It’s very normal for everyone to shed some hair each and every day, but excessive hair loss is a big concern for both men and women. It can start with a just a few hairs falling out, or losing some when you comb your hair. Sometimes, this excess hair falling off may later progress to baldness. Baldness refers to excessive hair loss from your scalp which can be either inherited or can be due to certain medications. Hair loss can also be a symtom of an underlying medical condition. Men, women, and even children can experience hair loss.
Some people who are less conscious about their appearance do not have any objection to hair loss and they let their baldness run its course without any treatment. However, others who are self conscious about their thinning hair try to cover it up with hairstyles, makeup, hats, or scarves. Lastly, some are extremely self conscious about their hair loss and they choose either medications or some kind of surgery that is available to treat their hair loss.
It is normal for us to shed about 50 to 100 hairs a day, and since we have about a million strands of hair on the scalp, this amount of hair loss does not matter and does not cause noticeable thinning of the hair. Also, gradual thinning is a normal part of aging. As one becomes old, the hair naturally starts to thin out. However, you may become bald if the rate of shedding is more than the rate of re growth or when the new hair is thinner than the old hair that is shed.
Hair Loss Causes
There are many reasons why one would have hair loss and they differ in men and women. To understand why hair loss exists, let us first understand the life cycle of hair.
Our hair goes through cycles of growth and rest, but its course is different for each individual. In general, the growth period lasts for about two to three years, and the hair grows about a centimeter per month. After the growth phase starts receding, the resting phase starts which continues for about three to four months. At the end of the resting phase, the hair strands fall out and new ones begin to grow in its place, thus the growth phase starts again. This cycle may become disrupted due to many reasons.
If you develop a hormonal imbalance or a specific irritation of the scalp, some hair follicles can potentially have a shorter growth phase and produce thinner and shorter hair shafts.
There are specific types of hair loss and the cause for each of them may be different. We need to understand the types of hair loss to better understand what is causing them.
- Pattern baldness: This type of hair loss can occur in both the genders. In this type, the normal growth phase of two to three years is shortened and the hair is also not as thick or sturdy. With each growth cycle, hair becomes rooted more superficially and tends to fall out more easily during shampooing or combing. Some researchers suggest heredity plays a key role in pattern baldness. Heredity also affects the age at which you begin to lose hair, for example, if your mother, father, or any of your grand parents started to lose his/her hair at a certain age, there is a good chance that you may also start losing your hair at the same time in your life. Heredity also affects the developmental speed, pattern, and extent of your baldness.
- Scarring alopecia: This type of hair loss is permanent and is characterized by inflammation of the hair follicle. Inflammation damages the hair follicle and it can cause the hair to fall out. Due to inflammation, the new hair does not grow. This condition may not occur independently and is usually associated with several skin conditions like lupus erythematosus or lichen planus.
- Alopecia areata: This is thought to be an autoimmune disorder (condition where one’s immune system attacks its own tissues), but the exact cause is unknown. People who develop this condition are generally in good health, but a few of them may have other autoimmune disorders like thyroid disease. Researchers believe that some people are genetically prone to get this condition, or a viral infection can contribute to the cause. In this condition, your hair generally grows back with treatment but may again fall out and regrow again. This may happen a number of times.
- Telogen effluvium: In this case, hair suddenly and unexpectedly falls out. It may occur when there is some kind of emotional or physical shock to your system which causes the hair roots to be pushed prematurely into the resting state, but generally within few months, the hair follicles become active again and new hair starts to grow. It may occur after emotional shock, such as the death of a loved one, a high fever due to certain diseases, sudden or excessive weight loss, surgery, or metabolic disturbances. Hair typically grows back once you treat the underlying condition, but it takes a long time and the growth may not be same as the earlier growth.
- Traction alopecia: This kind of hair loss occurs when you pull your hair too tight when you style it. The roots tend to weaken and the hair can fall out.
Another potential cause of hair loss is poor nutrition. Inadequate amounts of protein, iron, or vitamin B12 in your diet can cause you to experience hair loss.
