Hair Loss In Men and Women

Hair Loss In Men and Women

The causes of hair loss vary depending on a number of factors, including the most common form of hair loss – genetic hair loss for men or woman, illness, and medications you may be taking. To determine the cause of your hair loss you should schedule an examination with a hair loss expert like Dr. Katona who is certified by the American Board of Hair Restoration Surgery.

Other causes of hair loss in men and women are related to lifestyle. Factors such as stress, exposure to chemicals or UV rays, smoking and consuming alcohol can play a role in triggering or exacerbating the loss of hair, It is also important to be aware that certain types of hairstyles, including braids, tight ponytails and hair extensions, can cause tension and trauma to the hair follicle, leading to hair loss.

Male Pattern Hair Loss (Androgenetic hair loss)

This is the most common form of hair loss in men, impacting 50-70% of all males.  It is characterized by miniaturization of scalp hairs, where thick terminal hairs are replaced by finer, thinner versions of themselves.

Hair loss typically runs in families.  Classification of male pattern hair loss is often described using the Hamilton-Norwood Scale of hair loss, which classifies the severity of hair loss based on the extent of hair loss.  Most commonly, men experience hair loss in the frontal hairline and vertex (crown) of the scalp. Though this condition is often distressing to patients, many medical and surgical treatment options are available. Currently, there are only two FDA approved medications for male pattern hair.  Various low-level light therapy (LLLT) devices are FDA cleared for use in treating androgenetic alopecia. Hair restoration surgery can provide patients with a more permanent and dramatic solution.  Camouflaging agents are also quite popular and effective.


Temporary Hair Loss

Temporary hair thinning can be caused by a number of medical conditions, but temporary hair loss in men is commonly caused by hypothyroidism. When this condition is treated, the temporary hair thinning is typically reversed. It is important to see a physician to determine whether or not this is the underlying cause. Other potential causes for temporary baldness include general anesthetic, high fever, physical trauma, and chemotherapy. Temporary hair loss in women can be caused by inadequate iron intake due to heavy menstruation or following pregnancy. This type of hair loss can be reversed with the help of iron supplements and medical treatment.

High stress levels can also result in temporary baldness. Although this type of temporary hair loss is not fully understood, emotional and hormonal factors can result in an abnormally high amount of shedding. In general, with temporary hair loss, these hairs regrow after 3-4 months.

Telogen effluvium

This is defined as a diffuse hair shedding due to any major physiologically stressful event. The most common cause is childbirth, wherein women develop massive shedding 3-6 months after the baby is born.  Other examples include high fever, crash dieting or rapid weight loss, general anesthesia, or prolonged illness or hospitalization. Hormonal or thyroid disorders may also contribute, as can nutritional deficiencies or certain medications. Telogen effluvium can also result from major life events such as death of a loved one, divorce, or financial loss.

Hormonal causes

Starting or stopping birth control can result in hair shedding.  Many women suffer from polycystic ovarian syndrome (PCOS) or hyperandrogenism due to other causes (exogenous testosterone supplementation in post-menopausal women, or use of an androgenic progesterone in the setting of birth control).  These forms of hair loss can often by addressed by ceasing the androgenic supplementation or by adding oral spironolactone, which is a diuretic with anti-androgen properties.  Certain birth control pills containing drospirenone may also be helpful.

Thyroid disorder

Patients with untreated hyper- or hypothyroidism may present with hair shedding.  They may also notice eyebrow thinning or eyebrow loss.

Nutritional deficiencies

Low levels of iron, zinc, and vitamin D have all been linked with hair shedding in the medical literature.

Hair Loss From Medications

High dose vitamin A, isotretinoin, and certain cardiovascular drugs such as beta-blockers (metoprolol, propranolol) and low molecular weight heparin (and less commonly warfarin) have been linked with hair shedding.  There is some evidence that the same patients who develop hair loss are also genetically predisposed to cardiovascular disease, in which case the drugs may have more of a confounding than a causative effect.  In order to conclude that a medication is responsible for hair loss, a person must stop the drug, allow 3-6 months off it to see if the shedding resolves, and then (if they are willing) restart the drug to see if the shedding recurs. This process can take 6-12 months to fully evaluate. Patients should consult with their doctor before stopping any medication to avoid potentially dangerous effects.

Anagen effluvium

This type of hair loss occurs due to a disruption of the hair growth cycle while it is in its actively growing (anagen) phase. It most frequently occurs after certain forms of chemotherapy. The hair loss begins in a matter of 2-4 weeks after beginning therapy.  In most cases the hair loss is temporary but for others the hair may regrow only scantily or with permanently changed texture or caliber.  Certain chemotherapy drugs such as busulphan and cyclophosphamide have been associated with permanent hair loss.  Concurrent use of topical minoxidil has been shown to delay the loss of hair and speed its regrowth afterward.

Alopecia Areata

This is an autoimmune form of hair loss that presents with small round-to-oval patches on the scalp but can affect larger, more confluent areas, as well as the eyebrows, eyelashes, and body hair.  It most frequently presents in childhood but can occur at all ages. The hair follicles lose their usual immune privilege and come under attack by lymphocytes (T-cells). There may also be targeting of the melanocytes (pigment cells) associated with the follicles, resulting in white regrowth (poliosis). Alopecia totalis is loss of the entire scalp hair, while patients who lose of all body hair too develop alopecia universalis. Ophiasis is the term used to describe hair loss in the occipital scalp, and can be very difficult to treat.  First-line therapies include topical and intralesional corticosteroids but more severe or longstanding cases can require systemic even immunosuppressive therapy such as methotrexate or prednisone. There is increased use in treatment of alopecia areata with JAK inhibitors. However, many cases resolve spontaneously with no treatment whatsoever.

 Congenital Triangular Alopecia

Also known as temporal triangular alopecia, this form of alopecia is localized to the frontotemporal scalp.  It typically arises in early childhood and may present in a variety of shapes along the frontal and lateral hairlines including triangular, lancet-shaped or ovoid.  There is no inflammation or scarring in this condition.  On scalp pathology, the number of hair follicles is normal but many are miniaturized.  The mainstay of therapy for adults is hair restoration surgery.