Hair loss afflicts millions of people—and not just men, although their hair loss is often the most noticeable. Most women, too, experience some degree of hair loss as they grow older.
Hair is not living tissue like the skin but is composed of a protein called keratin, which is also the building block of fingernails and toenails. Each hair grows from a root enclosed by a follicle, a small pocket in the skin, that is nourished by blood vessels. Hair grows according to a genetic program (hormones are also involved), about half an inch a month; each hair grows for two to six years.
Part of your hair is growing and part resting at any given moment. After the rest period, the hair falls out. It’s normal to lose from 50 to 100 hairs a day (not many out of 100,000 in the average youthful head). When a hair falls out, a new one presumably grows in, but the catch comes when it doesn’t—when more falls out than grows back in.
Genetic baldness is caused by the body’s failure to produce new hairs. Nearly two-thirds of men develop some form of balding, and at least two-thirds of women have some form of hair thinning.
By far the most common form of hair loss is androgenetic alopecia, usually called male and female pattern baldness. (Alopecia is the medical term for hair loss.) About 35 million American men have male pattern baldness, the receding hairline that eventually turns into a bald pate (sometimes with very fine thin hairs replacing the original growth).
By age 50 half of all men of European origin will experience this kind of hair loss, which can begin as early as age 20. Some other genetic groups—Asians, some Africans and African Americans, and Native Americans—seldom or never get bald in this manner. Though the exact process that shuts down the hair follicles has yet to be explained, the male hormone testosterone plays a role.
Female pattern baldness usually begins at about age 30, becomes noticeable around age 40, and may be even more noticeable after menopause. The pattern of female hair loss is usually an overall thinning—two hairs where five used to be—rather than a bald area on top of the head, though women may have a receding hairline, too. It’s thought that about 20 million American women have such hair loss. As in males, hair follicles simply shut down, with hormones playing some role in the process.
Not all hair loss is normal. Sudden hair loss can indicate a medical problem, so you should see a physician.
Symptoms of Hair Loss
- In men: Receding hairline and progressively widening bald spot on the crown of the head (male pattern baldness).
- In women: Overall hair thinning.
- Sudden hair loss in sharply defined circular patches (a much rarer condition called alopecia areata).
What Causes Hair Loss?
Hereditary pattern baldness is determined by our genes and hormones. Sudden, dramatic hair loss, however, can have many causes. In women, contributing factors can be the hormonal changes of pregnancy and its aftermath. In both men and women, severe emotional stress, fad diets if pursued to the point of malnutrition, thyroid disorders, anemia, and various drugs and medications (particularly chemotherapy for cancer) can cause hair loss. Large doses of vitamin A may also cause the problem.
Hair loss caused by constantly wearing tight-fitting wigs or hats is called friction alopecia. Traction alopecia is hair loss caused by pulling hair too tight in ponytails or braids, so that it falls out. In most cases hair begins to grow again once the underlying problem is corrected or corrects itself.
More serious is alopecia areata ("area baldness"), which causes loss of hair in patches and is thought to be an autoimmune disorder. It can proceed to complete hair loss and affects about 2.5 million people in the United States. This condition can sometimes be treated successfully, and anyone who suffers from it should see a dermatologist. In many cases, it simply goes away by itself and new hair grows back in.
Drugs to Treat Baldness
Many products promoted as hair-loss remedies don't work. These range from wheat germ oil and lanolin to vitamin supplements to scalp massage (sometimes along with electrical stimulation). Two medications may offer some help for baldness, though they are far from perfect.
Minoxidil is available over the counter, this medication (brand name: Rogaine) seems to stimulate hair growth in men suffering from male balding; it’s also often effective for women with thinning hair. How the medication works is still not clear. It was originally developed as an oral drug to treat high blood pressure (it dilates blood vessels), and one unexpected side effect was that it stimulated hair growth. Then it was shown to promote new hair growth when applied to the skin.
It is available in two formulations, 2 percent for women and 5 percent for men. The 2 percent will promote hair growth in about 25 percent of men and 20 percent of women—and is the only formulation approved for women. There is disagreement about whether the 5 percent is actually more effective; it may also increase the incidence of side effects. Minoxidil does have definite limits:
- It affects only the crown of the head, just one of the trouble spots in hereditary male pattern baldness. A receding hairline or baldness at the temples is rarely restored.
- New hair is usually thinner and lighter, like baby hair; only a relative handful of men will show what the drug's manufacturer has optimistically termed "dense" new hair growth. And many men who try minoxidil will not experience any significant hair growth.
- Side effects may include unwanted hair growth on the face, especially in women. Dizziness and increased heart rate have also been reported, along with skin irritation, especially on the scalp. But the drug does not appear to affect blood pressure or produce other serious side effects. However, it should not be used by pregnant women.
- Minoxidil means lifetime commitment—at a cost of just under one dollar a day. Any new hair may vanish if you discontinue treatment, and the drug has not been shown to inhibit hair loss.
Marketed under the name Propecia for treating male-pattern baldness, finasteride is actually the same drug used in higher doses (and called Proscar) to treat an enlarged prostate (benign prostatic hyperplasia). Available only by prescription, Propecia works by blocking the hormone that shrinks hair follicles.
It is not effective for men over age 60 or for those who are completely bald. It does promote hair growth, and slow hair loss, in younger men who are just beginning to lose hair. In one study, 60 percent of men showed new hair growth and more than 80 percent showed slowing of hair loss.
But keep in mind these drawbacks:
- Propecia or Finasteride may lower levels of PSA, a protein measured to detect prostate cancer, and so can distort test results, making it more difficult to detect prostate cancer or other prostate disorders. If you are using Propecia and about to have a PSA test, be sure to tell your doctor.
