Hair Loss

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	References
	Credits

Is hair loss normal?

Everyone loses some hair every day. Losing up to 100 hairs a day is normal.

But if hair loss runs in your family, you could lose a lot more hair. Over time, you may end up with bald spots or hair that slowly gets thinner. About half of all people have this type of hair loss by around age 50.^{1, 2}

Other factors, such as diseases and medicines, also can cause you to lose more hair than normal.

Although hair loss is fairly common, it can be a tough thing to live with, especially when it changes how you look. But there are ways you can treat your hair loss.

What causes hair loss?

Common causes of hair loss include:

• Heredity. In most cases, hair loss is inherited, which means it’s passed down from one or both of your parents. This is called male-pattern or female-pattern hair loss.
• Stress, including physical stress from surgery, illness, or high fever.
• Chemotherapy, which is powerful medicine that destroys cancer cells.
• Damage to your hair from pulling it back too tightly, wearing tight braids or ponytails, or using curling irons or dyes.
• Age, since you grow less hair as you get older. Hair also gets thinner and tends to break more easily as you age.
• Poor diet, especially not getting enough protein or iron.
• Thyroid diseases, like hypothyroidism and hyperthyroidism.
• Ringworm of the scalp, which is common in children.

What are the symptoms?

Your symptoms will depend on what kind of hair loss you have.

If your hair is thinning, it happens slowly over time, so you may not notice the hairs falling out. If your hair is shedding, then clumps of hair fall out. You may lose hair all over your scalp, which is called general hair loss. Or you may lose hair only in one area, which is called focal hair loss.

With inherited hair loss, men usually get bald spots around the forehead or on the top of the head, while women have thinning all over the scalp.

See a picture of typical inherited hair loss.

Since your hair has a lot to do with your appearance, losing it may cause you to have lower self-esteem if you don't like how you look. This is especially true in women and teens.

How is hair loss diagnosed?

Your doctor will ask you some questions, like how much hair you're losing, when it started, and whether your parents have hair loss. He or she will look closely at your scalp and hair-loss pattern and may gently pull out a few hairs for tests.

If it’s not clear what’s causing you to lose your hair, your doctor may do a blood test or look at a sample of your hair or scalp with a microscope.

How is it treated?

How you choose to treat your hair loss depends on the cause. It also depends on your feelings. You may decide that you need treatment, or you may not be worried about thinning hair or baldness. The choice is up to you.

Hair loss that runs in the family can be treated with medicines or with surgery, such as a hair transplant. Some people choose to wear hairpieces, like wigs or toupees (say "too-PAYZ"). Finding different ways of styling your hair, like dyeing or combing, also can help. If hair loss is caused by something you can control, like stress or medicines, you can treat it by getting rid of the cause.

When you are deciding about treatment, think about these questions:

• Which treatment is most likely to work?
• How long will it take?
• Will it last?
• What are the side effects and other risks?
• How much will it cost, and will insurance cover it?

Will your hair grow back?

When your hair loss is inherited, your hair won't grow back naturally. Treatment can help some hair grow back and prevent more from falling out, but you probably won't get all your hair back. And treatment doesn't work for everyone.

When medicines, stress, or hair damage cause you to lose your hair, it often will grow back after you take away the cause. If this doesn't help, you may need other treatment.

If you're unhappy with how hair loss makes you look, treatment may boost your self-esteem. It’s natural to want to like the way you look.

But keep in mind that treatment, especially medicines and surgery, can have some side effects and risks. Be sure to discuss your decision with your doctor.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I treat inherited hair loss with medication?

Excessive hair loss (more than 100 hairs a day) can be caused by inherited factors, disease, stress, medications, injury, aging, or hair care.

Inherited hair loss

The most common cause of hair loss is genetics—you inherit the tendency to lose hair from either or both of your parents. This is called male-pattern hair loss or female-pattern hair loss. The medical term for this type of hair loss is androgenetic alopecia.

