By Dr. Loretta Lanphier, ND, CN, HHP, CH

Hair loss. Most of us associate it with older men going bald, but the truth of the matter is that there is much more to it than just middle-aged guys with shiny heads. It is a condition that can affect males or females of any age, and for a variety of reasons. The purpose of this article is to get a better perspective of how and why alopecia occurs.

What is Alopecia?

The short answer to that question is that alopecia, which is the medical term for total or partial hair loss, is caused by one of three main factors: hormonal changes, physical stress, or mental stress. It can happen in a variety of ways from gradually noticing more and more hair in your brush or in the bathroom sink, to suddenly noticing one day that a patch of your hair is missing. It can begin seemingly without prior warning or a definite cause, or you can know exactly why your hair is falling out, such as from the effects of chemotherapy. Hair loss can be strictly on your scalp, or can sometimes affect hair on other parts of your body as well.

Alopecia is most commonly found in men, but is also not an unusual phenomenon in women as well. Let’s take a look at some of the most common types of alopecia, and the causes behind them.

  • Androgenetic alopecia, also known as “pattern baldness” or “male pattern baldness,” is by far the most oft-found type of alopecia. It is estimated that a total of 1/3 of men and women are afflicted with androgenetic alopecia at some point in their lives. It is most common in men, but also affects women. However, it is usually much more visible and noticeable in men, thus the moniker “male pattern baldness.” It usually starts with most men at the temples and the crown of the head, and often leaves a telltale horseshoe shaped pattern on the scalp. It can lead to partial or total baldness. One characteristic of androgenetic alopecia is that the scalp of its victims is usually left in good condition, unlike some forms of alopecia that are associated with an unhealthy scalp that actually causes or contributes to the hair loss. Most ladies who have this type of alopecia have limited hair loss, typically around the front, sides, or crown of the scalp, and total baldness in women is very rare. Androgenetic alopecia is most often a permanent condition.
  • Alopecia areata and alopecia circumscripta can also affect men and women, and are characterized by hair loss that occurs in small, round patches, and can be limited to small areas, or extend to total baldness. They can also affect body hair in other places than just the scalp. These types usually involve temporary hair loss.

What Causes Alopecia?

Perhaps a basic discussion of how hair grows will help give us a better understanding of alopecia. The hair on our heads grows in different cycles, with most of it at any given time (about 90%) being in what is called the anagen stage, which is composed of 2-6 year old hair growth. The remainder is about 2-3 months old, and called the resting or telogen phase. As new hair grows in, the body automatically sheds a certain amount of hair in a recycling process. Most people lose about 50-150 hairs per day. The average rate of growth for new hair in most people is about ½ inch per month. Alopecia occurs when the rate of shedding exceeds the rate of new hair growth, or when new hair grows in that is thinner than the hair that has been shed.

As far as specific causes for hair loss, they vary with the type of alopecia:

  • Androgenetic alopecia is the result of hormonal changes in the body. As testosterone is converted in the body into a more potent form called dihydrotestosterone (DHT), it tends to shrink hair follicles and lead to partial or total baldness. This is more likely to occur as we age, but male-pattern baldness can exhibit itself in individuals, usually males, as early as their teen years. This type of hair loss is very closely related to your family history. The age of onset, the pattern of hair loss, and even the degree of hair loss are uncannily similar in family trees. One has a greater chance of getting androgenetic alopecia if it is found on either side of the family, father or mother.
  • Alopecia areata:  The causes of this type of alopecia are somewhat of a mystery, but the best evidence points to an autoimmune problem that results in temporary hair loss. Many individuals who are afflicted with this type of hair loss are otherwise healthy, and while the hair usually grows back, the process may repeat itself several times in a victim’s lifetime. There is also a genetic connection, as alopecia areata tends to run in families. Some researchers believe that these individuals have a propensity for this type of alopecia that may be triggered randomly by a virus or other antigen from time to time. Other theories point to environmental factors may play a role in the unpredictable appearance of this type of alopecia.

