Why Men Lose Their Hair
There are multiple explanations for how hereditary hair loss develops. But in order to properly
manage the symptoms of Androgenetic Alopecia, it is important to familiarize ourselves with its
causal mechanisms. In this chapter we will discuss why men and women lose their hair, and
provide insight into the nature and causes of several different types of hair loss.
Identifying Androgenetic Alopecia
How can you tell if you are experiencing early-stage Androgenetic Alopecia?
For most people, hair loss isn’t even noticeable until more than 50% of hair strands have
miniaturized. Although excessive shedding is an early indication that hair shafts are becoming
weak, even people without any visible hair loss lose an average of 50-120 hairs a day.
For this reason, we need a better way to identify pattern baldness before it becomes too obvious.
Catching hair loss early is important because existing treatments are more effective when there
are at least some hair follicles still functioning at the top of the scalp.
Common Causes of Hair Loss
Hair loss can be caused by a lot of different factors. Heredity, hormones and stress can all
contribute to hair fallout and miniaturization. Even though genetics is the most common factor,
there are other diseases and skin conditions that can result in hair loss.
Genes and Family History
Androgenetic Alopecia (hereditary hair loss, or AGA) is the most common form of hair loss. It
can be inherited from either parent, however it is most often linked to the mother’s side of the
family. Most males who experience hair loss have a family history of AGA. In females,
however, less than 50% of patients experience hair loss due to genetics.
• Male/Female Pattern Baldness (Androgenetic Alopecia/AGA)
AGA is the most common type of hair loss for both men and women, however it occurs
most often in the male population. In men, a pattern usually develops in the form of a
receding hair line and thinning crown. In women, hair is lost all over the head in a
diffuse, uniform pattern. This progression rarely results in complete baldness.
• Symptoms:
Hair shedding is the most noticeable symptom of hair loss. Observe the amount of hair
that you lose on a daily basis by checking your hair brush, shower strainer, pillow case
and clothes. If you suspect hair loss, look at family photos to see if the condition is
hereditary. Even though there is no clear explanation for the heritability of AGA, it has
been observed that those with a family history of hair loss are at a much higher risk of
losing their hair than others.
Testosterone and DHT
There are two primary sex hormones responsible for male pattern hair loss: DHT and
testosterone.
Testosterone is converted by tissues throughout the body into a hormone known as
dihydrotestosterone (DHT). DHT extends the resting phase of the hair follicle cycle and reduces
the growing phase. The natural result of this phenomenon is thinning hair over time. This effect
is especially prominent in men with ANA genes.
The good news for men who have not inherited this gene is that DHT and testosterone do not
cause hair loss by themselves. In fact, they are generally harmless, even to aging hair.
Both hormones are completely natural and necessary. DHT also plays a role in the growth of
body, beard, eyebrow, nose and ear hair.
Blocking DHT is the only way to stop the progression of hair loss in men that are genetically
susceptible. There are 5AR inhibiting drugs, such as finasteride and dutasteride, which are
manufactured solely for this purpose. However, it should be noted that the only FDA-approved
drug that has been proven safe and effective for the treatment of hair loss is finasteride.
Hair Loss Over Time
Merely the presence of balding genes or hormones is not enough to cause hair loss. The extent of
hair loss differs between individuals and can be significantly affected by DHT levels, age,
environmental and other factors.
Hair loss happens in cycles and does not happen instantly. It is still unknown why people who
are losing their hair experience alternating periods of slow and rapid hair loss.
Most men that develop extensive balding do so by the age of 30. However, half of the male
population shows some amount of balding by the time they reach age 45-50. This progression
slowly continues until they reach 60-65. Several clinical reports have demonstrated that
circulating levels of DHT slowly diminish over the course of a man’s life.
Those who begin the balding process into their 30s to 40s normally do not lose their hair as
quickly as those who start balding in their early 20s.
The most common balding patterns are:
• Frontal hairline recession
• Bald spot in the crown area
Stress
Contrary to popular belief, stress does not cause hair loss. Still, excessive stress can contribute to
hair loss through other means (hair pulling, poor hygiene, etc). Many traumatic experiences
(such as being laid off from work) can exacerbate the effects of hair loss like shedding, thinning
and dandruff.
