Understanding Hair Loss
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Understanding Hair Loss

For centuries, women's hair has been romanticized in folktales, legends, literature, and real life. Why, if not for her hair, Rapunzel would still be in that dank tower and Lady Godiva would have ended up in the jail for indecent exposure.

But, when it comes to hair, real life is no fairytale. According to Dr. Nia Terezakis, Clinical Professor of Dermatology at both Tulane and Louisiana State University, at least 20%-30% of women will experience some type of hair loss during their lifetimes. This is statistically on a par with men.

Hereditary Thinning

The most common form of hair loss in women, she says, is hereditary thinning. Hereditary thinning, which occurs in all races, can be inherited from either the mother's or father's side of the family, or both. It begins at the onset of puberty, but several years can pass before the thinning becomes noticeable, so a woman who begins thinning at puberty may not even realize she's thinning until she's in her late teens or even her 20s. In fact, says Terezakis, a woman has to lose about one half of her hair volume before it becomes noticeable. The rate at which the hair loss occurs varies between women.

Hereditary thinning occurs in totally normal, healthy women. Women with this type of hair loss retain their hairlines and thin diffusely, usually on the top of their heads. They may notice that their parts are wider on the top than on the sides.

A normal adult scalp sheds approximately 100 hairs per day. A woman with hereditary thinning will find that, although her hair is thinning, she's not shedding more than normal. This type of hair loss is treatable with twice-daily applications of minoxidil (Rogaine). Such treatments should be discontinued if a woman becomes pregnant. Because of hormonal activity, chances are good that little hair loss will occur during pregnancy and treatments may be resumed after the baby is born.

It's not known precisely why Rogaine works, but one theory is that it causes dilation of the blood vessels, which then release growth factors that stimulate hair growth.

Other Causes

While most people are familiar with hair loss resulting from chemotherapy treatments, other medications including certain cardiac medicines and antidepressants have also been reported to cause hair thinning. Some androgen-dominant birth control pills can also be a culprit, and elderly women may experience age-related hair thinning.

Hair loss can also be a sign of an eating disorder. Anorexia, bulimia, and fasting diets pull protein from the muscles, which can then cause diffuse shedding.

Normally, a single hair will grow for 2-10 years and then go into a resting phase, with each hair in a different phase at any given time. However, severe emotional distress can send a lot of the hair into a dormant phase resulting in thinning.

Inappropriate use or abuse of hair cosmetics can also lead to hair loss. Overusing perms or straighteners, wearing tight pigtails, ponytails, or cornrows, and sleeping with sponge rollers in your hair can all result in hair loss.

Alopecia Areata

Alopecia areata is a common disease that causes hair loss on the scalp and other parts of the body. In the severe form of the condition, alopecia universalis, all hair on the entire head and body is lost including eyebrows, eyelashes, and nose hairs. While research is ongoing, it is suspected that alopecia areata is an autoimmune disorder that may be genetic.

The disease usually starts with one or more small, round, smooth patches. Some people who develop only a few patches find their hair regrows within a year, even without treatment, according to the National Alopecia Areata Foundation. For others, treatment may require cortisone pills or cortisone injections into the affected areas, or the application of anthralin cream or ointment, topical minoxidil, or topical immunotherapy.

In extreme cases, wigs and hairpieces can be used to disguise the patches until hair regrowth begins. In any case, in alopecia areata the hair follicles remain alive below the skin surface, holding out the promise of regrowth.

If You Suspect Hair Loss

Signs of hair loss include loss of more than 100-150 hairs per day, every day, so a few hairs coming out when you brush or wash your hair doesn't necessarily mean you are losing your hair. A total change in the texture of your hair can also signal trouble, as can signs that your hair is breaking rather than coming out by the roots.

If you believe you are experiencing hair loss, Terezakis suggests finding a dermatologist who is knowledgeable in hair loss. The National Alopecia Areata Foundation maintains a list of such doctors. Keep in mind that many insurance companies balk at paying for hair loss treatments, claiming them to be cosmetic. Check with your individual insurer.

Lastly, hair loss is not a hopeless situation. "It is really emotionally difficult," Terezakis says, so seek support. But remember, "it's treatable and controllable. A positive approach is very important."


National Alopecia Areata Foundation

National Institute of Arthritis and Musculoskeletal and Skin Diseases


BC Health Guide

Canadian Dermatology Association


Cline, BW. Prevention of chemotherapy-induced alopecia: a review of the literature. Cancer Nurs. 1984; 7:221

Dorr, VJ. A practitioner's guide to cancer-related alopecia. Semin Oncol. 1998; 25:562.

Madani, S, Shapiro, J. Alopecia areata update. J Am Acad Dermatol. 2000; 42:549.

Last reviewed March 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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