Hair Loss

Hair Loss

What probably comes to mind when you think of hair loss, or alopecia, is an older man with a receding hairline and a bald spot on the top of his head. But from male pattern baldness to hair loss caused by autoimmune conditions, vitamin deficiencies, or stress, hair loss comes in many patterns and affect men of all ages.

You might be thinking, “Why is my hair thinning?” or “Why is my hair falling out?” More importantly, you might be wondering if your hair falling out is permanent or if there's something you can do to treat it.

Some forms of hair loss can actually be reversed, and the sooner you start, the better the outcome.

So let’s dive into all things hair loss — its symptoms, causes, treatments, and more.

Symptoms of Hair Loss

Classically, symptoms of hair loss in men include a receding hairline (particularly over the temples, creating a characteristic “M” shape) and signs of balding at the top of the head, referred to as the crown. 

But, as we mentioned, this only represents one of many types of hair loss (more on these below).

Hair loss can be sudden or gradual. In can come in waves or happen in stages. It can be permanent or temporary. In some cases, hair loss might not be a complete loss of hair. Instead, the hairs get thinner, shorter and lighter.

It's not a one-size-fits-all situation, and it comes with many potential signs and symptoms. Some of the common ones include:

• Hair loss on different parts of the head or body

• Thinning hair

• Patchy hair loss

In some cases, hair loss can also include:

• Itching

• Irritation

• Redness

• Scaling

• Oozing

• Pain

• Burning

• Tenderness

If your hair loss is related to a medical condition or vitamin deficiency, you could also experience:

• Skin changes

• Nail changes

• Other symptoms

Lastly, depending on how you feel about your hair loss, you may have symptoms such as:

• Stress

• Distress

• Low self-esteem or confidence

• Depression

Causes of Hair Loss

As you can guess, each type of hair loss has its own causes. 

Broadly speaking, the different types of hair loss can be broken down into two categories: non-scarring alopecia and scarring alopecia (also called cicatricial alopecia).

With non-scarring alopecia, hair follicles are preserved, meaning hair loss is potentially reversible. With scarring alopecia, hair follicles are irreversibly damaged, leading to permanent hair loss.

Non-scarring Alopecias

Of the two, non-scarring alopecia is the more common. Let’s take a look at each common cause of hair loss.

Male Pattern Hair Loss

Male pattern hair loss — also called androgenetic alopecia or androgenic alopecia — is a progressive type of hair loss. It’s mostly influenced by genetics, meaning the genes you get from your parents determine if you develop this type of hair loss. 

In the case of male pattern hair loss, in susceptible men, a hormone called dihydrotestosterone (or DHT), which is a derivative of testosterone, causes hair follicles to undergo a process called follicular miniaturization. 

Follicular miniaturization is what it sounds like — hair follicles get smaller, and the hairs they produce get thinner and lighter. Technically speaking, hairs transform from terminal hairs (the longer, darker hairs like the ones typically found on the scalp) to vellus hairs (the tinier hairs on the rest of the body). 

As the hair follicle shrinks, it also loses attachment to the arrector pili muscles under the skin that help hold it in place.

This whole process takes time. If you start addressing male pattern hair loss early on, hair loss can be delayed or even stopped completely. In some cases, it can even be reversed and you can regrow hair. But if the process is allowed to go on for too long, hair follicles can reach a point of no return.

In women, this form of hereditary hair loss is called female pattern hair loss. 

Telogen Effluvium

Telogen effluvium is a type of hair loss that occurs when hair falls out rapidly. 

It’s caused by stress (such as by experiencing a trauma) or a sudden change to the body, such as being in an accident, getting surgery, weight loss, having a change in your hormones (like during menopause, in women), childbirth, having an illness or starting a new medication. 

This type of hair loss is usually temporary.

Alopecia Areata

Alopecia areata is a type of hair loss that results in patches of complete hair loss. It’s an autoimmune hair loss disease, so it’s caused by the body’s immune system attacking your own hair follicles.

Traction Alopecia

Traction alopecia is a type of hair loss that can occur from certain hairstyles. When hair is pulled too tight repeatedly or for a prolonged period (like in tight braids or ponytails), it can result in areas of hair loss where the hair is being strained. While certain hairstyles can cause traction alopecia, wearing a hat is not considered a cause of hair loss.

