Furthermore, Penn dermatopathologists developed an even more advanced method called the HoVert technique for diagnosing hair loss and other disorders from a scalp biopsy. The technique uses a unique horizontal and vertical testing approach that provides a greater amount of information to the referring dermatologist than standard industry longitudinal scalp biopsies.
Telogen effluvium occurs when the normal balance of hairs in growth and rest phases is disrupted, and the telogen phase predominates. The disproportionate shedding leads to a decrease in the total number of hairs. Axillary and pubic areas often are involved, as well as the scalp.2 The hair-pluck test usually shows that up to 50 percent of hairs are in the telogen phase (in contrast to the normal 10 to 15 percent), although these results can vary in persons with advanced disease.4  The patient often is found to have had inciting events in the three to four months before the hair loss (Table 4).1,4 If 70 to 80 percent of hairs are in the telogen phase, the physician should look for causes of severe metabolic derangements, toxic exposures, or chemotherapy.1,4 No specific treatment for hair loss is required because normal hair regrowth usually occurs with time and resolution of underlying causes. Lack of significant historical events and a delay in regrowth should raise suspicion for syphilitic alopecia.1

Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)


Physical stress can also be a cause for hair loss. Any kind of physical trauma surgery, a severe illness, an accident, even the flu can lead to temporary hair loss. This can trigger a type of hair loss known as Telogen effluvium. Hair loss usually gets noticeable 3-6 months after the trauma but once your body recovers, your hair would start growing back again.
I’ve been to one Endocrinologist, probably 5 Dermatologists, and a Trichologist for my hair loss. I agree that you will probably need more than one doctor to get to the bottom of the cause of your hair loss. I wasn’t really happy with any of the doctors I saw (which is why I kept finding new Dermatologists). I even went to a Dermatologist “specialist” in hair loss at UCLA, and he just said I had TE and told me I could try Rogaine to jump-start my re-growth, but otherwise he had no suggestions. I think the most valuable visit I had was to a Trichologist, because he was the most caring and had the greatest knowledge about hair loss. He, along with some of the Derms, told me I had TE, and no miniaturization.
The main symptom of alopecia areata is hair loss. Hair usually falls out in small patches on the scalp. These patches are often several centimeters or less. Hair loss might also occur on other parts of the face, like the eyebrows, eyelashes, and beard, as well as other parts of the body. Some people lose hair in a few places. Others lose it in a lot of spots.
Sinclair Scale: The 5-point Sinclair Scale is a modified visual grading scale. Grade 1 is normal. This pattern is found in all girls prior to puberty, but in only half of women age 80 or over. Grade 2 shows a widening of the central part. Grade 3 shows a widening of the central part and thinning of the hair on either side of the central part. Grade 4 reveals the emergence of diffuse hair loss over the top of the scalp. Grade 5 indicates advanced hair loss. This grade is uncommon, occurring in less than 1% of women.
The topical sensitizers, diphencyprone or squaric acid dibutylester, have been used in those suffering from recalcitrant alopecia areata or those with more than 50% hair loss. The goal of treatment is to create an allergic contact dermatitis of the scalp. This alteration in the immune response occasionally is accompanied by hair regrowth. The efficacy of the topical sensitizers has been demonstrated in both young children and adults, but it probably works less than half the time. Recent success using oral janus kinase inhibitors, including tofacitinib, ruxolitinib, and baricitinib, have been shown to be efficacious in severe, extensive alopecia areata in adults, but long-term therapy has potential side effects. The durability of response to these medications is variable, and most patients experience recurrence of hair loss after discontinuation. Perhaps topical therapy with these types of drugs may be available in the near future.
Leprosy (Hansen's disease) is a disfiguring disease caused by infection with Mycobacterium leprae bacteria. The disease is spread from person to person through nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of temperature sensation, painless ulcers, eye damage, loss of digits, and facial disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of administration depends upon which form of leprosy the patient has.
There are numerous diseases that can affect the hair and scalp. Hair loss can be caused by a variety of conditions. Diseases such as alopecia areata, anemia, male/female pattern baldness, and infections of the scalp can all cause significant difficulty and loss of daily well-being. Stanford Dermatology has established a special clinic focusing on the diagnosis and treatment of these disorders of the hair.
Medications are available that encourage regrowth of hair. These medications, such as topical minoxidil* and oral finasteride, are not appropriate for everyone with hair loss. Hair growth medications work to varying degrees in different people, and only trigger complete regrowth in a minority of individuals. They work best for people who have smaller amounts of hair loss. Hair loss returns if you stop taking the medication. Finasteride is not appropriate for women who may become pregnant, as it can cause severe birth defects. Spironolactone, although not approved by Health Canada for this purpose, is a medication that may help women who are losing hair due to excess testosterone. Biotin is a vitamin that makes hair and nails stronger and is often used as an adjuvant therapy.
Age-onset thinning, or “miniaturization,” refers to a progressive decrease of the hair shaft’s diameter and length. This happens at least in part because of androgens like dihydrotestosterone (or DHT), a derivative of the male hormone testosterone that causes hair follicles to literally shrink in diameter. This type of hair thinning is referred to as androgenic alopecia, and it occurs in an equal pattern all over the scalp. However, pregnancy, ovarian cysts, medications, emotional or physical shock, and birth control pills can all affect hormone levels, making it complicated to pinpoint the reason for hair loss. For example, polycystic ovarian disease can exacerbate androgens and manifest as thinning, in which case you could treat the condition and fix hair loss. Get your hormone levels checked to see if an underlying health issue is the root cause.

