Telogen effluvium is the second most common type of hair loss. It is predominantly seen in women between the ages of 40-70, but may occur at any age. Its symptoms include excessive thinning, shedding, and balding and it may happen abruptly. Common causes of sudden hair loss include changes in hormone levels such as with child birth, menopause, poor nutrition, medical conditions such as iron deficiency anemia and hypothyroidism, medications, severe illness or infection, major surgery, and even extreme levels of stress.
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I agree with Dr. Franks in his opinion that not all board certified dermatologists are experts in the most recent advances in diagnosis and treatment of hair loss, and that a good place to look is the International Society of Hair Restoration Surgery.  It's the most academically-oriented of the many groups and alliances and coalitions of hair restoration doctors, and the one that does not require 5 figure payments annually to stay on their "preferred doctor's list," as so many of these groups operate in this fashion.

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.
For my hair loss I’ve seen four dermatologists, two endocrinologists and have spoken about it with my gynecologist, and general practitioner as well as have also seen someone who “specialized” in thyroid problems. All that’s missing is a partridge in a pear tree These are the total numbers I can recall over the last 8 years. Since my hair loss is hormone related I think that the endocrinologists were probably the most knowledgeable and most helpful about my situation. That’s me though, everyone’s hair loss and causes are different.
I’m typing on my iPad so forgive the many mistakes I will make. Thank you so much fornrplying I’ve been wondering where u and Pilar are. And good for u for not visiting. Ive had my moments where I can stay away and eve feel good. I had all of my extensions removed and I think it has affected the way I feel. But bit feels so good for them to be gone! And in all honesty my hair is in even better shape than it was before I got them. My ends are not as wispy as they were. I wore them for two months and they really made me feel better but I could never wash my hair like I wanted and every time my husband touched my head he said when are u going to get these out! Anyway I’ve felt not as good since I had them removed. I like to hibernate but my husband is a social butterfly; I use to be……but we All know how this changes you! Please please let me know how the propecia works. If there are any side affects, etc….like weight gain, moodiness, gloating etc…..there is a lady bin our office on spire and I have been reading the horrific side affects it has and I’m wondering about propecia. I hope u r doing really good. U sounded really strong in ur post and I’m glad. And yes I am deeply depresses over this. I would so get a hair system but my husband is soooooo anti fake anything. Which drives me crazy. I just want to feel better. Have a blessed nite and thank u. Please keep in touch and thank u for replying I felt I would hear from u. Have u spoken to the doc since u ve been on pro?
I would just like to spare anyone else In Los Angeles thinking about going to see the dermatologist who supposedly specializes in hair lossat UCLA (Dr Strick or something like that I think is his name) He is the most insensitive and uncaring Dr. I have ever met. After waiting close to 2 hours after my scheduled appt to see him. He gave me some xeroxed copy of an article on T E that was out of Glamour or Cosmopolitan or some Fashion magazine like that. He asked no questions. I wasnt even there for 10minutes but when I showed him a big bag of hair which I saved, that had fallen out in the past several weeks. He just very insensitively told me it was T E and it would grow back-basically like just get over it, then he gave me the bums rush out the door. 

“The most common cause of hair loss in both men and women is androgenetic alopecia, which is genetic pattern hair loss,” explains Dr. Michael B. Wolfeld, a board-certified plastic surgeon and an assistant clinical professor of plastic surgery at the Icahn School of Medicine at Mount Sinai Hospital in New York. The root cause of this type of hair loss is dihydrotestosterone (DHT), a byproduct of testosterone that shrinks certain hair follicles until they eventually stop producing hair.
Women also may experience AGA, often with thinning in the central and frontal scalp area but usually without frontal–temporal recession (Figure 3). A history and physical examination aimed at detecting conditions of hyperandrogenism, such as hirsutism, ovarian abnormalities, menstrual irregularities, acne, and infertility are indicated. Laboratory tests are of little value in women with AGA who do not have characteristics of hyperandrogenism.5

