Causes of Hair Loss

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.

I experienced hair loss in the crown area when I first began taking warfarin (blood thinner) in 2004 for bi-lateral pulmonary emboli, which ended up being a permanent condition. Thus, I have to take warfarin for life. As they say, this is better than the alternative.

I am now old enough (50’s) that some thinning hair might be inevitable. I take very good care of the hair. I shampoo gently and use a wide tooth comb, never pulling etc.

My question is has anyone experienced hair loss with blood thinners and, if so, are there ways to counteract the effect of Warfarin? Also, I was wondering if products like volumizing powder (which really does make the hair appear thicker), gels or any products that go against the scalp might clog the follicles and cause hair to fall out.

Most directions for hair products do not say to put it directly on the scalp, but volumizing powder does say to apply directly to the roots, making it difficult not to apply it to the scalp as well. I also wonder about hair loss concealers like Toppik or Miracle Hair. Is one markedly better than the other? Miracle Hair is much less expensive & seems to be similar. Do they block the follicles, causing hair loss?

I appreciate any help regarding these issues and thank you in advance. Oh, I guess I should ask what brand of hair color is least damaging to fragile hair. Again, my sincere thanks.

I have taken 1mg of finasteride for several years and am now in my mid-fifties.  Surprisingly, I have maintained decent coverage despite poor genes.  Recently my hair has changed significantly in texture and volume.  This has seemed to coincide with a bout with a kidney stone.  I was unable to keep anything down due to nausea including meds.  My hair wasn’t a priority and my finasteride dose was sporadic for almost a month. I have resumed my daily dose but fear that irreversible damage has been done.  Could this interruption have such dramatic effects on my hair health?

Propecia BoxStopping Propecia (finasteride) for one month can result in noticeable thinning. Unfortunately, no one can predict if restarting the drug will regrow hair that is lost during this period. The only way to find out is to start taking it again and wait for new hair growth. This can take up to 6 months to become noticeable.

It’s important to remember that hair grows an average of 1/2 inch per month. The hair shaft is made of dead keratin proteins. Because this visible hair is already dead, its texture doesn’t change quickly without some sort of external influence like chemical treatments. Instead, texture changes happen slowly over time as older hair is replaced with newer hair growth. That change can take several months to become noticeable.

I had the Brazilian keratin treatment done 11 months ago to straighten my hair. Immediately after, my hair started diffusing all over with scalp tightness. It falls out directly from the root when washing, drying and by just touching. I have tried everything and found hundreds of people online with the same problem. However, there are no solutions.

My hair is more than half gone. The hair’s texture changed from course to thin fragile hairs. The little new hair growth is also fine, miniature and thin with a light frizz halo around my crown. You can see my scalp everywhere.

Will my hair grow back? Will the hair eventually stop falling? My dermatologist says it’s telogen effluvium.

simplysmooth3Your dermatologist is most likely correct. Telogen effluvium (TE) can occur when the body is exposed to stress or trauma. Chemical treatments can damage or shock the roots, resulting in thinning hair. Hair loss due to TE is normally temporary but it may take many months to regrow hair to its former fullness.

Another less likely possibility is that your scalp suffered chemical burns from improper application. If your scalp was scarred, three is a possibility that some hair will not regrow.

Unfortunately, no one will be able to accurately predict your future hair growth at this stage. Only time will tell. In the meantime, you may find Rogaine (minoxidil) helpful in jump starting the growth and adding fullness to your hair.

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

I’m a 14 year old male who recently started to lose a lot of hair. I seem to pull out “clumps” of hair while showering at night and notice a lot of hair on my pillow in the morning. My Dad has hair loss, but he lost his hair in his 30’s and it only shed in a specific pattern. However, my hair seems to be thinning all over my entire head. Why am I losing hair as a teenager? Is this normal? Is it male pattern baldness like my Dad’s hair loss?

Although some individuals do start losing hair at an early age, 14 years old seems very young. Because you do have a family history of androgenic alopecia or male pattern hair loss, this could possibly be the culprit. However, normally androgenic alopecia wouldn’t affect individuals in your age group, nor would you see a thinning or shedding all over your entire scalp.

What would your explanation be if I told you I had a hair transplant 9 years ago, but I have less hair than I used to. My hairline has definitely receded more. All of my transplant hair is dead. Why? I would love to do something for my hair but what operation actually works? I really have to wonder if this is all a scam. The pics I see about this seem so fake. I don’t know what to believe.

hair_transplant_step_13It’s very unusual for hair harvested from the permanent donor sites to fall out. Normally, when hair continues to thin in the years after hair transplant surgery, it is due to continued loss of natural, non-transplanted hair. For this reason, hair restoration physicians normally recommend medically stabilizing hair loss with Propecia (finasteride) and Rogaine (minoxidil). However, if you’re sure that your transplanted hairline has receded, there are at least a couple of possible reasons that this might occur.

