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 are a man. If you are a woman, you may find that the hair on the top of your head is slowly thinning. About half of all
people have this type of hair loss by around age 50.
Other factors, such as
diseases and medicines, also can cause you to lose more hair than
Although hair loss is fairly common, it can be a tough
thing to live with, especially when it changes how you look. But there are ways
you can treat your hair loss.
Common causes of hair loss
Your symptoms will depend
on what kind of hair loss you have.
If your hair is thinning, it
happens slowly over time, so 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, which is called focal hair loss.
With inherited hair loss,
men usually get bald spots around the forehead or on the top of the head, while
women have some thinning all over the scalp, but mostly on the top of the head.
Since your hair has a lot to do with your
appearance, losing it may cause you to have lower self-esteem if you don't like
how you look. This is especially true in women and teens.
Your doctor will ask
you some questions, like how much hair you're losing, when it started, and
whether your parents have hair loss. He or she will look closely at your scalp
and hair loss pattern and may gently pull out a few hairs for tests.
If it's not clear what's causing you to lose your hair, your doctor may
do a blood test or look at a sample of your hair or scalp with a
How you choose to treat your
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.
Hair loss that runs in the
family can be treated with medicines or with surgery, such as hair
transplant surgery. Some people choose to wear hairpieces, like wigs or toupees (say
"too-PAYZ"). Finding different ways of styling your hair, like dyeing or
combing, also 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.
When you are deciding about treatment, think about these
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.
medicines, stress, or hair damage cause you to lose your hair, it often will
grow back after you take away the cause. If this doesn't help, you may need
If you're unhappy with how hair loss makes you
look, treatment may help you feel better. It's natural to want to like the
way you look.
But keep in mind that treatment, especially
medicines and surgery, can have some side effects and risks. Be sure to discuss
your decision with your doctor.
Learning about hair loss:
Living with hair loss:
Health Tools help you make wise health decisions or take action to improve your health.
hair loss (more than 100 hairs a day) can be caused by
inherited factors, disease, stress, medicines, injury, aging, or hair care.
The most common cause of hair
genetics—you inherit the tendency to lose hair from
either or both of your parents. This is called male-pattern hair loss or
female-pattern hair loss. The medical term for this type of hair loss is
In this type of
hair loss, your
genes affect how your hair grows. They trigger a
sensitivity to a class of hormones called
androgens, including testosterone, which causes
hair follicles (which hair grows from) to shrink. Shrinking follicles produce
thinner hair and eventually none at all. Men generally develop bald spots on
the forehead area or on the top of the head, while women often have thinning of the hair on the top of the head. About half of all people have
inherited hair loss by about 50 years of age.
Common causes of hair
Other causes of hair loss include:
Hair loss can be categorized by
types. Different types of hair loss may have different
causes. For example, one type of hair loss known as telogen effluvium is caused
by stress and side effects of medicines. Another hair loss type, traction
alopecia, is caused by hair care.
Hair loss can
occur as thinning, in which you may not notice hair falling out, or as
shedding, in which clumps of hair fall out.
In the most common
type of hair loss, inherited hair loss (androgenetic alopecia), men tend to lose hair on the front hairline and forehead and
on top of the head. Eventually, only hair around the ears, the sides, and the back
of the head remains. Women with this condition typically have gradual
thinning throughout the scalp, but mostly on the top of the head.
Other causes of hair loss may also show distinct
patterns. For example, conditions such as
trichotillomania (compulsively pulling at the hair) or
alopecia areata (in which the immune system attacks
hair follicles) result in obvious patches of hair loss, while stress and some
medicines result in clumps of hair falling out.
Because hair is an
important part of appearance, hair loss can also result in loss of self-esteem
and feeling unattractive, especially in women and teens.
What happens in
hair loss depends on its cause.
Inherited hair loss (androgenetic alopecia) is also called male-pattern hair loss or female-pattern hair loss. About half the population have some hair loss by about 50
years of age. Men may start losing hair between the ages of 15 and 25, and women are more likely to start losing hair between the ages of 25 and 30, or in some cases, after menopause.1
Men tend to lose hair on the front hairline and temples
and on top of the head. Eventually, they may go completely bald.
