Sometimes having a bad hair day isn’t simply a matter of an unruly wave or a little frizz. Occasionally, hair trouble can be a result of something else that’s going on in your body. Medical conditions like metabolic dysfunction or illness can lead to thinning hair or hair loss or have some other, more subtle effect. Anemia, thyroid dysfunction, hormonal disturbances, and nutritional inadequacies affect hair the most, but unless other symptoms can be identified, it is difficult to recognize that hair problems are due to illness. The effects of fever, accidents, surgery, or pregnancy are other overlooked reasons for hair trouble. Too often physicians chalk up the hair loss problem to genetics when it could be a result of illness or medication. So before you seek revenge on your hairstylist, you might want to give your doctor a call.
So when is hair loss a genetic issue? “If a woman comes to see me, the first thing I ask is whether or not anyone in her family has been affected by hair thinning or loss,” says Dr. Shelly Friedman, president of the American Board of Hair Restoration Surgery, who claims his grandmother suffered from the problem but no one could ever tell since she always wore her hair up. “Your hair gets its longevity from one side of your family and its texture and color from another, so you can have curly hair that’s destined to live forever or straight hair that’s destined to die by thirty-five. If the woman tells me no other female members of her family have hair loss, then I look at the possible medical reasons.”
As if it isn’t horrifying enough to be diagnosed with a medical condition, imagine being diagnosed with a problem that cites hair loss as a side effect. Though modern science is rapidly plugging away to find a solution, sometimes the hair issue can’t even be treated, because the treatment could interfere with the medications you are taking for the initial problem.
Philip Kingsley says, below-normal hemoglobin levels and below-average levels of iron storage can make your hair thin. A well-balanced diet, including vitamins and supplements, can help reverse the effect.
Kingsley, who also studied PCOS (polycystic ovarian syndrome), noticed an incidence of women’s hair loss with the disorder. In a study of women in London, 68 percent of women with thin hair had PCOS. Stress, which seems to be the root of all of our problems these days, is actually one of the biggest reasons for hair loss. Experts say that stress produces adrenaline, which can lead to the production of cholesterol and testosterone. If your hair follicles are sensitive to testosterone, hair thinning can occur. Lupus, an autoimmune disease, develops antibodies to its own cells and can, therefore, form antibodies to cells in the hair follicle.
Most common in middle-aged women, neurodermatitis is recognized by hard, patchy scaling above the nape of the neck at the base of the scalp. It itches drastically and scratching only makes it worse. Often confused with dandruff, neurodermatitis can go untreated. Kingsley suggests trying antidandruff shampoo or sulfur and salicylic acid cream or seeing a dermatologist for more advanced care.
Pityriasis amientacea is a thick scaling common in women in their forties and fifties and consists of adherent flakes climbing up the hair shaft. While often misdiagnosed, if treated correctly, it can be cured, but when neglected, it can cause hair loss.
Contact dermatitis is a recurrent scaly condition caused by an allergy to a certain product, like hair color. Since it usually flares up after the product has been applied, it is often easy to recognize.
Some other scalp conditions, according to Kingsley, may also be present but are extremely rare. Various folliculitis is an inflammation of the hair follicles caused by infection or the long-term use of a greasy product on the scalp. Rosacea can show up on the scalp in red blotches. And lichen simplex is a thickening of the skin on the scalp, caused by constant rubbing of the skin when it’s itchy and flaky. In all cases, Kingsley advises immediate treatment by a professional.
According to Jeffrey Epstein, M.D., D.A.C.S., a doctor in private practice in Miami, Florida, diet binges are another culprit. Excessive dieting or eating disorders can cause a nutritional deficiency, which may limit the transport of nutrients to the scalp and cause hair follicles to die and fall out.
Of all the medical conditions and treatments that alter the state of the body and may cause hair loss, the most well known is chemotherapy, which is a common treatment for most types of cancer. It causes the most drastic of hair conditions—from balding in certain areas to complete hair loss.
“When cancer is present, the cancerous cells grow at a higher rate and replicate too quickly,” explains Dr. Robert Guida, director of facial and plastic surgery at New York Weill Cornell Medical Center. “Chemotherapy causes cell destruction by blocking the cells and keeping them from regenerating. Cancer cells pick up chemotherapy agents quicker than normal cells but healthy cells are also affected. In addition, the toxins from the chemotherapy are damaging to the hair follicles.” Scientists are now studying genes that they hope will be used one day to make chemotherapy agents specific to particular cancer cells to prohibit them from affecting different areas of the body.