Alopecia areata affects people of all ages including young children. It produces circular patches of hair loss that appear overnight. More patches appear over time and eventually about 5% of people affected lose every hair on their body. This includes eyebrows, eyelashes and even nose hairs. In some people, hair grows back, either in the same place or on a previously unaffected part of the scalp or body.
I know that Planned Parenthood offers thyroid screening, should I try there to get mine checked to see if this is why my hair is thinning? I have no health insurance, I’m unemployed, and between feeling depressed and just incredibly tired, I don’t know how I can get a job and wait until benefits kick in to actually see a doctor. It’s so depressing. I always had fine hair, but a lot of it. It was shiny, mostly straight with a little wave, but now it’s just, what I consider to be, disgusting. I hate how my hair looks and it’s gotten to the point that I’m so stressed out I don’t even want to eat anymore. Which sounds awful, but I eat and I feel entirely not hungry and almost nauseated. I think it’s the tremendous stress. I’m afraid to call Planned Parenthood because part of me doesn’t want to know if there’s nothing that can be done, but do you think they can test for PCOS as well? My periods were always normal. I got it when I was 12, about 3 months before I turned 13, and they were like clockwork. Then when I was about 15/16, my grandparents died and that was a major shock and I got a few grey/white hairs, still not thinning/balding. Then when I was 17, I dyed my hair almost black because I was depressed, but hated it, tried to remove the color with over the counter stuff, and my hair turned into straw and was brassy orange. I ended up perming it at 18 because it was so frizzy and a friend convinced me that it’d be easier to just wear it curly than to keep blow drying it straight only to have it fuzz up/frizz up. This is probably tmi, and I’m sorry, but I need to vent. I was raped at 18 (a virgin) by 3 boys. I started eating a bunch of junk and withdrawing. I was always what I consider a chunky girl, but my weight has ballooned up since then. I have so much stress and the stress of this is exascerbating my hair loss I think, but I also fear I might have either hypothyroidism or PCOS, or potentially both. I’m even fearful I could have Cushings. The problem is that I don’t have health insurance anymore and any job I get will take about 3 months to kick in as far as benefits go. I just feel like it’s so unfair. Of course life isn’t fair, but still, it’s like this never ending circle for me. I can’t get to the doctor and get help without a job, but I don’t feel I can actually function without going to the doctor because I feel lousy. Oh, and my periods are all out of whack. I bleed monthly, but it’s like ceaseless. It’s so depressing knowing something is wrong, and having no hope to fix it. Thanks for listening.
What I hate most is how I feel about myself. As others have shared, I don’t want to wash or fix my hair any more than I have to for fear of lossing even more hair, thus I don’t want to leave the house. I also don’t like that most health care professionals give you a standard excuse for the hair loss: you’re getting older, hair thins; it’s hereditary; or the worst one..it’s due to stress! I wasn’t stressed until I pick a clump of hair from the shower drain or my hairbrush daily!

As the name suggests, androgenetic alopecia involves the action of the hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sex drive and regulation of hair growth. The condition may be inherited and involve several different genes. It can also result from an underlying endocrine condition, such as overproduction of androgen or an androgen-secreting tumor on the ovary, pituitary, or adrenal gland. In either case, the alopecia is likely related to increased androgen activity. But unlike androgenetic alopecia in men, in women the precise role of androgens is harder to determine. On the chance that an androgen-secreting tumor is involved, it's important to measure androgen levels in women with clear female pattern hair loss.