Women generally lose less hair than men, but they have a similar pattern of hair loss. Women may have slight, moderate, or even severe hair loss, but they don't usually lose all their hair.
For both men and women, inherited hair loss must be treated early for
hair to regrow.
Alopecia areata is
hair loss caused when the immune system attacks
hair follicles, where hair growth begins. It usually starts with one or more
small, round, smooth bald patches on the scalp and can progress to total scalp
hair loss or complete body hair loss. It often begins in childhood. The hair
usually grows back within 1 year. But hair loss in alopecia areata often comes
and goes—the hair will grow back over several months in one area but will fall
out in another area.
Hair loss also may be caused by stress,
disease, medicines or medical treatments. In these cases,
clumps of hair may fall out. But after the cause is stopped, the hair usually
grows back, although sometimes treatment may be needed.
Treatment to regrow hair does not work for everyone.
If your hair loss is inherited, treatment may not permanently restore your
hair. If your hair loss is caused by medicine, stress, or damage, hair often
grows back after the cause is removed, although sometimes you will need
For both men and women, hair thinning and baldness
increase the risk of sunburn and skin cancer on the scalp. When in the sun, it
is important to wear a hat or use a sunscreen with an SPF of 30 or more to
prevent sun damage to the scalp.
Factors that increase the
hair loss include:
Although most people with hair loss caused by
alopecia areata regrow their hair, certain people are
at greater risk for their hair not growing back. If you have a family history
of the condition, have the condition at a young age, have an
autoimmune disease, are prone to allergies (atopy), have extensive hair loss, or have abnormal
color, shape, texture, or thickness of the fingernails or toenails, you are
more likely to have permanent hair loss.
Call your doctor if:
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. Watchful waiting may be appropriate if your hair loss is
gradual and is similar to the pattern of hair loss seen in your parents or
brothers or sisters. But if your gradual hair loss bothers you, your doctor may
be able to slow or reverse it. If clumps of hair fall out, your hair loss may
be caused by a disease, and it is important to contact your doctor.
Hair loss caused by
alopecia areata often reverses on its own. Watchful
waiting is an option after you have been diagnosed with this condition.
professionals who can give you advice and treatment on hair loss
Hair transplant surgery is usually done by:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Hair loss is
diagnosed through a medical history and physical examination. Your doctor will
ask you questions about your hair loss, look at the pattern of your hair loss,
and examine your scalp. He or she may also tug gently on a few hairs or pull
The most common cause of hair loss—inherited hair
recognized. Men tend to lose hair from the forehead area and top of the head
with normal amounts of hair on other areas of the scalp. Women tend to keep their front hairline, but have thinning of the hair on the top of the head.
To determine the cause of your
hair loss, your doctor may ask you about:
If the reason for your hair loss is not
clear, your doctor may do tests to check for a disease that may be causing your
hair loss. Tests include:
Hair loss in women is more difficult to diagnose than
it is in men because the pattern of hair loss is not as noticeable as it is in
men. In women with mild to moderate hair thinning who are otherwise healthy
(with normal menstrual and fertility history), testing to
diagnose hair loss usually is not done. But in women who have irregular
menstrual cycles, continued episodes of
acne, or too much body hair (hirsutism), testing for a
class of hormones called
testosterone, is sometimes done.
Some people choose to treat
hair loss with medicines or surgery, such as hair
transplant surgery. Others choose to wear hairpieces (wigs or toupees) or use
different methods of hair styling (dyeing or combing). The approach you use
depends on the cause of your hair loss. Some people feel they need treatment,
while others are not as concerned about thinning hair or baldness.
If a disease, medicine, or stress is the cause, then treating the
disease, changing medicines, or eliminating or learning to manage the stress
may stop the hair loss.
Treatment for hair loss may help you feel better about how you look, although the trade-off might be that it
affects your health. Some medicines may have harmful side effects, and surgery
may carry certain risks.
Treatment for inherited hair
loss aims to prevent
hair loss, promote hair growth, and cover bald areas of the scalp. But
treatment is not successful for everyone, and you should not expect to regrow a
full head of hair.
