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Hair Loss

Topic Overview

How much hair loss is common?

Everyone loses some hair every day. Losing up to 100 hairs a day is normal.

But if hair loss runs in your family, you could lose a lot more hair. With this kind of hair loss, you may end up with bald spots if you are a man. If you are a woman, you may find that the hair on the top of your head is slowly thinning. About half of all people have this type of hair loss by around age 50.

Although hair loss is fairly common, it can be a tough thing to live with, especially when it changes how you look. But there are ways you can treat your hair loss.

What causes hair loss?

Common causes of hair loss include:

  • Family history. In most cases, hair loss is inherited, which means it's passed down from one or both of your parents. This is called male-pattern or female-pattern hair loss.
  • Stress, including physical stress from surgery, illness, or high fever.
  • Chemotherapy, which is powerful medicine that destroys cancer cells.
  • Damage to your hair from pulling it back too tightly, wearing tight braids or ponytails, or using curling irons or dyes.
  • Age. You grow less hair as you get older. Hair also gets thinner and tends to break more easily as you age.
  • Poor diet, especially not getting enough protein or iron.
  • Thyroid diseases, such as hypothyroidism and hyperthyroidism.
  • Ringworm of the scalp, which is common in children.

What are the symptoms?

Your symptoms will depend on what kind of hair loss you have.

If your hair is thinning, it happens slowly over time, so you may not notice the hairs falling out. If your hair is shedding, then clumps of hair fall out. You may lose hair all over your scalp, which is called general hair loss. Or you may lose hair only in one area, which is called focal hair loss.

With inherited hair loss, men usually get bald spots around the forehead or on the top of the head, while women have some thinning all over the scalp, but mostly on the top of the head.

Since your hair has a lot to do with your appearance, losing it may cause you to have lower self-esteem if you don't like how you look. This is especially true in women and teens.

How is hair loss diagnosed?

Your doctor will ask you some questions, like how much hair you're losing, when it started, and whether your parents have hair loss. He or she will look closely at your scalp and hair loss pattern and may gently pull out a few hairs for tests.

If it's not clear what's causing you to lose your hair, your doctor may do a blood test or look at a sample of your hair or scalp with a microscope.

How is it treated?

How you choose to treat your hair loss depends on the cause. It also depends on your feelings. You may decide that you need treatment, or you may not be worried about thinning hair or baldness. The choice is up to you.

If hair loss is caused by something that won't last or can be treated, your hair is likely to grow back. For example, if an underactive thyroid is causing the problem, taking thyroid medicine may help. And most hair lost during chemotherapy will grow back after the treatment ends.

Hair loss that runs in the family can be treated with medicines or hair transplant surgery. Some people choose to wear hairpieces, like wigs or toupees (say "too-PAYZ"). Finding different ways of styling your hair, like dyeing or combing, also can help.

If hair loss is caused by something you can control, like stress or medicines, you can treat it by getting rid of the cause.

When you are deciding about treatment, think about these questions:

  • Which treatment is most likely to work?
  • How long will it take?
  • Will it last?
  • What are the side effects and other risks?
  • How much will it cost, and will insurance cover it?

Will your hair grow back?

When your hair loss is inherited, your hair won't grow back naturally. Treatment can help some hair grow back and prevent more from falling out, but you probably won't get all your hair back. And treatment doesn't work for everyone.

When medicines, stress, or hair damage cause you to lose your hair, it often will grow back after you take away the cause. If this doesn't help, you may need other treatment.

If you're unhappy with how hair loss makes you look, treatment may help you feel better. It's natural to want to like the way you look.

Health Tools

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Decision Points focus on key medical care decisions that are important to many health problems.

Cause

Losing a lot of hair (more than 100 hairs a day) can be caused by inherited factors, disease, stress, medicines, injury, aging, or hair care.

Inherited hair loss

The most common cause of hair loss is genetics-you inherit the tendency to lose hair from either or both of your parents. This is called male-pattern hair loss or female-pattern hair loss. The medical term for this type of hair loss is androgenetic alopecia.

