Hair loss. It starts slow and progressively escalates as we age. However, try as we might to course-correct or battle Mother Nature, it’s often to no avail. The truth is that it hurts to lose your hair. It pains us to see those strands fall out, one by one.
While losing 50 to 100 strands per day is common, sudden and acute hair loss — the kind that sees you shedding far more than that per day — can be debilitating.
But you’re not alone.
According to the American Hair Loss Association, two-thirds of American men will experience hair loss by the time they’re 35. Meanwhile, 40 percent of women experience hair loss by the time they’re 40.
So the question then becomes, what causes hair loss? Is it poor health? Or are there some other causes that might be within my grasp or control?
Causes of Hair Loss
There are two main reasons for hair loss in men: male pattern baldness, which is genetic and hence unavoidable. The other is alopecia, which can have physiological or psychological causes, and may be treatable. But there are several others as well.
1. Male Pattern Baldness (MPB)
Also called androgenic alopecia, MPB is hereditary, meaning that you inherit it from someone in your genetic line. It isn’t very clear how exactly it passes from one generation to another, but it runs in families. Therefore, if close relatives are balding, you’ll probably have MPB when you’re older.
Research has not fully understood the hormonal changes that cause shrinkage of hair follicles. This is usually how male balding takes. However, it can happen earlier or later; research hasn’t understood exactly why.
We do know that MPB develops because your body becomes sensitive to a testosterone derivative hormone, dihydrotestosterone (DHT). It starts where the scalp is most sensitive to DHT.
Often, MPB begins by thinning around the temples and crown and gradually moves to the back of the head. This process can take as little as five years, but it often takes 15-25 years. It’s impossible to predict how long an individual might take.
Some people will start MPB in teenage, although 3 percent of children today show signs of alopecia in childhood. MPB can cause hair strands to become softer, shorter and finer.
2. Drug-Induced Hair Loss
Sudden-onset or temporary hair loss can indicate an underlying medical condition. It can also come as a result of the treatment of those conditions.
Anemia or thyroid function problems can cause temporary hair loss. Similarly, consuming diets low in iron, protein, zinc and other minerals can cause hair thinning. This is why vegetarians are more prone to thinning than non-vegetarians.
Hair loss can be caused by chemotherapy or radiation therapy to treat cancer. Once treatment is stopped, however, the hair will grow back.
Here are some drugs that can cause hair loss as a side effect:
- Retinoids (Vitamin A derivatives) to treat acne e.g. Accutane
- Anticoagulants like warfarin and heparin
- Cholesterol-lowering drugs like Gemfibrozil and Clofibrate
- Anticonvulsants like trimethadione
- Amphetamines and methamphetamines
- Some antifungals
- Beta-blockers to treat glaucoma like Timolol
- Allopurinol for gout
- Beta-blockers for hypertension and heart conditions e.g. Atenolol, Metoprolol, Nadolol, etc.
- Anti-inflammatory drugs, especially NSAIDs like Naproxen, Indomethacin, and Sulindac, also methotrexate (also used for chemotherapy)
- L-DOPA for Parkinson’s disease
- Drugs that treat thyroid dysfunction
- Beta-blockers for ulcers like Cimetidine, Ranitidine, and Famotidine
Always ask your doctor about the side effects of the medications they prescribe. If you’re more prone to hair loss, ask them if they can recommend alternatives without this side effect. Sometimes, however, the benefits of the treatment outweigh the risk of hair loss.
3. Stress, Shock and Depression
High-stress levels can cause three forms of hair loss:
- Telogen effluvium – At any time, 90 percent of your hairs are in the growth phase and 10 percent are in the resting phase. Hair in the resting phase falls in about two months. High stress pushes more hair follicles into the resting phase and increases your rate of hair loss
- Alopecia areata – The body’s immune system attacks their hair follicles causing hair loss. Evidence of this in relation to stress is still scanty, however.
- Trichotillomania – This is basically hair-pulling. Stress can create the uncontrollable urge to pluck out hair, and not just from your head.
Severe physical or emotional shock or sudden and excessive weight loss can also bring on temporary hair loss.
Depression can also worsen hair loss for two reasons. First, the higher stress levels will act as demonstrated above. Two, antidepressants are associated with hair loss as a side effect e.g. Prozac, Zoloft, etc.
4. Hormonal Therapy
Any hormone-containing or hormone-mimicking drugs may affect hair growth or shedding. These include estrogen/progesterone for hormone replacement therapy, all forms of testosterone, all hormonal birth control interventions, prednisone, and related steroid drugs and anabolic steroids (body-builders).