Testosterone replacement is becoming popular for men. Cotsarelis warns that this may accelerate hair loss. Propecia might help -- but because it prevents testosterone breakdown, it might affect the dose of male hormone replacement therapy. Cotsarelis warns men taking both Propecia and testosterone replacement to make sure their doctor carefully monitors their testosterone levels.
In our research and our conversations with experts, one name kept popping up repeatedly: Rogaine. As the first topical brand FDA-approved to help regrow hair (all the way back in 1988), Rogaine benefits from more than 20 years of clinical trials and consumer feedback. Rogaine was the first brand to offer a 5 percent minoxidil foam solution when it debuted Men’s Rogaine Unscented Foam in 2006, and virtually every treatment developed since (for both men and women) has been an imitation or derivation of that formula.
Around 30 million U.S. women will experience hereditary hair loss, or female pattern baldness (androgenetic alopecia), while others will struggle with situational hair loss, brought on by medical conditions, medications, poor health and nutrition, environmental factors such as smoking and sun damage, or even from adverse reactions to hair care products or treatments.
This blog is great in all the support and understanding it provides, but I had a pretty hard time finding any suggestions for treatments that have actually helped anyone. I’m 22 and my hair has been rapidly shedding over the past 5 months. It’s also gotten thin and brittle. After 2 blood screenings, a dermatologist visit, and a visit to my general practitioner, nothing has improved. The doctor’s told me to wait it out, and that sometimes this “just happens”. They tested my hairs and saw that most of them were in the “resting” telogen phase, and decided I had Telogen Effluvium (TE) for undetermined causes.
Even though modern folklore, and even some limited scientific studies, have suggested that the mother's side of the family is largely responsible for a genetic predisposition toward baldness, the truth is balding is not all our mothers' fault. In fact, doctors now say baldness patterns are inherited from a combination of many genes on both sides of the family. There are some environmental factors that come into play, too.
There’s also a women’s version (Women’s Rogaine Foam) — but a three-month supply costs $22 more online. The only difference between the two products are the instructions; women are instructed to apply once a day instead of twice. If you’re a woman who doesn’t feel like paying extra for marketing, the men’s product will suffice. A cheaper generic version is Kirkland Signature Minoxidil Foam, but with a longer history on the market and more customer testimonials, Rogaine is our first choice.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

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Typical first symptoms of alopecia areata are small bald patches. The underlying skin is unscarred and looks superficially normal. Although these patches can take many shapes, they are usually round or oval.[6] Alopecia areata most often affects the scalp and beard, but may occur on any part of the body with hair.[7] Different areas of the skin may exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or may be permanent. It is common in children.

Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. Anagen (A), the active growth phase, lasts two to seven years. Catagen (), the transition phase, lasts about two weeks. During this phase, the hair shaft moves upward toward the skin's surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle. Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.
Hair transplants are not an options for a very large proportion of women with genetic hair loss as the pattern of hair loss is diffuse or the amount of thinning is not suitable for restoration.  Also, hair transplantation is not an option for women with chronic telogen effluvium, nor for women with active frontal fibrosing alopecia, lichen planopilaris and a host of other conditions. 
Several types of hair shaft abnormalities can lead to hair loss. These conditions cause strands of hair to thin and weaken, making them vulnerable to breaking. The hair loss doesn’t occur in the follicle but as a result of a break somewhere along the hair shaft, which is the visible part of a hair strand. This can result in overall thinning, as well as in many small, brittle hairs.
There can be several factors behind hair loss such as environmental effects, aging, too much stress, excessive smoking, nutritional deficiencies, hormonal imbalance, genetic factors, scalp infections, use of wrong or chemically enriched hair products, certain medicines and medical conditions like thyroid disorder, autoimmune diseases, polycystic ovary syndrome (PCOS), iron-deficiency anemia, and chronic illnesses.
Iron supplements. Iron deficiency could be a cause of hair loss in some women . Your doctor may test your blood iron level, particularly if you're a vegetarian, have a history of anemia, or have heavy menstrual bleeding. If you do have iron deficiency, you will need to take a supplement and it may stop your hair loss. However, if your iron level is normal, taking extra iron will only cause side effects, such as stomach upset and constipation.
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