I wanted to talk to people about something that can be a difficult topic to bring up: hair loss, both for men and women. The medical term is alopecia, but most people just think it is a nightmare. There are a bunch of treatments out there, some are appropriate for you, and some may not be. The key is having a good relationship with your barber/stylist/significant other/friends so that they will be open with you if they see some thinning (the back of the head can be impossible to see on your own, unless to are snapping pics all the time!) Then making the decision wether you want to just let it ride and grow old gracefully, or make the decision to treat and having the knowledge of the treatments available, (which I will be giving you). Finally, having an open relationship with your HCP to bring up the issue and talk about treatments and what might work best with your lifestyle and hair loss diagnosis will help you to get the right treatment for you…be it medication, surgery, a hair piece, or a nice hat!
What is the definition of baldness/balding?
It is an excessive hair loss from your scalp due to either a medical condition, genetics, or medications and it can be present in anyone: men, women, children!! There is permanent hair loss (fe/male pattern baldness, scarring baldness after burns) and temporary hair loss (from medications, stress, vitamin deficiency).
How does hair grow?
Based on hormonal changes, damage or irritation (over processing with colors, sun damage, scars/trauma, etc) to the hair shaft, some areas of your head may have hair with shorter growth periods, or it will only grow to a shortened length. Your scalp hair goes through a period of growth called anagen, where the hair grows about 1/2 inch (1cm) per month for about 2-3 years, then the hair will stay dormant, a phase known as telogen, for 3 to 4 months, then it will fall out and the process restarts. The average person looses 50-100 hairs per day and has a total of 100,000 hair shafts on their head, so it is barely noticeable, but people with darker hair tend to see theirs more, and I think it leads to more unnecessary freak outs! But gradual thinning of the hair is part of the aging process, the problem arises when the telegen phase is more common than the anagen phase and you lose more hair than is growing at any given time.
What causes hair loss?
Pattern Baldness (androgenetic alopecia): occurs in both men and women, in which the growth time of hair shortens and the hairs are not as thick and not as deeply rooted, so they fall out easier. Heredity and genetics plays a major role, and determines the age and rate that you lose your hair and the speed at which it falls out.
Cicatrical (scarring) alopecia: occurs when inflammation causes damages and scars the hair follicle and doesn’t allow new hair to grow. I can be caused by different disease processes such as lupus.
Alopecia Areata: an autoimmune disease in which the disease is not well understood. It is a disease in which you may lose all your hair and then it grows back completely, this may happen a few times throughout your life. It usually occurs in otherwise healthy people, and some HCP’s believe that it may be related to environmental changes or hormonal changes.
Telogen Effluvium: A sudden change in your hair growth cycle, usually due to either a physical or emotional shock. Hair roots are pushed prematurely into the resting state, then fall out. Within a month or two, the growth process starts all over normally again. It usually occurs after a death of someone close, excessive weight loss, high fevers, extreme diets, nutritional deficiencies, or surgery. Once the issue is corrected or after a period of time and shock wears off, the hair re-grows.
Traction Alopecia: From excessive hairstyling that pulls the hair back or down, it can cause damage and scarring to the roots, then the hair is unable to grow back.
Nutritional deficits (low iron, protein, fad diets/crash diets, etc)
Medications (drugs for arthritis, depression, heart disease, blood pressure, and birth control)
Disease (diabetes, lupus, psoriasis)
Medical treatments (chemo, radiation)
Hormonal changes (pregnancy, childbirth, stress, menopause, thyroid issues)
Hair treatments (overprocessing with dyeing hair, straightening, perms)
Scalp infections (ringworm- a fungal infection)
Trichotillomania ( a mental disorder in which people have an irresistible urge to pull out their hair, can be eyebrows/head hair/etc, and the excessive pulling causes patchy areas without hair and over time can lead to scarring)
How will my HCP test me?
Your HCP will ask for a full medical history and ask about any lifestyle or emotional changes recently, about any diet changes, and will do a physical exam. They may pull out a few hairs to inspect the root and hair shaft itself, inspect the scalp, they may do a biopsy of the skin, and they may draw some blood to test for thyroid disease, etc.
What are treatment options?
I just want to let you know that most types of baldness can never be cured, but treatments can help.
Minoxidil (Rogaine): treatment for androgenetic alopecia and alopecia areata and it comes in 2% and 5% forms right over the counter in foam or liquid form to rub into your scalp. It can either regrow hair with hair thinner than your baseline OR just slow/stop hair from falling out (person dependent). It can take new hair 12 weeks of use to start growing, so be patient with it, but as soon as you stop using the product, the hair will fall back out. The only side effect is that your scalp can become irritated from use, so it may not be worth it if you don’t have much response.
Finasteride (Propecia): is a prescription pill to treat male pattern baldness, and needs to be taken daily to allow for a slowing of hair loss and a possible hair regrowth. It stops the conversion of testosterone to dihydotestosterone (DHT) which shrinks hair follicles, due to this though, it can decrease sex drive. It CANNOT BE USED BY WOMEN! Pregnant women cannot even touch this medication because it causes severe birth defects in male fetuses.
Corticosteroids: injections in the scalp can help with alopecia areata. And new hair grows within 4 weeks of starting the injections, which occur monthly. There are creams and ointments as well but they are not as effective.
Anthralin (Dritho-scalp): A cream or ointment that is a tar like substance that you put on and wash off daily that is used to treat psoriasis but it can stimulate hair growth and new hair can be seen in 12 weeks. It is a prescribed treatment.
Using your existing hair to cover areas that are missing hair.
Hair transplant little grafts of skin containing hair are taken from an area with larger amounts of hair and implanted in an area with less hair. Several transplantations are usually required to get the desired results due to continued hair loss (not of transplanted hair but of your baseline hair).
Scalp Reduction The name is just as it seems, the skin on your head is more pliable and stretchy than it seems, and stretching it out to remove areas of baldness makes the appearance of more hair. They can also create “flaps” and fold an area of skin bearing skin over an area of bald skin. This technique can be combined with hair transplantation to create the ultimate coiffe!!
Of course, there is always the option of wigs and hair pieces that can can be worn over your scalp and cover up, naturally looking, the areas of balding. And, there are tons of hair pieces that aren’t the toupees of the 70’s where nothing matches or blends it, it gets pretty high tech and some aren’t even noticeable, but they can be pricey!!
How can I prevent hair loss?
Eat a well balanced diet
Try to cope with stress in an appropriate way (talk to your HCP about support groups or therapy)
Avoid tight hairstyles and over-processing
Don’t pull at your hair or if you notice you do, talk to your HCP
Talk to your HCP early about hair loss of it is a concern and you are genetically predisposed
There are tons of options these days to treat hair loss for men and women. As a woman, I can totally understand wanting to treat balding in any way, but I don’t think always have to treat it, what’s wrong with a nice bald head? I say nothing. Maybe that is sexist of me, but I don’t think that there is anything to be embarrassed about! I hope this gives you all some insight into how balding occurs and ways to prevent and treat, and also clears up some rumors about treatments and gives you the ability to talk to your HCP about options!
Yours in Good Health