From time to time, everyone loses hair. During your morning shower, when you blow it out or when you give it a short brush, it might happen, and that's totally natural.
"We lose 50 to 100 hairs a day on average," says Francesca Fusco, M.D., a board-certified dermatologist who specializes in hair loss based in New York City. "That's all hair going through its stages, and to replace it, there'll be a new one."
But you might be dealing with something more severe when your hair begins to fall out regularly in large quantities, you begin to see bald spots, or your hairline begins to recede in areas it didn't before.
Don't believe that you are the only one that is going through this. "In women, hair loss is extremely common. Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, says it is actually becoming more and more popular.
According to a 2015 review of study, it can take a toll on an individual emotionally, particularly for women, beyond the physical aspect. It can affect your self-esteem, make you feel sad, and get in the way of your relationships with other people, because hair is so closely associated with femininity.
But to combat it in the first place, you need to know why your hair is falling out. Here, dermatologists and other experts discuss why you lose more hair and the best treatments to regain its volume and shine than normal.
- 1. Effluvium telogen
Telogen effluvium is a temporary condition in which you shed significant quantities of hair every day, usually while shampooing, styling, or brushing, after pregnancy, major surgery, severe weight loss, an illness (yes, including COVID-19), or intense stress can occur. During telogen effluvium, before moving rapidly into the shedding (or telogen) period, hair moves faster than normal from its growing phase into the "resting phase. Dr. Goldenberg says, "High stress conditions keep the body from giving hair the TLC it wants, causing hair to shed and fall out."
Symptoms: Women with telogen effluvium usually notice hair loss after a traumatic event for six weeks to three months. You can lose handfuls of hair at its height. Dr. Goldenberg says, "It can be very distressing."
Tests: Telogen effluvium tests are not available, but your doctor can ask you about recent life events and check for tiny "club-shaped" bulbs on the roots of the fallen hair. The bulbs indicate that the hair has gone through a full growth cycle, indicating that because of stress, the cycle may have intensified.
Treatments: In some situations, such as after birth or major surgery, before the hair loss slows, you can have to bide your time. "Usually it's solved. But it can become more persistent in some women,' says Dr. Goldenberg. Your bet for the best? Find a way and unwind to lower your levels of stress (A good place to start is these science-backed ways to alleviate stress.)
Taking a vitamin or supplement for hair development, such as biotin or other vitamin B types, can also be beneficial, says Dr. Goldenberg. To make it not conflict with any other medicines you might be taking, just check in with your doctor first.
- 2. The inherited lack of hair
According to the American Academy of Dermatology (AAD), hereditary hair loss or thinning is known as androgenetic alopecia and is the most common cause of hair loss. The gene may be inherited from either the mother's or father's side of the family, but if both of your parents have hair loss, you are more likely to have it.
The symptoms: The condition progresses slowly and can begin as early as your 20s, and women with this characteristic appear to grow thinning behind the bangs at the hairline, says Pamela Jakubowicz, MD, a board-certified dermatologist at New York City's Montefiore Medical Center. A expanding portion is another red flag, and the hair loss may be diffused, meaning it's distributed across the entire scalp.
The tests: To decide whether it is genetic and order blood work to rule out any factors, the dermatologist will investigate the history of hair loss, Dr. Jakubowicz says. Sometimes a biopsy of your scalp is done to see if miniaturized follicles have been substituted for the hair follicles, a surefire sign of inherited hair loss.
The treatments: While there is no way to fully stop inherited hair loss, by applying minoxidil (aka Rogaine), the only FDA-approved ingredient found to enhance hair loss, to the scalp twice a day you can delay the thinning. It works by improving the size of the follicles, resulting in larger hair strands. (Note only that minoxidil should not be used by women if they are pregnant or nursing.)
Minoxidil or finasteride (Propecia), an oral drug, can be used to treat men. "I also prescribe a biotin, zinc and copper multivitamin," Dr. Goldenberg says. With a medication called platelet rich plasma injections, a process in which the blood is drawn and then inserted into a system to isolate the red blood cells from plasma, he has also seen success in his patients. Per AAD, this plasma, which is "rich in platelets containing growth factors," is then directly injected into the hair follicles.
