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.
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 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.
Are you a hair dye junkie or someone who consistently flat irons? You could be damaging your hair with these hair care practices. Both excessive use of hair treatments (i.e. bleaching, perms, relaxers) and products (i.e. blow dryers, straighteners and curling irons) can make hair brittle. Luckily, these types of hair damage are not permanent -- change the bad-for-your-hair habit and your hair should restore itself!
Over time, men and women who consistently wear their hair in styles that pull at the scalp (i.e. tight braids, weaves, tight ponytails) may develop a condition termed "traction alopecia." According to Dr. Alexis, traction alopecia is a hair loss condition that is seen far more often in women than men. A couple of the experts we spoke to also said that in their practices they most often saw traction alopecia in African-American and Hispanic women -- although the condition spans all ethnic groups. Chris Rock's 2009 documentary film, "Good Hair," addressed some of these issues as they effect the African-American community. "Women put up with a lot of pain," Dr. Cotsarelis told The Huffington Post. "Pain to your scalp should be avoided." Sounds like a good rule of thumb to us!
Iron and protein deficiencies are two of the most common nutritional triggers for hair loss. If individuals have low levels of iron -- even if they are not anemic -- hair loss may occur. An article published in the May 2006 edition of the Journal of the American Academy of Dermatology concluded that hair loss treatment was made more effective when a patient's iron deficiency was treated. Dr. Cotsarelis says that he consistenly checks the iron levels of any patient that comes to him experiencing hair loss. However, the exact reason behind this correlation has not been proven. Protein deficiency is more straightforward. Hair growth requires protein, and when the body is not getting enough, it moves these protein supplies to other, more necessary functions. Once an individual's diet is adjusted hair growth usually returns to normal within a couple months. While not a deficiency, for those that have Celiac Disease or gluten-sensitivity, the introduction of the gluten protein into the system may also lead to hair thinning or loss. In this case, it is the immune system that attacks hair growth.
Although this trigger technically falls under nutritional deficiencies, we felt that it warranted specific attention. According to the American Academy of Dermatology, individuals who lose 15 or more pounds (even through healthy means) often experience some amount of hair loss. This type of hair loss usually self-corrects without any need for treatment. More concerning is hair loss as a result of an eating disorder, such as anorexia nervosa or bulimia. These eating disorders do not allow the body to receive the necessary vitamins, minerals and protein that it needs to function healthfully -- which in turn can shut down hair growth. "Anorexics can have very extreme hair loss," says Dr. Cotsarelis. "I had a patient in her 20s who was anorexic -- her hair was just coming out in gobs because of poor protein intake."
Hair loss is a common symptom of an imbalance in one's thyroid hormones. Both hypothryoidism (an underactive thyroid) or hyperthyroidism (an overactive thyroid) can lead to excessive hair shedding. Once the thyroid imbalance is treated, the hair generally regrows.
Doctors still are unsure what the scientific connection is between menopause and hair thinning -- but many women, in their perimenopausal years, experience some sort of generalized hair loss. Some combination of hormonal changes are likely at play. "We don't really understand exactly why, but it's pretty clear [that there is a connection]," says Dr. Cotsarelis. "[Many] women have very thick hair their whole life and then when they go through menopause, they [experience] thinning."
When we hear talk of "alopecia," most likely what is being referred to is alopecia areata. Alopecia areata is an autoimmune disease, which means that the body attacks itself. Alopecia areata is usually characterized by hair loss in round patches on the scalp or other parts of the body and affects men, women and children.
Telogen effluvium is defined by Dr. McMichael as "shedding due to physiologic stress." McMichael told The Huffington Post that a traumatic or particularly stressful event is a common reason that individuals experience this type of hair loss (even more so for women than men). The most common emotional causes of telogen effluvium are life-altering occurrences such as a death or going through a divorce. These events can cause hair to be forced into the resting state before they normally would be. According to Dr. Cotsarelis, this type of hair shedding often does not show up until two to four months after the trigger occurs.
Illness is another possible cause of telogen effluvium -- most often triggered by a high fever. The stress on the body that illness causes can become a disruption to the hair cycle. Once the illness is gone, the cycle gets itself back on track.
Many medications have hair loss listed as a possible side effect, although various types tend to affect each person differently. Medications that contain hormones -- such as the birth control pill are common hair loss culprits. According to Mayo Clinic, antidepressants, blood pressure medications and arthritis treatments are also frequent offenders.