Hair Loss – Causes, Symptoms, Treatments

What is Hair Loss?

Hair loss, also called alopecia, is a condition where people lose hair from their scalp or body. It can be a gradual thinning over time, or it can happen suddenly in patches. The severity of hair loss can vary greatly, from a small bald spot to complete baldness. It’s important to understand that losing some hair is normal. Shedding 50 to 100 hairs a day is part of the natural hair growth cycle. 

About 10% of the hair on our scalp is in the resting phase, while the other 90% is growing. The 10% that is in a resting phase will stay in that phase for 3 to 4 months, after that point, it will fall off and new hair will begin to grow. Hair Loss occurs when the hair falling out is slowly being replaced by new hair. Anyone at any age can experience hair loss.

Types of Hair Loss

Hair loss, while a common concern, can manifest in various ways depending on the underlying cause. Here’s a breakdown of some common types of hair loss:

• Androgenetic Alopecia: This is the most prevalent type, affecting both men and women with a genetic predisposition. In men, it’s known as male pattern baldness, presenting with a receding hairline and a balding crown. Women experience a more diffuse thinning across the scalp.
• Telogen Effluvium: This temporary hair loss is triggered by a disruption in the hair growth cycle. Stress, illness, childbirth, significant weight loss, or dietary deficiencies can all cause telogen effluvium. Hair loss typically occurs weeks or months after the triggering event and usually resolves on its own within a few months.
• Alopecia Areata: This autoimmune disease causes the immune system to attack hair follicles, resulting in sudden, patchy baldness on the scalp or beard. It can affect people of all ages, and sometimes even eyebrows and eyelashes are involved. There’s no known cure for alopecia areata, but treatments can help stimulate hair growth.
• Anagen Effluvium: This rapid hair loss is a side effect of certain medical treatments, particularly chemotherapy for cancer. Chemotherapy drugs target rapidly dividing cells, and unfortunately, hair follicles are also fast-growing cells. This leads to a quick and often significant shedding of hair. The good news is that hair usually regrows once the treatment is complete.
• Traction Alopecia: This type of hair loss is caused by hairstyles that put excessive tension on the hair follicles. Tight braids, cornrows, ponytails, or rollers worn for extended periods can lead to traction alopecia. In severe cases, permanent scarring of the scalp can occur.
• Tinea Capitis: This is a fungal infection of the scalp, also known as ringworm. It causes itchy, scaly patches on the scalp and hair loss. Tinea capitis is contagious and requires treatment with antifungal medication.

Genetic Links to Hair Loss

Genetics play a significant role in determining your susceptibility to hair loss, particularly for the most common type known as androgenetic alopecia. 

Androgenetic alopecia is passed down through families. You inherit genes from both parents that influence how sensitive your scalp is to a hormone called dihydrotestosterone (DHT). DHT is a byproduct of testosterone and shrinks hair follicles over time, leading to shorter hair growth phases and ultimately finer, thinner hair.

While the exact mechanism is still being unraveled, androgenetic alopecia isn’t caused by a single gene. Researchers believe a combination of genes is responsible, and variations in these genes determine your individual risk and the specific pattern of hair loss.

While genes from both parents influence androgenetic alopecia, the “X” chromosome plays a particularly important role. Men inherit one X chromosome from their mother and one Y chromosome from their father. Women have two X chromosomes, one from each parent. Certain variations on the X chromosome, particularly from the mother’s side, can increase sensitivity to DHT and make men more prone to male pattern baldness. However, it’s important to remember that genes on other chromosomes also contribute, and women can inherit androgenetic alopecia as well.

Having a family history of hair loss increases your risk, but it doesn’t guarantee you’ll experience it. Environmental factors, lifestyle choices, and even other genes can all influence whether or not you develop androgenetic alopecia.

Hormonal Fluctuations and Hair Loss

Hormonal fluctuations throughout a woman’s life can significantly impact hair growth and contribute to hair loss. During pregnancy, a surge in estrogen and progesterone levels promotes hair growth, leading to thicker, fuller hair for many women. However, after childbirth, these hormone levels drop dramatically, which can trigger a temporary form of hair loss called telogen effluvium. This typically occurs several weeks to months postpartum and usually resolves on its own within a few months.

As women transition into menopause, their estrogen and progesterone levels plummet. This hormonal shift disrupts the hair growth cycle, causing hair follicles to enter the resting phase prematurely and shortening the growth phase. Consequently, hair becomes thinner and sheds more easily, leading to overall hair loss. It’s important to note that not all women experience significant hair loss during menopause, and the severity can vary depending on individual hormonal changes.

