Causes of Hair Loss


This question comes from a member of our hair loss social community and discussion forums

I recently dyed my hair a darker color. After the color treatment, however, it looks like I’m losing my hair! Can hair dye cause hair loss? Is it temporary? Any other explanations for what’s going on?

hair dyeHair dyes normally cause alopecia via structural damage to the hair shaft – also known as trichorrexia nodosa. This would manifest as shorter “broken hairs” – in the shower, sink, on the pillow, etc – without a bulb at the end, or the appearance of a variety of small, thick hairs growing near the scalp surface.

Some people have a genetic predisposition to shaft breakage that is “set off” by a harsh environmental factor – brushing, chemical dyes, harsh shampoos, etc. This could be the case here.

While hair loss from harsh dye is possible, there may be another explanation: a starker contrast between scalp color/tone and hair shaft color/tone always creates a “thinning” appearance. This is the reason why Caucasian men with lighter hair can undergo hair transplantation at lower densities and still achieve good results. It’s possible that you dyed the hair darker and it now simply looks thinner because of the more obvious contrast with your scalp.

If it is related to trichorrexia, it should naturally reverse itself; if it is related to contrast, you should see a difference after the hair grows out.
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Blake Bloxham – formerly “Future_HT_Doc”

This question comes from a member of our hair loss social community and discussion forums

I’m going to see a doctor about my hair loss. I think I suffer from androgenic alopecia or male pattern hair loss; however, I want an evaluation to see if something else is causing the thinning. Should this work up include blood testing? If so, what type of blood work should I get to evaluate the hair loss?

blood workGenerally, male pattern hair loss is a clinical diagnosis made by closely examining the scalp. Furthermore, there is really no defined “hair loss” blood panel. However, some cases of alopecia – especially in female patients – aren’t as obvious, and many doctors check blood levels of: thyroid stimulating hormone (TSH) , total and free testosterone, estradiol, DHEA(S), hemoglobin (a complete blood count to assess anemia), vitamin D, iron, and maybe DHT, ANA (autoimmune), and prolactin. Some of these blood tests are more specific than others, and doctors will chose which are best for each individual patient.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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This question comes from a member of our hair loss social community and discussion forums

I’m feeling depressed about my hair loss; what should I do?

depressionPatients feeling truly depressed by hair loss must seek out the help of a mental health professional as soon as possible. While alopecia itself is a legitimate symptom and requires treatment, the depression is more urgent. It’s also important to address the depression before treating the hair loss. A mental health professional will understand that the alopecia is a component of the depression, and treat it alongside the depressed thoughts. For example, a mental health provider may help analyze why the hair loss is causing depressed mood, provide coping mechanisms to help get through the day, and also refer to a hair loss physician to treat the alopecia.

While this may seem excessive, it’s important not to simply treat the hair loss and ignore the depression. It may seem like fixing the alopecia will fix the depressed mood; however, the depression may be related to a variety of issues, and ignoring it or assuming things could make the situation worse.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

Watch hair transplant videos on YouTube

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This question comes from a member of our hair loss social community and discussion forums

I’ve been losing my hair for several years. I initially thought I suffered from androgenic alopecia or male pattern hair loss; however, members of online forums now say it may be diffuse unpatterned alopecia or DUPA. What is DUPA? Can it be fixed with hair transplant surgery?

DUPAI’m not 100% sold on the idea of “DUPA” or it’s cousin “diffuse patterned alopecia” (“DPA”).

Traditionally, non-scarring alopecia is broken down into several categories: focal, patterned, and diffuse. Focal alopecia includes conditions like alopecia areata; patterned includes androgenic alopecia and female pattern hair loss; and diffuse covers conditions like telogen effluvium, anagen effluvium, loose anagen syndrome, atrichosis, and hyoptrichosis. However, it does not – traditionally – include “DUPA” or “DPA.” Maybe the categorization is out of date, but I generally try to stay away from these terms – or at least from DPA. I do understand that “DUPA” is a good description for one clinical picture – which I will explain below.

I would classify hair loss fitting this diffuse pattern as follows:

Either: diffuse androgenic alopecia that is best described by the Ludwig and not the traditional Hamiltion-Norwood hair loss scale; OR you could call it diffuse unpatterned alopecia if you are experiencing thinning in the donor region (which is the only time I really think this term is appropriate).

This question comes from a member of our hair loss social community and discussion forums

I’ve taken an antidepressant medication without side effects for years. During this time, I also experienced some hair loss. I always attributed the thinning hair to “male pattern hair loss”, but I recently read about antidepressant drugs causing alopecia, and now I’m wondering: is an antidepressant causing my hair loss? Is it true that antidepressants can even cause hair loss?

antidepressantsIn a perfect world, pharmaceutical medications would treat diseases effectively with no adverse side effects. We, unfortunately, do not live in this world. Medications are not perfect. While many are considered “modern miracles,” and cure people of ailments responsible for significant morbidity and mortality in the past, these powerful “wonder drugs” often come with a set of equally powerful – but much less wonderful – side effects. Unfortunately, hair loss is a side effect of several trusted and proven antidepressant medications.

