair loss is hair that is thinning or is falling out of your scalp. It's fairly common. Everyone loses some hair every day. Losing up to 100 hairs a day is normal.

But if hair loss runs in your family, you could lose a lot more hair. With this kind of hair loss, you may end up with bald spots if you're a man. If you're a woman, you may find that the hair on the top of your head is slowly thinning.

What causes it?

In most cases, hair loss is inherited. That means it's passed down from one or both of your parents. Age, stress, poor diet, certain diseases, and side effects of medicines or medical treatments can also cause hair loss.

What are the symptoms?

Your symptoms will depend on what kind of hair loss you have. If your hair is thinning, you may not notice the hairs falling out. If your hair is shedding, then clumps of hair fall out. You may lose hair all over your scalp, or you may lose hair only in one area.

What does inherited hair loss look like?

Inherited hair loss (androgenetic alopecia, also known as male- or female-pattern hair loss) is the most common cause of hair loss. It is inherited from either or both the mother and the father.

• In men, hair loss occurs on the scalp above the forehead and on the top of the head. Bald spots are noticeable.
• In women, hair loss occurs as thinning of the hair all over the scalp, but mostly on the top of the head. Women tend to keep their front hairline and do not generally develop bald spots.

How is hair loss diagnosed?

Your doctor will ask you about your past health and examine your scalp and hair loss pattern. Your doctor may gently pull out a few hairs for tests. If it's not clear what's causing your hair loss, your doctor may do a blood test or look at a sample of your hair or scalp.

How is it treated?

Treatment for hair loss depends on the cause. It also depends on your feelings. You may decide that you need treatment, or you may not be worried about thinning hair or baldness. The choice is up to you.

If hair loss is caused by something that won't last or can be treated, your hair is likely to grow back. For example, if an underactive thyroid is causing the problem, taking thyroid medicine may help. And most hair lost during chemotherapy will grow back after the treatment ends.

Hair loss that runs in the family can be treated with medicines or hair transplant surgery. Some people choose to wear hairpieces, like wigs or toupees. Finding different ways of styling your hair, like dyeing or combing, can help.

If hair loss is caused by something you can control, like stress or medicines, you can treat it by getting rid of the cause.

Cause

Common causes of hair loss include:

• Family history. In most cases, hair loss is inherited. That means it's passed down from one or both of your parents. This is called male-pattern or female-pattern hair loss.
• Stress, including physical stress from childbirth, surgery, illness, or high fever.
• Cancer treatment, including chemotherapy and radiation.
• Medicines, such as anticoagulants, cholesterol-lowering drugs, or hormones.
• Damage to your hair from pulling it back too tightly, wearing tight braids or ponytails, or using curling irons or dyes.
• Age. You grow less hair as you get older. Hair also gets thinner and tends to break more easily as you age.
• Not getting enough protein or iron from the foods you eat.
• Thyroid diseases, such as hypothyroidism and hyperthyroidism.
• Ringworm of the scalp, which is common in children.

Types of hair loss

There are many types of hair loss. They include:

• Androgenetic alopecia. This is inherited hair loss. In this type, the hair follicles sprout hairs that are thinner than normal. The hairs become thinner and thinner. Over time, the follicles wither away.
• Alopecia areata. This is hair loss that happens when the immune system mistakenly attacks hair follicles.
• Telogen effluvium. This type is caused by things such as stress, illness, poor nutrition, certain medicines, or hormone changes.
• Trichotillomania. This is a condition in which a person feels an urge to pull hair out of the scalp, eyelashes, or eyebrows.
• Traction alopecia. This hair loss is caused by your method of styling your hair, such as having tight braids or ponytails.

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Prevention

There are some things you can do that may reduce or prevent hair loss. These include avoiding certain medicines, reducing stress, getting adequate protein and iron in your diet, and using hairstyles that don't damage your hair. Inherited hair loss (androgenetic alopecia) cannot be prevented.

Symptoms

Your symptoms will depend on what kind of hair loss you have.

If your hair is thinning, it happens slowly over time. You may not notice the hairs falling out. If your hair is shedding, then clumps of hair fall out. You may lose hair all over your scalp, which is called general hair loss. Or you may lose hair only in one area. This is called focal hair loss.