Treatment options for AGA (Table 3)6 focus on decreasing androgen activity. Minoxidil (Rogaine) and finasteride (Propecia) are the only medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of AGA (Figure 4).6 Minoxidil is available without a prescription as a 2-percent topical solution that can be used by both men and women and as a 5-percent solution (Rogaine Extra Strength) that should be used by men only. The mechanism of action by which minoxidil promotes hair growth is unknown, but it appears to act at the level of the hair follicle. Minoxidil is an effective treatment for male and female AGA and is recommended as first-line treatment by the American Academy of Dermatology guidelines.5
“I think their effectiveness is not as significant as finasteride or minoxidil,” says Dr. Wolfeld, “however, it’s something that can be used quite easily by patients at home. If they use it two or three times a week, I tell them it can help to thicken their hair.” Results can take up to 18 months to show up, so Dr. Wolfeld stresses that patience is a virtue.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
My scalp is pain-free but has on occasion flared again but 1/100 of the original pain. My scalp still needs frequent shampooing (I could go weeks without it before) to keep the dermatitis at bay. My hair and scalp are still fairly dry and brittle despite aloe for moisture, avocado oil to moisturize and seal in moisture and Behentrimonium Methosulfate to close cuticles, provide slip and halt hair snapping, BUT the breakage is 90% better. I’m still too afraid to go back to humectants though I know they’re amazing as moisture-retainers for dehydrated hair. I have spots of completely missing hair towards my hairline that hasn’t and will probably never regrow but I’m focusing on nursing everything else back to health. 

I had an amazing dermatologist who cured me of my acne b/c she sent me to an endocrynologitst who did agree w/ her that I had PCOS, but when the Aldactone didn’t work, the dermatologist told me “well tha’s that, you have male pattern balding.” She said it like you have two arms and two legs – just a matter of fact, no big deal, but it landed like she sent a single young woman a death sentence. I never went back to her and have not seen a dermatologist since then b/c right after her I went to Dr. Strick at UCLA same kind of stuff (mentioned it in other comment) and am now working w/ my endocrinologist and internal medicine doctors. I agree, you must go to more than one b/c doctors do not know everything and some don’t even know what they are supposed to know for their own field and specialty – they are human too and are good at some things and lacking in othters. Just keep looking until you get someone who cares that this is an upsetting matter for you and will help you find solutions that actually work for you individually instead of a bottle of Rogaine like it’s an apple or 2 aspirins and then call them in the morning.
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.

Consider consultation with a dermatologist who has an interest in hair loss disorders. They can, admittedly, be difficult to find. Looks like you are about 3 hours away from a noted hair loss expert, Dr. Elise Olsen at Duke University. If it is very important to you, it may be worthwhile for you to travel. Hair loss cannot be appropriately diagnosed without a face-to-face consultation.


Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. The U.S. Food and Drug Administration (FDA) has approved minoxidil to treat hair loss. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
Brushing your hair every morning about 30 mins and evening about the same duration of time with rounded tip hair-brush, will do recondition your scalp with better blood circulations. Do not use comb, it will damage your scalp. Also take hair supplements/vitamins. Believeth or not, ladies still flirting on me, even-though I’m in my mid 40s with lots of hair. 🙂
If you have hair loss, you have options, like topical treatments, oral medications, red light procedures, to prevent more hair loss.   But, Curtis says,  "The only way to guarantee hair is the transplant."    She says once you find out what's causing hair loss, you and your doctor can decide how aggressively you want to approach the problem.   She says, "I say to patients, 'Here's what we can do to prevent further loss...'  If you say, 'Dr. Curtis, I want hair." Here's what we have to do, we're going to move it from the back to the front, nobody will know, it will look fantastic."
Taking hair supplements can be helpful for anyone who is experiencing hair loss or hair thinning. Dendy Engelman, MD, a board-certified dermatologic surgeon at Medical Dermatology & Cosmetic Surgery in New York City, previously recommended Nutrafol, a research-backed hair supplement, to Prevention. "This uses highly concentrated botanicals to address every stage of the growth cycle," she says. Nutrafol's hair supplements include vitamin E and ashwagandha (an adaptogen that helps balance cortisol levels in the body), among others.
I stumbled on this website accidentally and am amazed at all your stories. I think it’s so wonderful that you all support each other in this way. I’m so sorry that you’re all missing your beautiful hair that you previously had. I am 51 and don’t really know what it would be like to have beautiful hair. I’ve always had what my mother calls “Peter Pan” hair. It never grew up. When I was three years old, I finally started to grow some hair. It got to be the way some other very young childrens’ hair was–very soft, thin, and fine. There just wasn’t a whole lot of it to begin with. You could easily see my scalp in a lot of places on my head. Well, over the course of the next 48 years, the only change in my hair is that I’ve been steadily losing what little there was to start with. I’ve never been able to put it in a pony tail or pig tails because it looked ridiculous and the scrunchy or rubber bands wouldn’t stay in anyway. There just wasn’t enough hair. I’d have to twist the rubber bands around like 20 times to try to get them to stay in–unsuccessfully. I started to notice the diffuse thinning around the age of 30. Now, at 51, people are always asking me if I’m on chemo. I’ve seen a doctor for the depression and anxiety after my separation from my husband 10 years ago and the resulting loss of my 7-year old son, but not for the loss of my hair as I thought (and was told by my internist) that nothing could be done for me. I was very ill with the depression for years, and even now can only work PRN at my hospital; but on the days I’m not working, I don’t leave the house, I don’t eat, I don’t even get out of bed. I don’t think my hair loss is due to the Effexor XR that I take for the depression, but I’m wondering if it could be from the poor nutrition and the fact that I take no supplemental vitamins. Should I go to a doctor even at this late date? The thinning has gotten so severe on my temples, crown, and above my ears that I wonder if improved nutrition would even help. What kind of doctor would I see even if I thought it would help? I’m very embarrassed by the way I look, and very lonely since I can’t date because men want nothing to do with me and most women seem embarrassed to be seen with me. I’ve tried to live a happy life despite the way I look, but I think it would be wonderful if there were actually some way I could be helped to look like a normal woman. Does anyone have any advice? Thank you for taking the time.
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 reading all the stories, I had great hair until 15 years ago,and then the texture of my hair drastically changed. It be became “dead hair” wirery. I call it it my chicken feathers just taking its time to fall out which it has done over a long period of time, but I now have bald spots on the sides and thinning in my bangs. I started buying wigs years ago knowing that this was something that was inevitable. I’ve had all the tests and tried all the products, nothing..just curious if anyone else has had the “dead hair” issue
"Others are taking hair follicles out of human scalp and growing them with dermal papilla cells," Cotsarelis says. "If they grow in culture, you might be able to recombine them with skin cells and form new follicles. This would let you expand the number of follicles you get for a hair transplant. This may not be that far off -- five to 10 years, maybe. There's very good evidence you will be able to do that."
Minoxidil (Rogaine, generic versions). This drug was initially introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it. Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then a 5% solution has also become available when a stronger solution is need for a woman's hair loss.