In this type of hair loss, your genes affect how your hair grows. They trigger a sensitivity to a class of hormones called androgens, including testosterone, which causes hair follicles (which hair grows from) to shrink. Shrinking follicles produce thinner hair and eventually none at all. Men generally develop bald spots on the forehead area or on the top of the head, while women have an overall thinning of the hair throughout the scalp. About half of all people have inherited hair loss by about 50 years of age.^{2, 1}

See an illustration of typical inherited hair loss.

Other causes of hair loss

Common causes of hair loss include:

• Ringworm of the scalp (tinea capitis), which is common in children.
• Mental stress or physical stress, such as recent surgery, illness, or high fever. You may have a lot of hair loss 4 weeks to 3 months after severe physical or emotional stress. Your hair usually will grow back within a few months.
• Hair care. Pulling your hair back too tightly or wearing tight braids or ponytails can cause hair loss. You may lose hair around the edge of the hairline, especially around the face and forehead. Using curling irons or dyes continually can also result in hair loss. Hair usually grows back when these activities are stopped.
• Age. As you age, your hairs tend to break more easily, and hair follicles do not grow as much hair.
• Poor nutrition, especially lack of protein or iron in the diet. Hair returns after you change your diet to get enough of these nutrients.
• Thyroid diseases including hypothyroidism and hyperthyroidism.

Other causes of hair loss include:

• Alopecia areata, an autoimmune disease in which your immune system attacks hair follicles, resulting in obvious, round hairless patches on any area of the scalp or body. Severe cases involve many bald patches of hair or complete loss of hair on the scalp or body, although in some cases there is hair thinning without distinct patches of baldness. Hair usually grows back within 1 year without treatment; however, 10% of people with the condition may never regrow their hair.²
• Diseases, such as lupus, syphilis, or cancer. Hair may grow back on its own, although you may also need treatment.
• Side effects of medications or medical treatments, such as blood thinners (anticoagulants) or chemotherapy. Hair usually grows back after you stop using the medication or when the treatment is over.
• Trichotillomania, a compulsive behavior in which a person pulls hair out of the scalp, eyelashes, or eyebrows. There is usually mounting tension before pulling and a feeling of relief afterward. Trichotillomania often results in noticeable hair loss.
• Injury to the scalp including scarring. Injuries can damage hair follicles and cause hair loss.
• Changes in hormone levels. Childbirth, taking birth control pills, or changes in a woman's menstrual cycle can affect the hair growth cycle and cause hair loss. Hair usually will grow back.

Hair loss can be categorized by types. Different types of hair loss may have different causes. For example, one type of hair loss known as telogen effluvium is caused by stress and side effects of medication. Another hair loss type, traction alopecia, is caused by hair care.

Hair loss can occur as thinning, in which you may not notice hair falling out, or as shedding, in which clumps of hair fall out.

In the most common type of hair loss, inherited hair loss (androgenetic alopecia), men tend to lose hair on the front hairline and forehead and on top of the head. Eventually, only hair around the ears, the sides, and back of the head remains. Women with this condition typically have gradual thinning throughout the scalp.

See an illustration of typical inherited hair loss.

Other causes of hair loss may also show distinct patterns. For example, conditions such as trichotillomania (compulsively pulling at the hair) or alopecia areata (in which the immune system attacks hair follicles) result in obvious patches of hair loss, while stress and some medications result in clumps of hair falling out.

Because hair is an important part of appearance, hair loss can also result in loss of self-esteem and feeling unattractive, especially in women and teens.

What happens in hair loss depends on its cause.

Inherited hair loss

Inherited hair loss (androgenetic alopecia) often begins between the ages of 12 and 40, and about half the population has some hair loss by about 50 years of age.^{1, 2} The hair loss generally is gradual. Men tend to lose hair on the front hairline and forehead and on top of the head. Eventually, only hair around the ears, the sides, and back of the head remains. Women with this condition typically have gradual hair thinning throughout the scalp. This type of hair loss must be treated early for hair to regrow.

See an illustration of typical inherited hair loss.