Vitamin Deficiency

Some vitamin deficiencies, such as a biotin deficiency and iron deficiency, can lead to hair loss or unhealthy hair.

Trichotillomania

Trichotillomania, also called hair-pulling disorder, is a mental health condition in which a person habitually and compulsively pulls out their own hair. The hair can be pulled directly from the scalp, but can also include other parts of the body including the eyebrows, arms, legs, and elsewhere.

Hair Loss Related to Another Condition

Other medical conditions can cause hair loss, such as psoriasis, syphilis, thyroid disease or a fungal infection like ringworm (tinea capitis). Depending on the medical condition and severity, these may also be scarring alopecias.

Hair Loss Related to a Medication

Hair loss can sometimes be a side effect of medication. If you suspect this is the case, talk to your healthcare provider — don’t stop taking any medication without their guidance. Other medical interventions can also cause hair loss, such as chemotherapy, which is associated with anagen effluvium.

Scarring Alopecias (Cicatricial Alopecias)

There are many different kinds of scarring alopecia. In these cases, hair follicles are damaged by inflammation. Types include but aren’t limited to frontal fibrosing alopecia, lichen planopilaris, discoid lupus erythematosus, folliculitis decalvans, dissecting cellulitis and central centrifugal cicatricial alopecia.

Hair Loss Risk Factors

Just like there are many types of hair loss, there are also many different risk factors.

Chief among them is your genes. Having a history of hair loss on either side of the family — your mother’s or your father’s — can increase your risk of experiencing hair loss.

Other risk factors include:

• Advanced age

• Poor diet

• Having a medical condition that can cause or contribute to hair loss

• Taking a medication that can cause hair loss as a side effect

• Stress

• Certain hairstyles that pull on the hair

• A sudden change, such as something major happening physically or emotionally

When to See a Doctor

According to the American Academy of Dermatology, losing 50 to 100 hairs a day is normal. So, if you’re waking up with just a few hairs on your pillow or you see some hairs stuck in your comb after using it, there usually isn’t cause for concern — this is normal hair shedding. 

However, if you notice a sudden change in how much hair you’re losing, feel like your hairline has changed or your hair feels thinner when you run your hands through it, it can be time to talk to a healthcare provider.

In some cases, you might not be the first person to notice hair falling out. A friend might tell you that the hair at the top of your head looks thinner, or after looking at an old photo of you, a friend might say it looks like your forehead has gotten larger. These can also be signs that your body is changing, and a conversation with a healthcare professional is a good idea.

You should also contact a provider if your symptoms are sudden or if you’re experiencing other symptoms along with your hair loss, like irritation, redness, flaking, skin and nail changes and more.

Diagnosing Hair Loss

To diagnose hair loss, a medical professional will typically start by asking you about your symptoms and taking a medical history. 

They may ask things like:

•  How long you’ve been experiencing hair loss

• If you have hair loss in your family 

• If you recently started taking any new medications or supplements.

Next, a healthcare provider might do a physical exam in which they pay close attention to your hair, skin and nails. 

During this physical exam, they’ll look for signs of what could be causing your hair loss and other skin conditions you might have. There are also specific tests they might do, like the pull test. The pull test involves pulling several hairs at once to see how many come out.

In some cases — like if you have very classic male pattern hair loss — additional testing might not be necessary. 

In others, your healthcare provider may run additional tests — like a scalp biopsy, blood tests or microscopic hair exams — to help figure out what might be causing your hair loss. 

Hair Loss Treatment

The specific medical treatment for your hair loss will depend on the type of hair loss you have. 

For many, medication is the right approach for treating hair loss. And there are lots of treatment options to choose from. The two most common medications used for treating male pattern hair loss in men are finasteride and minoxidil. They can be used separately or together. So let’s take a closer look at each of these.

Finasteride

Finasteride is a type of prescription medication known as a 5-alpha-reductase inhibitor. Remember DHT, the hormone that can lead to follicular miniaturization and male pattern hair loss? Well, 5-alpha reductase inhibitors like finasteride prevent the conversion of testosterone to DHT.

Finasteride is available as a generic medication or as the brand name Propecia®, which is FDA-approved to treat male pattern hair loss. It’s also available in a higher dose as a generic and as the brand name Proscar®. 