In this type of hair loss, your genes affect how your hair grows. They trigger a sensitivity to a class of hormones called androgens, including testosterone, which causes hair follicles to shrink. Hair follicles are the openings that hair grows from.

Shrinking follicles produce thinner hair and eventually none at all. Men generally develop bald spots on the forehead area or on the top of the head, while women often have thinning of the hair on the top of the head. About half of all people have inherited hair loss by about 50 years of age.

Other causes of hair loss

Different types of hair loss may have different causes. Common causes of hair loss include:

  • Age. As you age, your hair tends to break more easily, and hair follicles do not grow as much hair.
  • Mental stress or physical stress, such as recent surgery, illness, or high fever. You may have a lot of hair loss 1 to 3 months after severe physical or emotional stress. Your hair usually will grow back within a few months.
  • Hair styling and products. Pulling your hair back too tightly or wearing tight braids or ponytails can cause hair loss. You may lose hair around the edge of the hairline, especially around the face and forehead. Using curling irons or dyes a lot can also result in hair loss. Hair usually grows back when you stop doing these things.
  • Ringworm of the scalp, which is common in children.
  • Poor nutrition, especially lack of protein or iron in the diet. Hair returns after you change your diet to get enough of these nutrients.
  • Thyroid diseases, including hypothyroidism and hyperthyroidism.

Other causes of hair loss include:

  • Alopecia areata, an autoimmune disease in which your immune system attacks hair follicles, resulting in round hairless patches on any area of the scalp or body. Severe cases involve many bald patches of hair or complete loss of hair on the scalp or body, although in some cases there is hair thinning without distinct patches of baldness. The hair loss usually is not permanent. Hair grows back within 1 year for many people.
  • Diseases, such as lupus, syphilis, or cancer. Hair may grow back on its own. In some cases, treatment may help.
  • Side effects of medicines or medical treatments, such as blood thinners (anticoagulants) or chemotherapy. Hair usually grows back after you stop using the medicines or when the treatment is over.
  • Trichotillomania, a compulsive behavior in which a person pulls hair out of the scalp, eyelashes, or eyebrows. There is usually mounting tension before pulling and a feeling of relief afterward. Trichotillomania often results in noticeable hair loss.
  • Injury to the scalp, including scarring.
  • Changes in hormone levels. Childbirth, taking birth control pills, or changes in a woman's menstrual cycle can affect the hair growth cycle and cause hair loss. Hair usually will grow back.

Symptoms

Hair loss can occur as thinning, in which you may not notice hair falling out, or as shedding, in which clumps of hair fall out.

In the most common type of hair loss, inherited hair loss (androgenetic alopecia), men tend to lose hair on the front hairline and forehead and on top of the head. Eventually, only hair around the ears, the sides, and the back of the head remains. Women with this condition typically have gradual thinning throughout the scalp, but mostly on the top of the head.

Other causes of hair loss may also show distinct patterns. For example, conditions such as trichotillomania (compulsively pulling at the hair) or alopecia areata (in which the immune system attacks hair follicles) result in obvious patches of hair loss, while stress and some medicines result in clumps of hair falling out.

Because hair is an important part of appearance, hair loss can also result in loss of self-esteem and feeling unattractive, especially in women and teens.

What Happens

Inherited hair loss

Inherited hair loss affects about half of men by the time they are 50 years of age. And it affects almost half of women by the time they reach 60 years of age.footnote 1

With inherited hair loss (androgenetic alopecia), men tend to lose hair on the front hairline and temples and on top of the head. Eventually, they may go completely bald.

Women generally lose less hair than men, but they have a similar pattern of hair loss. Women may have slight, moderate, or even severe hair loss, but they don't usually lose all their hair.

For both men and women, inherited hair loss can be treated early to slow down or stop hair loss.