Besides these two major types of hair loss, there are other less common causes for alopecia:

  • Chemotherapy:  One of the most well known side effects of chemotherapy or radiation therapy used to treat some kinds of cancer is alopecia that can manifest itself as partial or total baldness. This hair loss is usually temporary.
  • Thyroid disorders:  Both hypothyroidism (too little thyroid hormone) and hyperthyroidism (too much thyroid hormone) can result in changes in the condition of the scalp and growth of the hair. Hypothyroidism causes the hair to grow in thinner and finer. The opposite happens with hyperthyroidism. Hair tends to thicken, sort of alopecia in reverse.
  • Fungal infections, often involving the same fungi that cause ringworm or athlete’s foot, can attack the scalp and cause alopecia. One way that this can be diagnosed is by looking at the scalp under a black light. This particular type of fungus will be visible in black light.
  • Certain autoimmune diseases, such as lupus erythematosus for example, can cause diseases of the scalp and result in hair loss.
  • Malnutrition can also cause alopecia. Inadequate amounts of iron or protein in the diet are just two examples. Sometimes folks with eating disorders will experience alopecia as well.
  • Some medications can trigger hair loss as well. Examples include birth control pills, blood pressure medications, certain antidepressants, and some drugs for gout and arthritis.
  • Hair treatments such as harsh dyes and chemicals can cause hair loss in some folks. Even tightly drawn hairstyles can bring on a certain amount of hair loss known as “traction alopecia.”  Be careful how you care for your hair!
  • Recent surgery or a recent high fever has also resulted in alopecia in some cases. It is thought that these factors can affect the normal cycles of hair growth and shedding.
  • Pregnancy and/or childbirth can also affect the normal patterns of hair growth and lead to temporary hair loss in the first few months after giving birth.
  • A rather unique form of alopecia that is kind of in its own category is caused by a mental disorder that causes patients to tear their hair out. This type of alopecia is called trichotillomania. A somewhat related form, in that it is caused by emotional and/or physical stress is called Telogen effluvium.This type of temporary hair loss often affects individuals who have been through a traumatic or stressful experience such as the loss of a loved one or a divorce.

What Treatments Are Available for Alopecia?

Trying to grow hair back on the head, especially of men, has been a huge industry ever since the days of the traveling snake oil peddlers of yesteryear. In more modern times, we have all the big drug companies competing for our business, with the aid of mass marketing. (In some cases, not too much different than the snake oil peddlers).

As with most drugs, be careful before you jump on their bandwagon. One medication in particular has some very nasty potential side effects. It is called Propecia (finasteride), and it can cause impotence and decreased libido in men. But that’s not the worst of it. It has not been approved by the FDA for use by women because it has a tendency to cause birth defects. In fact, this stuff is so toxic that they warn pregnant women not to even handle broken or crushed tablets because even a small amount absorbed through the skin can cause serious birth defects in male children! Not something I want to put in my body. Corticosteroids are also something to stay away from. I would not recommend letting anyone inject them into your scalp, no matter how badly you want your hair back.

Some safe and successful natural treatments have proven very hopeful. Saw palmetto is known for its ability to discourage the formation of DHT from testosterone. A diet high in zinc, Vitamin B6, and biotin (a B-complex vitamin) has also proven to promote healthy hair growth.

Of course, there are always hairpieces and toupees to consider as well. Actually, these are kind of old technology. Hair weaves that use a donor’s hair along with your own hair to stimulate re-growth are currently very popular.

Another option you may want to consider is the “go natural “ movement that is gaining momentum with many men these days. “Bald is beautiful” seems to be the battle cry, as many men have decided to let nature takes its course. It seems many women are discovering they are attracted to bald men as well.

A lot of jokes are made about balding men and the extremes they go to in order to remedy the situation, but for some people, especially those who have lost their hair due to traumatic experiences such as chemotherapy treatments, it is no laughing matter. If you are seeking to overcome alopecia, do your homework and learn as much as you can about all the various options. As with most medical issues these days, you must be an educated consumer and make the best choice for yourself, given the circumstances.

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