One type of hair loss that can be caused by stress is Telogen Effluvium. TE is a reversible kind
of hair shedding that is distinctly different from AGA.
Lack of Blood Supply
As mentioned earlier, blood circulation to the scalp ceases where hair is nonexistent; essentially
because blood is no longer needed to supply hair follicles with oxygen and nourishment.
Nevertheless, there are doctors who claim that lack of blood circulation to the scalp contributes
to hair loss. This may or may not be true.
What we do know is this: a certain amount of oxygen and nutrition is required for growing hair.
When a person undergoes hair transplant surgery, hair follicles that have been transplanted to
portions of the scalp that were previously devoid of hair have a larger supply of blood than the
bald skin had initially.
Environmental Issues
Environmental causes for hair loss are common, but most of them can be avoided. Harmful
environmental factors include harsh chemical treatments, tight braiding, restrictive head
coverings and other accessories that put stress on hair follicles. Regular perming, dyeing, curling
and exposure to extreme heat can also contribute to hair loss.
Diseases that Cause Hair Loss
Although Androgenetic Alopecia is the most common form of hair loss, there are other causes.
There are lots of different medical conditions that can cause hair loss or “alopecia” (the medical
term for hair loss). Hair loss can also be caused by side effects related to medical treatments.
Alopecia has two categories:
• Non-scarring alopecia – hair has the potential to grow back.
• Scarring alopecia – there is a very small chance of hair regrowth even after treating this
disorder; hair follicles are permanently damaged.
Non-scarring Alopecia
Non-scarring is the most common form of alopecia. It has several different types:
• Androgenetic Alopecia (AGA)
◦ hereditary thinning
• Alopecia Areata
◦ hair loss in localized round patches, or all throughout scalp
• Telogen Effluvium (TE)
◦ diffuse scalp hair loss
• Anagen Effluvium Alopecia
◦ more rapid and pronounced form of TE
Alopecia Areata
After AGA and TE, Alopecia Areata is the third most common type of hair loss. AA occurs
when white blood cells mistakenly attack hair follicles in the body. When this happens, the
affected follicles are destroyed, resulting in localized bald patches. Because AA is an autoimmune
disease, its progression is sporadic and quite difficult to treat effectively.
Recently, researchers from Columbia University identified 8 genes that directly contribute to
Alopecia Areata. This discovery will help patients more accurately predict the severity of their
condition at the onset of the disease, and will facilitate the development of more effective
treatment options.
Diagnosing the Disorder
Like most other types of hair loss, the most prevalent symptom of Alopecia Areata is severe hair
shedding. In patients with AA, this shedding generally results in round, bare patches on the skin.
Hair loss from Alopecia Areata is quite variable; some sufferers experience much more hair loss
than others.
Treatment Options
There are still many experimental treatments that can be attempted, however. These include:
• Creams and shampoos for the scalp
• Minoxidil – applied directly onto the scalp. Minoxidil is more commonly used for the
treatment of pattern baldness but shows signs of effectiveness for AA.
• Irritants (anthralin or topical coal tar)
• Topical immunotherapy
• Steroids – specifically for AA treatment. Steroids are used to stop the body's immune
system cells from attacking and destroying hair follicles.
• Cyclosporine – a strong immunosuppressant made specifically to inhibit T cells (immune
system cells) from attacking the hair follicles.
There have also been studies published in the journal Archives of Dermatology (vol. 134, 1998;
49-52) that suggest aromatherapy oils may be effective in treating AA. The results thus far have
been limited, however, and this therapy is not widely accepted.
Telogen Effluvium
Telogen Effluvium (TE) is a type of non-scarring condition that results in excessive hair
shedding. Although TE is the second most common type of hair loss, there has been relatively
little research conducted to determine its underlying causes. Where the acceptable amount of
fallen hair strands is usually around 100, patients experiencing TE may lose over 400 per day.
Telogen Effluvium can affect people of all ages and races.
Causes:
• Postpartum alopecia (recently gave birth)
• Crash dieting/dietary deficiencies
• Physical trauma (e.g. car accident, etc.)