I can only speculate since I don’t know your hair loss history and have no photos for reference, but one possibility is that you are genetically predisposed to advanced hair loss and, 9 years ago, your donor hair was harvested from outside the permanent zone in an area that was not resistant to the effects of DHT. If your donor area is still intact and dense enough to hide your scar then this is probably not the case.

I’m a woman with alopecia in two areas of my head. I would like to know what I can use to regrow hair in these areas. I have tried Rogaine but it gave a lot of itching. I herd there is a shampoo for hair loss. Does it work?

rogaine-women-3month-thumbRogaine (minoxidil) is the best hair loss treatment currently available for females with thinning hair. Which Rogaine product did you try? If you were using men’s 5% liquid, I would first suggest trying Rogaine for Women (2% minoxidil) as it you may find it less irritating. Another option you may wish to investigate is Rogaine Foam or a generic minoxidil foam. These foam-based products do not contain propylene glycol which can cause itching, irritation and redness.

There are no shampoos clinically proven to treat androgenic alopecia. However, there is some evidence that suggests Nizoral dandruff shampoo with the active ingredient ketoconazole may be as effective as minoxidil for treating hair loss.

For more about the possible benefits of ketoconazole, see the following article on our Hair Loss Q&A Blog: Does Ketoconazole Work as a Hair Loss Treatment?

Most importantly, there are several causes of female hair loss. If you have not yet done so, I highly recommend consulting with a dermatologist in order to determine if your balding is genetic or non-genetic.

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.

I am a 50 year old woman and my hair has always been super thin. It now has not grown for years and the back is thinning so much I am looking bald in one spot. What can I do? I am presently living in Singapore and get lots of herbal hair loss treatment suggestions that really don’t work.

female hair lossThere are many potential causes of female hair loss. Your first step should be to consult with a dermatologist specializing in hair loss or a skilled and experienced hair restoration physician.

As you’ve discovered, herbal remedies are highly unlikely to regrow hair. Rogaine (minoxidil) is the only clinically proven and FDA approved hair loss treatment currently available for females. As with any hair loss drug, Rogaine must be used indefinitely.

Once the drug is discontinued, thinning will resume. For this reason, we always recommend that hair loss sufferers continue to apply Rogaine as directed for between 6 months and one year before assessing their results.

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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newton gravityAlthough androgenic alopecia (male pattern baldness) is a complicated condition, scientists have understood the mechanism behind this type of hair loss for a number of years: In androgenic alopecia, genetically susceptible hair follicles  are exposed to high levels of dihydrotestosterone (DHT) hormone, which causes abnormal cycling and eventually permanent loss of function in these follicles. This process causes a gradual hair thinning and eventually leads to permanent patterned baldness. For years, the inciting factor or underlying cause of androgenic alopecia was cited as simply genetics; however, Turkish plastic surgeon Dr. Emin Tuncay Ustuner recently proposed a new theory to explain the underlying cause of male pattern baldness: gravity.

Yes, gravity! As strange as it sounds, Dr. Ustuner believes the effect of gravity explains not only male pattern baldness, but also why body hair and scalp hair react differently to DHT and why females experience more hair loss after menopause. According to Dr. Ustuner, the force of gravity on the scalp puts excessive pressure on hair follicles and eventually causes hair loss. In younger individuals, the layer of fat under the superficial scalp is thick and “well hydrated,” and this creates a cushion that prevents the hair follicles from being suffocated as gravity forces the scalp down toward the skull. However, as individuals age, the amount of fat decreases and gravity begins to cause follicle damage and hair loss. The hair follicles in the back and sides of the scalp – those normally spared in androgenic alopecia – aren’t affected by gravity because they don’t lay under the top of the scalp and do not experience the increased pressure from gravity. What’s more, because the female sex hormone estrogen promotes fat building, Ustuner believes the association between female hair loss and menopause (cessation of normal estrogen cycling) can be explained by a decrease in scalp fat with decreasing levels of estrogen.

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

After being told by my doctor that my estrogen hormone levels are abnormal, I began to notice hair loss. I’m now wondering if changes in my hormone levels can cause hair loss and what I can do to treat this? Can changes in hormone levels cause hair loss in women?

female hair lossFemale pattern hair loss is a complicated condition. Unlike androgenic alopecia or male pattern hair loss – which is usually caused by a derangement of a single hormone (DHT or dihydrotestosterone) – female hair loss can often be traced to a variety of blood level abnormalities. Abnormal levels of elements such as sex hormones (testosterone, DHT, estrogen, progesterone, etc.), iron, thyroid hormones, blood glucose (sugar), and a variety of other important metabolic substrates can be attributed to hair loss in women.

This  means fluctuating hormone levels or changes in normal blood hormone levels can lead to female hair loss. Treating this would likely involve first seeing an endocrinologist (hormone specialist) to determine if a hormone derangement is present, and next seeing a hair loss specialist for treatment (unless the endocrinologist feels comfortable treating the hair loss as well). Though female pattern hair loss from hormone imbalance is a complicated issue, it can often be reversed and treated with proper care.
Blake – aka Future_HT_Doc

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

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