Evaluating and treating hair loss (alopecia) is an important part of primary care, yet many physicians find it complex and confusing. Hair loss affects men and women of all ages and frequently has significant social and psychologic consequences. This article reviews the physiology of normal hair growth, common causes of hair loss, and treatments currently available for alopecia.
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.
When your hormones get out of whack as a result of thyroid disease, your whole body can feel off-kilter. Your weight, your mood, and even your thinking, can be affected, and you may have a host of other physical symptoms too. Hair loss is a common side effect of thyroid disease, but it's not a permanent problem as long as you get the treatment you need.
Your doctor might also suggest the prescription pill finasteride, sold under the brand name Propecia and also in generic versions. Although the drug is not federally approved for use in female patients, some doctors have observed good results in postmenopausal women. But women who are planning to have children should not take this drug because it can cause birth defects.
In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See "Life cycle of a hair.") That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called "follicular miniaturization." As a result, thicker, pigmented, longer-lived "terminal" hairs are replaced by shorter, thinner, non-pigmented hairs called "vellus."
The scalp pain has not gone away. I have tried 100 things prescribed by 100 doctors. Dermatologists have told me to add zinc supplements to my diet, use a cream with “clobetasol propionate” on my scalp, improve the quality of my scalp by getting rid of any flakiness – hundreds of options. Trichodynia – pain of the scalp – is a poorly understood subject. I don’t know if it is hormonally related, and exacerbated by the stress (of losing so much hair) – I cannot answer you.
The loss of hair can be sudden, developing in just a few days or over a period of a few weeks. There may be itching or burning in the area before hair loss. The hair follicles are not destroyed and so hair can re-grow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous, full recovery without any form of treatment.
Trichotillomania is a psychiatric impulse-control disorder.17 The mean age of onset is eight years in boys and 12 years in girls, and it is the most common cause of childhood alopecia.1,15 Although any part of the body can be involved, the scalp is the most common. Patients also may eat the plucked hairs (trichophagy), causing internal complications such as bowel obstruction.18 The hair loss often follows a bizarre pattern with incomplete areas of clearing (Figure 9). The scalp may appear normal or have areas of erythema and pustule formation. A scalp biopsy may be necessary to rule out other etiologies, because patients may not acknowledge the habit.
I was searching the internet and came across this wonderful site. I really appreciate you posting this article. I have always had a small bald patch on one side of my head. My mom told me it had always been there so I didn’t worry about it. Recently it has been getting larger and the hair around it is getting lighter. On the other side my hair is thinning and the color and texture is changing. It also seems to be falling out. I have excessive hair loss on a regular basis. I am only 24 years old and I can’t stand that my hair is falling out. I went to the dermatologist and he gave my injections but they didn’t work. He said I have alopecia areata and that the other side was a normal receding hairline. (He barely even looked at it) He then told me after the injections weren’t working to try Rogaine. I think it might be helpful to see an endrocrinologist as I have also been having problems with anemia. Again, thank you so much for the information you have provided.
Laser light therapy is not a baldness solution, and the HairMax takes a time commitment: You have to use the product for 15 minutes a day, three days a week and you have to keep using it indefinitely to get results. Still, laser light therapy has no major side effects, and may be best for men who have noticed some increased shedding and want to maintain more of the hair they have on their head.
The other main hair-loss treatment that was recommended by all four dermatologists I interviewed is finasteride, often called by its brand name Propecia. This FDA-approved medication is only available with a prescription, but these days, it’s found as a generic and ordered online after a virtual consultation, through start-ups like Hims, Keeps, and Lemonaid.
The Rogaine rep we spoke to explained that the different packaging (and therefore different prices) has to do with the FDA-approval process: “We discovered in clinical trials that the hair loss patterns between men and women are different,” she said by way of explanation. “Men typically have that bald spot on the crown of their head, where women generally have a general thinning throughout, but concentrated more on the top of the head. So for FDA approval, we had to come up with two different, gender-specific products, so the directions were more explanatory.”