• Usage of anti-depressants
• Surgery
• Chronic stress
Treatments:
• Treatments for TE depend on what circumstances initiated the condition.
• For short-term TE that was triggered by having surgery or giving birth, follicles will start
to recover and hair will grow back within a relatively short time period.
• For persistent TE, the factor that is causing the condition must be removed (stress, dietary
deficiency, etc.)
Most TE conditions are normally not permanent and hair will eventually grow back. TE usually
lasts between 6 and 12 months.
Tinea Capitis
Tinea capitis is a fungal infection caused by dermatophytes (mould-like fungi). It is also known
as “ringworm of the scalp,” “ringworm of the hair,” “herpes tonsurans,” and “tinea tonsurans.”
Tinea capitis infection is contagious. It can be transmitted either by direct contact or through
contact with a contaminated item. Tinea capitis can occur at any age.
Common symptoms:
- Dandruff
- Bald patches
- Severe itching of the scalp
- Small black dots on the scalp
- Scaly lesions on the scalp that may be inflamed
Treatments:
Oral medicines are usually prescribed to treat tinea capitis infections. These generally require
usage with ketoconazole shampoo.
In order to avoid catching tinea capitis, it is important to maintain good hygiene, avoid contacted
with infected persons and shampoo the scalp regularly.
Thyroid Conditions and Hair Loss
The thyroid is one of the endocrine glands responsible for making hormones. It helps set our
metabolism, which distributes the different nutrients we receive from eating.
There are 2 types of thyroid disorder:
1) Hypothyroidism: This is the most common type of thyroid disorder. Symptoms include weight
gain and constant fatigue.
2) Hyperthyroidism: This is the result of a thyroid that is too active. This can lead to weight loss,
heart palpitations or heat sensitivity.
How Thyroid Conditions Affect our Hair
Thyroid disease (whether hyperthyroidism or hypothyroidism) can often cause rapid hair loss.
However, those suffering from thyroid disease may lose hair in places other than their scalp. For
instance, hair loss on the outer edge of the eyebrows is common.
Thyroid Disease Treatments
Treating thyroid disease means keeping thyroid hormones balanced and stable.
Thyroid treatments:
• Medical therapy with anti-thyroid drugs
• Radioactive iodine and the destruction of the thyroid gland
• Surgery to remove the thyroid gland
Scarring alopecia
According to the American Hair Loss Association, Scarring Alopecia (also known as “cicatricial
alopecia”) refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair
loss patients. Scarring Alopecia occurs around the world in otherwise healthy men and women of
all ages.
In Scarring Alopecia, hair loss happens in areas where scars manifest. No hair will grow back in
the area where scarring alopecia occurs.
Lupus
Lupus is an autoimmune disease that causes organ tissues to become inflamed. At some point
during the development of the disease, 50% of those suffering from lupus also experience hair
loss. This mostly occurs in the temple area.
There are 2 types of lupus:
• Systematic lupus erythematosus (SLE) – may cause non-scarring hair loss. Once this
disease is successfully treated, hair eventually grows back.
• Discoid lupus erythematosus – can manifest anywhere in the body, but most commonly
on the head and neck. It may cause scarring hair loss and irregular patches of dark skin
(hyperpigmented) or almost white skin (hypopigmented).
Symptoms:
• Reddish facial rashes
• Sensitive to the sun
• Mouth ulcers
• Arthritis
• Low fevers
• Fatigue
There is no treatment for hair loss that is caused by lupus, but medications for the disease itself
may help restore hair growth.
Other Causes of Hair Loss
Hair Loss as a Result of Medication
There are a number of medications for which hair loss is a common side effect. Listed are some
of the most common ones (courtesy of Hair Loss for Dummies):
• Acne medications, such as isotretinoin (Accutane)
• Anti-inflammatory drugs, such as naproxen (Naprox), indomethacine (Indocin), and
naproxen (Naprosyn)
• Antidepressives, such as paroxetine (Paxil), fluoxetine hydrochloride (Prozac), and
sertraline hydrochloride (Zoloft)
• Beta blockers, such as nadolol (Corgard), propanolol (Inderal), metoprolol (Lopressor),
and atenolol (Tenormin)
• Birth control pills
• Blood thinners, such as warfarin sodium (Coumadin) and heparin
• Cholesterol-lowering drugs, such as gemfibrozil (Lopid)
• Gout medications, such as allopurinol (Lopurin or Zyloprim)
• Seizure medications, such as trimethadione (Tridone)
• Ulcer medications, such as famotidine (Pepcid), cimetidine (Tagamet), and ranitidine
(Zantac)
Rare Causes of Hair Loss
We have already covered the most common conditions that cause hair loss. In this section, we
will outline two conditions that are slightly less common.