However, all is not lost …

Of the numerous types of antidepressants available today, two classes are (most commonly) associated with hair loss: tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI). Both classes of drugs officially list “hair loss” as a potential side effect; however, both also report hair loss occurring only in a very small number of medication users. For example, several types of SSRIs list hair loss as a “rare” side effect that occurs in approximately 1-2% of users. Even more encouraging, many see a reversal of the hair loss after stopping the medication. This is, however, not guaranteed – as many drugs “unmask” dormant permanent types of alopecia like androgenic alopecia (“male pattern baldness”). In these cases, the hair loss is not reversible. In these instances, however, it’s important to understand that the drug only revealed or accelerated an underlying condition; it did not actually cause a primary hair loss.

AA before and afterTwo months ago, news broke that tofacitinib citrate – a rheumatoid arthritis drug – regrew a full head of hair in a patient suffering from alopecia areata. Now, it appears as if alopecia areata sufferers have more cause for celebration: Earlier today, Columbia University Medical Center announced that ruxolitinib, a drug used to treat a bone marrow disorder called myelofibrosis, restored hair in patients suffering from alopecia areata.

Alopecia areata differs from traditional androgenic alopecia, or male pattern hair loss, in several important ways: first, it is defined as an “autoimmune alopecia” – meaning it occurs when the body’s immune system mistakenly attacks and damages hair follicles; second,  it can progress and cause hair loss in regions of the face and body (this is commonly known as alopecia totalis and alopecia universalis); and third, it was, until very recently, extremely difficult to treat and caused disfiguring hair loss in an estimated 6.5 million in the United States alone.

One of these 6.5 million is Dr. Angela Christiano, a researcher in the dermatology department at Columbia University. Dr. Christiano’s team spent years determining the specific cause and underlying pathway behind alopecia areata, and came to the following conclusions: alopecia areata is caused by immune cells in two specific pathways; and both pathways could be blocked by a class of drugs known as JAK inhibitors.


I have been prescribed isotretinoin for my seborrheic dermatitis and I’m afraid that it might cause hair loss?

accutane-pillsThinning hair is one of the of the many known side effects of Accutane (isotretinoin). In many cases, this hair loss is temporary. However, for those susceptible to the effects of androgenic alopecia (genetic baldness), there is always a chance that these weakened hairs may not regrow.

I have no documentation to support this, but I suspect that Rogaine (minoxidil) may help to counter the increased balding from Accutane as it is a vasodilator that increases blood flow to the follicles. But, I would certainly discuss that with your dermatologist.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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This question comes from a member of our hair loss social community and discussion forums:

I was diagnosed with androgenic alopecia (male pattern hair loss) several years ago. I recently underwent routine lab work with my primary care doctor and was told I suffer from an underactive thyroid or hypothyroidism. I’m now wondering if my hair loss could be caused by my thyroid gland and not the androgenic alopecia?

thyroid hair loss betterHypothyroidism – where the thyroid gland secretes too little thyroid hormone and, as a result, the pituitary gland in your brain secretes excessive thyroid stimulating hormone (TSH) – is associated with alopecia.

However, hair loss in hypothyroidism is more commonly seen in female patients and likely wouldn’t resemble a patterned alopecia- like you would see in androgenic alopecia. If your hair loss resembles the characteristic “patterns” seen in male pattern hair loss, like vertex thinning and thinning in the frontal-temporal regions, then it is likely caused by androgenic alopecia and not the thyroid.

However, hair loss caused by thyroid problems is usually reversible and could be seen in men as well. If the hair loss is related to the thyroid, appropriately treating the thyroid problems by closely following your doctor’s recommendations could affect the alopecia as well. Make sure to discuss this thoroughly with both the doctor treating the thyroid and a hair loss expert.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by recommended hair restoration surgeon Dr. Wen-Yi Wu:

Does the hair loss medication Propecia affect beard hair growth?

staffs1en[1]Since Propecia (finasteride) is a DHT blocker, it would be reasonable to assume that DHT stimulates beard growth. Thus, blocking DHT (with finasteride) would tend to inhibit its growth.

In practice, this does not seem to be the case, i.e. we don’t find that the medical hair loss treatment Propecia has any effect on facial hair. The reason is not clear.

Dr. Wen-Yi Wu
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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Michael Beehner:

How is Lichen planopilaris diagnosed? Is it just a visual diagnosis or are there tests?

Dr_Beehner_photoThe clinical picture and a biopsy are the usual ways to to diagnose Lichen planopilaris (LPP). It is thought to probably be of an autoimmune etiology. It can sometimes overlap with Alopecia Areata in its clinical appearance, but the hair loss is usually more “splotchy” with multiple, small patches irregularly spread all over the head, including in the donor area. It leaves a “scarring alopecia” result, which means that in each of these little bald patches there are no pores or follicular elements of any sort.

We usually wait at least two years after any sign of disease activity (enlarging, redness, scaling) before considering hair restoration surgery. Some hair transplant surgeons will then perform a repeat biopsy to make sure there are no lymphocytes present around nearby follicles near the edge of these lesions before transplanting. When the diagnosis has already been confirmed before a patient reaches me, I will often give the patient the choice between re-biopsying or doing test grafts. The good news about this diagnosis, as opposed to alopecia areata, is that it often will “burn out” and remain inactive for a long time or for that patient’s life span.

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