Hair Loss

Hair Loss

Finding the Perfect Cover-Up

The way you style your hair--whether you bob it or braid it, sculpt it into peaks or dye it purple--can say a lot about you.

Women have always made personal statements with their hair, and that's one of the main reasons that hair loss can be so traumatic, says Marietta Lynn Baba, Ph.D., professor of anthropology at Wayne State University in Detroit, who has studied the significance of hair in various American subcultures.

"People get really uptight when they lose hair because they lose this identity marker," explains Dr. Baba. "Hair is also a signal of one's health and vitality. And having hair, for a woman, is a sign of her sexuality. It's a gender marker."

Losing hair can be just as tough for a woman to deal with as it is for a man. In fact, when researchers at Erasmus University in the Netherlands interviewed 58 women with permanent hair loss, they found the loss contributed to low self-esteem in three-quarters of the group.

More Common than You Think

Bald men are a more familiar sight than bald women. But hair loss in women is more common than you may think. Generally their hair thins, but not to the point where they've got recognizable bald spots.

"In men, it's easier to see," says David A. Whiting, M.D., director of the Baylor Hair Research and Treatment Center in Dallas. "Women don't go totally bald, even if their hair loss is severe. They get a thinning on their heads but they retain an intact frontal hairline, so it's not so obvious."

Although some women inherit a genetic predisposition to lose hair more or less permanently, most lose it only temporarily.

Lots of things can lead to temporary thinning, says Harry L. Roth, M.D., professor of dermatology at the University of California at San Francisco. Surgery, fevers, anemia, nutritional deficiencies and rapid weight loss can do it. Emotional stress can cause temporary hair loss, as can an underactive thyroid, anemia, menstrual irregularities and severe cases of psoriasis, dandruff and eczema. Pregnancy can set the stage for temporary loss, and chemotherapy drugs, certain blood pressure medications, birth control pills, high doses of vitamin A and the acne drug Accutane can also cause it, Dr. Roth says.

It can take three months before things like stress, a new medication or an illness cause hair loss. So if your hair starts thinning, ask yourself whether you got a new prescription or went on a crash diet a few months earlier. Keep in mind that it often takes another three months before the hair you lost grows in again.

Are You Really Losing It?

Every day, the average head sheds 100 to 125 hairs. During an initial active stage, which lasts two to six years, the hair grows. Then comes a two- to three-month resting stage, after which hair gets pushed out by up-and-coming replacements. Finding 100 to 125 hairs in your comb, bathtub and towel every day, therefore, does not mean your hair is thinning. It means it's reached old age, and usually each hair is replaced.

If you're shedding more than the usual number and wonder if something is amiss, Dr. Roth suggests a simple test. Grab a small tuft of hair in your fingers and gently pull your hand through it. If you get more than one or two hairs per pull, you're losing more than average.

The good news is that if you're losing this much hair all at once, you're probably losing it only temporarily, Dr. Roth says. Permanent hair loss tends to be more gradual, confirms Laura Sears, M.D., a dermatologist in Dallas.

Avoiding Temporary Loss

You can prevent a lot of temporary thinning by taking care of your hair--and the rest of yourself. Here's how.

Shampoo. Contrary to popular belief, frequent shampooing won't make your hair fall out. And if psoriasis, seborrheic dermatitis or eczema is causing your hair loss problem, washing with a medicated shampoo should help solve it, according to Dr. Sears.

Check out the cosmetologist. Permanent waves and dye jobs won't cause hair loss either--if they're done properly. An inexperienced stylist who leaves perm solution on too long and then uses it with a peroxide dye could damage your hair so much that it breaks off near the roots, Dr. Roth says. Choose an established salon rather than a beauty school and ask friends to recommend a stylist.

Waylay a fever. If you get an illness--like strep throat--that brings on fever, see a doctor right away, Dr. Roth advises.

Eat right. Avoid fad diets and the nutritional deficiencies that go with them. Eat at least five servings of fruits and vegetables, two servings of low-fat milk, yogurt or cheese, a few small portions of protein-rich foods and plenty of whole grains daily, says Dr. Roth. Hold fat consumption to 25 percent of daily calories and exercise more to lose weight. A daily multivitamin is okay, but avoid megadoses, particularly big doses of vitamin A, since too much A can cause hair loss.