Cosmetic approaches to hair loss include:
loss can be caused by
medicines or medical treatments, recent surgery, high
fevers, emotional stress,
lack of protein or
hair care, such as using dyes. Often, treating the
cause stops the hair loss, and hair grows back. In some cases, other treatment
Hair loss caused by
cancer treatment requires special care: use mild
shampoos and do not use a hair dryer.
occurs when the
immune system attacks hair follicles, where hair
growth begins. Because hair usually 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.
Medicine used for alopecia areata includes:3
How successful your treatment
is depends on your expectations and the cause of hair loss. Treatment for hair
loss caused by an illness, medicine, or damage to the hair usually is more
successful than treatment for inherited hair loss.
about treatments for inherited hair loss include:
Women with inherited hair loss who wish to take birth
control pills should use a pill type that does not add to hair loss, such as a
norgestimate or desogestrel.4
Hair loss that
is caused by
lack of protein or
hair care may be prevented. Avoiding certain
medicines, reducing stress, getting adequate protein and iron in your diet, and
using hairstyles that don't damage your hair may reduce or prevent hair
Inherited hair loss (androgenetic alopecia) cannot be prevented.
Home treatment for
hair loss includes hair care and hairstyling
techniques that may help you cover thinning or bald spots on the scalp. This
may be easier for women because inherited hair loss (androgenetic alopecia) causes a general thinning that
is usually not as severe as it is in men. Hair sprays, dyes, and perms can help
make the hair appear fuller.
In women with inherited hair loss,
hair care and the occasional use of grooming products, hair sprays, hair color,
teasing, permanents, or frequent washing won't increase hair loss. But if
your hair loss is caused by hair care, then perms and dyes may contribute to
more hair loss.
For both men and women, 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.
hair loss can slow thinning of hair and increase
coverage of the scalp by growing new hair and enlarging existing hairs. But
they need to be taken continuously. If the medicines are stopped, any hair that
has grown in will gradually be lost, and within 6 to 12 months your scalp will
most likely appear the same as before treatment.
Medicines often used to treat inherited hair loss
(androgenetic alopecia) include:
Medicines used to treat
alopecia areata, which is caused when the immune
hair follicles, include:3
If you are taking medicine for
inherited hair loss, do not expect to regrow a full head of hair. Hair coverage
is improved on the top of the head, but not on the forehead area. But when you
stop taking these medicines, hair loss begins again.
is not approved for women by the U. S. Food and Drug Administration (FDA). Women who are
or may become pregnant should not take or handle crushed or broken tablets,
because finasteride can cause birth defects.
Surgery to cover bald areas of the scalp may
be used to treat
hair loss. If successful, surgery may be a permanent
treatment for hair loss.
The most common types of surgery to treat hair loss
Surgery may be a more permanent
solution than medicines to treat hair loss, but it is expensive, it involves
surgical risks, and there is a chance that not all hair follicles will remain
Other treatment for
hair loss includes:
The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool at www.aad.org/find-a-derm.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Alopecia Areata Foundation (NAAF) funds
research and research workshops that promote knowledge about alopecia areata,
its causes, and treatments. The NAAF provides local support and education for
people who have alopecia areata and for their families and also acts as an
advocate for people who have alopecia areata.
The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
CitationsWhiting DA (2006). Disorders of hair. In DC Dale,
DD Federman, eds., ACP Medicine, section 2, chap. 13.
New York: WebMD.Unger WP, et al. (2010). Androgenetic alopecia. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 36–38. Edinburgh: Saunders Elsevier.Hague J, Berth-Jones J (2010). Alopecia areata. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 31–35. Edinburgh: Saunders Elsevier.Habif TP, et al. (2011). Hair and nail diseases. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 562–589. Edinburgh: Saunders.Other Works ConsultedKestenbaum TM (2010). Diseases affecting the hair. In JC Hall, ed., Sauer's Manual of Skin Diseases, 10th ed., pp. 337–347. Philadelphia: Lippincott Williams and Wilkins.Wolff K, Johnson RA (2009). Disorders of hair follicles and related disorders. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 962–986. New York: McGraw-Hill.
May 29, 2012
Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine
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