This hormonal disorder affects how the ovaries function, leading to an imbalance of estrogen, progesterone, and androgen levels. Increased androgen levels, particularly testosterone, can contribute to hair loss in women with PCOS. The mechanism is similar to androgenetic alopecia in men, where DHT shrinks hair follicles and shortens the growth phase. Hair loss in PCOS can manifest as a receding hairline or general thinning on the scalp.

Medical Conditions and Their Link to Hair Loss

Hair loss can be a symptom of various medical conditions. Here are some examples and why addressing the underlying issue is crucial:

• Autoimmune Diseases: Conditions like alopecia areata, lupus, and thyroid disorders can trigger hair loss by attacking hair follicles or disrupting the hair growth cycle. In these cases, treating the autoimmune disease itself is essential for preventing further hair loss and potentially promoting hair regrowth.
• Scalp Infections: Fungal infections like ringworm and bacterial infections can cause itchy, inflamed patches on the scalp, leading to hair loss in those areas. Addressing the infection with antifungal or antibiotic medications is necessary to clear the infection and prevent permanent scarring that could hinder hair regrowth.
• Nutrient Deficiencies: Deficiencies in iron, vitamin D, biotin, or zinc can all contribute to hair loss. These deficiencies can disrupt the hair growth cycle or impair the health of hair follicles. Addressing the deficiencies through dietary changes or supplements can often reverse hair loss.
• Trichotillomania: This is a mental health condition characterized by repetitive hair pulling. It can lead to significant bald patches and requires treatment for the underlying psychological cause to stop the hair pulling behavior and allow for hair regrowth.

Medications and Hair Loss

Many medications and medical treatments can have hair loss as a potential side effect. Here’s a breakdown of some common categories and how they might contribute to hair shedding:

Chemotherapy Drugs target rapidly dividing cells to kill cancer cells. Unfortunately, hair follicles are also fast-growing cells, and chemotherapy can damage them, leading to a rapid and often significant shedding of hair. This hair loss is usually temporary, and hair typically regrows once treatment is complete.

Anticoagulants (Blood Thinners) like warfarin can cause hair loss in some people. The exact mechanism isn’t fully understood, but it’s theorized to be related to reduced blood flow to the scalp or interference with nutrient delivery to hair follicles.

Certain antidepressants, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), can sometimes cause hair loss as a side effect. The reason for this isn’t entirely clear, but it might be related to how these medications affect hormone levels or blood flow.

Retinoids, derived from vitamin A, are used to treat acne and other skin conditions. Isotretinoin (Accutane) is a particularly potent retinoid known to cause hair loss as a side effect. Retinoids can affect the hair growth cycle by shortening the growth phase and pushing follicles into a resting phase prematurely, leading to shedding.

Beta-Blockers are commonly used for high blood pressure and heart problems. While not as common as other side effects, some people experience hair loss while taking beta-blockers. The mechanism is not fully understood, but it may be related to reduced blood flow to the scalp or hormonal changes.

Anabolic Steroids are performance-enhancing drugs that can cause hair loss in both men and women. They work by mimicking testosterone, which can stimulate hair growth in men but also contribute to male pattern baldness. In women, the increase in testosterone-like effects can lead to hair loss patterns similar to those seen in men.

The Impact of Stress and Lifestyle Choices on Hair Loss

Stress can contribute to temporary hair loss by disrupting the natural hair growth cycle. Here’s how it works:

• The Hair Growth Cycle: Hair follicles go through three distinct phases: growth (anagen), transition (catagen), and resting (telogen). The anagen phase, which determines hair length, typically lasts for years in healthy individuals. Stress can push hair follicles prematurely into the telogen phase, shortening the growth phase and leading to increased shedding.
• Stress Hormones: When the body experiences chronic stress, it releases hormones like cortisol. Elevated cortisol levels can disrupt the delicate balance of hormones involved in hair growth, further contributing to hair loss. Additionally, cortisol can reduce blood flow to the scalp, potentially limiting the delivery of essential nutrients to hair follicles.
• Immune System: Chronic stress can also weaken the immune system. A compromised immune system may struggle to fight off scalp infections or inflammatory conditions that can contribute to hair loss.