OCD: Hair Pulling
Many people aggressively pull their hair when they feel frustrated or upset. This is a fairly
obvious reason for hair fallout.
Every once and awhile hair pulling can be understandable, but it can also be indicative of a
disorder known as OCD (Obsessive Compulsive Disorder); where one literally pulls out his/her
hair repeatedly.
This type of OCD is called Trichotillomania (TTM). Luckily, once pulling and tugging stops,
hair can grow back because TTM is a non-scarring form of hair loss.
TTM is more commonly found in children than adults and is most common among women.
Trichotillomania can be categorized into 2 groups:
1) Those who feel pleasure from pulling their hair / those who intentionally pull out their hair
due to itch or pain.
2) Habitual hair pulling; non-intentional.
Trichotillomania treatment options:
1) Cut hair short (this works well, especially with children)
2) Seek therapy with a professional (i.e. psychiatrist). Medication like Clomipramin (antidepressant)
may reduce symptoms and self-monitoring of the behavior can also be an option.
Traction Alopecia
Traction alopecia refers to the gradual loss of hair due to continuous follicular tension. People
who wear their hair in tight hairstyles (braids, ponytails, pigtails, etc.) are especially prone to
traction alopecia. Traction alopecia can also be a result of tight roller curlers and hair
straighteners.
Traction alopecia is more common in women than in men. Although reversible when it is caught
in its early stages, this form of hair loss can lead to scarring when it becomes persistent. The only
treatment for late-stage traction alopecia is surgical hair transplantation.
There are multiple explanations for how hereditary hair loss develops. But in order to properly
manage the symptoms of Androgenetic Alopecia, it is important to familiarize ourselves with its
causal mechanisms. In this chapter we will discuss why men and women lose their hair, and
provide insight into the nature and causes of several different types of hair loss.
Identifying Androgenetic Alopecia
How can you tell if you are experiencing early-stage Androgenetic Alopecia?
For most people, hair loss isn’t even noticeable until more than 50% of hair strands have
miniaturized. Although excessive shedding is an early indication that hair shafts are becoming
weak, even people without any visible hair loss lose an average of 50-120 hairs a day.
For this reason, we need a better way to identify pattern baldness before it becomes too obvious.
Catching hair loss early is important because existing treatments are more effective when there
are at least some hair follicles still functioning at the top of the scalp.
 | ||
| An image depicting male pattern and female pattern baldness |
Common Causes of Hair Loss
Hair loss can be caused by a lot of different factors. Heredity, hormones and stress can all
contribute to hair fallout and miniaturization. Even though genetics is the most common factor,
there are other diseases and skin conditions that can result in hair loss.
Genes and Family History
Androgenetic Alopecia (hereditary hair loss, or AGA) is the most common form of hair loss. It
can be inherited from either parent, however it is most often linked to the mother’s side of the
family. Most males who experience hair loss have a family history of AGA. In females,
however, less than 50% of patients experience hair loss due to genetics.
• Male/Female Pattern Baldness (Androgenetic Alopecia/AGA)
AGA is the most common type of hair loss for both men and women, however it occurs
most often in the male population. In men, a pattern usually develops in the form of a
receding hair line and thinning crown. In women, hair is lost all over the head in a
diffuse, uniform pattern. This progression rarely results in complete baldness.
• Symptoms:
Hair shedding is the most noticeable symptom of hair loss. Observe the amount of hair
that you lose on a daily basis by checking your hair brush, shower strainer, pillow case
and clothes. If you suspect hair loss, look at family photos to see if the condition is
hereditary. Even though there is no clear explanation for the heritability of AGA, it has
been observed that those with a family history of hair loss are at a much higher risk of
losing their hair than others.