Conditions like diabetes and lupus are two known diseases to cause hair loss.
Certain drugs used in the treatment of gout and arthritis can cause hair loss. Psychological disturbances like depression and heart problems like high blood pressure may cause hair loss in some people. Women on contraceptives (birth control pills) may also experience hair loss.
Undergoing chemotherapy or radiation therapy for cancer treatment causes hair loss. These treatments will cause healthy, growing hair to fall out. Once the treatment is over, your hair will likely grow back.
Another common reason for hair loss is hormonal changes and imbalance, and this can cause temporary hair loss especially in women. In a woman’s life, hormonal changes occur during pregnancy, childbirth, after discontinuing birth control pills, at the onset of menopause, or due to an overactive or underactive thyroid gland. During pregnancy, it is normal to have thicker hair, however, it’s common to lose more hair than normal following child delivery.
Chemicals used for dying hair or those used in styling can cause hair to become damaged and fall out, especially if you leave the dye in for an extended period of time.
Overstyling using pins and curls, excessive brushing or combing can also cause hair to fall out if the hair shaft becomes damaged.
Fungal infections of the scalp (such as ringworm) can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally grows back.
There is one type of psychological disorder or a mental illness which can cause hair to fall out. Patients who are diagnosed with this illness have an irresistible urge to pull out their hair, whether it is from the scalp, eyebrows, or other areas of the body. Hair pulling from the scalp often leaves them with patchy bald spots on their head.
Hair Loss Symptoms
Let us now discuss permanent hair loss and temporary hair loss.
Permanent hair loss
For men, pattern baldness can begin early in life. It affects one third of men and women. For men, the hair line will begin to recede and can proceed to partial or completely baldness. In women with pattern baldness, the hair loss is limited to thinning at the front, sides, or crown, but they rarely experience complete baldness.
Permanent hair loss can also be seen in cases where the scalp is inflamed and thus damage can occur to the hair follicles, but this rarely occurs. Since inflammation is present, the patchy hair loss is associated with itching or pain.
Temporary hair loss
In Alopecia areata, the hair loss usually occurs in small, round, smooth patches, but limits itself to only a few patches. The patchy hair loss in not limited to the scalp but it can be on any area where hair is present (eyebrows, eyelashes, and facial hair). In rare cases, it can progress to cause hair loss to the entire body.
In hair loss due to psychological or emotional stress, the temporary hair loss can occur suddenly due to emotional shock, significant illness, or major life stress. Each time you comb, a handful of hair may come out. This type of hair loss usually causes overall hair thinning but there are no bald patches.
Another type of hair loss, which we discussed above, is traction type hair loss. Bald patches can occur if you regularly wear certain hairstyles, such as pigtails, braids or cornrows, or if you use tight rollers. Hair loss typically occurs where hair is pulled tightly, but this generally happens after a longer period of time.
In Anagen effluvium, which is hair loss after cancer treatment, hair falls out soon after beginning therapy. In some cases, there is complete baldness. When therapy is completed, the hair cycles re-establish themselves, and hair begins to regrow.
Hair Loss Diagnosis
Diagnosing the cause of hair loss can be time consuming for your doctor. The diagnosis is not based specifically on how your hair looks. Your doctor will take your complete medical history and your family history and will carry out an examination of the hair. Your age, habits, nutrition, the pattern of hair loss, the rate of hair loss, the appearance of nearby hairs and accompanying other bodily symptoms will all be investigated by your doctor. All these factors help in reaching a correct diagnosis of the cause of hair loss.
After reviewing your personal and family history along with examining your hair, your physician still may not be able to diagnose your condition. Your physician will then be forced to perform specific tests to try and diagnose your condition. Tests that physicians utilize are explained below.
- Pull test: To perform this test, your physician will hold your hair and pull to see how many hairs come out. This helps determine the stage of the shedding process.
- Skin scrapings: Sometimes the skin of the scalp has to be scraped or a few hairs plucked from the scalp to help verify whether an infection is causing hair loss.
