Twenty million women suffer a significant amount of hair loss; about 25 percent show some signs by age forty, but 60 percent of all women experience hair loss by menopause. Gradual loss of hair, as a disease, is a result of alopecia areata or hereditary and aging pattern baldness. Hereditary hair loss is caused by a gradual miniaturization of certain hair follicles, which makes hair grow in shorter and thinner and eventually stop growing.
Think you’re thinning? Different women grow and shed hair at different rates. At any given time, as much as 85 percent of the scalp hair is growing up to an inch a month and may continue to grow for two to six years without stopping. When the phase ends, each hair has a two- to six-month resting period and then begins a shedding phase. Only 10 to 15 percent of hair is in the resting phase at one time. Before long, a new strand of hair begins to sprout from the root, replacing the older strand above it, thus a new growth period begins. New hair can grow back shorter and thinner in diameter, so it takes up less space on your scalp. Experts remind us that it’s normal to shed 50 to 100 hairs a day and not likely to be noticeable, since most of us have 100,000 hairs on our head.
Sixty percent of all women experience some hair loss by menopause. Twenty-five percent show signs of hair loss by age forty.
Most types of hair loss are often diagnosed as hereditary. After all, now that we know most women will suffer some sort of hair loss as they age, we can always chalk it up to our genetic predispositions. Women are born with androgens, the male hormones that cause hair loss if you are genetically predisposed, as well as estrogens, the female hormones that have the opposite effect.
“Whenever the hormone testosterone is present, there is a possibility of female androgenic alopecia,” explains Shelley Friedman, D.O., president of the American Board of Hair Restoration Surgery. “Testosterone has an opportunity to change into a bad hormone called dihydrotestosterone, which can cause hair loss. The enzyme 5-alpha reductase is the catalyst that turns testosterone into dihydrotestosterone, so until your body has access to it, which is usually when you hit adolescence, you won’t experience hair loss. “We all have 5-alpha reductase, but the follicles in the scalp can either be sensitive or insensitive to dihydrotestosterone. The degree of hair loss that we experience is dependent on which of our follicles are sensitive. Women with hair follicles that are sensitive to dihydrotestosterone will have a receding hairline. Those with sensitive follicles in the crown region will have a bald spot at the back of their head. It’s all genetic.”
As we age, hair becomes thinner, starting at the root. At around age forty, follicle size begins to narrow.
Female pattern baldness occurs when hair falls out but new hair does not grow in its place. This problem is associated with genetic predisposition, aging, and levels of endocrine hormones or androgens. Changes in the levels of the androgens can affect hair production. For example, after the hormonal changes of menopause, many women find that the hair on their head has thinned, while facial hair becomes coarser. Although new hair is not produced, the follicle remains alive, suggesting the possibility of new hair growth. Unlike male pattern baldness, in female pattern baldness, hair thins all over the head, but the frontal hairline is maintained. There may be a moderate loss of hair on the crown, but this will rarely result in complete baldness. A skin biopsy or other procedure may be used to diagnose medical disorders that cause loss of hair.
Most women don’t mind baring their souls but have a big problem baring their scalp. Unfortunately, though usually mild to moderate, female pattern baldness is permanent. The only drug or medication approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness is minoxidil (Rogaine), used topically on the scalp, which we will discuss further in Chapter 12. Hair loss recurs when usage is stopped.
Thinning hair is a natural part of aging. Even women who are considerably healthy have hair that is thickest at age twenty and it begins to thin thereafter. That’s why it’s important to be prepared for our hair to thin, so that we can recognize the signs at an early stage and slow the process while we still have plenty of hair on our heads. Try these simple tests to determine if you are starting to lose your hair.
Any of these tests will help you determine whether you need to see a dermatologist or a specialized stylist for advice.
Two percent of the population at one time or another suffers from alopecia areata, an extensive condition in which hair loss occurs in noticeable bald patches. It can be evident in one large patch or many small ones. What is actually happening is that when the hair grows, it appears white in the center and regains color as it gets longer. One of the most common forms is complete loss of hair on the head in a circular patch 1-10 cm in diameter.
Alopecia totalis, a severe form of alopecia areata, is characterized by a complete loss of scalp hair and is caused by the body’s attack on normal hair follicles. Hair suddenly falls out in a generalized pattern, resulting in complete baldness of the scalp.
Scientists have been studying the life cycle of hair for years. Biologists understand much about the development of our hair follicles from their first embryonic appearance to the last stages of life. Proteins play a role in directing many of those steps, and researchers are uncovering additional “regulatory” molecules as well. Yet despite new developments, there is still much to learn about why hair begins to thin and fall out.
MYTH: Shaving one’s head will cause hair to grow back thicker.
FACT: Shaving one’s head will result in … a shaved head! Triggered by stress, hair that is lost in alopecia areata will sometimes grow back after the stress disappears. In other cases, treatment is necessary. Complete baldness is rare. The psychological damage associated with alopecia areata is the most damaging aspect of the condition since it is sudden and unexpected. Alopecia areata tends to appear in families with a history of asthma, eczema, or autoimmune disorders, such as rheumatoid arthritis or lupus erythematosus. It can be treated with cortisone injections, topical minoxidil (Rogaine), or other medications that stimulate hair growth.
One of the biggest misconceptions is that only 15 to 20 percent of women experience hair thinning, when in fact 50 percent of women will experience some degree of thinning by age fifty; virtually all of us will experience thinning after age fifty. In addition, while many women think hair thinning always begins in women in their 505, 60s, or 70s, thinning in women actually occurs in their 20s, 305, or 403. And though women may experience hair thinning just as men do, they can also lose their hair in a completely different way. Unlike men, who get bald spots, women experience diffused thinning, particularly in the crown and temporal areas of the scalp, which is often easier to camouflage.