Any woman who has encountered hormonal changes, whether in the form of puberty, pregnancy, or menopause, knows that hormones drastically affect us physically and emotionally. Hair loss is no exception. In pregnancy, mild degrees of hirsutism, male patterns of hair growth, can be found, making the proportion of hair in the growing phase during pregnancy lighter than that in the resting phase. “Certain hormones make hair follicles fall out as a group in a particular area, while normal follicles tend to fall out in separate intervals,” explains Albert George Thomas, clinical associate professor of OB/GYN and director of family-planning services at Mount Sinai School of Medicine in New York City. “In the process, neighboring hair will cover empty spaces where hair has been lost. The process is reversed when hair grows and it’s time for the alternate hair to fall out.” Thomas, who is careful not to minimize the effects on the occasional patient who has severe hair loss, adds that while certain drugs might help retard the loss of hair on the scalp, gynecologists don’t recommend using any medications during pregnancy even if it seems like the benefits will far outweigh any risks.
Hair loss is also seen during the postpartum period for about three to four months following delivery. “In pregnancy, there are high levels of estrogen and progesterone, which are responsible for hair loss,” says Thomas. “In the postpartum phase, when breast-feeding is on demand around the clock, estrogen levels are lowered and eventually return to normal and hair grows back.” Normal hair growth will occur six to fifteen months postpartum and it’s usually not as thick as it was before pregnancy. This shedding process represents the reactivation of the hair follicle followed by new growth. “Some women are put on birth control pills to help stabilize postpartum hormonal balance and stimulate hair regrowth,” says Sharon Weiner, M.D., a Los Angeles-based OB/GYN. “The nursing period is still a time of fluctuation.”
MYTH: Women experience hair thinning the same way men do.
FACT: Unlike men, who get bald spots, women experience diffused thinning, particularly in the crown and temporal areas of the scalp.
Weiner says it’s difficult to know how each woman reacts to oral contraception. “Some say their hair feels better, and gets thicker and stronger, while others say they feel their hair is thinning,” she says. “It’s a matter of individualizing the pill and finding the rate of estrogen and progesterone that’s right for each woman.” Menopause and perimenopause bring about other issues. In menopause, the amount of estrogen decreases and the level of androgens increases. “This concentric recruitment makes all of the hair follicles fall out as a group,” says Thomas.
“Postmenopause, there is a fine balance between estrogen and testosterone, which comes with an elevated risk of heart disease, osteoporosis, and hair loss,” says Dr. Epstein. “There is often a greater percentage of testosterone compared to estrogen, which may not be an actual elevation in testosterone but merely a depression or decrease in estrogen levels.” “Women face many hair problems as they go through menopause and we are undertaking extensive research right now to learn more about it,” says Dr. Weiner, who says she is hearing complaints of hair loss from women even under the age of forty. She is currently investigating the combination of hormones and genetics and their effects on hair loss to advise patients better on which combination of hormones to take.
MYTH: Stress causes permanent hair loss.
FACT: Although it’s true that stress can be a factor in the temporary thinning of hair, it has no lasting effect on the condition of the hair. Once stress is treated, thinning no longer occurs as a symptom of that condition.
Hair loss can be a devastating thing, both physically and emotionally. So it’s understandable why many women who experience it often seek counseling to soothe their state of mind. Unfortunately, there aren’t many proven treatments available. According to a panel of mental health experts reporting in the February 1997 Journal of the American Medical Association, depression has been undertreated in the United States, either because doctors don’t have the necessary training to effectively treat it or because they may not view the condition seriously enough. Some studies have shown that only one in ten Americans with depression receive adequate treatment. When left untreated, depression can interfere with personal relationships and job performance and can increase your risk for other illnesses, according to a panel organized by the National Depressive and Manic Depressive Association. It’s the fourth-leading public health problem in the world, yet only one in every three people suffering from depression ever seeks help.