Other Lifestyle Factors Affecting Hair Health:

• Diet and Nutrition: Hair follicles require a steady supply of nutrients to function properly and produce healthy hair. Deficiencies in iron, vitamin D, biotin, or zinc can all negatively impact hair growth and lead to thinning or shedding. A balanced diet rich in protein, essential vitamins, and minerals is crucial for maintaining healthy hair.
• Sleep: Adequate sleep is essential for overall health, including hair health. During sleep, the body repairs and regenerates tissues, including hair follicles. Chronic sleep deprivation can disrupt this process and contribute to hair loss.
• Smoking: Smoking restricts blood flow throughout the body, including the scalp. This reduced blood flow can limit the delivery of oxygen and nutrients to hair follicles, hindering hair growth and promoting hair loss.
• Excessive Hair Styling: Frequent use of harsh styling tools like hot irons, curling irons, or tight hairstyles can damage hair, leading to breakage and hair loss.

Hair Care Practices and Their Link to Hair Loss

Several hair care practices can weaken the hair shaft and increase the risk of breakage and hair loss. 

Blow dryers, straighteners, curling irons, and other heated tools can damage the hair shaft by breaking down the keratin, a protein that gives hair its strength and structure. This  leads to dry, brittle hair that’s prone to breakage.

Chemical treatments like bleaching, perming, and harsh coloring can strip away the hair’s natural oils and protective layer. This leaves hair weak, vulnerable, and more susceptible to breakage.

Hairstyles that pull the hair back tightly, like ponytails, buns, or cornrows, can put a strain on the hair follicles, especially at the hairline. Over time, this constant tension can lead to breakage and even traction alopecia, a form of hair loss caused by pulling stress.

Brushing or combing too harshly, especially when hair is wet and more vulnerable, can damage the hair cuticle (outermost layer) and cause breakage. Detangling gently with a wide-tooth comb when hair is wet and using a leave-in conditioner can help minimize this risk.

How is Hair Loss Diagnosed?

Diagnosing hair loss involves a two-pronged approach: a consultation with a doctor or dermatologist and potentially some in-office tests. 

Consultation:

• Medical History: The doctor will ask detailed questions about your medical history, including any recent illnesses, medications you’re taking, and family history of hair loss.
• Hair Loss Pattern: They’ll closely examine your scalp to assess the pattern of hair loss (gradual thinning, receding hairline, patchy loss).
• Hair Shedding: They might gently tug on some hairs to see if an excessive number falls out (pull test).

Tests (if needed):

• Blood Tests: These can check for underlying conditions like thyroid problems, iron deficiency, or hormonal imbalances that might be contributing to hair loss.
• Scalp Biopsy: In rare cases, a small sample of scalp tissue might be extracted and examined under a microscope to rule out specific causes like fungal infections or scarring alopecia.
• Trichoscopy: This non-invasive test uses a special magnifying device called a trichoscope to examine the hair follicles and scalp in detail.

Hair Loss Treatment

Hair loss treatment depends on the underlying cause. If your hair loss is due to an identified medical condition like thyroid issues, iron deficiency, or hormonal imbalances, treating the underlying cause is often the first step. Once the condition is under control, hair loss may slow down or stop altogether.

For Androgenetic alopecia (male/female pattern baldness), which is the most common cause of hair loss, medications like Minoxidil (Rogaine) and Finasteride (Propecia) are often prescribed. Minoxidil is a topical medication that can stimulate hair growth, while Finasteride is an oral medication for men that works by blocking a hormone that contributes to hair loss (not suitable for women).

For individuals with significant hair loss, hair transplantation surgery might be an option. In this procedure, hair follicles are extracted from a donor area on the scalp and transplanted to bald or thinning areas. Another possible solution is Low-level laser therapy (LLLT) involving using lasers to irradiate the scalp. While the exact mechanism isn’t fully understood, some studies suggest it may promote hair growth.

Maintaining a healthy lifestyle with a balanced diet rich in essential nutrients, managing stress, and getting enough sleep can all contribute to a healthy scalp environment and potentially slow hair loss. For some people, wigs and hairpieces can offer a cosmetic solution to hair loss.

What Medications are Most Often Prescribed for Hair Loss

For treating Androgenetic alopecia, the most common cause of hair loss, there are two main medications a doctor might prescribe:

• Minoxidil (Rogaine): This is a topical medication that comes in liquid, foam, or shampoo form. You apply it directly to your scalp twice a day. Minoxidil helps stimulate hair growth and may slow down hair loss. It’s important to note that results can take several months to become noticeable and consistent use is required to maintain benefits.
• Finasteride (Propecia): This is an oral medication available only by prescription. It’s specifically for men and works by blocking a hormone that contributes to hair loss. Finasteride can slow hair loss and promote some hair growth, but it’s not effective for everyone and may have side effects like decreased libido or erectile dysfunction.