Asked Questions About Hair Loss
Asked Questions About Hair Loss
Hair Loss Myths
Loss of hair at a very tender age has become a common disorder. Hair is
formed in minute pockets in the skin, called follicles. An up growth at
the base of the folic, called the papilla, actually produces hair; when
a special group of cells turn amino acids into keratin, a type of
protein of which hair is made. The rate of production of this protein
"building blocks." determines hair growth. The average growth rate is
about 1.2 cm per month, growing faster on women between the ages 15 and
There are many potential causes of hair loss. It is important to
determine the cause of your hair loss because the cause will usually
determine the type of treatment you should have.
Male pattern baldness: Male pattern baldness,
also known as androgenetic alopecia, is a hereditary form of hair loss.
Male pattern baldness is by far the most common cause of hair loss,
affecting over 20 million men in the United States. To fully understand
what goes on in male pattern baldness, let's briefly revisit the hair
cycle. Over time, some hair follicles begin to shrink, producing finer,
shorter hairs (“peach fuzz”). This is what accounts for thinning of the
scalp. These changes usually start at the temples, appearing as the
classic “receding hairline.” It also occurs on the crown of the scalp.
Eventually, hair follicles may begin to die, leading to hair loss. Bald
spots may increase in size until the entire top of the head is bald
with hair remaining only on the sides. (Fortunately, there are several
medical and surgical treatments for androgenetic alopecia.)
Medication: An annoying side effect
of certain medications may be temporary hair loss in a small percentage
of patients. Examples of the more common drugs known to have this
effect include certain blood pressure medications (beta blockers such
as Inderal®), blood thinners (warfarin and heparin), as well as
some of the medications used to treat gout, arthritis, and heart
problems. Also, high doses of vitamin A may also cause hair loss which
Chemotherapy: Many agents used to
treat cancer will cause hair cells to stop dividing, stopping hair
growth. Up to 90% of the hairs may fall out 1 to 3 weeks after cancer
treatment. Fortunately, the hair does regrow in most cases when the
treatment is completed. Cancer patients should be warned of this side
effect so that they have the opportunity to prepare for any possible
hair loss, such as getting a wig or hairpiece, if desired, prior to
Tinea Capitis: Tinea capitis, or
ringworm, is a fungal skin infection that can cause a patchy form of
hair loss when the scalp is infected. A ringworm
scalp infection results in hairs breaking off at the surface of the
scalp. There may be redness, flaking, scaling, swelling, and even
oozing at the affected areas on the scalp. And there is often itching
and pain as well. Severe cases of ringworm may lead to swollen glands
in the neck or back of the head.
A contagious form of hair loss, most common in children. It is spread
by contact, such as sharing brushes, towels, and hats, and is commonly
spread from child to child at daycare centers or schools. Some strains
of tinea capitis can also be contracted from pets, particularly cats.
Fortunately, this infection is curable with oral antifungal medication,
and it is important that all affected family members, classmates, and
pets be treated to prevent reinfection.
Alopecia Areata: Alopecia areata appears
as discrete, smooth, round patches of hair loss about the size of a
coin or larger. There may be one or several of these coin-sized patches
of hair loss. This condition is most often limited to one area of the
body but can affect the scalp, beard, eyebrows, eyelashes, or any hair
on the body. A severe form of this disease, known
as alopecia universalis, results in total loss of all scalp and body
hair. Fortunately, this is rare.
The cause of alopecia areata remains a mystery. It is
not uncommon, affecting approximately 2% of the population. It may
occur at any age and is equally common among women and men. Besides the
hair loss, affected persons are usually otherwise healthy. In some
cases, the bald area(s) will spontaneously regrow hair over several
months without treatment. In other cases, the bald spots may
There are various topical treatments available for alopecia areata,
which may be beneficial in some cases. In my practice, I have found
that the most effective treatment for localized bald spots is the
injection of a steroid solution directly into the involved areas. The
steroid solution remains localized to the injected areas and is not
absorbed in the body in large enough amounts to cause any side effects.
These injections can be repeated at monthly intervals until there is a
cosmetically acceptable regrowth of hair.
Telogen Effluvium: Telogen effluvium is a
condition characterized by a generalized, diffuse hair loss that occurs
2 to 3 months after a significant stress on the body, such as major
surgery, severe illness, or even crash dieting. Any severe shock to the
system can cause more than 20% of our hair follicles to enter into the
resting phase of the hair cycle, rather than the normal 10%, as
previously discussed. As a result, more hairs are shed than usual,
which leads to significant thinning of hair. The good news is that in
most cases, these hairs will return to their growing phase within a few
months, but it will take longer for the thin areas to fill in. I
counsel my patients not to expect a return to their normal head of hair
for at least 6 months.