- Punch biopsy: A biopsy includes taking out a piece of tissue from the scalp to view it under a microscope to make a diagnosis. During this test, he may use a tool to remove a small section of your skin’s deeper layers.
- Screening for other related diseases: Your doctor may perform tests to determine if you have a medical condition that is causing hair loss, such as thyroid disease, diabetes, or lupus. You may also have to tell him if you are taking any medications for any disease as hair loss is a side effect of certain drugs, such as those that treat gout, arthritis, depression, and heart problems.
Hair Loss Treatment
If baldness has occurred, whether permanent or temporary, it cannot be cured, but it can definitely be hidden. If there is thinning of your hair, it can be treated to help promote hair growth or hide hair loss.
The effectiveness of medicines used to treat hair loss depends on why the hair loss has occurred, the extent of hair loss, and the individual response to treatment. Generally, treatment is less effective if hair loss is severe. Treatment is most effective when a correct diagnosis is done to evaluate the underlying condition. When the underlying condition is treated, it’s likely that your hair will regrow.
Some over-the-counter medications are available in liquid or foam form that is designed to be rubbed onto the scalp to grow hair and to prevent further loss.
Plenty of creams and ointments are also available on the market but it is better to apply them after consulting with your doctor.
Different brands of shampoos claim to be effective against hair loss, but again it is better to obtain proper consultation from your doctor before you start using them.
Your doctor may also use steroid injections into the scalp, but many injections may have to be applied over an extended period of time to see results. Some doctors also prescribe steroid pills. In most cases, new hair may be visible in a month’s time after the injections. However, steroid treatment has a risk of developing many side effects.
Surgery including hair transplants are also undertaken. Hair transplant techniques like punch grafts, minigrafts, micrografts, slit or strip grafts are practiced when more conservative measures have failed.
For these techniques, your doctor will refer you to a cosmetic surgeon who will take tiny plugs of skin, each containing one to a few hairs, from the back or sides of your scalp and implant them into the bald sections. This cannot happen in one session, so several transplant sessions may be needed.
Another surgery that is performed for hair loss is called scalp reduction surgery. In this operation, the hairless portion of the scalp is removed and the space is closed with hair covered scalp. Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. This type of surgery can be combined with hair transplantation to give the best results of a natural-looking hairline.
Surgical procedures to treat baldness are generally expensive and can cause significant discomfort to the patient and can be painful. Many people choose not to follow through with this treatment. With surgery, there are always possible risks of infection or scarring. It takes a few months before you would assess the quality of the new hair.
Read more about PRP Treatment for Hair Loss.
Wigs and hairpieces
If other treatments have failed, you may want to consider wearing a wig or hairpiece. A wig is used to cover either permanent or temporary hair loss. It is a head of hair that is made from either human hair, animal hair, or some synthetic material.
Hair Loss Prevention
In most cases, hair loss is dependent on an underlying cause. When you treat the underlying cause, the hair loss is treated. On the other hand, hair loss that is due to poor hygiene, nutritional deficiencies, or stress can definitely be prevented. Good hair hygiene, regular shampooing, and proper nutritious diet rich in proteins, vitamins, and iron can possibly prevent certain types of hair loss. One can use hairstyles that do not damage hair.
Questions to ask your doctor about hair loss at your first doctor visit
- What is the reason for my hair loss?
- Do I need to undergo any tests or examinations. If yes, what kinds?
- Is my condition temporary or do I have permanent hair loss?
- What treatment do you suggest?
- I have other health conditions. Is my hair loss related to any of these?
- How can I best manage them together?
- Are there any restrictions that I need to follow?
- Do I need to follow a certain diet?
- What vitamins are good for hair loss?
- How do I prevent hair loss?
- My scalp itches. Can this be a reason for my hair loss?
- Should I see a specialist?
- What will it cost to see a specialist, and will my insurance cover seeing a specialist?
- Is there any alternative to the medicine you are suggesting for me?
- Do I need surgery if all other treatments fail?
- What do I do if surgery fails?