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11 Sneaky Reasons Your Hair Is Falling Out

First Posted: 08/11/11 09:09 AM ET   Updated: 10/11/11 06:12 AM ET

Not only is August the last month of summer, but it's also National Hair Loss Awareness Month -- who knew? According to the American Academy of Dermatology (AAD), hereditary hair loss alone affects more than 80 million men and women in the United States. And for these men and women, this hair loss may be a significant source of anxiety.

A 2007 survey conducted by the International Society of Hair Restoration Surgery, found that more than 57 percent of respondents (all men) would choose to have hair on their head over a car, a cell phone, a laptop or a television set. A different survey referenced in “Women and Hair Loss: A Physician’s Perspective,” written by president and CEO of the Hair Foundation, Dr. Matt Leavitt, found that 43 percent of women are at least “somewhat concerned” about hair loss. These concerns are not unfounded as there are numerous conditions -- both hereditary and otherwise -- that can cause your hair to thin or fall out. But where is the line between “normal” hair loss and something that may indicate another issue?

We spoke to a few hair loss experts about the issue of hair loss and why it happens -- we even discovered a few sneaky hair loss culprits.

The Basics
Your hair lives in a state of constant cyclical movement. At any given moment a certain percentage of hair is in a “Growth Phase” (usually about 85 percent of hairs), a “Transitional Phase,” or a “Resting Phase.” When a given hair follicle transitions from resting to growth, the old hair is pushed out by a new hair.

It is this cycle that causes what we think of as every day hair loss -- most people lose between 50 to 100 hairs each day. And on days when we shampoo, we tend to lose more, says Amy McMichael, M.D., a professor of dermatology at Wake Forest Baptist Health. Hence, why none of us should be alarmed if we leave a small clump of hair behind after we shower (although unclogging the drain is probably a good idea).

Paradi Mirmirani, M.D., a dermatologist with The Permanente Medical Group, explains the life cycle of hair as, "a very biologic rhythm … where certain things can disrupt this rhythm.” Dr. Mirmirani explains that these “disruptions” are what often lead to hair loss.

The Most Common Cause
Although there are a large array of possible triggers for hair loss, the most common cause remains male and female pattern baldness. “Fifty percent of men and women will have some manifestation of hereditary hair loss,” says Mirmirani, “although the pattern of hair loss differs."

This genetically-driven hair loss is not experienced through excessive shedding, but rather a gradual thinning of the hair. Baldness just doesn’t happen overnight. It is also experienced differently in men and women. While men often go completely bald -- specifically on the crown or top of their heads -- women usually experience general thinning on the top of the scalp and rarely experience anything close to total baldness. According to George Cotsarelis, M.D., chairman of the University of Pennsylvania Department of Dermatology, female pattern hair loss “tends to start early if it’s going to be severe.” He says of his female patients, “They [often] think they’ll be bald and [get] very frightened. Most of the time if they’re in their 40s, 50s, 60s, they’re not going to.”

As an aside, many men and women that experience pattern baldness are also shown to have higher than average levels of insulin. Although the correlation between insulin resistance (pre-diabetes) and hair loss had been well-established in men, in the last decade, research has found the same connection in women.

What Other Causes Are There?
Besides male and female pattern baldness (also called androgenetic alopecia) any number of things can trigger temporary and permanent hair loss. Since most people that experience excessive hair shedding only do so on a temporary basis, Dr. Mirmirani says that sometimes the culprit is never discovered. “There are probably various signals [other than the major ones] that can lead to shedding, but we’re just not in tune with what those are,” she says.

Dermatologists are in tune with many of the hair loss triggers, though. We rounded up some of the sneakiest culprits.

But remember, if you are concerned about excessive hair loss, it’s always best to seek the advice of a medical professional. “When there is an acute … loss of hair -- either in patches or diffusely -- evaluation by a medical professional … is indicated. This way appropriate treatment can be started as early as possible,” says Andrew F. Alexis, M.D., MPH, assistant clinical professor at Columbia University.

Trichotillomania
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Trichotillomania is an impulse control disorder. Although the underlying causes for this disorder are not concretely understood, its most obvious symptom is the urge to break or pull out one's own hair. Individuals that have trichotillomania cannot control these urges and often pull out entire patches of their hair -- often from the scalp or eyebrows. The disorder is fairly rare -- 4 percent of people in the U.S. are affected by it -- although men are less likely to experience these urges than women are.
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