Other Causes: Iron deficiency (anemia)
as well as thyroid disease (either an under active or overactive
thyroid) can result in hair loss. Your doctor may order specific
laboratory tests to check for these conditions. Hair loss that is
associated with either anemia or thyroid disease is reversible with
What causes hair loss?
Alopecia is the general medical term for hair loss, and it has many
different causes. Normal human hairs can be classified according to
their phases of growth. Anagen is the growing stage of hair, while
telogen is the sleeping stage of hair. About 80 percent of the hairs in
the human scalp are growing hairs and about 20 percent of them are
sleeping hairs. It has been estimated that the scalp normally contains
about 100,000 hairs. Therefore, the average number of hairs that can be
lost in a day is about 100. Contrary to popular belief, neither shaving
nor hormonal changes, such as menstruation, has any effect upon hair
Hair loss can
be broken down into several different types, including alopecia areata
(temporary hair loss in a coin-shaped patch), telogen effluvium
(temporary hair loss secondary to a stressor on the system), and
androgenetic alopecia (male-pattern hair loss). For the purposes of our
discussion, we will focus on male-pattern hair loss. It generally shows
itself in the 20s or early 30s by gradual loss of hair, chiefly on the
top of the head and in the angles at the frontal hairline. There are
several different patterns to this hair loss, but male-pattern hair
loss is the most frequently encountered type. The exact mechanisms are
still unknown. We have no doubt, however, that inherited factors and
the effect of androgens (male hormones) on the hair are most
Is stress a factor in hair loss?
Stress does not cause
hair loss—it simply makes a bad situation worse. Telogen effluvium, for
example, occurs after an insult to the system. The most common cause is
pregnancy. This can result in extensive and worrisome hair loss in
women in the first few months after the birth of a baby. It is,
however, temporary and returns completely.
is DHT and how is it involved in hair loss?
DHT stands for
dihydrotestosterone. This is the active form of the male hormone
testosterone. It has been suggested that high DHT levels in genetically
predisposed hair follicles initiate baldness. It is this chemical
conversion from testosterone to dihydrotestosterone that is blocked by
hair restoration products, such as finasteride, which is a prescription
medicine and the active ingredient in Propecia, another prescription
medication to treat hair loss. Finasteride blocks the formation of
active testosterone and allows those hairs predisposed to inactivity to
become active again and make new hairs.
What is the relationship
between genetics and hair loss?
Although not the primary
cause of male-pattern hair loss, genetics does have a significant role
in male-pattern hair loss. It is, however, polygenic, in that there is
more than one factor at work. It is unclear whether having an affected
mother or an affected father predisposes descendants to greater risks.
Can hair loss occur in
What can be the cause of a
sudden loss of a large mass of hair?
loss can occur as early as 15, although it typically begins anywhere
from the 20s and early 30s. Familiy history may help determine if this
is going to occur, as parents with a history of early-onset
male-pattern hair loss may increase the risk for this to occur in
descendants. Alopecia areata and telogen effluvium, two other forms of
temporary hair loss, can occur in children as young as one year of age.
Other precipitating factors may also be involved.
Stressors to your system,
such as illness, high fever, pregnancy, extreme weight loss or gain,
and drug use, can cause temporary hair loss. This occurs when the ratio
of growing to resting hairs is upset and more of the growing hair
shifts into a resting phase. A greater quantity of normally sleeping
hairs falls out, prompting a visit to the dermatologist. This type of
hair loss is temporary and full regrowth should be expected.
Do shampoos and other hair products cause hair loss?
An allergic reaction to any constituent in shampoo or
hair products can cause hair loss. Shampoos are designed to be as safe
as possible, although there is always someone who will react to them.
Caustic hair dyes, straighteners, and other products can certainly
cause inflammation of the scalp and result in hair loss.
Can my hairstyle cause my
hair to fall out?
can contribute to hair loss, most notably styles involving tight braids
or pull-backs. This form of hair loss is called traction alopecia. This
occurs when the hair is pulled tightly back and fastened at the base of
the skull, or braided into tight braids or rows. Exposure to this type
of hairstyle over long periods can result in a scarring alopecia, with
no potential for regrowth.