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I’m so glad I came across this site. I’m 41 and started to lose my hair in Aug 2011. It started out as two bald spots in the back near the hairline. I went to a Dermatologist who started me on steroid injections, Topicort, and hair, skin and nails vitamins. After a few months, they didn’t seem to help. I went to my Internal Medicine md. He ordered all types of blood tests, $4,000 worth, which all but my Vitamin D came back normal. I started a Vitamin D supplement. He suggested I live my life and be happy. I then went to an Integrative Medicine md, who ran more blood tests that came back normal, urine tests that came back normal, and had me do a GI Repair Kit. I even tried going gluten free. I take a multivitamin, Omega 3, B Complex, Vitamin D 10,000 units, and hair, skin and nail Vitamins. I’ve cut out fast food and processed food. Drinking lots of water. Not exercising like I should. I began to gray in my twenties and have been dyeing my hair for years. The Dermatologist told me it didn’t cause the hair loss. I went months without dyeing my hair just to see if it would help. Nothing has helped or stopped my hair loss. I have now lost most of the hair in the back and on the left side over my ear leading to the front. A month a go I noticed a huge bald area on the right side in the front. I have been so depressed and self-conscious about my hair loss. I have been staying in the house and avoiding gatherings for fear of someone noticing. After spending lots of money and not getting any answers, I feel so helpless. I purchased a wig, but since my remaining hair is long and covers the bald areas, I haven’t started wearing it yet. It is a comfort knowing that I’m not the only one going through this. People don’t seem to understand. I know I’m not my hair, and my hair doesn’t make me, but it is a very traumatic thing to go through. I’ve decided to take my Internal Medicine md’s advice and to just live my life. I can’t continue to be depressed over something I can’t control. I wish everyone luck and I will continue to follow.
In-office laser light treatments or at-home handheld devices, such as the HairMax LaserComb, supposedly grow new hair by stimulating blood flow to the area (think: an amped-up version of a scalp-stimulating shampoo). Just don’t expect the device to make your noggin go from looking like George Costanza’s to Jerry Seinfeld’s. “These lasers won’t grow any new hair. If anything, they may just help you hang on to some of the hair that you already have a bit longer,” says Dr. Joyce.
It is perfectly normal for people to shed 50 to 100 hairs per day. This generally doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time that hair is shedding. However, hair loss occurs when this hair growth cycle and shedding is disrupted or when the hair follicle becomes destroyed and replaced with scar tissue. Female pattern hair loss (androgenetic alopecia) is the most common form of hair loss in women. This occurs gradually and is caused by genetics (from either side of the family), age, and the action of a specific male hormone, dihydrotestosterone (DHT). This hormone is found in lesser amounts in women and it preys on the hair follicles, preventing them from receiving vital nutrients for proper hair follicle growth, leading to the hairs shrinking, and resulting in a shorter lifespan. Interestingly, DHT does not need to be elevated to generate hair loss. Estrogen, when lowered as commonly seen in menopause, creates a change in the ratio of male to female hormones, giving an edge to these male hormones. Compounded with the sensitivity of DHT to the hair follicles, heredity can affect the age at which a woman begins to lose her hair, as well as the rate of hair loss and the extent of baldness. 
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
I too have been having bad hair loss. I am 25 years old and since the birth of my second child 2 1/2 years ago, it has not stopped. It is normal for it to fall out for a few months after child birth so I wasn’t too worried at first. After about 6 months it started to slow down then all of a sudden started up again. And has been falling out ever since. I am really thin in the front and around the temples and just recently, has become really unhealthy. It breaks and is very course. I have been to 3 derms. and 2 PCP’s. All my lab work has always come back normal. And they just tell me to use Rogain. The past 6 months I have been trying to get pregnant again and haven’t been able to. I got pregnant with my last 2 very easy and feel that my hair loss and not being able to get pregnant are intertwined. I also have gained about 15 pounds. I don’t want to use the Rogain because I am trying to get pregnant and don’t know the effects it will have if I did get pregnant. I don’t know what to do next. I am in the Phoenix area so if anyone know of any good docs around here please let me know.
Aside from medication and lasers, some opt for hair transplants — a procedure where hairs are removed from another part of your body and then transplanted to the thinning or balding areas. Does it work? In a word, yes. Research suggests that most hair transplant recipients report are "very satisfied" with their results. While successful, transplants are also far more expensive than medications, foams, or lasers with costs averaging anywhere from $4,000 or $15,000.