Go easy. Don't pull your hair into tight ponytails or braids. The constant tension can make it fall out, says Dr. Roth.

Accentuate the Positive

Whether the thinning is temporary or permanent, you can enlist all sorts of cosmetic techniques to camouflage it. Try these.

Go short and curly. Cut your hair short or perm it, and it will have more volume. That means it'll do a better job of covering your scalp and masking loss, Dr. Sears says.

Give eye shadow a new venue. If your scalp is reflecting light and drawing attention to itself, dust it with eye shadow that matches your hair color, Dr. Sears suggests. Your scalp won't be as noticeable and your hair will look thicker.

When Loss Is Lasting

If your hair loss doesn't ease up after a month, have a doctor check it out, Dr. Roth says. You may have a thyroid problem, a menstrual cycle irregularity, anemia or a severe case of psoriasis, seborrheic dermatitis or eczema. Tumors on the adrenal glands or ovaries and adrenal gland irregularities can also cause continued hair loss, he says.

If the hair is falling out in patches, the cause could also be an autoimmune disorder. Researchers speculate that an immune system glitch causes this patchy hair loss, known as alopecia areata. It's estimated that 2.5 million Americans have it. Some lose only small swatches of hair on their scalps. Others lose even their eyebrows and eyelashes. The hair may regrow and fall out repeatedly or never regrow at all. Cortisone treatments can help bring it back.

Most often, however, permanent hair loss is genetic. According to estimates, more than 20 million American women carry the gene or genes for hereditary hair loss, also known as androgenetic alopecia.

You can inherit this legacy from your mother's and/or your father's side of the family, says Howard Baden, M.D., professor of dermatology at Harvard Medical School.

In this type of alopecia, genes seem to make hair follicles more sensitive to dihydrotestosterone, a form of the male sex hormone testosterone, Dr. Sears explains. Under the influence of dihydrotestosterone, follicles stop doing their job.

Medical Options

Both men and women produce testosterone. But men produce much more, which explains why hair loss is more common in men. Women also produce more of the female sex hormone estrogen, which usually offsets testosterone's effect on hair follicles.

"Most women are protected by production of a sufficient level of estrogen until they hit menopause and the estrogen level drops," says Walter Unger, M.D., associate professor of dermatology at the University of Toronto. Depending on their genetic heritage, though, some women start to see hair loss as early as their teens.

Even if your hair loss is permanent, you've no reason to throw in the towel. See your doctor. She may suggest one of these treatments for you.

Rub in minoxidil. The most commonly prescribed treatment for hair loss--and the only one with the Food and Drug Administration's seal of approval--is minoxidil (Rogaine). It's a clear, nonoily lotion you rub into your scalp twice daily.

In a study, researchers at the University of Texas at San Antonio tested minoxidil on 308 women with androgenetic hair loss. One group used 2 percent minoxidil twice a day. The other group used a placebo. After 32 weeks, 13 percent of the minoxidil group had moderate hair growth and half had minimal growth. By comparison, 6 percent of the placebo group had moderate growth and 33 percent had minimal growth. Apparently the drug works equally well in both men and women, Dr. Baden says. It usually takes a couple of months for minoxidil to show results, Dr. Whiting notes, and you have to use it regularly. If you stop, the hair you gained will fall out again. And you shouldn't use minoxidil if you're pregnant, Dr. Whiting says.

Ask about anti-androgens. Anti-androgen drugs can sometimes slow hair loss by blocking male sex hormones (androgens) and prevents the shrinking of hair follicles that leads to hair loss, Dr. Whiting says. The most commonly prescribed anti-androgen is spironolactone. A newer drug called Proscar, originally used for prostate disease, may be even more effective. "In some people Proscar not only stops hair from falling out, it encourages extra growth," he says.

If you're pregnant, you shouldn't use antiandrogens. Going off the medication doesn't necessarily mean you'll start losing hair again, but it could happen. The changes in hormone production that accompany pregnancy may counter the hair loss somewhat, Dr. Baden says.

Consider birth control pills. An extra dose of female sex hormones may also slow hair loss. "Birth control pills can bring in a little more estrogen to counteract testosterone," Dr. Sears explains.

Think about hormone replacement therapy. By the same token, hormone replacement therapy may slow loss after menopause, Dr. Sears says. Talk over the pros and cons with your doctor.