More than 80% of men and 50% of women will experience the physical and emotional effects of hair loss during their lifetime. To make matters worse, hair loss has SO many different causes, making it impossible for “Dr. Google” to sort out. So if you notice any unusual hair loss, it's really important to see your doctor. The sooner you get to the root of the problem (literally and figuratively…ha!), the sooner you can get started with a treatment plan or feel reassured if you have a self-limited condition.

A board certified dermatologist at ShanthiMD Dermatology will take a thorough history of the hair loss, including family history, check for signs of inflammation or infection, and order blood tests to check for internal causes of hair loss. If there are signs of excess androgen activity (such as menstrual irregularities, acne, and excess facial and body hair), a hormonal evaluation is recommended. A scalp biopsy is useful in some cases, especially if scarring alopecia is suspected.

The most common type of hair loss in women is the same as it is in men: androgenetic (hereditary) alopecia, also known as female (or male) pattern hair loss (FPHL or MPHL). Women often see diffuse hair thinning and/or a widening part, whereas men see a receding hairline and/or a bald patch at the crown of the scalp. Luckily, women rarely become bald. In both sexes, hair loss from androgenetic alopecia occurs because the growing phase (anagen) of the hair cycle shortens causing the hair shaft to get thinner and thinner over time, until eventually it falls out and doesn’t regrow. FPHL can start any time after the onset of puberty, but is most commonly seen around menopause, which supports an additional hormonal cause. Women normally produce some androgen or male hormone (ex. testosterone) as this has important functions in both sexes. But when there is excess androgen activity, hair loss can occur.

Other common causes of hair loss include:

• hypothyroidism (low thyroid hormone levels)

• low blood counts due to iron deficiency

• traction alopecia (tight hairstyles continuously pull on the hair shaft damaging hair follicles and eventually leading to permanent hair loss)

• telogen effluvium (physical or emotional stress to the body such as surgery, childbirth, death of a loved one, etc. which causes about 30% of hairs to shift from the growth phase (anagen) into the resting phase (telogen) where they are more likely to fall out)

• alopecia areata (when your own immune system attacks hair follicles)

• inflammation (ex. psoriasis)

• infection (ex. fungus)

• trichotillomania (pulling out your own hair, often to relieve stress)

• medication side effects (ex. chemotherapy)

While a bit of stress keeps us from sitting on the couch all day, chronic stress and the resulting inflammation is linked to a wide variety of medical problems, including hair loss. Physical and/or emotional stress shifts hair from the growth cycle to the resting cycle, in which it is more likely to fall out. And what’s worse, there really isn’t a targeted treatment for this.

Ever heard the saying, “you are what you eat?” Well, the same goes for your hair! A balanced diet is necessary for strong, healthy hair. When you don’t get the vitamins, minerals, protein, and other nutrients that your body needs, it can cause hair to fall out. For example, iron deficiency is one of the most common causes of hair loss in women. You may also notice hair loss if you lose more than 15-20lbs in a short amount of time.

Bald patches are most commonly seen on the crown of the scalp in male pattern hair loss. There is also a condition called alopecia areata in which your own immune system attacks your hair follicles causing circular, patchy hair loss. Hair loss in alopecia areata is most often seen on the scalp, but can also occur in the eyebrows, eyelashes, beard, and other hair-bearing areas. It’s unknown exactly why this happens, but genetics and stress are thought to play a role. Although this is a self-limited condition, monthly corticosteroid injections by a dermatologist into the bald patches are very effective in reducing inflammation around the hair follicle and helping hair to regrow faster.

Among the more common health conditions to cause hair loss are thyroid disease and polycystic ovarian syndrome (PCOS). The thyroid hormone is important for development and maintenance of hair follicles. Both under and over-production of thyroid hormone can result in hair loss, but usually only if severe and prolonged. Hair loss is temporary and regrowth is expected with treatment of the underlying thyroid disorder, although this may take several months.

PCOS is a common hormone disorder which causes excess facial and body hair (hirsutism) and less commonly, scalp hair loss. Since PCOS causes excess androgen activity, patients may experience female pattern hair loss (FPHL). Hairs lost due to PCOS will not grow back without treatment. The anti-androgen medication, spironolactone, is often prescribed in combination with oral contraceptive pills (also lowers androgens) with moderate success.

Who doesn’t want thicker, fuller, more luscious hair? With an overwhelming number of nutraceuticals available on the market today, and the lack of FDA regulation of product claims, it can be very hard to know what really helps. An oral anti-androgen (ex. finasteride, dutasteride, spironolactone) is the most effective pharmaceutical treatment for androgenetic alopecia. But hair supplements can also be helpful, especially if a patient can not or does not want to take an oral medication. Look for ingredients like Biotin and Saw palmetto. Biotin is a B vitamin that is essential for healthy hair and nails. Products should contain at least 2500 mcg of Biotin and no more than 5000mcg, as taking more than this may affect the accuracy of other lab tests. Saw palmetto can block the hormone DHT (dihydrotestosterone), the active form of testosterone and the main target of anti-androgen medications like finasteride. Nutrafol, which we use at ShanthiMD Dermatology, is a nutraceutical product containing Biotin 3000 mcg and Saw Palmetto as well as other proprietary botanicals with potent anti-inflammatory, anti-stress, antioxidant, and DHT-inhibiting properties. A research study published in the peer-reviewed Journal of Drugs in Dermatology showed statistically significant improvement in hair growth, density and quality, albeit in a small number of patients. Iron supplementation is only recommended if lab tests show a deficiency, otherwise it can simply result in an upset stomach and constipation.

Once the cause of hair loss is determined, your ShanthiMD dermatologist will explain all of the treatment options available and help you to choose the best one for you. In some cases, hair will regrow on its own without treatment!