- 3. Areata alopecia areata,
Alopecia areata is an autoimmune condition in which hair follicles are attacked by the immune system. In the United States, it can affect up to almost 7 million people and occurs in all genders, ages, and ethnicities. The cause is unclear, but stress or illness can trigger it, Dr. Goldenberg says.
The symptoms: In three ways, the disorder may occur. Dr. Fusco says that alopecia areata usually causes round, smooth baldness patches on the forehead, eyebrows, or legs. Total hair loss on the head is known as alopecia totalis, while alopecia universalis is called hair loss that happens all over the body. "Some patients have indicated that they felt something in that area, a tingling or an annoyance, before the bald spot happened," says Dr. Fusco.
The tests: Watching the hair loss pattern will typically decide whether you have alopecia areata, as can blood tests. In order to rule out underlying disorders that can cause hair loss, you may also be given a test to measure the hormones.
Treatments: Alopecia areata is commonly treated, Dr. Fusco notes, with intralesional corticosteroids. There are also promising clinical trials involving JAK inhibitors such as oral tofacitinib (Xeljanz) for more advanced cases, which for some have resulted in regrowth. Even, minoxidil (Rogaine) can help. It's necessary to reduce stress as well.
- 4. Alopecia traction
Traction alopecia is a type of hair loss that according to AAD, occurs as a result of tight or heavy hairstyles. It's "forcefully dragging hair out of your scalp." This triggers hair follicle inflammation that eventually contributes to hair follicle scarring and destruction,” says Oma N. Agbai, M.D., assistant clinical professor of dermatology at the Davis School of Medicine, University of California.
Wearing tight hairstyles such as braids, weaves, and even dreadlocks is most commonly seen in people of African descent," says board-certified dermatologist Ife J. Rodney, M.D., founding director of Eternal Dermatology + Aesthetics in Fulton, MD. "Braids and weaves bring pressure on the scalp and hair follicles. Even if they're not done tightly, with dreadlocks, the weight of them can build tension.
However, Dr. Rodney says, traction alopecia can be encountered by anyone. I see a lot of military women in tight buns who have to wear their hair and have traction alopecia," she says." "Ballet dancers are also able to get it."
Symptoms: Early on, along the hairline, you can see scaling and flaking along the hairline, along with what seems to be tiny bumps around the hair follicle, Dr. Rodney says, which are the product of hairline inflammation. Scalp tenderness may be present as well. The hair should grow back if caught early enough, Dr. Rodney says. "But if it goes on for years, "the hair won't grow back again.
The tests: There is no set test for traction of alopecia, but you will be tested by your doctor and will want a biopsy to help decide whether you have the disease, Dr. Agbai says. "Traction alopecia can look very similar to other hair loss styles, such as frontal fibrosing alopecia or alopecia areata, and this can be differentiated from other types of alopecia and driven by a biopsy," she says.
Treatments: First, you will be advised to change your hairstyle to something less tight by your doctor. As Dr. Rodney says, "Wear your hair down and around your ears." You have to ask the hairstylist to make them loose if you have braids. "If you have dreadlocks, you'll want to wear them on the shorter side so that they're not too heavy on the scalp." If you pull your hair back that way, she also suggests loosening your buns or ponytails.
In order to relieve superficial inflammation around your hair follicles, your doctor can also prescribe the use of a steroid ointment. "In order to get the drug to the root of the bulb of the hair follicle, we can also do steroid injections, which are not too painful," Dr. Rodney says.
Overall, Dr. Rodney advises that you be mindful of how you feel about your scalp. "If you feel tight or uncomfortable with your hairstyle at all, it's too tight," she says. "No pain should be present at all."
- 5. Side Effects of Treatment
Some medicines, such as some cholesterol-lowering medicines, blood pressure medicines, warfarin (an anti-coagulant), psoriasis medicines, anti-seizure medicines, and anti-arrhythmia medicines, all have hair loss as a possible side effect, says Jennifer Wider, MD, a women's health specialist.
Symptoms: Three months or so after you start a new drug, you may find that you start losing your hair.
The tests: Talk about details with your doctor. Although your doctor can also look at whether you have an underlying disorder, the type of drug you are taking will decide what they test for just to be sure.
Treatments: To try to reduce the side effects, the doctor might consider moving to another drug, Dr. Wider says, or supplementing it with something else.
