Everyone loses hair. In fact, it’s normal to lose between 50 and 100 hairs a day, according to the American Academy of Dermatology. But what if it seems like there’s significantly more loss than that?
“Once you exceed that, you’re losing it at an abnormal rate,” says Dr. David J. Wong, clinical associate professor of dermatology at Stanford University. Contrary to popular notion, hair loss is not just a condition that men face: up to 40 percent of women in America also experience it.
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But what about for women? It’s commonly more accepted — and expected — that men lose their hair. But when women begin to lose theirs, the psychological damage can be just as devastating as any serious disease, taking an emotional toll that can directly affect physical health, says the American Hair Loss Association, a consumer organization dedicated to the prevention and treatment of hair loss.
Studies have shown that patients who experience hair loss suffer from self-esteem and body image issues, impacting their social life and feelings of attractiveness.
Female Pattern Hair Loss (FPHL)
The most common cause of progressive hair loss in women, FPHL (Female Pattern Hair Loss, also known as androgenetic alopecia), affects about 30 million American women, according to the American Academy of Dermatology.
FPHL has a distinct appearance. Hair thins mainly on the top and crown of the scalp, usually beginning with a widening through the center hair part.
Wong explains it this way: “Female pattern hair loss is characterized by miniaturization of the hair follicles, where the hair follicles become smaller and produce shorter, thinner, more brittle hairs, and can eventually stop producing any hair. The hair follicles not only miniaturize but also can become deleted with a decrease in total number of follicles.”
Unlike men, women tend to keep their hairline, except for normal recession (which happens to all of us as time passes, Wong says). The hair loss in women will rarely result in total baldness, as it can in men.
Making a Diagnosis
Since women develop hair loss for many reasons (more on that below) and each requires different treatment, it’s wise to consult with a dermatologist, says Wilma F. Bergfeld, senior dermatologist at the Cleveland Clinic and past president of the American Academy of Dermatology.
Diagnosis is usually based on a few factors — ruling out other causes of hair loss, the appearance and pattern of the hair loss and your medical history (though FPHL is usually not a sign of an underlying medical disorder).
“It’s like peeling an onion to figure out what all the complicating factors are causing the hair loss,” Bergfeld says. “Oftentimes, hair loss can be due to a combination of factors, especially since after age 50, a variety of diseases and conditions can begin to develop in women.”
Possible Causes for Hair Loss
The reasons for female pattern hair loss are not totally understood, although it is thought to be related to a family history of male or female baldness, changes in the levels of male hormones (androgens) and aging. Five possible causes:
Close to 50 percent of women will experience some degree of hair loss or thinning before age 50, which often worsens with menopause, according to the North American Menopause Society. “Your hormones have been supporting your hair growth,” explains Bergfeld. “When estrogen dips, the hair begins to change.”
Illness or Underlying Medical Conditions
Thyroid disease, diabetes, lupus or anemia are among the 30 or so diseases that can cause sudden hair loss, according to the American Academy of Dermatology (AAD), which says that hair loss can often be the first sign of disease. Other conditions include ringworm, polycystic ovary syndrome (PCOS) and some cancer treatments.
Stress or Trauma
You may notice excessive hair shedding several months after a stressful or traumatic event (like divorce or loss of a spouse), sudden or excessive weight loss, a high fever or surgery, according to the Mayo Clinic. That shedding is normal and temporary — but may be long-lasting if the stress persists.
Dieting and Poor Nutrition
Eat poorly and your hair could suffer: The body shifts its nutritional stores to vital organs like your brain and heart — and away from your hair — if there is a shortage.
Low protein, low iron stores, low vitamin D and calcium can cause hair loss, says Bergfeld. But taking nutritional supplements for what you might be missing isn’t necessarily the answer. A study published in Clinical and Experimental Dermatology found that excessive levels of supplements can actually cause hair loss and should not be used unless there is an actual deficiency.
Years of pulling your hair too tight in a bun or ponytail or wearing it in cornrows or braids can put stress on the hair and cause a type of hair loss known as traction alopecia. So can bleaching or regular use of dyes, relaxers and other hair products as well as straightening irons and curling wands.
Treatment for Hair Loss
The only over-the-counter medication approved by the Food and Drug Administration (FDA) for female pattern hair loss is minoxidil (commonly known by the brand names Rogaine or Theroxidil), a topical treatment which helps slow or stop hair loss in about one in four or five women and can produce some new growth of fine hair in some women, according to Harvard Health Publications
It usually takes about one year to see how well the treatment will work for you and this is a life-long commitment: if stopped, hair loss begins again.
While treatment may induce hair growth, it usually won’t change the course of the condition.
If minoxidil does not work, there are other “off-label” medicines, which include spironolactone (Aldactone), a drug used to treat hypertension; cimetidine (Tagamet), a class of histamine blockers; Ketoconazole, an antifungal agent and sometimes hormone replacement therapy (HRT).
The American Academy of Dermatology says that once your dermatologist has determined the cause of your hair loss, he or she can tell you what to expect. Sometimes, the hair will begin to re-grow on its own. Other times, you may need to change what you are doing to allow the hair to start re-growing.
“The key is to detect the signs early, so that we can intervene with potential treatments at the earliest possible stage when we can minimize the effects,” explains Wong.
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