Proscar is FDA-approved to treat the symptoms of benign prostatic hyperplasia (BPH), which is an enlarged prostate. 

There’s another 5-alpha-reductase inhibitor called dutasteride that’s also FDA-approved to treat the symptoms of BPH, but is sometimes used off-label to treat hair loss in men.

Propecia, or generic finasteride, is a pill intended to be taken daily. It is also sometimes found in compounded medications — alone or combined with other active ingredients — and in a topical form that can be applied directly to the scalp. 

Some men may prefer this form of finasteride because it reduces the risk of experiencing unwanted finasteride side effects, such as sexual side effects (including decreased libido and erectile dysfunction).

Minoxidil

Minoxidil is the active ingredient found in the brand name Rogaine®. It is a topical medication that is available over the counter, and it comes in different strengths — 2% and 5% — and in various forms — as a topical solution or foam. 

Researchers aren’t entirely sure of how minoxidil works, but it’s thought that it increases blood flow to hair follicles and could prolong the anagen phase (growth phase of the hair growth cycle) of a hair.

Recently, there has also been a lot of buzz about oral minoxidil. Oral minoxidil is an FDA-approved blood pressure medication, but research shows it can effectively be used off-label to treat hair loss.

Like all medications, both finasteride and minoxidil can cause side effects. They also aren’t appropriate for everyone and could interact with other medications you’re taking. Keep your healthcare provider up to date with all of your medications and medical conditions.

Other Hair Loss Treatments

While finasteride and minoxidil are the most common medications used for hair loss and the only ones specifically FDA-approved for male pattern hair loss, other interventions can also be effective. The exact treatment depends on the type of hair loss you are experiencing — some of these treatments can be effective for male pattern hair loss, while others are better for other hair loss types. 

• Ketoconazole, an antifungal medication, has some activity against 5-alpha-reductase (similar to how finasteride works). 

• Spironolactone, another blood pressure medication, can be used to treat hair loss in women because of its effects on hormones.

• Low-level laser therapy (LLLT) uses a laser, typically over several treatment sessions, to stimulate hair growth.

• Platelet-rich plasma (PRP) involves injections of your own blood components to prevent hair loss and promote new growth. 

• Other injections, such as corticosteroids, can be given as a potential treatment. 

• Supplements like biotin ( vitamin B7), vitamin E, saw palmetto and more. Research on the efficacy of supplements for hair loss is generally weak or mixed, so we still need to learn more before these can be considered hair loss “treatments.”

In general, medications and treatments to treat hair loss and promote hair growth can take time to work — typically several months. In some cases, it can also appear that things are getting worse before they get better.

And if all of this doesn’t work for you, surgery can be an option, too. Different types of hair transplantation surgery include follicular unit transplantation (FUT) and follicular unit extraction (FUE). To learn more about whether hair transplant surgery is right for you, talk to a healthcare provider.

Lastly, let’s not forget about hair tattoos, wigs and toupees. Is it your natural hair? No. But can it be just as stylish? Yes!

Hair Loss Prevention Tips

Hair loss is a BIG topic. It affects many people. There are many different types. There are many different causes. There are many different treatments. It seems like it would be easiest just to avoid hair loss in the first place. So, is that possible? Can you prevent hair loss?

Unfortunately, preventing hair loss altogether just isn’t in the cards for some people. Nearly everyone’s hair will thin with age and, for a large part of the population, genetics determines what you get to keep on your head.

But that doesn’t mean there isn’t anything you can do. If you’re concerned about hair loss, try to:

• Eat a healthy, balanced diet

• Manage stress

• Use hair care products that aren’t damaging to your hair and scalp

• Avoid hairstyles that tightly pull on your hair

• Cut back on unhealthy habits, like smoking

• Treat other health conditions you might have

And if you notice your hair is falling out and want to do something about it, schedule an appointment with a healthcare provider. For some kinds of hair loss, the sooner you intervene, the better — and you could not only prevent further hair loss but potentially even regrow some new hair.

You can go to your primary care provider or a dermatologist, or you can connect with a healthcare provider online from the comfort of your own home and start addressing hair loss today.

When it’s that easy, why wait? A fuller head of hair — if you want it — might be just around the corner.