Hair-Saving Secrets

The shock sets in when you find your shower drain clogged with hair... or your pillow covered with scads of loose hairs.

Could it be that you're losing your hair? It's hard to believe -- that only happens to men, or does it? Although hair loss is not generally associated with women, it's a significant, serious, and widespread female health problem -- one that causes embarrassment, frustration, depression, anxiety, poor self-esteem, even marriage problems. It can make you feel older and more self-conscious, too, plus you tend to worry excessively about how to conceal your hair loss.

If your once-thick hair is falling out in clumps, or if you've got bald patches peeking out from your scalp, you're not alone. More than 20 million women in the United States alone -- 40 percent of them under age forty -- are suffering from hair loss.

If your hair has started to thin out, take heart. You can do something about it. There are more options available than ever before to prevent and treat hair loss. A vast number of prescription medications have been scientifically shown to slow down, even reverse, hair loss. Newer, over-the-counter potions offer hope, too, when before there was none. What's more, huge advances have been made in surgical procedures, such as hair transplantation and scalp reduction, to help restore your hair to its former crowning glory. This is an exciting time in the treatment of hair loss!

11 questions to ask your doctor to pinpoint the cause

If you notice unusual hair loss, see your doctor (preferably a dermatologist) as soon as you can. Hair loss and thinning can lead to fear, anxiety, and depression -- all of which can seriously affect physical health. Proper treatment can help reverse hair loss and, in doing so, erase much of the psychological discomfort you are experiencing.

You can help your doctor or dermatologist arrive at a more accurate diagnosis. Prior to your appointment, scribble down the facts behind your hair loss and general health by answering these questions:

How long have you been losing your hair?
When did the hair loss start?
Is your hair coming out by the roots or breaking off?
Have you had any recent illnesses or surgery?
Do you have a family history of baldness?
Are you taking any medications or supplements?
What is your normal diet?
Have you experienced sudden, unexplained weight loss?
Have you had a recent pregnancy, hysterectomy, or experienced any menstrual irregularities?
What kind of hair care products do you use, including shampoos, conditioners, chemicals (rinses, bleaches, straighteners, or permanents)?
What do you use to style your hair (electric rollers, dryers, hot curlers, regular rollers, teasing, or use of rubber bands)?

In addition, bring in a photograph of yourself taken a few years earlier when you had more hair, or a handful of hair that has recently fallen out.

All of this information will help your physician or dermatologist take a detailed medical history, which is usually the first step in making an accurate diagnosis. Your medical history will help your doctor sort out whether your problem is a physiological response to stress, a reaction to a drug or supplement, a side effect of an illness, an inherited tendency, or a cosmetically induced problem.

Your hair is falling out and you don't know why. The reason could be as simple as an iron deficiency or as complex as a hormonal problem. Understanding the possible causes, and identifying them early, can help you seek the right treatment -- treatment that can potentially alter the course of your hair loss and save your hair from further shedding.

Androgenetic Alopecia (Hereditary Hair Loss)

The most common cause of hair loss is rooted in your genes. Known technically as androgenetic alopecia, hereditary hair loss can begin any time after puberty, but usually sets in before the age of forty and may accelerate around the time you reach menopause.

Androgenetic alopecia affects both men and women. Balding men typically get receding hair lines and large patches of hair loss fringed by a horseshoe-shaped ruffle of hair, whereas women generally have diffuse hair thinning all over the scalp, most noticeably over the top of the scalp, just behind the bangs. About 50 percent of all women who experience hair loss have androgenetic alopecia, also termed female-pattern baldness.

If your hair is vanishing, you may have inherited the gene for hair loss, but not necessarily from your mom. This gene can come from either parent.

As a result of genetics, cells in hair follicles become abnormally sensitive to certain hormones. Like a telephone line, these hormones transmit messages that tell the follicle to produce less hair. In response, those follicles express their genetic fate by shortening their growing cycles and making thinner and finer hair. Some follicles go on permanent strike, stopping production altogether. Thus, androgenetic alopecia involves both genetic and hormonal factors.

The hormones that affect hair loss are known collectively as androgens. In women, androgens are produced by the ovaries and adrenal glands.

With androgenetic alopecia, you may lose your hair gradually, but you will never go completely bald. And with proper treatment, hair loss is partially reversible.

A powerful class of drugs, antiandrogens, can mount the required defense and sabotage the activity of androgens. There are two classes of antiandrogens: steroidal and nonsteroidal. Steroidal antiandrogens are hormones, whereas nonsteroidal antiandrogens have no hormonal activity. They were developed as potentially safer, less risky alternatives to steroidal antiandrogens.

Types of Antiandrogens

There are many types of antiandrogens, some available only in Europe and Canada. Although they can make hair regrow and slow the progression of hair loss, none are approved by the U.S. Food and Drug Administration (FDA) as hair-loss treatments but are authorized only for the treatment of other medical conditions. Hair regrowth just happens to be one of their side effects.

Even so, many physicians and dermatologists recommend antiandrogens for hair loss, anyway. It is important to point out that while being treated with antiandrogens, you should not get pregnant. According to current medical literature on antiandrogens, these drugs can potentially feminize a male fetus.