Other causes of hair loss

Alopecia areata is hair loss caused when the immune system attacks hair follicles, where hair growth begins. It usually starts with one or more small, round, smooth bald patches on the scalp, and can progress to total scalp hair loss or complete body hair loss. It often begins in childhood. The hair usually grows back within 1 year. But hair loss in alopecia areata can come and go-the hair often will grow back over several months in one area but will fall out in another area.

With hair loss caused by stress, disease, medicines or medical treatments, clumps of hair may fall out. But after the cause is stopped, the hair usually grows back, although sometimes treatment may be needed.

What Increases Your Risk

Factors that increase the risk of hair loss include:

  • Genetics (inherited tendency). If one or both of your parents have hair loss, it is likely that you will also.
  • Disease or illness. Certain diseases or an illness can cause hair loss. The diseases may include ringworm of the scalp ( tinea capitis), thyroid diseases such as hyperthyroidism and hypothyroidism, or lupus. The illness may include a severe infection or high fever.
  • Age. Many people have some hair loss by the age of 50.
  • Medicines and medical treatments. Certain medicines or medical treatments can cause scalp problems and hair loss.
  • Hair care and styling. Some methods of hair care or hair styles can damage hair and cause hair loss.

If you have alopecia areata, you are more likely to have permanent hair loss if:

  • You have a family history of the condition.
  • You have the condition at a young age.
  • You have an autoimmune disease.
  • You have allergies (atopy).
  • You have a lot of hair loss.
  • You have abnormal color, shape, texture, or thickness of the fingernails or toenails.

When To Call a Doctor

Call your doctor if:

  • Your hair loss is sudden, rather than gradual.
  • You notice hair shedding in large amounts after combing or brushing, or if your hair becomes thinner or falls out.
  • You are concerned that a medicine may be causing your hair loss.
  • Your skin is scaly or has a rash, or you have any change on your skin or scalp with hair loss.
  • Your hair is gradually thinning and balding, and you want to discuss treatment options with your doctor.

Who to see

Health professionals who can give you advice and treatment on hair loss include:

Hair transplant surgery is usually done by:

Exams and Tests

Hair loss is diagnosed through a medical history and physical exam. Your doctor will ask you questions about your hair loss, look at the pattern of your hair loss, and examine your scalp. He or she may also tug gently on a few hairs or pull some out.

The most common cause of hair loss-inherited hair loss-is easily recognized. Men tend to lose hair from the forehead area and top of the head with normal amounts of hair on other areas of the scalp. Women tend to keep their front hairline, but have thinning of the hair on the top of the head.

Hair loss history

To determine the cause of your hair loss, your doctor may ask you about:

  • Characteristics of your hair loss. Is your hair thinning, with your scalp becoming more visible, but your hair is not noticeably falling out? Or is your hair shedding, with lots of hair falling out?
  • How long your hair loss has been occurring. How long has it been since you had your normal amount of hair?
  • Your family history of hair loss. Does your mother or father, brother or sister, or any other relative have hair loss? If so, what caused their hair loss?
  • Your hairstyling habits. Has your hair become fragile from pulling it too tight or from other hairstyling habits? Have you had any chemical treatments to your hair, such as permanents (perms) or bleaching? Do you use a blow-dryer that may be too hot? Is a curling iron damaging your hair?
  • Any recent illness. Have you had any skin rashes, such as ringworm, recently?
  • Medicines you are taking. Are you taking blood thinners (anticoagulants) or medicines for arthritis, depression, or heart problems? Have you had any cancer treatment?
  • Your diet. Are you getting enough protein and iron in your diet?

Tests

If the reason for your hair loss is not clear, your doctor may do tests to check for a disease that may be causing your hair loss. Tests include:

  • Hair analysis. Your doctor will take a sample of your hair and examine it under a microscope. A scalp sample might also be taken.
  • Blood tests, including testing for a specific condition, such as an overactive or underactive thyroid gland (hyperthyroidismor hypothyroidism).