Testosterone and DHT
There are two primary sex hormones responsible for male pattern hair loss: DHT and
testosterone.
Testosterone is converted by tissues throughout the body into a hormone known as
dihydrotestosterone (DHT). DHT extends the resting phase of the hair follicle cycle and reduces
the growing phase. The natural result of this phenomenon is thinning hair over time. This effect
is especially prominent in men with ANA genes.
The good news for men who have not inherited this gene is that DHT and testosterone do not
cause hair loss by themselves. In fact, they are generally harmless, even to aging hair.
Both hormones are completely natural and necessary. DHT also plays a role in the growth of
body, beard, eyebrow, nose and ear hair.
Blocking DHT is the only way to stop the progression of hair loss in men that are genetically
susceptible. There are 5AR inhibiting drugs, such as finasteride and dutasteride, which are
manufactured solely for this purpose. However, it should be noted that the only FDA-approved
drug that has been proven safe and effective for the treatment of hair loss is finasteride.
Hair Loss Over Time
Merely the presence of balding genes or hormones is not enough to cause hair loss. The extent of
hair loss differs between individuals and can be significantly affected by DHT levels, age,
environmental and other factors.
Hair loss happens in cycles and does not happen instantly. It is still unknown why people who
are losing their hair experience alternating periods of slow and rapid hair loss.
Most men that develop extensive balding do so by the age of 30. However, half of the male
population shows some amount of balding by the time they reach age 45-50. This progression
slowly continues until they reach 60-65. Several clinical reports have demonstrated that
circulating levels of DHT slowly diminish over the course of a man’s life.
Those who begin the balding process into their 30s to 40s normally do not lose their hair as
quickly as those who start balding in their early 20s.
The most common balding patterns are:
• Frontal hairline recession
• Bald spot in the crown area
Stress
Contrary to popular belief, stress does not cause hair loss. Still, excessive stress can contribute to
hair loss through other means (hair pulling, poor hygiene, etc). Many traumatic experiences
(such as being laid off from work) can exacerbate the effects of hair loss like shedding, thinning
and dandruff.
One type of hair loss that can be caused by stress is Telogen Effluvium. TE is a reversible kind
of hair shedding that is distinctly different from AGA.
Lack of Blood Supply
As mentioned earlier, blood circulation to the scalp ceases where hair is nonexistent; essentially
because blood is no longer needed to supply hair follicles with oxygen and nourishment.
Nevertheless, there are doctors who claim that lack of blood circulation to the scalp contributes
to hair loss. This may or may not be true.
What we do know is this: a certain amount of oxygen and nutrition is required for growing hair.
When a person undergoes hair transplant surgery, hair follicles that have been transplanted to
portions of the scalp that were previously devoid of hair have a larger supply of blood than the
bald skin had initially.
Environmental Issues
Environmental causes for hair loss are common, but most of them can be avoided. Harmful
environmental factors include harsh chemical treatments, tight braiding, restrictive head
coverings and other accessories that put stress on hair follicles. Regular perming, dyeing, curling
and exposure to extreme heat can also contribute to hair loss.
Diseases that Cause Hair Loss
Although Androgenetic Alopecia is the most common form of hair loss, there are other causes.
There are lots of different medical conditions that can cause hair loss or “alopecia” (the medical
term for hair loss). Hair loss can also be caused by side effects related to medical treatments.
Alopecia has two categories:
• Non-scarring alopecia – hair has the potential to grow back.
• Scarring alopecia – there is a very small chance of hair regrowth even after treating this
disorder; hair follicles are permanently damaged.
Non-scarring Alopecia
Non-scarring is the most common form of alopecia. It has several different types:
• Androgenetic Alopecia (AGA)
◦ hereditary thinning
• Alopecia Areata
◦ hair loss in localized round patches, or all throughout scalp
• Telogen Effluvium (TE)
◦ diffuse scalp hair loss
• Anagen Effluvium Alopecia
◦ more rapid and pronounced form of TE
 |
| An example of non-scarring alopecia. |
Alopecia Areata
After AGA and TE, Alopecia Areata is the third most common type of hair loss. AA occurs
when white blood cells mistakenly attack hair follicles in the body. When this happens, the
affected follicles are destroyed, resulting in localized bald patches. Because AA is an autoimmune
disease, its progression is sporadic and quite difficult to treat effectively.