Men’s Rogaine Extra Strength Solution is the liquid version of our top pick. It didn’t make our final cut because it includes propylene glycol, which causes irritation in roughly one-third of its users. With that said, Dr. Wolfeld finds that it can be even more effective in practical daily use. In his experience, “the solution can penetrate and get into your scalp a little bit better” than the foam — especially if you’re not taking the time and effort to apply the foam correctly. This seems crazy to us since the foam so quickly dissolved into a liquid in our tests, but if you’re worried, try a one-month supply of the liquid and make the switch to foam if you notice any irritation.
Hi! Any recommendations for doctors that care about or specialize in hair loss in South Carolina (or NC or GA for that matter–I can travel.) I am very glad to have found this site. I am 3 months into using 5% Rogaine and taking 50 mg of Spiro. I have noticed a decrease in shedding but no regrowth.Very very very stressful problem to have. So nice to have ideas and support here.
The more research i do about hair color and PPD/PTD allergy the more I think that my hair loss is from that… it has been 7 months now and my hair is growing back. I have not had a tight /itchy scalp/ no more feeling as though bugs are crawling in my hair. I have only gone to the Hair loss dermatologist-whom did not think it was hair dye and the regular doctor to check my hormones. I would love to cover my gray – My hair is very dry at the roots. I went to a stylist(hair loss sprecialist) not much info there-master colorist-she did not know about PPD allergy- I do think stopping coloring my hair has help me keep me from lossing more hair and I think some have grown back. I really would like to color, but I am blonde and gray so I don’t think henna will work. I want to tell you about the reaction I had was first itching and then hair loss. Please take note if that happens to you. Then doctors- they said it was probably not the dye.Wrong! They said Hair loss came with age and hormones. I had all of those tested . Then 6 months later I had the salon dye my hair and a bad reaction bumps and itching and hair loss.Again! I still would like to see a doctor that has knows about hair loss or PPD allergy Or a salon. I have not found anyone in Florida. Keep researching. Mostly I have learned from these web sites and I have educated the doctors and the salon. I know it is all about money and that is how these chemicals stay in the products we are using. I did use rogaine before my first reaction. I thought might have had a chemical reaction from the rogaine and hair dye being used in the same week.

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.
Anti-androgens. Androgens include testosterone and other "male" hormones, which can accelerate hair loss in women. Some women who don't respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens. Doctors will usually prescribe spironolactone together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.) Possible side effects include weight gain, loss of libido, depression, and fatigue.

If a pregnant woman comes in contact with crushed or broken Finasteride tablets, wash the contact area right away with soap and water. If a woman who is pregnant comes into contact with the active ingredient in Finasteride, a healthcare provider should be consulted. If a woman who is pregnant with a male baby swallows or comes in contact with the medicine in Finasteride, the male baby may be born with sex organs that are not normal.
If you do decide to start treatment to save your hair, a good place to start is with minoxidil, more commonly known as Rogaine. Don’t expect this hair-loss treatment to create luscious locks; minoxidil is better at slowing down or preventing more loss rather than promoting hair growth. But, according to Dr. Amy McMichael, professor and chair of Wake Forest Baptist Medical Center’s Department of Dermatology, it is effective “if used as recommended, with evidence of improvement seen around six to nine months.” Simply massage the foam or solution into your scalp once or twice daily, and for best results, use a formula with 5 percent concentration.
when i was 24, went to so. america to visit family. they hadn’t seen me since my last visit, which was when i was 17. there was a guy who i had liked and hung out with when i spent my 17th summer there and was excited to see him once again, “as an adult”. i think it was the second day or so of hanging out with him when he says to me: “hey, i noticed you’re losing your hair”. i was beyond embarrassed at that moment and all i could muster out was, “yeah, i know”. thanks for pointing it out there buddy. next came anger mixed with that embarrassment. i felt, and still feel, that people stare at my head and notice my thinning hair when they are talking to me. when i came back to the states a few weeks later, the first thing i did was make an appt with my pcp. she referred me to an endocrinologist who found my testosterone level slightly elevated. it was in the 70 range. i didn’t have masculinization going on so she told me she didn’t want to put me on medication and to return if i noticed in increase or changes in symptoms.