Hair loss in women

Hair loss in women is more difficult to diagnose than it is in men because the pattern of hair loss is not as noticeable as it is in men.

Testing to diagnose hair loss usually is not done in women with mild to moderate hair thinning who are otherwise healthy. But in women who have irregular menstrual cycles, continued episodes of acne, or too much body hair (hirsutism), testing for a class of hormones called androgens, including testosterone, is sometimes done.

Treatment Overview

How you treat hair loss depends on the cause. You may decide not to treat hair loss if it doesn't bother you.

Some people choose to treat hair loss with medicines or hair transplant surgery. Others choose to wear hairpieces (wigs or toupees) or use different methods of hair styling (dyeing or combing).

If a disease, medicine, or stress is the cause, then treating the disease, changing medicines, or managing stress may stop the hair loss.

Treatment for hair loss may help you feel better about how you look. But some medicines may have harmful side effects, and surgery may carry certain risks.

Inherited hair loss

Treatment for inherited hair loss aims to prevent hair loss, promote hair growth, and cover bald areas of the scalp. But treatment is not successful for everyone, and you should not expect to regrow a full head of hair.

Medicines

Medicines include:

  • Minoxidil. Minoxidil (Rogaine) is available without a prescription and is sprayed on and/or rubbed into the scalp twice a day.
  • Finasteride. Finasteride (Propecia) is available by prescription and is taken once a day in pill form.

Surgery

Surgery includes hair transplants and procedures such as scalp reduction and scalp flaps.

Hairpieces and hair products

Cosmetic approaches to hair loss include:

  • Wearing hairpieces. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. Hair weaving, which involves sewing or braiding pieces of long hair into existing hair, is not recommended because it may cause permanent hair loss.
  • Using certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. But continual use of perms or dyes may result in more hair loss.

Other concerns with hair loss

Treating the cause often stops hair loss, and hair grows back. In some cases, other treatment is needed.

Hair care for cancer treatment

Hair loss caused by cancer treatment requires special care: Use mild shampoos. Do not use a hair-dryer.

Alopecia areata

Alopecia areataoccurs when the immune system attacks hair follicles, where hair growth begins. Because hair often grows back within a year, you may decide not to have treatment. Understanding the come-and-go nature of hair loss with this condition can help you make the best treatment decision. Children and teens may need counseling to help them adjust to the hair loss.

Medicines, such as corticosteroids, can be used to treat alopecia areata.

Women taking birth control pills

Women with inherited hair loss who wish to take birth control pills should use a pill type that does not add to hair loss, such as a norgestimate or desogestrel.footnote 2

Success of treatment

How successful your treatment is depends on your expectations and the cause of hair loss. Treatment for hair loss caused by an illness, medicine, or damage to the hair usually is more successful than treatment for inherited hair loss.

Prevention

Hair loss that is caused by medicines, stress, lack of protein or iron, or hair care may be prevented.

Avoiding certain medicines, reducing stress, getting adequate protein and iron in your diet, and using hairstyles that don't damage your hair may reduce or prevent hair loss.

Inherited hair loss (androgenetic alopecia) cannot be prevented.

Home Treatment

Home treatment for hair loss includes hair care and hairstyling techniques that may help you cover thinning or bald spots on the scalp. This may be easier for women because inherited hair loss causes a general thinning that is usually not as severe as it is in men.

Hair care products

In women with inherited hair loss, hair care and the occasional use of grooming products, hair sprays, hair color, teasing, permanents, or frequent washing won't increase hair loss. But if your hair loss is caused by hair care, then perms and dyes may contribute to more hair loss.

You may want to try:

  • Scalp concealers or hair thickeners such as Couvre or Toppik. These products give the appearance of having fuller hair until the next time you wash your hair.
  • A hairpiece. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. But hair weaving, which involves sewing or braiding pieces of long hair into existing hair, is not recommended because it may cause permanent hair loss.
  • Hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp.
  • Laser phototherapy combs. These combs use low levels of light to increase hair growth on the scalp. They are designed for use at home.