Ringworm is a fungal infection that can cause hair loss in patches if it develops on the scalp. It is the same infection that causes athlete’s foot and can also affect the nails.
Folliculitis is an inflammation of the hair follicle. If left untreated, the hair will fall out and the follicle could be damaged permanently, creating bald spots.
Piedra is a fungus that infects the hair fibers, causing them to develop hard nodules.it can affect hairs anywhere, including the armpits and genitals. Severe piedra infection, while benign, can cause the hair fiber to weaken and fall out easily.
Seborrheic dermatitis is a skin condition, but it can affect the scalp. If this happens, hair can fall out temporarily, and grow back once the condition is treated.
Autoimmune disease like lupus can also cause hair loss since your immune system attacks the hair follicles.
Alopecia areata is also associated with an over-active immune system. Other than stress, it can be genetic, in which case the alopecia starts in childhood. It affects over 6.8 million people in the US, often before 30 years of age.
Finally, wearing tight ponytails, doing tight braids or adding heavy extensions can stress the follicle and cause the hair to fall out. This is called traction alopecia and it is temporary to a degree. With prolonged over-grooming, the affected follicles can be damaged permanently.
Hot oil treatments and heat processing can also damage hair follicles and hair strands.
Myths Concerning Hair Loss
You have probably heard some things about losing hair and you’re wondering whether or not they are true. The following are some myths you can finally put to bed:
- Swimming in chlorinated water or washing with salty water doesn’t cause hair loss. However, the salt does leach your hair strands because of osmosis, which makes hair brittle and more likely to fall out.
- Wearing caps can only cause “hat hair”; it doesn’t cause hair loss
- Sunscreen does not cause hair loss. In fact, you should apply sunscreen to areas where your hair has receded
- Hair dryers also don’t cause hair loss. They simply dehydrate your hair strands making them more brittle as above.
Treatments for Hair Loss
Medicine has immense strides is reducing or preventing hair loss in men. Today, it is even possible to replace lost hair through surgery!
That said, most of the hair loss treatments marketed in websites and men’s magazines are dubious. Talk to an expert and ensure that your treatment option is FDA-approved. The American Hair Loss Association also has trustworthy resources you can take advantage of.
Early treatment is crucial to getting the best results out of your treatment program. For example, DHT only causes hairs to fall out after prolonged exposure. Caught early, it is possible to suppress the effect of DHT and so slow down or stop the process of hair loss.
Below is some detail on the available treatment options:
1. Finasteride, Propecia/ Proscar
Finasteride is a generic form of the brand name drugs Propecia and Proscar. It was originally used to treat prostate gland enlargement. During clinical trials, researchers noticed hair growth as a side effect. Since it was an approved drug, getting FDA approval for reversal of MPB wasn’t difficult.
Finasteride works by inhibiting the enzyme that converts testosterone to DHT. Taken daily, it can reduce DHT levels by 60 percent, which stops the progression of hair loss. This was shown in 86 percent of the participants, 65 percent of whom showed substantial regrowth.
Finasteride is generally well tolerated, but often leads to impotence, low libido, swelling and tenderness of feet, hands and breasts, weakness, dizziness, and trouble ejaculating.
Also, you must take it for life to maintain its effect on hair preservation. If you stop, the effects will be reversed within a year. It takes about 3 months before you see noticeable benefits. Women or children must never use Finasteride or Propecia.
Note that Propecia affects the PSA antigen levels and can lead to inaccurate results if you’re taking the PSA test.
2. Minoxidil (Ioniten)
Minoxidil was the first FDA-approved drug for MPB. Before, the pill was used to control hypertension. Hair growth was discovered as a side effect. Unlike Finasteride, Minoxidil caused hair growth on the head and other body parts e.g. cheeks, forehead, back of the hands, etc.
However, Minoxidil does not affect the hormonal cause behind MPB, and so its effect is largely temporary. It is not effective for long-term control of balding. It is still recommended if you have not responded well to Finasteride or wish to supplement its effects.
Minoxidil is a lotion that is applied to the scalp. The oral formulation is not recommended because of undesirable hair growth on other body parts.
Is There A Way To Solve Your Hair Loss Problems?
Hair loss has a psychological aspect to it, especially if it begins when you are very young. Some men have changed career paths as a result of losing hair.
If you notice you’re losing hair more than normal, seek treatment early. If treatment isn’t for you, acceptance can help you to enjoy a full and happy life. Some men opt to get the bald haircut to mask the balding, for example.
Do you have any concerns about hair loss? Fill this questionnaire to get started on the road back to a full head of hair.