- 6. Problems with thyroids
Thyroid issues are common in women, particularly over the age of 50, says endocrinologist Theodore C. Friedman, MD, MPH, based in Los Angeles. In fact, according to the American Thyroid Association, 1 in 8 women will develop a thyroid condition in their lifetime.
Your thyroid is responsible for generating thyroid hormone, which is responsible for everything from your basal metabolic rate, the rate at which your body uses oxygen and energy to work, to the growth of your hair, skin and nails. The thyroid is the small, butterfly-shaped gland that sits at the base of your neck.
But you can find changes in bodily functions when you don't have the correct number. You are said to have hypothyroidism, or an underactive thyroid when too little is squeezed out. You're said to have hyperthyroidism, or an overactive thyroid, if the body produces too much of the hormone.
Symptoms: A host of symptoms can be caused by hypothyroidism (too little hormone), including unexplained weight gain, exhaustion, constipation, depression, and trouble concentrating. It can make hair, nails, and skin more brittle and break more easily. Hyperthyroidism is less common than hypothyroidism, but may lead to unexplained weight loss, heart palpitations, nervousness, irritability, diarrhea, damp skin, and weakening of the muscles. Both too little and too much thyroid hormone will freak out your hair follicles, resulting in hair loss.
The tests: In an effort to coax the thyroid to produce thyroid hormone, a blood test analyses thyroid-stimulating hormone (TSH), which is formed by the pituitary gland. Hypothyroidism is typically suggested by excess TSH, whereas abnormally low levels suggest hyperthyroidism.
"The treatments: "An important aspect of the therapy is the fixing of thyroid imbalances," Dr. Goldenberg says. Therefore to restore levels to normal, your doctor can prescribe thyroid hormone medication. To ensure an appropriate dose, routine TSH tests might be performed.
- 7. Anemia with Iron Deficiency
Iron deficiency tends to be an uncommon cause for hair loss, but when dealing with this, women will "completely" have hair loss, Dr. Goldberg says. Women who have severe periods or who do not consume enough iron-rich foods may be vulnerable to iron deficiency, in which the body does not produce enough hemoglobin, a protein that carries oxygen to the body's tissues. Your count of red blood cells in turn drops rapidly, zapping your energy. According to a 2013 research study, about 10 million people in the United States are iron-deficient, and it's more common in women than in men.
Symptoms: Anemia with iron deficiency causes severe tiredness, fatigue, and pale skin. You may have trouble focusing and feel headaches or cold hands and feet as well. You can be out of breath from some form of exertion. Your hair can start thinning and falling out as well, Dr. Goldenberg says.
The tests: To diagnose iron-deficiency anemia, a blood test to measure ferritin, the protein that stores iron in your body, is typically required. Your doctor can also check your blood levels for hematocrit, which tests the amount of red blood cells that make up your blood.
Eat iron-rich foods such as beef, pork, fish, leafy greens, fortified cereals, and beans, ideally along with vitamin C-rich foods that increase iron absorption. At least 18 milligrams of iron a day and 8 milligrams after menopause are required by women. Although supplementation might be appropriate, prior to popping a pill, you should speak to your doctor about the recommended dose.
- 8. Syndrome of Polycystic Ovaries
In the United States, as many as five million people suffer from polycystic ovary syndrome (PCOS). The disorder that can begin as early as age 11 is triggered by a hormonal imbalance in which too many male hormones are released by the ovaries. Often, PCOS causes infertility.
The symptoms: PCOS on the ovaries can cause facial hair growth, irregular cycles, acne, and cysts. And while your scalp may undergo hair loss, you may find more hair on the body elsewhere, Dr. Fusco says.
Tests: The doctor will typically administer a blood test to check for excessive levels of testosterone and DHEAS (dehydroepiandrosterone), a testosterone by-product.
Treatments: Most PCOS cases are treated with birth control pills such as Yasmin, which contains a potent testosterone-blocking anti-androgen. Your doctor can prescribe spironolactone (Aldactone), which also blocks male hormones, if you can't use birth control pills. Weight loss can also benefit by reducing the influence of male hormones.
When you get your hair back, you can need to be careful. "It may take several weeks to months for the associated hair loss to improve when hormonal conditions such as PCOS are treated," says Joshua Zeichner, MD, director of cosmetic and clinical dermatology research at Mount Sinai Hospital in New York City.