Hi Lisa, hope you were able to speak with your doctor. I also talked at length with my mom and sister and feel a little better. My mom has hair but it is very thin but I forget she has had surgeries and takes a lot of meds for various conditions and she knows this has caused her hair loss. My sister has PCOS and that has made her hair thin out. I had a good appt with my dermatology nurse. She sat and talked with me and listened and was very interested and caring. I cried for about half the visit. She examined my head and does see the thinning but it isn’t consistent for androgentic alopecia and there aren’t any just out of nowhere hairloss in the family (she seemed more concerned with females than male relatives). What I haven’t stated is that I don’t handle stress well, the last time I underwent major stress was with the acne and she thinks it has taken on another form. To be as brief as I can besides taking two night classes, working full time, single mom no help from their dad ( a teen daughter and preteen son!), major stress at work, separated/divorced, financial stress, found out my dad’s prostate cancer came back, aging parents (they can’t take care of things like they used to and I’m living with them and it’s on me now), and just found my ex husband (not my kids’ dad) has lung/brain cancer and we aren’t on speaking terms and we work for the same company, oh yeah and I have new boyfriend. The last of this list happened all this month. I know I haven’t been eating well, and with the constipation if I’m severely stressed it runs right through me, then I know its bad. So she and I decided to go with biotin & a multivitamin, see my PCP she really wants me back on anti anxiety pills, I will still see him but I want to talk to him more at length because it can cause hairloss, we are continuing my 200 mg of aladactone, my orthotricyclen, eat better, I do have regrowth in my bangs. She is very concerned about my mental health (my BFF says to me “how is my ball of nerves today?” that’s how bad I am!). I know I just need to manage it better and talking to her was the first step because she too went through a stress shedding period (I do remember it, it was a year ago) and her hair is coming back in. She said it will come back for me. But for my own psychological health she said for me to get the rogaine foam for men and use it, just so I can see regrowth faster. She said they say not to use if for women because of the pregnancy issue and that isn’t a factor for me. I also had burning and itching but with the use of Nioxin it is better. She also said only wash my hair once a day (I usually do twice), and use low heat for my hair. She is going to see me in three weeks.


You are what you eat – and that’s true for your hair as well. A diet containing mostly whole foods, especially the skin of plants such as cucumbers, potatoes, peppers, and even bean sprouts are rich in the mineral silica and contribute to hair strength. Foods like lean meats are high in iron and are essential to the protein-based, building blocks of hair growth.


A directed history and physical examination usually uncover the etiology of hair loss. The history should focus on when the hair loss started; whether it was gradual or involved “handfuls” of hair; and if any physical, mental, or emotional stressors occurred within the previous three to six months3  (Table 1). Determining whether the patient is complaining of hair thinning (i.e., gradually more scalp appears) or hair shedding (i.e., large quantities of hair falling out) may clarify the etiology of the hair loss.4


The characteristic finding of alopecia areata is one or more well-circumscribed areas of otherwise normal, hairless skin in hair-bearing areas. Occasionally, it may be necessary to biopsy the scalp to confirm the diagnosis. Other findings that may be helpful are the appearance of short hairs that presumably represent fractured hairs, short thin hairs, and gray hair growing in a bald area. Other causes of hair loss are generally excluded from the consideration by history and clinical evaluation.

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.
I have had alopecia universalis for 12 years now. It was very difficult in the beginning when my hair began to fall out. I was in college and devastated because I thought my life was over. I have now grown to accept myself and the way I look now. I know I would not be who I am today without this having happened, and I really like me! It does get better, but it is a process. A good support system and love from family and friends gets you through. Good luck to you all on your journey.
"Dr. Yaker is ABSOLUTELY AMAZING! He is innovative, highly professional, incredibly skilled and extremely passionate about hair restoration. His bedside manner is one of complete dedication and compassion with genuine care for his patients and their needs. He strives for excellence in everything he does, and it's evidenced by his loyal client following and their satisfaction with their incredible outcomes. I'd recommend him to anyone & everyone interested in hair restoration or transplantation."
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Spironolactone, an aldosterone antagonist with antiandrogenic effects, works well as a treatment for hirsutism and may slow hair loss in women with AGA, but it does not stimulate hair regrowth. Estrogen may help to maintain hair status in women with AGA, but it also does not help with regrowth. Few controlled studies have examined the many non–FDA-approved hair growth agents such as cyproterone acetate (not available in the United States), progesterone, cimetidine (Tagamet), and multiple non-prescription and herbal products. A full discussion of approved and unapproved treatments for AGA can be found elsewhere.6,7 In all forms of alopecia, hairpieces and surgical transplants can produce satisfactory results but are expensive.
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.
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