Many women who experience male pattern baldness believe it is inherited from their mother’s side of the family. The fact is, the gene for male pattern baldness can come from the mother’s or father’s gene pool. Therefore, b aldness can be inherited from either side of the family since many genes can be involved. So there’s no point in studying your family history and paying close attention to how soon your mom’s or dad’s hair falls out. Your hair loss process is entirely unique to you.
All women lose hair at some point during the day, whether it’s while brushing, combing, washing, or styling their hair, or whether their hair falls out on their pillow while they are sleeping or into the drain while they are in the shower. Sometimes women lose over 100 hairs per day, and many times they don’t even notice, or they are aware of the loss but think it’s normal. If you don’t have male pattern baldness, new hairs will soon replace the hairs that fall out. If you do have male pattern baldness, however, even losing the “normal” 75 to 150 hairs a day can be a concern, because many of those hairs are being shed by follicles that are in the process of dying. Therefore, the new hairs those follicles create will be progressively thinner, until the follicles are only capable of making fine peach-fuzz hairs. Eventually, those follicles will die and no longer produce any hairs at all.
So you’re losing your hair. You may think that all you have to do is eat right, exercise, or start a religious Rogaine regimen to increase the number of hair follicles on your head. But while a proper diet and a healthy workout routine will do your body good, they won’t help add to the number of follicles you have. Actually, the number and diameter of your hair follicles are a hereditary issue and completely out of your control. Nothing you do will alter how many hair follicles you have. You can, however, use preventative and treatment measures outlined in this book to combat the follicle-killing effect of DHT, the androgen created when the hormone testosterone is acted upon by the enzyme 5-alpha-reductase.
Another known misconception is the belief that hair will keep growing and growing if you never get it cut. Even if you’ve always wondered what your hair would look like at its longest, the truth is that the length of your hair depends on its natural cycle, which is unique to each individual. The longer the hair’s growth phase, the longer the hair will grow. If you have a naturally long growth phase, you can grow your hair to well below your waist. If you have a naturally shorter growth phase, your hair will be shed before it grows that long and will only grow to a certain length. The duration of your particular growth phase is based on heredity and is affected by nutrition.
Healthy diets are always helpful in maintaining hair that’s strong and beautiful. In Chapter 13 of this book, we discuss natural and nutritional treatments for hair loss as well as foods and dietary vitamins and supplements that can help hair stay healthy and looking beautiful. Does this mean you can chow down on a meal of steak and potatoes every night? Or do you have to maintain a strict diet of fruits, vegetables, and proteins to keep hair looking great? There is a connection between balding and eating animal fat, particularly red meat, because high-fat diets lead to greater DHT production and more damage to hair follicles. But it’s a good idea to maintain a well-balanced diet, with a healthy portion of all of the necessary good groups.
If you haven’t worn a hat in years because you think it may have an effect on hair loss, it’s time to rummage through the closet for your favorite topper and get back into the swing of covering your head. Surprisingly enough, many women believe that wearing a hat causes hair loss. But it’s just not true. Experts believe that as long as you don’t wear a hat that’s so tight it restricts circulation-blood flow to the hair follicles, it will not cause hair loss. Hats can, however, damage hair because of the effects of sweat, dirt, and skin particles that can clog pores. So make sure the inside of your hat is kept scrupulously clean. Blow-drying your hair does not cause hair loss, but excessive heat and intensive styling can damage hair. It can dry, burn, and fray hair that may then fall out, to be replaced by new hair that will sprout from the follicle beneath the skin during the growth phase. Curling and straightening irons can have a similar effect, so keep styling with them to a minimum. If you’re hanging around the house all day on a Saturday, give your hair a break and skip the styling process. Or let hair air-dry every other day during the week to give it a break from the harmful effects of the heat that comes along with some of the best-looking styles.
Some women go a couple of days in between shampoos because they believe frequent shampooing will make their hair fall out faster and in greater excess. If you are afraid to shampoo your hair in the shower because you see so much hair coming out in the drain, know that everyone loses a certain amount of hair when it’s wet. You may actually think you notice it more in the shower when you have to clean it out of the drain or on your bathroom floor, which is usually not carpeted and a good backdrop for hair to show up on. Shampooing only loosens the hair follicle’s base and may actually cause faster growth as the massage action of shampooing has a stimulating effect on hair.
No woman is exempt from the problem of hair loss. The rumor that hair loss only happens to Caucasian women with fine, blond hair is just that: a rumor. While it’s true that women with fine hair are more likely to experience thinning, it is also true that hair may thin regardless of its texture—and thinning has nothing to do with hair color or ethnicity. In fact, African-American women account for a large portion of the consumers who seek out hair loss remedies, products, and treatments. Asian women also experience thinning and other hair problems at high rates. High levels of stress can also cause temporary hair loss. Anxiety and tension have no lasting effect on the condition of the hair. Once the problem is treated, thinning will stop and eventually hair will grow. There is also a lot of debate about whether or not hair loss is seasonal. Some people believe hair grows most in the spring when testosterone levels are lowest, and hair loss accelerates in the fall when testosterone levels peak. Others go so far as to say that twice as much hair is lost in the fall as in the spring. But we know that the bottom line is that everyone loses hair according to her own time schedule. There is no hard-and-fast season-related rule that applies.
Although there is some comfort in knowing that many of the common myths associated with hair loss are far from factual, the reality is that many women do encounter some degree of hair thinning. And, when they do, it can be an extremely difficult and emotional experience. Psychological stress and a loss of self-esteem can be an issue for many women, in reaction to their change in appearance.