Other causes of hair loss

Alopecia areata is hair loss caused when the immune system attacks hair follicles, where hair growth begins. It usually starts with one or more small, round, smooth bald patches on the scalp and can progress to total scalp hair loss or complete body hair loss. It often begins in childhood. The hair usually grows back within 1 year. However, hair loss in alopecia areata often comes and goes—the hair will grow back over several months in one area but will fall out in another area.

Hair loss may be caused by stress, disease, or medications or medical treatments. In these cases, clumps of hair may fall out. However, after the underlying cause is stopped, the hair usually grows back, although sometimes treatment may be needed.

Treatment to regrow hair does not work for everyone. If your hair loss is inherited, treatment may not permanently restore your hair. If your hair loss is caused by medication, stress, or damage, hair often grows back after the cause is removed, although sometimes you will need treatment.

For both men and women, hair thinning and baldness increase the risk of sunburn and skin cancer on the scalp. When in the sun, it is important to wear a hat or use a sunscreen with an SPF of 30 or more to prevent sun damage to the scalp.

Factors that increase the risk of hair loss include:

• Genetics (inherited tendency). If one or both of your parents have hair loss, it is likely that you will also.
• Disease or illness. Certain diseases or an illness can cause hair loss. The diseases may include ringworm of the scalp (tinea capitis), thyroid diseases such as hyperthyroidism and hypothyroidism, or lupus. The illness may include a severe infection or high fever.
• Age. Many people have some hair loss by the age of 50.
• Medications and medical treatments. Certain medications or medical treatments can cause scalp problems and hair loss.
• Hair care and styling. Some methods of hair care or hair styles can damage hair and cause hair loss.

Although most people with hair loss caused by alopecia areata regrow their hair, certain people are at greater risk for their hair not growing back. If you have a family history of the condition, have the condition at a young age, have an autoimmune disease, are prone to allergies (atopy), have extensive hair loss, or have abnormal color, shape, texture, or thickness of the fingernails or toenails, you are more likely to have permanent hair loss.

Call your health professional if:

• Your hair loss is sudden, rather than gradual.
• You notice hair shedding in large amounts after combing or brushing, or if your hair becomes thinner or falls out.
• You are concerned that a medication may be causing your hair loss.
• You have a rash, scaliness, or any change in the skin on your scalp with hair loss.
• You see signs of bacterial infection on your scalp, such as:
  • Increased pain.
  • Swelling, redness, tenderness, or heat.
  • Red streaks extending from the area.
  • Discharge of pus.
  • Fever of 100°F (37.8°C) or higher with no other cause.
• Your hair is gradually thinning and balding, and you want to discuss treatment options with your health professional.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting may be appropriate if your hair loss is gradual and like the pattern of hair loss seen in your parents or brothers or sisters. However, if your gradual hair loss bothers you, your health professional may be able to slow or reverse it. If clumps of hair fall out, your hair loss may be caused by a disease, and it is important to contact your health professional.

Hair loss caused by alopecia areata often reverses on its own. Watchful waiting is an option after you have been diagnosed with this condition.

Who To See

Health professionals who can give you advice and treatment on hair loss include:

• Family medicine doctors.
• Internists.
• Physician assistants.
• Nurse practitioners.
• Dermatologists.

Hair transplant surgery is usually done by:

• Dermatologists.
• Plastic surgeons.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Hair loss is diagnosed through a medical history and physical examination. Your health professional will ask you questions about your hair loss, look at the pattern of your hair loss and examine your scalp, and may tug gently on a few hairs or pull some out.

The most common cause of hair loss, inherited hair loss (androgenetic alopecia), is easily recognized. Men tend to lose hair from the forehead area and top of the head with normal amounts of hair on other areas of the scalp. Women tend to have the same amount of thinning of hair throughout the scalp.