Telogen Effluvium

The second most common form of hair loss is telogen effluvium, usually triggered by severe physical or emotional stress, but also by other causes. Together, telogen effluvium and androgenetic alopecia account for about 95 percent of all hair-loss cases.

With telogen effluvium, an abnormally high percentage of actively growing hairs abruptly enter telogen, the resting phase of hair growth. The cells in the hair's matrix appear to stop dividing. Consequently, hair begins to fall out. It affects mostly women in their forties, fifties, and sixties. With telogen effluvium, your hair may begin to fall out in clumps, and the shedding may last two to three months, or longer.

There are three types of telogen effluvium: sudden, delayed, and chronic.

Sudden Telogen Effluvium

This type of shedding usually begins in response to bodily stress, such as a high fever. Hair loss occurs quite suddenly and rapidly.

Delayed Telogen Effluvium

This form can strike within several months after you undergo extreme physical or psychological stress, such as a severe illness or major surgery. Example: If you have a total hysterectomy, you may experience hair thinning a few months afterward. Accidents or the death of a parent or child have also been known to trigger this form of telogen effluvium.

If you notice handfuls of hair coming out in your comb or brush during the weeks following the birth of your baby, rest assured that the shedding is fairly common. It, too, is a form of delayed telogen effluvium.

After delivery, your hair may retreat into its resting phase and begin to fall out. But within four to eight months it will start growing again. Some women, however, report that their new hair is not as thick as it was prior to pregnancy. Others find that pregnancy permanently changes their hair color, or relaxes their curls.

Chronic Telogen Effluvium

If the shedding persists for months or years, you may have chronic telogen effluvium. Hair is usually lost from the entire scalp. But rest assured: Total baldness is not the end result.

Diet and Telogen Effluvium

Insufficient protein in your diet can lead to telogen effluvium. When protein is in short supply, your body tries to conserve as much as possible. One of its defense mechanisms is to shift growing hairs into their resting stage, and those hairs eventually fall out. Eating more protein, however, reverses this type of hair loss. Crash dieters and some vegetarians are at risk of losing their hair due to protein deficiencies.

Occasionally, a shortage of iron in your diet will also produce telogen effluvium. Blood tests easily detect low iron levels, and you can correct the condition by taking iron supplements and eating iron-rich foods.

Women who suffer from eating disorders such as anorexia or bulimia often experience telogen effluvium as a result of severe nutritional deficiencies.

Nonchronic Telogen Effluvium

In nonchronic cases, telogen effluvium is reversible and growth returns to normal on its own. No treatment is required, although some physicians may prescribe a mild tranquilizer to calm jangled nerves. Quite often, when patients take antianxiety medication, their hair shedding slows down. This is not a result of the medication but rather a result of their calmer mental state.

Hair-Pulling

A fairly common cause of hair loss is trichotillomania, or habitual hair-pulling. Unlike androgenetic alopecia, telogen effluvium, or other types of hair loss, trichotillomania is not a medical problem but rather a psychological disorder.

Approximately 8 million people in the United States have this condition. Most are adult women. Research indicates that hair-pullers have low self-esteem, suffer from anxiety, experience frequent bouts of depression, and are dissatisfied with their bodies.

Trichotillomania usually begins in childhood and can be successfully treated by psychological counseling and stress management techniques. When trichotillomania is suspected, a dermatologist may take a skin biopsy to look for scalp hemorrhaging and empty hair follicles. Hair usually grows back, although repeated pulling over many years may permanently destroy hair follicles.

Alopecia Areata

It starts with a tiny bald spot on your head, no bigger than the tip of a felt marker. Within months, it spreads to the size of a penny, then a quarter. Before long, you have only sprigs of hair sticking out from an otherwise hairless scalp.

You're suffering from alopecia areata, a disease that strikes adults and children randomly -- even those in very good health. More than 2 million Americans of all ages have it, and it affects men and women alike.

No one knows what causes alopecia areata, although it is thought to be an autoimmune disorder in which the body mistakenly attacks the hair follicles. Inflammation of the follicles and surrounding hair structures sets in. This reaction causes the hair follicles to retreat into the deeper layers of skin. Shut off from a nutrient supply, the follicles starve, begin shedding hair, and enter a dormant period.

Hair loss due to alopecia areata can occur very rapidly, or slowly, or at irregular intervals. About 25 percent of people with alopecia areata have a family history of the disease. Stress can also trigger alopecia areata, as can exposure to industrial chemicals.

Treating Alopecia Areata

There's no cure for alopecia areata, but there are numerous treatments that are quite effective. And in many cases, some or all of your hair grows back on its own, whether or not you undergo treatment. If your hair loss is patchy, your hair will probably come back. But if you've been losing your hair for five years or more, your chances are not as good. Unfortunately, there is a high relapse rate for alopecia areata, even after treatment.

While there are many promising drugs that promote hair growth, there are many more that cause hair to thin or fall out altogether. And rarely do doctors tell you that baldness is a potential side effect of a drug they prescribe. You may have to dig up this information for yourself, or have your doctor look up the side effects in the Physicians' Desk Reference for you.

