Hair loss can affect just your scalp or your entire body. It can be the result of heredity, hormonal changes, medical conditions or medications. Anyone can experience hair loss, but it's more common in men.
Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some people prefer to let their hair loss run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the treatments available to prevent further hair loss and to restore growth.
Before pursuing hair loss treatment, talk with your doctor about the cause of your hair loss and treatment options.
Hair loss can appear in many different ways, depending on what's causing it. It can come on suddenly or gradually and affect just your scalp or your whole body. Some types of hair loss are temporary, and others are permanent.
Signs and symptoms of hair loss may include:
- Gradual thinning on top of head. This is the most common type of hair loss, affecting both men and women as they age. In men, hair often begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair.
- Circular or patchy bald spots. Some people experience smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out.
- Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
- Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
- Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.
When to see a doctor
See your doctor if your child or you are distressed by hair loss and want to pursue treatment. Also talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your or your child's hair. Sudden hair loss can signal an underlying medical condition that requires treatment.
People typically lose about 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.
Hair loss is typically related to one or more of the following factors:
- Family history (heredity). The most common cause of hair loss is a hereditary condition called male-pattern baldness or female-pattern baldness. It usually occurs gradually with aging and in predictable patterns — a receding hairline and bald spots in men and thinning hair in women.
- Hormonal changes and medical conditions. A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems. Medical conditions include alopecia areata (al-o-PEE-she-uh ar-e-A-tuh), which causes patchy hair loss, scalp infections such as ringworm and a hair-pulling disorder called trichotillomania (trik-o-til-o-MAY-nee-uh).
- Medications and supplements. Hair loss can be a side effect of certain drugs, such as those used for cancer, arthritis, depression, heart problems, gout and high blood pressure.
- Radiation therapy to the head. The hair may not grow back the same as it was before.
- A very stressful event. Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.
- Certain hairstyles and treatments. Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot oil hair treatments and permanents can cause inflammation of hair follicles that leads to hair loss. If scarring occurs, hair loss could be permanent.
A number of factors can increase your risk of hair loss, including:
- Family history of balding, in either of your parent's families
- Significant weight loss
- Certain medical conditions, such as diabetes and lupus
Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.
These tips may help you avoid preventable types of hair loss:
- Avoid tight hairstyles, such as braids, buns or ponytails.
- Avoid compulsively twisting, rubbing or pulling your hair.
- Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.
- Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.
- Avoid medications and supplements that could cause hair loss.
- Protect your hair from sunlight and other sources of ultraviolet light.
- Stop smoking. Some studies show an association between smoking and baldness in men.
- If you are being treated with chemotherapy, ask your doctor about a cooling cap. This cap can reduce your risk of losing hair during chemotherapy.
Before making a diagnosis, your doctor will likely give you a physical exam and ask about your medical history and family history. He or she may also perform tests, such as the following:
- Blood test. This may help uncover medical conditions related to hair loss.
- Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
- Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss.
- Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.
Effective treatments for some types of hair loss are available. You might be able to reverse hair loss, or at least slow further thinning. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment within a year.
Treatments for hair loss include medications, surgery to promote hair growth and slow hair loss.
If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.
Medications are available to treat pattern (hereditary) baldness. Options include:
Minoxidil (Rogaine). This is an over-the-counter (nonprescription) medication approved for men and women. It comes as a liquid or foam that you rub into your scalp daily. Wash your hands after application. At first it may cause you to shed hair. New hair may be shorter and thinner than previous hair. At least six months of treatment is required to prevent further hair loss and to start hair regrowth. You need to keep applying the medication to retain benefits.
Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).
Finasteride (Propecia). This is a prescription drug approved for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits. Finasteride may not work as well for men over 60.
Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.
- Other medications. For men, the oral medication dutasteride is an option. For women, treatment may include oral contraceptives and spironolactone.
Hair transplant surgery
In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left.
During a hair transplant procedure, a dermatologist or cosmetic surgeon removes tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. Some doctors recommend using minoxidil after the transplant, to help minimize hair loss. And you may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.
Surgical procedures to treat baldness are expensive and can be painful. Possible risks include bleeding and scarring.
The Food and Drug Administration has approved a low-level laser device as a treatment for hereditary hair loss in men and women. A few small studies have shown that it improves hair density. More studies are needed to show long-term effects.
Lifestyle and home remedies
You may want to try shaving, other styling techniques and products, scarves, a wig, or a hairpiece. Talk with a hair stylist for ideas. These nonmedical solutions can be used to cover permanent or temporary hair loss.
If your hair loss is due to a medical condition, the cost of a wig may be covered by insurance.
Preparing for an appointment
You're likely to first bring your concerns to the attention of your family doctor. He or she may refer you to a doctor who specializes in the treatment of skin problems (dermatologist).
What you can do
- List key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're taking.
- List questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For hair loss, some basic questions to ask your doctor include:
- What is likely causing my hair loss?
- Are there other possible causes?
- What kinds of tests do I need?
- Is my hair loss permanent or will it grow back? How long will it take?
- What is the best course of action?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Do you have any brochures or other printed material that I can take home with me?
- What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing hair loss?
- Has your hair loss been continuous or occasional?
- Have you noticed poor hair growth, hair breakage or hair shedding?
- Has your hair loss been patchy or overall?
- Have you had a similar problem in the past?
- Has anyone in your immediate family experienced hair loss?
- What medications or supplements do you take regularly?
- What, if anything, seems to improve your hair loss?
- What, if anything, appears to worsen your hair loss?