- It's not recommended for men with liver problems. It is also not approved for use by women, since it can cause birth defects and, in studies, has not restored hair on postmenopausal women.
- Reported side effects include reduced sexual drive and function (but these are rare).
- Like minoxidil, Propecia must be taken every day to sustain its benefit—at a cost of about $50 a month.
- No one has any idea of Propecia’s long-term side effects. This is disquieting, given that the prime candidates are young men who could be taking the drug for many years.
What If You Do Nothing?
It’s impossible to prevent male and female pattern baldness, and in most people the baldness will almost always become more noticeable as they age. For hair loss caused by illness, medication, radiation therapy, or hormonal fluctuations, hair will usually grow back when the condition or treatment has ended.
Home Remedies for Hair Loss
You can find hundreds of hair-loss remedies offered on the Internet and in drug and health food stores. But if your hair loss is male or female pattern baldness, there aren't any nonmedical approaches that will halt hair loss or restore your hair. At the same time, there are hair-care practices and cosmetic remedies that can help you protect the hair you have and make the most of your appearance.
- Choose your shampoos wisely. Avoid alkaline pH shampoos. Use baby shampoo, and shampoo no more than once a day. "Revitalizing" shampoos or multi-product shampoo "systems" that promise to restore hair will not grow your hair back.
- Dry your hair with care. Avoid excessive toweling. If you use a hair dryer, keep it on a low setting.
- Comb tenderly. Always handle your hair gently, particularly if it is thinning. Combing is less injurious to hair than brushing.
- Don’t overbrush. If you must brush, do so when your hair is dry. Grandmother’s hundred strokes a day was'’t great advice, particularly if your hair is thinning. Be sure to disentangle the hair from the brush. Avoid hairbrushes and combs that pull your hair. Use either a natural bristle brush or a nylon brush with rounded edges.
- Protect your hair. Avoid bleaching, hot combs, excessive sun exposure, permanent waving, and straightening.
- Resort to camouflage. Especially for women, a short haircut and hair cosmetics such as sprays, gels, and mousses can hide thinning. Hair dyes can minimize the visual and psychological effects of hair loss. Permanent dyes, of course, can dry out the hair shaft if they are used over long periods, but they won’t injure the root or promote additional hair loss. Whether using a dye at home or going to a salon, don’t skip the patch test for possible allergic reactions. At home, follow package directions carefully.
- Try cosmetic trickery. Buy a powdered eye shadow the color of your hair and apply it lightly to your scalp in the thin spots. It’s harmless and may make thinning hair less noticeable.
- Be skeptical of products that promise hair growth. Products containing lanolin, vitamins, or ingredients such as wheat germ are harmless when applied to the head, but they won’t make hair grow or prevent it from falling out. Nor is there evidence to support any herbal products for hair growth. Products with large amounts of estrogen might stimulate hair growth (though the evidence for this is poor); unfortunately, there are almost always unpleasant side effects.
Certain surgical techniques for hair replacement provide varying degrees of hope for some people—though at considerable expense and with sometimes less than satisfactory results.
Also called "hair intensification" or "hair integration," hair weaving means adding to thin hair by weaving or braiding wefts of human hair or synthetic fibers into existing hair. Apart from the expense (anywhere from $50 to $2,500), this poses two problems: first, it may be difficult to keep your hair and scalp clean; second, it stresses existing hair and may cause it to fall out.
The American Hair Loss Council advises that only people with plenty of healthy hair should consider hair weaving—and even these people should plan to keep the "intensified" hair for only a few weeks.
Hair implantation, or grafting, is a form of cosmetic surgery in which patches of skin with healthy hair follicles are transplanted into balding or bald areas. Usually, patches are taken from the back of the scalp and moved to the top of the head. The transplanted hairs always fall out, but new ones grow back in a few weeks.
Another method is called scalp reduction—that is, the bald patch is partly excised and the areas of the scalp that still have hair are pulled closer together. Surgery works best to correct male pattern baldness rather than the overall thinning of hair that most women experience.
Hair transplants are better than they used to be. Doctors can use micrografts instead of transplanting larger patches of hair, and they can place them in small incisions, feathering the hairline so that it looks like natural hair. There is also less risk of scarring using this technique. It is still a long, laborious, and expensive procedure requiring a series of office visits, sometimes at long intervals. Transplantation is not covered by most medical insurance, and the cost can easily run up to $10,000.
Unsatisfactory results are no longer as likely as they once were, but they are a real risk: a "doll's hair" look, scarring, and patches of thin transplanted hair over scalp sections that continue to grow bald. If you decide to go this route, choose a surgeon with care, and beware of seductive brochures showing "after" photos of men with thick, wavy hair. Ask to see some real clients. Also, confirm the doctor's credentials. Check with the department of plastic surgery at a nearby university medical school.
It's impossible to prevent male and female pattern baldness. However, a healthy and well-balanced diet may help prevent hair loss. Consume generous amounts of nuts, grains, seeds, vegetable oils, honey, vegetables and fruits augmented by milk, liver, yeast and wheat germ. Proper hygiene especially on the scalp should also be observed.
Beyond Home Remedies: When To Call Your Doctor
Any sudden hair loss is a reason to consult your physician, who after an examination may refer you to a dermatologist.
What Your Doctor Will Do
Your doctor will take a careful history, along with hair and scalp samples, if necessary, to identify the nature of the problem. Certain medications are associated with hair loss as a side effect, and if you are taking one of these, your doctor will try to find an alternative. If a scalp infection is the cause, specific treatment will be started. If alopecia areata—an autoimmune disorder that causes the immune system to destroy hair follicles—is suspected, therapy will be initiated with topical steroids.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media