- 9. Psoriasis of the scalp, dandruff, and other skin disorders
An unhealthy scalp can cause inflammation and, Dr. Goldenberg says, "if the inflammation is deep in the scalp, it can cause hair loss." Seborrheic dermatitis (dandruff), psoriasis, and fungal infections such as ringworm are skin disorders that contribute to hair loss.
Symptoms: Seborrheic dermatitis allows the scalp to lose its skin, so on your shoulders or in your hair, you will find greasy, yellowish scales. It may be the product of Malassezia yeast, hormonal shifts, or the skin's excess oil. Scalp psoriasis, an autoimmune disease causing rapid turnover of skin cells, creates a very thick white scale that if pulled off may bleed.
You will find red patches on your scalp with ringworm, a fungus that you contract by touching an infected person or animal, which may be diffused, Dr. Jakubowicz says.
The tests: A scalp physical examination can help you decide which disease you have. A fungal culture and possibly a scalp biopsy may recognize ringworm. Only don't hang on to this. "See the dermatologist to make sure it's not a more extreme skin condition if you still have acne, swelling, hair breakage or hair loss," Dr. Goldenberg says.
Treatments: Each disorder normally needs a prescription: dandruff medicated shampoo, psoriasis medications or light therapy, and ringworm oral antifungals.
- Uh. 10. Styling unnecessary
Too much shampooing, styling, and dying, Dr. Goldenberg says, will damage your hair, contributing to hair breakage and loss. It is always a combination of treatments, such as keratin, coloring, and blow-drying, that does the harm.
Symptoms: It will simply crack if the fallout happens from external damage caused by fashion, and you will not see those club-shaped telogen bulbs at the ends.
The tests: Dr. Jakubowicz performs a pull test: she takes a small handful of about 50 hairs, pulls gently, and checks to see if bulbs are on the ends of the hair that comes out.
Treatments: Stop using devices that heat up your hair. Set cool and low settings for your hair dryer and minimize the use of flat and curling irons (say, for special occasions). Don't wait for it to dry if you use hair gel or hair spray before you comb through it so the hair will harden and be more likely to break.
Consider pivoting only one or two shades from its usual color if you have to dye your hair: the more extreme the color alteration, the more chemicals you need, resulting in excess breakage.
- 11. A diet that is low-protein
Although protein deficiency is uncommon for people living in developing countries, if you have recently become a vegan or vegetarian and have not worked enough plant-based proteins into your diet, you might not be getting enough of the nutrient.
When this occurs, according to the AAD, your body will ration whatever protein is already in your body by shutting down hair growth. Typically, this happens two or three months after the consumption of protein decreases.
The symptoms: A protein deficiency can cause bloating, brittle nails, fatigue and weakness in addition to hair loss. You won't be having those club-shaped telogen bulbs at the ends when your hair splits.
Tests: If your doctor is concerned that your thinning hair might be responsible for a lack of protein, he or she may conduct a blood draw for a total protein test that tests all of the proteins in your blood.
Treatments: Consuming more protein is likely to avoid hair loss, Dr. Goldenberg says, because protein deficiency is a type of malnutrition that stresses the body. Excellent sources of protein are beef, eggs and fish, as are many foods based on plants, including tofu, legumes, nuts, and tempeh.
- 12. Via menopause
A normal disorder that affects women as they age is menopause. By definition, menopause, according to the National Institute on Aging (NIA), is a point in time 12 months after a woman's last cycle. Your body releases fewer estrogen and progesterone hormones during this period.
The symptoms: Everybody experiences menopause differently, but the NIA says you can find symptoms such as hot flashes, sleeping issues, moodiness, irritability, sexual discomfort, and depression. Also, hair loss may be a concern. "Hair loss occurs during menopause due to hormonal changes," says Dr. Broader. "The result is a slowing of hair growth and thinning of hair in many women as estrogen and progesterone decrease."
The tests: Your doctor can recommend a blood test to check the levels of follicle-stimulating hormone and estradiol to rule out any other causes of the changes you are experiencing, the NIA says.
"Treatments: "During this period, it's important to treat your hair well and gently," says Dr. Wider. "With hair dryers and ironing equipment, prevent excessive heat. Without additional additives, use mild shampoos and conditioners. Keep your body hydrated.' Speak to your doctor about choices for treatment if that doesn't help.