With inherited hair loss, men usually get bald spots around the forehead or on the top of the head. Women have some thinning all over the scalp, but mostly on the top of the head.

What Happens

When you have hair loss, you lose more than 100 hairs a day. Hair loss may look like bald spots, thinning hair on the top of the head, or patches of hair falling out. Hair may or may not grow back. It depends on what's causing the hair loss.

When to Call a Doctor

Call your doctor if:

• Your hair loss is sudden, rather than gradual.
• You notice hair shedding in large amounts after combing or brushing, or if your hair becomes thinner or falls out.
• You are concerned that a medicine may be causing your hair loss.
• Your skin is scaly or has a rash, or you have any change on your skin or scalp with hair loss.
• Your hair is gradually thinning and balding, and you want to discuss treatment options with your doctor.

Exams and Tests

Your doctor will ask you about your past health and will do a physical exam. Your doctor will look closely at your scalp and hair loss pattern and may gently pull out a few hairs for tests.

Your doctor will also ask you some questions about your hair loss, like how much hair you're losing, when it started, and whether your parents have hair loss.

The most common cause of hair loss—inherited hair loss—is easy to recognize. Men tend to lose hair from the forehead area and top of the head, but they have normal amounts of hair on other areas of the scalp. Women tend to keep their front hairline but have thinning hair on the top of the head.

Your doctor will look closely at your hair and scalp. If it's not clear what's causing your hair loss, your doctor may take a sample of your hair or have other tests done.

Treatment Overview

Treatment for hair loss depends on the cause. It also depends on your feelings. You may decide that you need treatment, or you may not be worried about thinning hair or baldness. The choice is up to you.

How well treatment works depends on your expectations and what caused the hair loss. Treatment for hair loss caused by an illness, medicine, or damage to the hair usually works better than treatment for inherited hair loss.

Treatment for hair loss may help you feel better about how you look. But some medicines may have harmful side effects. And surgery may carry certain risks.

When you are deciding about treatment, think about these questions:

• Which treatment is most likely to work?
• How long will it take?
• Will it last?
• What are the side effects and other risks?
• How much will it cost? And will insurance cover it?

Treatment for inherited hair loss

When your hair loss is inherited, your hair won't grow back naturally. Treatment can help some hair grow back and prevent more from falling out, but you probably won't get all your hair back. And treatment doesn't work for everyone.

The goal of treatment is to prevent hair loss, promote hair growth, and cover bald areas of the scalp.

Some people choose to treat hair loss with:

• Medicines, such as minoxidil, finasteride, and spironolactone. Minoxidil (Rogaine) is available without a prescription. Finasteride and spironolactone are available by prescription.
• Surgery. The types of surgery to treat hair loss include hair transplants and procedures such as scalp reduction and scalp flaps.

Others may use hair products to thicken hair or a spray or powder to hide the scalp. A different hair style may help. Or you might want to try a hair piece, wig, or toupee.

Treatment for other causes of hair loss

If a disease, medicine, or stress is the cause of hair loss, then treating the disease, changing medicines, or managing stress may stop the hair loss. And your hair is likely to grow back. For example, if an underactive thyroid is causing the problem, taking thyroid medicine may help. And most hair lost during chemotherapy will grow back after the treatment ends.

If alopecia areata is the cause of hair loss, medicines such as corticosteroids can be used to treat it. But because hair often grows back within a year, you may decide not to have treatment. Understanding the come-and-go nature of hair loss with this condition can help you make the best treatment decision. Children and teens may need counseling to help them adjust to the hair loss.

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Self-Care

Home treatment for hair loss includes hair care and hairstyling techniques that may help cover thinning or bald spots on the scalp.

Hair care products

With inherited hair loss, hair care and sometimes using grooming products, hair sprays, hair color, teasing, or frequent washing won't increase hair loss. But if your hair loss is caused by hair care such as perms and dyes, you may want to try:

• Scalp concealers or hair thickeners.
• A hairpiece. These are made from human or synthetic hair that is implanted into a nylon netting.
• Certain hair care products and styling techniques.
• Laser phototherapy combs. These combs use low levels of light to increase hair growth on the scalp.

Skin cancer protection

Hair thinning and baldness increase the risk of sunburn and skin cancer on the scalp. When in the sun, wear a hat or use a sunscreen with an SPF of 30 or more to prevent sun damage to the scalp.

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