Recently, researchers from Columbia University identified 8 genes that directly contribute to
Alopecia Areata. This discovery will help patients more accurately predict the severity of their
condition at the onset of the disease, and will facilitate the development of more effective
treatment options.
Diagnosing the Disorder
Like most other types of hair loss, the most prevalent symptom of Alopecia Areata is severe hair
shedding. In patients with AA, this shedding generally results in round, bare patches on the skin.
Hair loss from Alopecia Areata is quite variable; some sufferers experience much more hair loss
than others.
Treatment Options
There are still many experimental treatments that can be attempted, however. These include:
• Creams and shampoos for the scalp
• Minoxidil – applied directly onto the scalp. Minoxidil is more commonly used for the
treatment of pattern baldness but shows signs of effectiveness for AA.
• Irritants (anthralin or topical coal tar)
• Topical immunotherapy
• Steroids – specifically for AA treatment. Steroids are used to stop the body's immune
system cells from attacking and destroying hair follicles.
• Cyclosporine – a strong immunosuppressant made specifically to inhibit T cells (immune
system cells) from attacking the hair follicles.
There have also been studies published in the journal Archives of Dermatology (vol. 134, 1998;
49-52) that suggest aromatherapy oils may be effective in treating AA. The results thus far have
been limited, however, and this therapy is not widely accepted.
Telogen Effluvium
 |
| Hair loss caused by telogen effluvium hair shedding. |
shedding. Although TE is the second most common type of hair loss, there has been relatively
little research conducted to determine its underlying causes. Where the acceptable amount of
fallen hair strands is usually around 100, patients experiencing TE may lose over 400 per day.
Telogen Effluvium can affect people of all ages and races.
Causes:
• Postpartum alopecia (recently gave birth)
• Crash dieting/dietary deficiencies
• Physical trauma (e.g. car accident, etc.)
• Usage of anti-depressants
• Surgery
• Chronic stress
Treatments:
• Treatments for TE depend on what circumstances initiated the condition.
• For short-term TE that was triggered by having surgery or giving birth, follicles will start
to recover and hair will grow back within a relatively short time period.
• For persistent TE, the factor that is causing the condition must be removed (stress, dietary
deficiency, etc.)
Most TE conditions are normally not permanent and hair will eventually grow back. TE usually
lasts between 6 and 12 months.
Tinea Capitis
 |
| An image of hair loss caused by tinea capitis. |
Tinea capitis is a fungal infection caused by dermatophytes (mould-like fungi). It is also known
as “ringworm of the scalp,” “ringworm of the hair,” “herpes tonsurans,” and “tinea tonsurans.”
Tinea capitis infection is contagious. It can be transmitted either by direct contact or through
contact with a contaminated item. Tinea capitis can occur at any age.
Common symptoms:
- Dandruff
- Bald patches
- Severe itching of the scalp
- Small black dots on the scalp
- Scaly lesions on the scalp that may be inflamed
Treatments:
Oral medicines are usually prescribed to treat tinea capitis infections. These generally require
usage with ketoconazole shampoo.
In order to avoid catching tinea capitis, it is important to maintain good hygiene, avoid contacted
with infected persons and shampoo the scalp regularly.
Thyroid Conditions and Hair Loss
The thyroid is one of the endocrine glands responsible for making hormones. It helps set our
metabolism, which distributes the different nutrients we receive from eating.
There are 2 types of thyroid disorder:
1) Hypothyroidism: This is the most common type of thyroid disorder. Symptoms include weight
gain and constant fatigue.
2) Hyperthyroidism: This is the result of a thyroid that is too active. This can lead to weight loss,
heart palpitations or heat sensitivity.
How Thyroid Conditions Affect our Hair
Thyroid disease (whether hyperthyroidism or hypothyroidism) can often cause rapid hair loss.
However, those suffering from thyroid disease may lose hair in places other than their scalp. For
instance, hair loss on the outer edge of the eyebrows is common.
Thyroid Disease Treatments
Treating thyroid disease means keeping thyroid hormones balanced and stable.
