Hair Loss

Male Pattern Baldness

What causes hair loss? Actually, individual hairs are being lost all the time: it is common to lose up to 100 hairs per day. If you are losing more than that, or if parts of your scalp are becoming prominent, you may be losing more than the normal amount of hair.

Scalp hairs remain in an active growing phase for 2 to 6 years.  Then the hairs transition to a resting phase for three weeks and stay in that rest phase for three months. It’s during the resting phase that the individual hair falls out, after which the follicle starts growing a new hair. Unless it doesn’t: sometimes the follicle doesn’t go around again. It’s still there, but not entering the growth phase. So, when we see a common type of hair loss called “male pattern baldness” (what we’re used to seeing in a significant percentage of older men) the reason is that the bald area is full of stagnant follicles. If we could “wake up” the follicles, hair would grow out again. [We’ll discuss how this is done when we get to the Treatment section.]

Female Pattern Baldness

Female pattern baldness” is also quite common – it generally means a noticeable thinning of the hair occurring in women.  Another name for both male and female pattern baldness is androgenetic alopecia. While men usually present with a receding frontal hairline, in the woman’s version the hair becomes thinner predominantly over the frontal scalp. Though the frontal hairline is usually spared, females usually show a widening of the part. And there are other types of hair loss, too.

Alopecia Areata

Alopecia areata is an auto-immune disease in which the body attacks its own hair follicles resulting in patchy loss of hair growth: the size of the patches could be about the size of a quarter or it could be much larger – even covering the entire scalp.  Nearly 2% of the U.S. population will have some degree of alopecia areata in their lifetime.

Hormones can affect hair growth and loss, too. Just after having a child, a woman’s hormonal changes can induce a noticeable loss of hair. During the pregnancy the follicles may have remained longer than usual in the growth phase, and when pregnancy ends many follicles go into the hair loss phase at the same time, which leads to a lot of hair loss a few months after delivery. Abnormal hormonal balance may cause hair loss: returning the hormones to normal may allow the follicles to return to normal growth behavior.

Steroid use by athletes can lead to hair loss similar to that found with hormonal problems.

Children may be affected by fungal infections which interfere with hair growth; treating the infection can restore the hair.

Certain medications (e.g., blood thinners,anti-hypertensives, anti-depressants) can produce excessive hair loss. The hair usually returns to normal after the medication is stopped.

Constant tension can pull out large areas of hair. Tightly worn pony-tails yield a neat appearance, but may have this side effect.

Stress can lead to extensive temporary hair loss. The stress can be of any source, including bodily stress felt as a result of surgery, or personal stress.


Living with hair loss can be hard, especially in a culture that views hair as a sign of youth and good health. For small areas of hair loss on the scalp, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows. Children often wear bandanas to cover hair loss; and wearing the appropriate jewelry and makeup can bring attention to other areas of the face and body and away from the scalp.

There are many different treatments for alopecia, depending on what type of hair loss you are diagnosed with.  In general, androgenic alopecia (male and female pattern hair loss) cannot be avoided. However, you can prevent additional hair loss by not applying too much stress to your hair  (ponytails, cornrows, tight clips or tight rollers) and avoiding hot oil treatments or perms, which can scar the hair follicle. A recent study showed that sunscreen and scalp protection (hats, caps, headpieces) are important to help ameliorate hair loss later in life and that sunburns on the scalp at a young age leads to hair loss in adulthood.

Rogaine (also known as Minoxidil) is a non-prescription 2% (women) or 5% (men) preparation that has been approved by the FDA for male and female pattern alopecia. Topical minoxidil solution promotes hair growth when the hair follicle is small and not growing a thicker hair.  Some studies have shown it to be  useful in promoting hair growth in alopecia areata. The solution, which can be applied once or twice daily, can  take 3 – 6 months before you see new hair growth appear.  Minoxidil can stimulate hair growth in both men and women and slow down hair loss, but it cannot “cure” baldness.

Another medication used for hair loss is Propecia, a prescription medication approved by the FDA only for male pattern hair loss. It comes in pill form and has been shown to cause the formation of new hair growth in men.  Both Rogaine and Propecia will help cause new hairs to be formed but the growth will stop if the medications are discontinued.

Both Minoxidil and Propecia work by “waking up” the follicles that are already present, but dormant, in the skin.

Treatments for other types of hair loss including alopecia areata consist of various topical therapies, oral medications, or injections into the scalp which will help regrow new hair.  If adequate treatment is not available for your type of hair loss, you may consider trying different hairstyles, wigs, hairpieces, hair weaves, or artificial hair replacement. Hair transplants are also an option.

Outside resources: For information on how to deal with alopecia areata, you can visit the National Alopecia Areata Foundation’s web site. Among other things, they have a packet of information for dealing with elementary schools, including a sample letter to send to other parents.