In all other cases, there are many treatments available for hair loss. Its important to remember that not one treatment works for all types of hair loss and often the best response is achieved by using multiple treatments. A positive response to treatment can be seen as new hair growth, thickening of existing hairs, and/or reduction of hair loss. A treatment plan by your ShanthiMD dermatologist may include one or more of the following treatments:

• Platelet-rich plasma (PRP) injections: This in-office treatment has become very popular in recent years and for good reason! There is strong scientific evidence to support that it is a safe and effective treatment for hair loss and also, as natural as it gets! PRP is obtained by drawing a small amount of your blood and using a machine to spin it down and isolate the platelets, which contain lots of your own body’s natural growth factors. It is then injected back into your scalp at the level of the hair follicles in areas of hair loss. A nerve block makes your treatment virtually painless. We recommend monthly injections for the first 3-4 months and then once every 3-6 months thereafter for maintenance.

• Minoxidil (Rogaine®): The 5% solution is a safe and effective treatment for hair loss and it is the only topical treatment FDA-approved for female pattern hair loss. I recommend at least a 9-month trial before deciding whether or not it’s helping you and if it is, you must keep using it to maintain the benefit.

• Laser for at-home use: Red light therapy (RLT) or low level laser therapy (LLLT) in theory could thicken hair follicles. While only a few studies have looked at these devices, the results are promising and require as little as 20 minutes of use twice a week. The downside is that the devices are expensive, do not work for everyone, and more research needs to be done to see if new hair growth is sustainable in the long term.

• Hair transplant: If you have an area of thinning or balding due to male or female pattern hair loss, a hair transplant can be an effective and permanent solution. Keep in mind that hair transplants are very expensive, not covered by insurance, and that not everyone is a good candidate.

• Finasteride (Propecia®) and dutasteride: These medications are FDA approved to treat male pattern hair loss. I recommend at least a 6-month trial before deciding whether or not it’s helping you and if it is, you must keep using it to maintain the benefit. In addition, finasteride and dutasteride are sometimes used off-label to treat hair loss in post-menopausal women.

• Spironolactone: For pre-menopausal women who have FPHL, this anti-androgen medication is often used. Studies have shown that ~40% of women who take this medication for a year will experience improvement in hair loss. As it can cause birth defects, an oral contraceptive pill is often prescribed with it.

• Biotin, iron, protein, and/or zinc: These supplements are recommended if your clinical history or blood tests reveal that you have deficiencies.

While it is totally okay to rock a stylish updo or sleek ponytail every once in a while, try not to do it on a daily basis. If you regularly wear your hair in tight hairstyles, the constant pulling on the hair shaft can result in permanent damage to the hair follicle and a type of hair loss called traction alopecia. This includes weaves, extensions, and tight braided hairstyles. If you are planning on getting weaves or extensions, opt for the sewn-in kind. Braided styles should be kept in for no more than 2-3 months. The first signs of hair thinning due to traction alopecia can be broken hairs at the front of your hairline, a receding hairline, or patchy hair loss where hair is tightly pulled. If you notice any of these signs, it goes without saying that you should stop pulling on your hair immediately to prevent scarring of the hair follicle and irreversible hair loss! Looser, natural hairstyles are the key to both treatment and prevention of traction alopecia.

Red light therapy (RLT) also known as low level laser therapy (LLLT) in theory could thicken hair follicles. One very small study revealed that people who received RLT had improved hair density compared with those in a placebo group, but IMHO more studies are needed to support this finding and see if new hair growth is sustainable in the long term. Anecdotally, a few of my patients have reported success with these devices, however, every one of them was using at least one other treatment modality, so take this with a pinch of salt! If a patient wants to “try everything” and it is not going to destroy their budget (many devices cost several hundred dollars), I wouldn’t discourage them from using it – some home devices require as little as 20 minutes twice a week (ex. Theradome PRO LH80).

Minoxidil (Rogaine) solution is a safe and effective treatment for hair loss and it is the only topical treatment FDA-approved for female pattern hair loss. While it can definitely help some people suffering with hair loss, it doesn’t help everyone and it’s not a miracle medication. First, it doesn’t work overnight. I recommend at least a 9-month trial before deciding whether or not it’s working for you. Like other hair loss treatments, positive results can be measured by new hair growth (~50% of the time), thickening of existing hairs, and/or reduction of hair loss (~80% of the time). Also, like other hair loss treatments, you are married to it for life! If you stop using Rogaine, hair loss returns within a few months. Lastly, unless you’re planning on going as Wolverine to next year’s Halloween party, you should avoid letting the solution drip onto areas other than the scalp such as the cheeks or forehead (side effect: unwanted hair growth!)

Unfortunately, there are no specific natural ingredients or oils available for home use that have been clinically shown to grow hair on their own. Just being honest!

Dr. Colaço’s tips for managing hair loss at home:

• Gentle hair care. Use gentle, sulfate-free shampoos and conditioners. A conditioner that is too thick can weigh hair down and decrease volume.

• Limit heat. Try to limit use of hot tools or use the lowest heat settings: this includes hot-oil treatments, blow dryers, curling irons, straighteners etc.

• Avoid pulling. Wearing your hair in tight hairstyles (sleek buns, ponytails, braids, etc.) and use of extensions, weaves, etc can cause hair loss over time. Loose, natural hairstyles are safest.

• Limit chemical treatments. Coloring, perming, straightening, relaxing and other chemical treatments should be limited and preferably done by a professional.

• Please stop smoking! Smoking causes inflammation throughout the body, which makes so many things worse, and hair loss is no exception.

• Eat healthy. Eating too few calories every day can cause hair loss. So can not getting enough vital nutrients such as iron or protein.