Hair loss history

To determine the cause of your hair loss, your health professional may ask you about:

• Characteristics of your hair loss. Is your hair thinning, with your scalp becoming more visible, but your hair is not noticeably falling out? Or is your hair shedding, with lots of hair falling out?
• How long your hair loss has been occurring. How long has it been since you had your normal amount of hair?
• Your family history of hair loss. Does your mother or father, brother or sister, or any other relative have hair loss? If so, what caused their hair loss?
• Your hairstyling habits. Has your hair become fragile from pulling it too tight or from other hairstyling habits? Have you had any chemical treatments to your hair, such as permanents (perms) or bleaching? Do you use a blow-dryer that may be too hot? Is a curling iron damaging your hair?
• Any recent illness. Have you had any skin rashes, such as ringworm, recently?
• Medications you are taking. Are you taking blood thinners (anticoagulants) or medications for arthritis, depression, or heart problems? Have you had any cancer treatment?
• Your diet. Are you getting enough protein and iron in your diet?

Tests

If the reason for your hair loss is not clear, your health professional may do tests to check for a disease that may be causing your hair loss. Tests include:

• Hair analysis. Your health professional will take a sample of your hair and examine it under a microscope. A scalp sample might also be taken.
• Blood tests, including testing for a specific condition, such as an overactive or underactive thyroid gland (hyperthyroidism or hypothyroidism).

Hair loss in women is more difficult to diagnose than it is in men because the pattern of hair loss is not as noticeable as it is in men. In women with mild to moderate hair thinning who are otherwise healthy (with normal menstrual cycles and fertility history), testing to diagnose hair loss usually is not done. However, in women who have irregular menstrual cycles, continued episodes of acne, or too much body hair (hirsutism), testing for a class of hormones called androgens, including testosterone, is sometimes done.

Some people choose to treat hair loss with medications or surgery, such as hair transplantation. Others choose to wear hairpieces (wigs or toupees) or use different methods of hair styling (dyeing or combing). The approach you use depends on the cause of your hair loss. Some people feel they need treatment, while others are not as concerned about thinning hair or baldness.

If a disease, medication, or stress is the underlying cause, treating the disease, changing medications, or eliminating or learning to manage the stress may stop the hair loss.

Treatment for hair loss may boost self-esteem and overall well-being, although the trade-off might be that it affects your health. Some medications may have harmful side effects, and surgery may carry certain risks.

Inherited hair loss

Treatment for inherited hair loss (androgenetic alopecia) aims to prevent hair loss, promote hair growth, and cover bald areas of the scalp. But treatment is not successful for everyone, and you should not expect to regrow a full head of hair.

Medications include:

• Minoxidil. Minoxidil (Rogaine) is available without a prescription and is sprayed on and/or rubbed into the scalp twice a day.
• Finasteride. Finasteride (Propecia) is available by prescription and is taken once daily in pill form. Finasteride has not been proven effective in women and is not approved for women by the U.S. Food and Drug Administration (FDA).³ Women who are or may become pregnant should not take or handle crushed or broken tablets, because finasteride can cause birth defects.

For more information, see:

Should I treat inherited hair loss with medication?

Surgery includes:

• Hair transplantation surgery. During this surgery, your health professional will move small grafts (pieces of skin with hair follicles) from areas of your scalp with full hair to areas of your scalp that are bald or thinning. The grafts may include single hairs or up to 30 hairs in one graft. This is the most common type of surgery used to treat hair loss.
• Scalp reduction. Scalp reduction involves removing large areas of bald scalp from the head. Sections of the scalp with growing hair are then stretched and sewn together to fill in the bald areas.
• Scalp flaps. Scalp flaps involve moving a large section of scalp containing hair from the side and back of the scalp to a bald area. One side of the flap remains attached to the scalp as the section of scalp with hair is moved to cover a bald area. The complication rate of this procedure is higher than other procedures because of bleeding, scarring, and infection after surgery.

Cosmetic approaches to hair loss include:

• Wearing hairpieces or having weaves. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. Hair weaving involves sewing or braiding pieces of long hair into existing hair.
• Using certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. However, continual use of perms or dyes may result in more hair loss.

Treatment for other causes of hair loss

Hair loss can be caused by diseases, medications or medical treatments, recent surgery, high fevers, emotional stress, lack of protein or iron, and hair care, such as using dyes. Often, treating the underlying cause stops the hair loss, and hair grows back. In some cases, other treatment is necessary.

Hair loss caused by cancer treatment requires special care: use mild shampoos and do not use a hair dryer.