Skin cancer protection

For both men and women, hair thinning and baldness increase the risk of sunburn and skin cancer on the scalp. When in the sun, wear a hat or use a sunscreen with an SPF of 30 or more to prevent sun damage to the scalp.

Medications

Medicines for hair loss can slow thinning of hair and increase coverage of the scalp by growing new hair and enlarging existing hairs. But they need to be taken regularly. If you stop the medicine, hair loss returns. Do not expect to regrow a full head of hair. Hair coverage is improved on the top of the head, but not on the forehead area.

Medicine choices

Medicines often used to treat inherited hair loss include:

  • Minoxidil (Rogaine), which is available without a prescription. It is sprayed on and/or rubbed into the scalp twice a day.
  • Finasteride (Propecia), which is a prescription medicine. It is taken once a day in pill form.

Medicines used to treat alopecia areata, which is caused when the immune system attacks hair follicles, include:footnote 3

  • Corticosteroids injected into the scalp. The corticosteroid is injected many times about1 cm (0.4 in.) apart every 4 to 6 weeks. This is the most common treatment in adults and is best used for treating patchy hair loss.
  • Corticosteroid ointments or creams you put on the scalp. Corticosteroids may be used along with injected steroids or with other medicines such as minoxidil (Rogaine).
  • Corticosteroids you take by mouth (oral). Although this does result in hair growth, it is rarely used because of the side effects of oral corticosteroids.
  • Contact immunotherapy, which triggers an allergic reaction on the scalp that may help hair to grow.

Surgery

Surgery to cover bald areas of the scalp may be used to treat hair loss. If successful, surgery may be a permanent treatment for hair loss.

Surgery choices

The most common types of surgery to treat hair loss include:

  • Hair transplant surgery. During this surgery, your doctor will move small grafts (pieces of skin with hair follicles) from areas of your scalp with full hair to areas of your scalp that are bald or thinning. The grafts may include single hairs or up to 30 hairs in one graft. This is the most common type of surgery used to treat hair loss.
  • Scalp reduction. Scalp reduction involves removing large areas of bald scalp from the head. Sections of the scalp with growing hair are then stretched and sewn together to fill in the bald areas.
  • Scalp flaps. Scalp flaps involve moving a large section of scalp containing hair from the side and back of the head to a bald area. One side of the flap remains attached to the scalp as the section of scalp with hair is moved to cover a bald area. The complication rate of this procedure is higher than other procedures because of bleeding, scarring, and infection after surgery.

What to think about

Surgery may be a more permanent solution than medicines to treat hair loss, but it is expensive, it involves surgical risks, and there is a chance that not all hair follicles will remain healthy.

Other Treatment

Other treatment for hair loss includes counseling, if hair loss is caused by compulsive pulling of your hair (trichotillomania).

References

Citations

  1. Nguyen J, Cotsarelis G (2013). Disorders of hair. In EG Nabel et al., eds., Scientific American Medicine, chap. 58. Hamilton, ON: BC Decker. https://www.deckerip.com/decker/scientific-american-medicine/chapter/58/pdf. Accessed November 21, 2016.
  2. Habif TP, et al. (2011). Hair and nail diseases. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 562-589. Edinburgh: Saunders.
  3. Hague J, Berth-Jones J (2010). Alopecia areata. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 31-35. Edinburgh: Saunders Elsevier.

Other Works Consulted

  • Kestenbaum TM (2010). Diseases affecting the hair. In JC Hall, ed., Sauer's Manual of Skin Diseases, 10th ed., pp. 337-347. Philadelphia: Lippincott Williams and Wilkins.
  • Wolff K, Johnson RA (2009). Disorders of hair follicles and related disorders. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 962-986. New York: McGraw-Hill.

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Ellen K. Roh, MD - Dermatology

Current as ofOctober 5, 2017

Current as of: October 5, 2017

Author: Healthwise Staff

Medical Review: Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Ellen K. Roh, MD - Dermatology