“One of most traumatic situations for a woman to deal with is when she starts losing her hair,” says Aleta St. James, a New York City-based emotional healer, who councils women on what they can do about it. “As a woman, this is a very difficult challenge, but there are ways around it.” On a practical level, St. James suggests that women get a wig to wear until their hair starts to grow in again to make them feel pretty and attractive. In addition, she recommends concentrated efforts that will emotionally and spiritually help them release feelings that if they aren’t pretty, they are unlovable. “I try to help women deal with their self-consciousness, the feeling that everyone is looking at them because there’s something wrong with them,” says St. James. “I try to teach them how to release that idea and understand that most people have empathy.” Her advice: When you start to feel someone is looking at you as if they think there’s something wrong with you, take a deep breath and release that feeling; then declare to yourself that the spirit in you honors the spirit in them. This will help make you feel connected to people rather than feeling separated from them and will give you a sense of calmness. “Reframe your relationship with these people,” she adds. “Instead of seeing them as enemies or people who criticize you and make you feel small, see them as being connected to you in spirit.” To test-drive St. James’s mood-lifting techniques, try this visualization exercise: Close your eyes and visualize a gold-colored light coming into the top of your head. Concentrate on your negative feeling strongly and breathe that gold light into the part of your body where the feeling is stuck. Hold for a count of three and release. If you can visualize the gold light and pair it with the breath in your chest, heart, or throat area, you have targeted the grief. As you release your breath and the color, release your negative emotion. On the next inhale, think of something that gives you a strong feeling of love and draw that feeling into your body. Continue until the negative feeling has completely disappeared. Think about parts of yourself that you feel are attractive and embellish on those to obtain a true positive light.
St. James acknowledges that you may not be the only one who needs help in this department. “If someone is being critical of you, instead of feeling diminished and dosed down, send them love,” she continues. “Realize that most of these people would probably be terrified if this happened to them. Think of a pink sun right in your heart and send it to the person. This will stop you from feeling bad and from trying to defend yourself and make you realize that you can make a difference in their lives.”
The next time you pop an aspirin, take a good look in the mirror first. Even this common medication can cause scalp flaking, itching, and inflammation. If you are prone to asthma, hay fever, or eczema, you may even be more exposed to these effects. In fact, many routinely prescribed prescription and nonprescription drugs can cause temporary hair loss, aggravate female pattern baldness, trigger its onset, and cause permanent hair loss. Ask your physician if you can substitute one of these medications for a drug that doesn’t have hair-loss side effects or use a natural treatment instead.
Acne drugs like Accutane, a derivative of vitamin A, may cause extensive drying of the scalp and other body surfaces, resulting in hair loss. The average prescribed dosage is often taken over the course of sixteen weeks, but a substantial amount of hair falls out toward the final weeks and usually grows back afterward.
Antibiotics can cause redness, tenderness, and flaking of the scalp if used over a long period of time. Anticoagulants like panwarfin, sofarin, coumadin, and heparin injections block dotting factors, so some believe they increase circulation to bring nutrients to the scalp.
Birth control pills contain hormones like estrogen, which can improve the appearance of your hair. Stop taking birth control pills, and there’s a chance you could experience hair loss. But don’t despair; it will only last about six months. Hormone-containing drugs and drugs prescribed for hormone-related reproductive conditions can potentially cause hair loss. Hormone replacement therapy (HRT) for postmenopausal women contains estrogen and/or progesterone, which can be metabolized into androgenic compounds, such as testosterone; anabolic steroids and prednisone can have similar effects.
Cholesterol-lowering drugs and convulsion/epilepsy anticonvulsants can cause hair loss. Antidepression medications, including Prozac, Zoloft, and Paxil, amphetamines used for dieting, and antifungals also trigger hair loss. Beta-blocker drugs, used to treat glaucoma and high blood pressure, can make hair fall out. Anti-inflammatory drugs, including those prescribed for localized pain, swelling, and injury, can help reduce scalp inflammation and help hair grow. Levadopa, administered for Parkinson’s disease, can cause hair loss, too.
When it comes to thyroid imbalances, common treatment drugs such as Eltroxin  (synthroid) and Tertroxin  (euthroid) need to be monitored carefully because an overdose or underdose can cause hair loss. Sedatives, tranquilizers, and barbiturates, taken over a long period of time, can cause redness or flaking of the scalp as well as thinning hair. Some also cause the scalp to be extra sensitive to sunlight. Many drugs used to treat stomach difficulties and ulcers can also affect hair loss.
Vitamins, often only thought of as beneficial, can also have some negative effects when it comes to your hair. Excessive doses of vitamin A (anything over 2,500 i.u. a day to 5,000 i.u. maximum) can make hair fall out. In addition, large doses of vitamin C can result in redness, flakiness, or itchiness of the scalp and skin, and vitamin E can prevent adequate iron absorption, leading to hair loss.
Once you realize that your hair is thinning or falling out, it’s important to consider your treatment options, which include hair regrowth products, physical hair additions, and surgery.