Thyroid treatments:
• Medical therapy with anti-thyroid drugs
• Radioactive iodine and the destruction of the thyroid gland
• Surgery to remove the thyroid gland
Scarring alopecia
According to the American Hair Loss Association, Scarring Alopecia (also known as “cicatricial
alopecia”) refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair
loss patients. Scarring Alopecia occurs around the world in otherwise healthy men and women of
all ages.
In Scarring Alopecia, hair loss happens in areas where scars manifest. No hair will grow back in
the area where scarring alopecia occurs.
 |
| Hair loss caused by scarring alopecia. |
Lupus
Lupus is an autoimmune disease that causes organ tissues to become inflamed. At some point
during the development of the disease, 50% of those suffering from lupus also experience hair
loss. This mostly occurs in the temple area.
There are 2 types of lupus:
• Systematic lupus erythematosus (SLE) – may cause non-scarring hair loss. Once this
disease is successfully treated, hair eventually grows back.
• Discoid lupus erythematosus – can manifest anywhere in the body, but most commonly
on the head and neck. It may cause scarring hair loss and irregular patches of dark skin
(hyperpigmented) or almost white skin (hypopigmented).
Symptoms:
• Reddish facial rashes
• Sensitive to the sun
• Mouth ulcers
• Arthritis
• Low fevers
• Fatigue
There is no treatment for hair loss that is caused by lupus, but medications for the disease itself
may help restore hair growth.
Other Causes of Hair Loss
Hair Loss as a Result of Medication
There are a number of medications for which hair loss is a common side effect. Listed are some
of the most common ones (courtesy of Hair Loss for Dummies):
• Acne medications, such as isotretinoin (Accutane)
• Anti-inflammatory drugs, such as naproxen (Naprox), indomethacine (Indocin), and
naproxen (Naprosyn)
• Antidepressives, such as paroxetine (Paxil), fluoxetine hydrochloride (Prozac), and
sertraline hydrochloride (Zoloft)
• Beta blockers, such as nadolol (Corgard), propanolol (Inderal), metoprolol (Lopressor),
and atenolol (Tenormin)
• Birth control pills
• Blood thinners, such as warfarin sodium (Coumadin) and heparin
• Cholesterol-lowering drugs, such as gemfibrozil (Lopid)
• Gout medications, such as allopurinol (Lopurin or Zyloprim)
• Seizure medications, such as trimethadione (Tridone)
• Ulcer medications, such as famotidine (Pepcid), cimetidine (Tagamet), and ranitidine
(Zantac)
Rare Causes of Hair Loss
We have already covered the most common conditions that cause hair loss. In this section, we
will outline two conditions that are slightly less common.
OCD: Hair Pulling
Many people aggressively pull their hair when they feel frustrated or upset. This is a fairly
obvious reason for hair fallout.
Every once and awhile hair pulling can be understandable, but it can also be indicative of a
disorder known as OCD (Obsessive Compulsive Disorder); where one literally pulls out his/her
hair repeatedly.
This type of OCD is called Trichotillomania (TTM). Luckily, once pulling and tugging stops,
hair can grow back because TTM is a non-scarring form of hair loss.
TTM is more commonly found in children than adults and is most common among women.
Trichotillomania can be categorized into 2 groups:
1) Those who feel pleasure from pulling their hair / those who intentionally pull out their hair
due to itch or pain.
2) Habitual hair pulling; non-intentional.
Trichotillomania treatment options:
1) Cut hair short (this works well, especially with children)
2) Seek therapy with a professional (i.e. psychiatrist). Medication like Clomipramin (antidepressant)
may reduce symptoms and self-monitoring of the behavior can also be an option.
Traction Alopecia
Traction alopecia refers to the gradual loss of hair due to continuous follicular tension. People
who wear their hair in tight hairstyles (braids, ponytails, pigtails, etc.) are especially prone to
traction alopecia. Traction alopecia can also be a result of tight roller curlers and hair
straighteners.
Traction alopecia is more common in women than in men. Although reversible when it is caught
in its early stages, this form of hair loss can lead to scarring when it becomes persistent. The only
treatment for late-stage traction alopecia is surgical hair transplantation.