- 13. Dramatic loss of weight
"Studies have shown that rapid or severe weight loss can cause hair loss," states Dr. Wider, typically due to the lack of certain nutrients, including protein.
Symptoms: If you start losing weight rapidly (typically described as losing more than 5 percent of your weight in six months to a year you will note. Your jeans will be looser and you'll see the number on the scale go down if you weigh yourself daily. If you experience hair loss, it can happen all of a sudden.
Tests: The doctor may prescribe blood tests to see what's causing your rapid weight loss if you're not trying to lose weight, which may include concerns such as just not eating enough, thyroid problems, celiac disease, or even mental health conditions such as depression.
Treatments: If you're trying to lose weight, address any vitamin deficiencies that might be causing your hair loss with your doctor. If not, and there is an underlying problem behind the weight loss, remember this When a person regains weight, once the necessary medication is decided, the hair loss will stop and begin to grow back," Dr. Wider says.
- Uh. 14. Lupus Lupus
Lupus is a chronic inflammatory condition in which the healthy tissues are attacked by the body's immune system. According to the Lupus Foundation of America, the disease affects around 1.5 million Americans and appears to hit females during their childbearing years.
Symptoms: Severe fatigue, headaches, oral ulcers, and sore, swollen joints are frequently caused by lupus. A butterfly-shaped rash grows across the bridge of the nose in many individuals and becomes more susceptible to the light. Fever, swelling in the feet and hands and around the eyes, chest pain, and anemia are other signs.
Many individuals with lupus often experience hair loss, which may be mild and occur when shampooing or brushing the hair, or it can be more severe, coming out in patches and followed by a scalp rash, says Arthur Weinstein, MD, Washington Medical Center's director of the rheumatology division. Lupus is also called the great imitator because these signs occur in many other conditions.
The tests: For symptoms of inflammation, such as heat, discomfort, swelling and redness, a rheumatologist will evaluate joints and other tissues. Lupus can also be confirmed by a blood test to assess levels of anti-nuclear antibodies (ANA). Rheumatologists can also assess whether patients have four of the 11 diagnostic criteria set by the American College of Rheumatology, although sometimes lupus can be indicated by fewer criteria along with a skin biopsy, Dr. Weinstein says.
Treatments: If the hair loss is followed by joint pain, exhaustion, or other lupus symptoms, see a rheumatologist. You ought to see a dermatologist who is likely to recommend a topical cream if you already have a rash on the scalp.
- 15. Chemo-therapy
Chemotherapy acts to destroy cancer cells in your body, but in the process, it can also kill healthy cells, including those behind the growth of hair. "In order to stop development, chemotherapeutic agents attack rapidly developing cells (like cancer)," says Dr. Wider. "Unfortunately, they also target healthy cells such as hair cells, and a person may lose their hair as a result of chemotherapy."
Symptoms: Thinning hair and/or hair that falls out in clumps can be visible.
The tests: You probably won't need any, considering that chemotherapy's common side effect is hair loss.
The treatments: There is a fairly recent FDA-approved treatment that can help, called a cooling cap. According to the National Cancer Institute, scalp cooling is thought to avoid hair loss by decreasing blood flow to hair follicles. Blood vessels constrict when the scalp is cooled, and that may restrict the amount of chemotherapy medication that enters hair follicles.
- 16. 16. Trichotillomaniaa
According to the National Association for Rare Disorders (NORD), trichotillomania is a disease that induces an intense desire to constantly pull your own hair out, causing hair loss. Although this can affect hair all over your body (including eyebrows and eyelashes), it most frequently affects the hair on the scalp.
Symptoms: In general, symptoms include excessive hair-pulling and an impulse to pull the hair. People with the condition can also experience tension until they pull and then release, NORD says. Since the scalp is a major pulling point, individuals with trichotillomania can concentrate on one or two areas, resulting in bald patches. The disease can be very distressing.
Tests: After a doctor conducts a clinical examination, takes a thorough case history, and rules out other possible causes of hair loss, people are generally diagnosed with trichotillomania.
Treatments: Trichotillomania is commonly managed, NORD states, through psychotherapy and medicine. Cognitive behaviour therapy is typically used in psychotherapy, which seeks to recognize and modify the thoughts and feelings that cause a person to pull their hair. Multiple drugs can also help, including clomipramine, n-acetyl cysteine, and olanzapine.