Hi, I cannot afford to go to see Dr. Redmond even though I live in NY (he’s just too pricy, I have no insurance, etc…) but I’m going to see the ob/gyn towards then end of the month to get help because I’m convinced I have PCOS (literally all the symptoms) and I was wondering, what birth control is best for hair? I’ve read Dr. Redmond’s site before and I could have sworn that Yaz or Yasmin kept popping up in the faqs section or somewhere on that site as good bcp for hair loss. I realize some people experienced hair loss after going off those pills, but if you have hair loss prior to bcp, I could have sworn Dr. Redmond listed those as good at helping hair loss and I thought some women claimed (elsewhere, not on his site) that they’ve regrown some hair after going on Yasmin. Sorry if I’m rambling, but does anyone know? Thanks. If I have PCOS, which I’m sure I do, I’m pushing for Spironolactone because I’ve read of a bunch of women who’ve had great success at regrowing hair with it, and one story on this site about a woman named “Jen” had great results. I think it took her 2 years, and she allegedly grew back 90-95% of her hair (also taking Metformin, dieting and exercising, and using Nizoral shampoo) so I’m trying to remain optimistic. It’s not just being 27 & single that makes me horrified at losing hair, though it doesn’t help, I’d still be freaking out if I was 57. If I could regrow even 30% to 50% I’d be elated. Because ultimately, I’m holding out hope for stem cells to be all of our “saviors.” Lol. There are 3 companies working on adult stem cell therapies for hair loss (from what I’ve seen here and elsewhere, they are Histogen, Follica, and Aderans) not to mention a Cairo Dermatologist who has successfully helped children with alopecia areata/totalis regrow significant amounts of hair, though only in one study and the results are only preliminary. Who knows. But still, fingers crossed that I can get these stupid hormones under control and stop my daily horror at washing my hair and seeing my once beautiful hair fall away. I always took my hair for granted and often complained about it, but I’d give anything for my thick long hair back. I had fine hair always, but tons of it and I always wore it long. Now I wear it pulled back in a bun to hide as best I can all that scalp showing through. Thanks for this site, it’s keeping me from going off the deep end.
I am 45 years-old and started noticing a thinning of my hair about 2 years ago. I did see a dermatologist specialized in hair loss and was only prescribed a testosterone lab test which came back normal. My scalp is vey itchy but I do not have dandruff or any signs of dry skin. It sometimes hurts so bad I wake up at night. I was prescribed a steroid shampoo and a steroid lotion which have helped calm down the itchiness and pain if used regularly. I was diagnosed with Female baldness (mostly on the top which is really thin now) and dermatitis. not further explanations. I was also prescribed Rogaine 5% and a mixture of Rogaine and RA to use every 3 days. once a day. should I start using them twice a day? its only been 3 months and I have not noticed a change. I accepted a job to work from home because I was getting too self conscious to go to work at the office. I am very concerned by my appearance usually but this hair loss is a constant worry.
Speaking of a new style: Don’t choose one that’s so high maintenance that it needs to be heat styled daily—the damage you’ll do with too much hot tool usage can leave strands damaged and fried, and breaking before it can grow to a certain length. Plus, thinner hair tends to break easier, so you want to avoid any extra damage-inducing practices at all costs. Make a conscious effort, too, to brush more gently, and use a moisturizing and reparative hair mask to hydrate hair and nourish the scalp—where hair gets most of its strength.

I want to say that all of you are very courageous and sharing. I appreciate everything I have read here. Thankfully, I am starting out in a slightly better position – I still have a fair amount of hair left. I started with a HUGE amount of hair. For the last 6 – 12 months, I have been losing handfulls of hair in the shower every morning, then some more when I comb it out, then a bit more when I put styling product in it, then just a bit more during the day. The shower is the huge hit, though. I’m 37 and on a ton of medication – synthroid, neurontin (an amitryptiline derivative), anti-depressants, and a host of pain medications for a degenerative back problem. I brought my hair loss up to a doc around the time it started, since I was already on synthroid, he re-tested my levels, and said everything was fine. My hair structure has always been on the thin side, but there was just so damn much it didn’t matter – now there is a lot less. What used to take upwards of 20 minutes to dry with a dryer, now takes 5. I’ve been worried about it for quite a while, and didn’t know what to do. I started my on-line research today with hair extensions and stumbled on this site. I am encouraged that I’m starting my search for an answer relatively early in my hair loss journey. I have some great advice and questions to go in to see my doc about. If anyone has any recommendations for the Boise, ID area for a dermatologist and endocrinologist, I would really appreciate it.