Chemotherapy and Hair Loss

Hair loss is a well-known side effect of many cancer chemotherapy drugs. These medications attack the fast-dividing hair cells of the matrix, and hair is lost from 90 percent or more of the scalp. Within a few weeks after cancer therapy ends, however, hair grows back. Even so, long-term exposure to chemotherapeutic drugs may cause scarring alopecia. Hair loss caused by chemotherapy and other drugs is known as anagen effluvium.

Prescription Drugs

Many common prescription drugs thin out hair, too. These include: antidepressants, pain medications, blood thinners, high blood pressure medications, and some cholesterol-lowering drugs.

In certain cases, birth control pills also cause hair loss. Case in point: If you have an inherited tendency toward hair loss and you take birth control pills, the pills may cause your hair to fall out. In this instance, talk to your doctor about switching to a different pill. Taking an estrogen-dominant pill, for example, may help against further fallout.

Dietary Supplements

Certain dietary supplements can be culprits in hair loss. For example, megadoses of vitamin A (in excess of 50,000 international units daily) can promote hair loss. So can DHEA, a popular supplement thought to slow down the aging process.

A few herbs have been associated with hair loss, too. One of these is astragalus, a popular immune-boosting herb. It contains a natural chemical called selenocystathionine, known to cause hair loss. Hair is very high in the mineral sulfur and sulfur-containing proteins; selenocystathionine interferes with the metabolism of sulfur.

With any type of dietary supplement, including herbal formulations, read the label for its list of ingredients. If you're experiencing hair loss or thinning, stop taking the supplement in question and discuss the matter with your physician.

Age-Related Hair Loss

It's inevitable: We all lose hair as we age. Typically, you'll notice a very gradual, diffuse thinning of your scalp hair, starting at about age fifty. Unlike other forms of hair loss, there's usually no noticeable shedding, just a gradual thinning out. If your hair loss is severe in the years following menopause, particularly on the frontal scalp, then you're probably suffering from androgenetic alopecia as well. There's no specific treatment for age-related hair loss. However, certain supportive treatments such as proper diet and supplementation may help minimize it.

Disease-Related Hair Loss

There are a number of diseases that will produce hair loss. When the disease is cured, however, hair loss will usually reverse itself.

Syphilitic Alopecia

If you're losing your hair for no apparent reason and other causes have been ruled out, your physician may examine you for syphilis, a three-stage bacterial disease transmitted by sexual contact or through infected blood.

A diagnosis of syphilis can be confirmed by blood tests. If caught early and treated appropriately, syphilis can be completely cured. If not treated, the disease leads to death. Syphilis is treated with antibiotics, and hair growth returns to normal after the disease is cured.

Thyroid Disease

Thyroid disease can lead to hair loss. Hyperthyroidism occurs when the thyroid gland overproduces thyroid hormone -- a condition that may cause hair to fall out. An underactive thyroid leads to hypothyroidism, and one of its symptoms is also hair loss. In both diseases, hair loss can be reversed with proper medication. Hair starts growing a few months after thyroid hormone levels have normalized.

Bacterial Infections

A fairly common type of disease-related hair loss is bacterial infection. One of these is folliculitis, an infection of the hair follicles. Small, pus-filled pimples form around the hair follicles, and hair may thin out. Another type of bacterial infection is pyoderma, which makes the skin red and scaly. The presence of bacterial infections can be confirmed by culture tests. Bacterial infections can be treated topically or by oral medications, depending on the severity of the disease.

Fungal Infections

Although rare in adults, fungal infections such as ringworm often lead to hair loss. The presence of a fungal infection can be confirmed by a culture. Hair loss caused by ringworm is treated with an antifungal drug called griseofulvin (Gris-PEG, Grisactin, or Fulvicin- P/G), and occasionally with oral steroids if inflammation is present.

Seborrhea and Psoriasis

Skin disorders such as seborrhea and psoriasis can lead to hair loss also. Seborrhea occurs when the sebaceous glands become overactive, resulting in excessive production of sebum. Treatment often involves the use of medicated shampoos and anti androgen drugs.

Affecting approximately 3 million Americans, psoriasis is a genetic disease in which the life cycle of skin cells fast-forward abnormally, and the result is skin eruptions and scaling. Psoriasis typically affects the elbows, knees, trunk, and scalp. Treatment involves medications and phototherapy (exposure of the skin to ultraviolet light).

Cosmetically Induced Hair Loss

A form of hair loss that may be categorized as either scarring or nonscarring alopecia is cosmetically induced hair loss. It is caused by certain hairstyles and the use of chemicals.

Hairstyles

Wearing tight hairstyles such as pigtails, ponytails, cornrows, or using tight rollers can pull on your hair, causing hair to fall out. This type of hair loss is called traction alopecia. In many cases, it will scar your scalp. But provided there is no scarring, your hair will grow back normally after you stop the pulling.

Dyes, Bleaches, and Permanent Waves

In addition, chemical treatments such as dyes, bleaches, or permanent waves, if applied incorrectly, can weaken the hair and cause breakage. In extreme cases, hair can even fall out. Further, an allergic reaction to hair dye can also cause hair loss.