Hair Loss

What is the normal cycle of hair growth and loss?

The normal cycle of hair growth lasts for 2 to 6 years. Each hair grows approximately 1 centimeter (less than half an inch) per month during this phase. About 90 percent of the hair on your scalp is growing at any one time. About 10 percent of the hair on your scalp, at any one time, is in a resting phase. After 2 to 3 months, the resting hair falls out and new hair starts to grow in its place.

It is normal to shed some hair each day as part of this cycle. However, some people may experience excessive (more than normal) hair loss. Hair loss of this type can affect men, women and children.

What causes excessive hair loss?

A number of things can cause excessive hair loss. For example, about 3 or 4 months after an illness or a major surgery, you may suddenly lose a large amount of hair. This hair loss is related to the stress of the illness and is temporary.

Hormonal problems may cause hair loss. If your thyroid gland is overactive or underactive, your hair may fall out. This hair loss usually can be helped by treatment thyroid disease. Hair loss may occur if male or female hormones, known as androgens and estrogens, are out of balance. Correcting the hormone imbalance may stop your hair loss.

Many women notice hair loss about 3 months after they’ve had a baby. This loss is also related to hormones. During pregnancy, high levels of certain hormones cause the body to keep hair that would normally fall out. When the hormones return to pre-pregnancy levels, that hair falls out and the normal cycle of growth and loss starts again.

Some medicines can cause hair loss. This type of hair loss improves when you stop taking the medicine. Medicines that can cause hair loss include blood thinners (also called anticoagulants), medicines used for gout, medicines used in chemotherapy to treat cancer, vitamin A (if too much is taken), birth control pills and antidepressants.

Certain infections can cause hair loss. Fungal infections of the scalp can cause hair loss in children. The infection is easily treated with antifungal medicines.

Finally, hair loss may occur as part of an underlying disease, such as lupus or diabetes. Since hair loss may be an early sign of a disease, it is important to find the cause so that it can be treated.

Can improper care of my hair cause hair loss?

Yes. If you wear pigtails or cornrows or use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia (say: al-oh-pee-sha). If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals used in permanents (also called “perms”) may cause inflammation (swelling) of the hair follicle, which can result in scarring and hair loss.

What is common baldness?

The term “common baldness” usually means male-pattern baldness, or permanent-pattern baldness. Male-pattern baldness is the most common cause of hair loss in men. Men who have this type of hair loss usually have inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. In male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head.

Women may develop female-pattern baldness. In this form of hair loss, the hair can become thin over the entire scalp.

Can my doctor do something to stop hair loss?

Perhaps. Your doctor will probably ask you some questions about your diet, any medicines you’re taking, whether you’ve had a recent illness and how you take care of your hair. If you’re a woman, your doctor may ask questions about your menstrual cycle, pregnancies and menopause. Your doctor may want to do a physical exam to look for other causes of hair loss. Finally, blood tests or a biopsy (taking a small sample of cells to examine under a microscope) of your scalp may be needed. Return to top.

Is there any treatment for hair loss?

Depending on your type of hair loss, treatments are available. If a medicine is causing your hair loss, your doctor may be able to prescribe a different medicine. Recognizing and treating an infection may help stop the hair loss. Correcting a hormone imbalance may prevent further hair loss.

Medicines may also help slow or prevent the development of common baldness. One medicine, minoxidil (brand name: Rogaine), is available without a prescription. It is applied to the scalp. Both men and women can use it. Another medicine, finasteride (brand name: Propecia) is available with a prescription. It comes in pills and is only for men. It may take up to 6 months before you can tell if one of these medicines is working.

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To say that every person is a unique individual is somewhat trite, but it is a trite saying that is also true. We inherit genes from our parents that shape our physical selves and we live in social and cultural environments that influence the way we think and act. Yet, no matter how similar (or different) we may be in genetic and socio-cultural heritage, each of us is a one-time-only human being with a deeply-sensed feeling of individuality.

One of the consequences of our individuality is the way we see ourselves—our self-image, how we perceive ourselves and how we hope and strive to be perceived by other people. The “me” that I imagine myself to be, that I see in the mirror, and that I hope to present to others is greatly influenced by cosmetic features of my face and head. I style scalp hair to enhance my self-image and the “me” I present to others.

Hair loss can significantly disturb my self-image and make me be concerned about how I am perceived by others. Concern about hair loss may lead to a decision to consult a hair restoration specialist about medical or surgical hair restoration. Consultation with a hair restoration specialist may have been preceded by a self-help approach using an over-the-counter hair restoration medication.

When the “me” I perceive myself to be sits down with a hair restoration specialist to discuss hair loss and hair restoration, both of us should be aware that the basic issue is not hair loss but rather the consequences of hair loss to my self-image. What I want hair restoration to accomplish is restoration of a self-image that satisfies me and that I believe will present a satisfactory “me” to others.

What do I want the physician hair restoration specialist to accomplish? To arrive at that understanding with the physician, it is helpful if I can put into words what I perceive to be the negative effects of hair loss. This perception varies from person to person and is rarely just a concern about a bald spot or a receding hairline. It is most likely that a number of perceived negative effects are organized around a major concern about self-image—for example, loss of attractiveness, looking older than my years, embarrassment about “going bald”, loss of self-confidence.

When the hair restoration specialist understands my over-arching concerns about hair loss, the next step is to determine (1) what I hope hair restoration to accomplish, (2) what is the best approach to realizing my goals, and (3) reach agreement on the most effective approach to hair restoration, the likely outcome of hair restoration, the amount of time I will have to commit to the procedure, and the cost.

Similarly to helping my doctor understand how I believe hair loss affects my self-image, I need to work with the doctor to be sure we both understand what I mean when I use broadly descriptive terms such as “full head of hair”, “natural look”, “too thin”, “younger look”, etc. Such terms may be very meaningful to me in terms of self-image, but they are not helpful to a hair restoration specialist who must plan hair restoration to meet specific aesthetic goals such as hairline placement and hair density. Reaching common semantic understanding—getting on the same page, so to speak—can also be important if we have to agree on some compromises. For example, if I insist on a “full head of hair”, and the physician knows that I have an inadequate supply of donor hair to achieve that goal, we will need to work out an acceptable compromise that addresses my aesthetic concerns and is technically feasible.

It is helpful to remember that my concern regarding hair loss is really a concern about self-image. My concern about hair restoration is that my expectation for restoring self-image will be met. The physician’s concern is to understand my worries about hair loss and expectations for restoring self-image, and to successfully address them with the science and art of hair restoration.

Dr. Tejinder Bhatti