Interesting. After reading these posts, I called a dermatologist in the Houston, TX area asking for an appt. and whether he prescribes medication for hair loss in women. I mentioned Spironolactone. He told the nurse that he does not, and that it can actually cause hair loss. This is exactly the frustration we all experience. You hear a different opinion from each Dr. and don’t know what the right answer is. If anyone knows of a good endocrinologist in Houston, please let me know. I’ve been losing hair for about 5 yrs (now 39 yrs) and have to use hair-loc extensions just to feel confidence when in public. I did not see much about Propecia in these posts. Have any women taken it w/ much success?
And though this treatment appears to be safe and somewhat effective, it’s hard to tell who will react well to this low-level light therapy, which is why the doctors I spoke with were hesitant to fully endorse it. “We’re not sure what the optimal power is, what the optimal wavelength is, we don’t even really know the mechanism of action of how this is working,” says Rieder. Plus, it doesn’t work on everyone. “There are subpopulations of patients who do respond to low-level laser light, but this is not easily predictable,” explains McMichael, though she adds that the risk of using the LaserComb is low.
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.

My daughter is 17 and has had significant hair loss over the past 4 years. It has really made her self conscience and depressed. We have been to dermatologists that have done scalp biopsies , natural doctors for herbs, etc. Does anyone know of a really good dermatologist that specializes in hair loss and is knowledgable about immune disorders? We live in St Louis, but are willing to travel for help.


Shedding is never fun — just ask my vacuum cleaner. It’s even less fun when you realize the golf ball size bits of hair you’re tugging out of the roller came from your own head. Oh, the horror! As we get older (yes ladies, this is for you too) our once glorious crown of healthy hair can become brittle, or even worse, be genetically predisposed to jump ship, leaving our poor, bald heads to fend for themselves.
Jimenez, J. J., Wikramanayake, T. C., Bergfeld, W., Hordinsky, M., Hickman, J. G., Hamblin, M. R., & Schachner, L. A. (2014). Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study. American Journal of Clinical Dermatology, 15(2), 115–127.
Loose anagen syndrome, which most commonly presents in young children, occurs when hair that is not firmly rooted in the follicle can be pulled out easily. Most of the time, hair falls out after it has reached an arbitrary maximum length. Children with loose anagen syndrome often cannot grow hair beyond a relatively short length. The condition more commonly affects girls with blond or brown hair.

My hair started thining out this past year. I notice my hair falling out when i got pregnant with my son. I got diabetes with my pregnancy. my scalp itches and it hurts. It feels like i had my hair tied up so tight and let it go. it hurts to move my hair. i saw a dermatologist and said it was due to the stress of child birth. it has been over a year and is still falling out. has anyone heard of this and what i can do. My Pcp check my hormone levels and said everything is fine. I need help.
Too much stress is bad for health and beauty, but did you know there’s a known connection between stress and hair loss, too? Constant stress can cause cortisol levels to spike, which can contribute to increased hair shedding. To relieve stress and its damaging effects on your hair, try meditation, regular exercise, keeping a regular sleep schedule, or any other activity that helps you decompress.

Hi! Any recommendations for doctors that care about or specialize in hair loss in South Carolina (or NC or GA for that matter–I can travel.) I am very glad to have found this site. I am 3 months into using 5% Rogaine and taking 50 mg of Spiro. I have noticed a decrease in shedding but no regrowth.Very very very stressful problem to have. So nice to have ideas and support here.
Many medical conditions can cause hair loss, with thyroid disease a common culprit. Thyroid problems include both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism). Because hair growth depends on the proper functioning of the thyroid gland, abnormal levels of thyroid hormone produced by this gland can result in hair changes, along with many other side effects, if left untreated. When there is too much thyroid hormone, the hair on your head can become fine, with thinning hair all over the scalp. When there is too little of this hormone, there can be hair loss, not just on the scalp, but also anywhere on the body.
I recently noticed I was loosing hair on the front of my head, I started using the rogain Foam and after a month my hair started falling out even more. It’s gotten really bad, I can see my entire scalp now and my hair is falling out in chunks. Rogain advised you loose hair making room for new ones to grow, has anyone had any experience using rogain? Is This normal?
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