How effective is hair
is a surgical office procedure for the treatment of hair loss. This is
accomplished by actually transferring grafts or small sections of hair
bearing skin from the back of his scalp to bold areas on the top of the
head. Micro grafts, containing one hair, and mini grafts, containing
two to seven hairs, are usually used. This technique is very effective
in most types of hair loss, including male and female pattern loss. It
is also effective when concealing scar injury and complications from
disease. It is especially effective in concealing the scars from facial
plastic surgical procedures (face lifts, brow lifts, etc.). Even
eyebrows can be reconstructed with excellent cosmetic appearance. Women
in particular are excellent candidates, as their hair loss tends to be
diffuse and can afford them full coverage of the area while undergoing
healing. Best of all, your results are permanent.
Hair Loss Myths
You might be surprised to learn that many people are unable to untangle
fact from fiction when it comes to hair loss. Some of the blame lies
with the many companies and individuals exploiting hair loss myths in
order to sell bogus hair products. Other myths may linger because
people with hair loss, particularly women, are reluctant to talk about
an issue that remains sensitive and sometimes emotional.
The following are some
popular myths about hair loss to watch out for:
Myth: Only Men Experience Pattern Baldness
Myth: Pattern Baldness
Comes From Your Mother's Side Only
For those of
you secretly blaming your mother's grandfather for your male- or
female- pattern baldness, it's time to let go. The hair loss gene does
not get passed down from your mother, nor does it skip a generation. If
fact, there isn't even a single hair loss gene; researchers think
pattern baldness is probably due to the interaction of several genes
inherited from both parents.
reality, hair loss is
just as common in women as it is in men, though the degree of loss
tends to vary by gender. "By the age of 50, over 50 percent of men have
significant hair loss," Dr. McAndrews says. "For women, about 25
percent have significant hair loss by the age of 50, though it may be
less apparent because women are more conscientious about hiding it than
men are." The timing and pattern of
pattern baldness is also different in men and women. While men tend to
start losing hair in the 30s and 40s, hair loss begins in the 40s or
50s in women, though it can occur as early as the 20s. And while men
first lose hair in the front and at the top of the head, women's hair
thins diffusely throughout the scalp.
Until recently, women
have been reluctant to seek treatment, but hair restoration surgeons
say that women make up more and more of their practices.
Myth: Poor Blood Flow Causes Pattern Baldness
This myth has been used
to sell hair loss products as bizarre as a
device that allows you hang upside down in your closet overnight in
order to restore blood flow. But as Paul McAndrews, MD, a
board-certified dermatologist and hair restoration surgeon and a
clinical professor at the University of California School of Medicine,
explains, "Blood supply is excellent in the balding region, which is
why hair transplant works so well."
Myth: Pattern Baldness is Caused
Mites, Plugged Follicles, Vitamin Deficiencies
manufacturers claim that pattern hair loss is due to a hair mite called
the demodex mite that can be removed with certain shampoos, or to
plugged hair follicles, which can be unplugged with a shampoo or laser
Dr. McAndrews says
there's no evidence to support either of those theories. "The dermodex
mite has been seen for centuries on hair follicles on face and scalp.
If the mite contributed to hair loss, my beard hair would be gone."
As for plugged
hair follicles, they simply lead to ingrown hairs, he says.
Other manufacturers claim that vitamin deficiencies cause pattern
baldness. Although some studies have linked crash diets to temporary
hair loss, malnutrition is rarely a cause of hair loss in the United States. And consuming more of a
given vitamin, such biotin or zinc, than required will not have an
impact on hair re-growth.
So why are people so willing to buy into these myth-based products?
"Hair loss can be devastating," says Gregory Pistone, MD, a
board-certified dermatologist and hair restoration surgeon practicing
in Marton, New Jersey. "I think anytime you're dealing with an issue
that concerns self-esteem, you will find a lot of people trying to make
a quick buck by playing on people's weaknesses."
Myth: Hair Transplant Can Only Produce a
"Pluggy Look" Older
approaches to hair transplantation involved grafts containing 8 to 20
hairs. Such large grafts made the scalp look as if it had "plugs" of
hair. Today's techniques, if performed by a qualified hair transplant
surgery, allow the surgeon to transplant tiny grafts of one to four
hairs, creating a very natural look.
unless hair transplant is done improperly, it's
undetectable," Dr. Pistone says. One reason this myth persists may be
because the people in whom a transplant is visible are usually those
who've had older surgical techniques. That's why it's still important
to ensure you see a hair qualified transplant surgeon; research their
education and ask to meet patients who had their hair transplant
performed by them.