Alopecia areata occurs when the immune system attacks hair follicles, where hair growth begins. Because hair usually grows back within a year, you may decide not to have treatment. Understanding the come-and-go nature of hair loss in this condition can help you make the best treatment decision. Children and teens may need counseling to help them adjust to the hair loss.

Medication used for alopecia areata includes:

• Corticosteroid ointments or creams you put on the scalp. There is little evidence that they cause hair growth.⁴
• Corticosteroids injected into the scalp. The corticosteroid is injected many times about 1 cm (0.4 in.) apart every 4 to 6 weeks. This is the most common treatment and is best used for treating patchy hair loss. Limited research reports that hair grows back at the site of injection in some people.⁴
• Corticosteroids you take by mouth (oral). Although this results in hair growth, it is rarely used because of the side effects of oral corticosteroids.
• Contact immunotherapy. Contact immunotherapy is an experimental therapy that may be the most effective treatment for severe alopecia areata.⁴ A common medication used is diphenylcyclopropenone (DPCP), which is "painted" on the scalp once a week.

Other medications used to treat alopecia areata include minoxidil (Rogaine), anthralin, and cyclosporine. Anthralin is sometimes used in combination with minoxidil. These medications affect the immune system and may stimulate hair growth, but they do not prevent hair loss.

What To Think About

How successful your treatment is depends on your expectations and the cause of hair loss. Treatment for hair loss caused by an illness, medication, or damage to the hair usually is more successful than treatment for inherited hair loss.

Considerations about inherited hair loss include:

• The cost. Medication or surgery to treat hair loss can be expensive and often is not covered by insurance.
• Length of treatment. Medications must be taken continuously or the regrown or thickened hair will fall out. Surgery can be lengthy, and in most cases you will need several surgeries to achieve the coverage you want.
• Side effects. Long-term effects of some hair loss medications are not known.
• Type of treatment. Medications that must be taken continuously can be expensive and can increase the chance of side effects. Surgery, which may be a more permanent solution, is also expensive. In addition, surgery involves risks and the chance that not all hair follicles will remain healthy.

Women with inherited hair loss who wish to take birth control pills should use a pill type that does not add to hair loss, such as a norgestimate or ethynodiol diacetate.⁵

Hair loss that is caused by medications, stress, lack of protein or iron, or hair care may be prevented. Avoiding certain medications, reducing stress, getting adequate protein and iron in your diet, and using hairstyles that do not damage your hair may reduce or prevent hair loss.

Inherited hair loss (androgenetic alopecia) cannot be prevented.

Home treatment for hair loss includes hair care and hairstyling techniques that may help you cover thinning or bald spots on the scalp. This may be easier for women because inherited hair loss (androgenetic alopecia), causes a general thinning that is usually not as severe as it is in men. Hair sprays, dyes, and perms can help make the hair appear fuller.

In women with inherited hair loss, hair care and the occasional use of grooming products, hair sprays, hair color, teasing, permanents, or frequent washing will not increase hair loss. However, if your hair loss is caused by hair care, then perms and dyes may contribute to more hair loss.

For both men and women, hair thinning and baldness increase the risk of sunburn and skin cancer on the scalp. When in the sun, wear a hat or use a sunscreen with an SPF of 30 or more to prevent sun damage to the scalp.

Medications for hair loss can slow thinning of hair and increase coverage of the scalp by growing new hair and enlarging existing hairs. However, they need to be taken continuously. If the medications are stopped, any hair that has grown in will gradually be lost, and within 6 to 12 months your scalp will most likely appear the same as before treatment.

For more information, see:

Should I treat inherited hair loss with medication?

Medication Choices

Medications often used to treat inherited hair loss (androgenetic alopecia) include:

• Minoxidil. Minoxidil (Rogaine) is available without a prescription and is sprayed on and/or rubbed into the scalp twice a day.
• Finasteride. Finasteride (Propecia) is available by prescription and is taken once daily in pill form. Finasteride has not been proven effective in women and is not approved for women by the U.S. Food and Drug Administration (FDA).³ Women who are or may become pregnant should not take or handle crushed or broken tablets, because finasteride can cause birth defects.

Medications used to treat alopecia areata, which is caused when the immune system attacks hair follicles, include:

• Corticosteroid ointments or creams you put on the scalp. There is little evidence that they cause hair growth.⁴
• Corticosteroids injected into the scalp. The corticosteroid is injected many times about 1 cm (0.4 in.) apart every 4 to 6 weeks. This is the most common treatment and is best used for treating patchy hair loss. Limited research reports that hair grows back at the site of injection in some people.⁴
• Corticosteroids you take by mouth (oral). Although this does result in hair growth, it is rarely used because of the side effects of oral corticosteroids.
• Contact immunotherapy. Contact immunotherapy is an experimental therapy that may be the most effective treatment for severe alopecia areata.⁴ A common medication used is diphenylcyclopropenone (DPCP), which is "painted" on the scalp once a week.

Other medications used to treat alopecia areata include minoxidil (Rogaine), anthralin, and cyclosporine. Anthralin is sometimes used in combination with minoxidil. These medications affect the immune system and may stimulate hair growth, but they do not prevent hair loss.

What To Think About

If you are taking medication for inherited hair loss, do not expect to regrow a full head of hair. Hair coverage is improved on the top of the head, but not on the forehead area. However, when you stop taking these medications, hair loss begins again.

Finasteride has not been proven effective in women and is not approved for women by the FDA.³ Women who are or may become pregnant should not take or handle crushed or broken tablets, because finasteride can cause birth defects.

Surgery to cover bald areas of the scalp may be used to treat hair loss. If successful, surgery may be a permanent treatment for hair loss.

Surgery Choices

The most common types of surgery to treat hair loss include:

• Hair transplantation surgery. During this surgery, your health professional will move small grafts (pieces of skin with hair follicles) from areas of your scalp with full hair to areas of your scalp that are bald or thinning. The grafts may include single hairs or up to 30 hairs in one graft. This is the most common type of surgery used to treat hair loss.
• Scalp reduction. Scalp reduction involves removing large areas of bald scalp from the head. Sections of the scalp with growing hair are then stretched and sewn together to fill in the bald areas.
• Scalp flaps. Scalp flaps involve moving a large section of scalp containing hair from the side and back of the scalp to a bald area. One side of the flap remains attached to the scalp as the section of scalp with hair is moved to cover a bald area. The complication rate of this procedure is higher than other procedures because of bleeding, scarring, and infection after surgery.

What To Think About

Surgery may be a more permanent solution than medications to treat hair loss, but it is expensive, involves surgical risks, and there is a chance that not all hair follicles will remain healthy.

Other treatment for hair loss includes:

• Hairpieces or weaves. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. Hair weaving involves sewing or braiding pieces of long hair into existing hair.
• Hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp.
• Behavior modification, if hair loss is caused by compulsive pulling of your hair (trichotillomania).

The U.S. Food and Drug Administration (FDA) warns consumers that other than FDA-approved minoxidil (Rogaine), there are no over-the-counter creams, lotions, or other products that can induce new hair to grow or cause hair to become thicker. Also, shampoos that claim to promote hair growth by unclogging follicles have not been proven to work. However, there are some products that may make hair appear thicker and others that may cover bald spots.

Limited research on the dietary supplements saw palmetto and beta-sitosterol shows they may help men with inherited hair loss (androgenetic alopecia) regrow hair.

Citations

1. Thiedke CC (2003). Alopecia in women. American Family Physician, 676(5): 1007–1014.

2. Habif TP (2004). Hair diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed., pp. 834–863. Philadelphia: Mosby.

3. Springer K, et al. (2003). Common hair loss disorder. American Family Physician, 68(1): 93–102.

4. MacDonald Hull SP, et al. (2003). Guidelines for the management of alopecia areata. British Journal of Dermatology, 149: 692–699.

5. Habif TB, et al. (2005). Hair and nail diseases. In Skin Disease: Diagnosis and Treatment, 2nd ed., pp. 516–541. Philadelphia: Elsevier Mosby.