Alopecia areata is thought to be a systemic autoimmune disorder in which the body attacks its own anagen hair follicles and suppresses or stops hair growth.[9] For example, T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss. It has been suggested that hair follicle in a normal state are kept secure from the immune system, a phenomenon called immune privilege. A breech in this immune privilege state is considered as the cause of alopecia areata.[12] A few cases of babies being born with congenital alopecia areata have been reported.[13]
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.
Figure 2 is used with permission from Utah Valley Family Practice Residency Program.Figures 3 and 10 are used with permission from the Utah Valley Family Practice Residency Program. Figure 5 is used with permission from Mark Luba, M.D., Good Samaritan Family Practice Residency. Figure 6 is used with permission from Richard Usatine, M.D., UCLA. Figures 9 and 11 are reprinted with permission from the American Academy of Dermatology.
Many factors can contribute to hair disorders. Alopecia, or hair loss, may be caused by medical conditions such as lupus, thyroid disorder, protein or iron deficiencies, or hormonal imbalances.  Hirsutism -- abnormal hair growth in women (such as a beard or chest hair) -- may be caused by ovarian, adrenal, thyroid or pituitary conditions. Identifying the cause, and treating the condition are our goal. 
What’s important to know: the cause of hair loss is specific to each individual, which is why it is so important to have a board-certified dermatologist examine, diagnose, and treat your condition. DR.DENNIS GROSS will review your symptoms, examine your scalp, perform a possible scalp biopsy, and/or order medical and blood tests if an underlying medical condition (like thyroid disease, diabetes, or autoimmune diseases like lupus) is suspected.

Susan – I am horrified to read that two of your doctors actually made fun of you… oh my gosh that is awful! I’m so sorry you had to go through that. I am also surprised that your doctors wouldn’t do any bloodwork other than thyroid. What City/ State do you live in? Maybe someone can recommend a doctor in your area that would be more helpful. While many times bloodwork results end up coming back normal there is that possibility that your results would point to something that may be the cause of your hair loss, especially since you say you have no genetic hereditary hair loss in your family. I know you stated your hair is still falling out, but do you see any results from the propecia and mens rogaine? When did your hair loss start?
i’m currently 41. I started noticing my hair texture changes first, when I was 17, a junior in high school. as a child and teenager I had thick, curly hair. and, i started dying it in 8the grade, just the bang area, for the whole 80’s new wave look. in high school i’d dye it blue/black as i entered a new “phase” of the 80’s, lol. the texture of my hair started to feel thinner, and was getting knottier. and i noticed it was mostly the top layer; my underlying layer of hair was still bouncy. then i noticed i couldn’t wear bangs any longer. i was sad, confused and embarrassed. this was before the internet so basically i just dealt with it not knowing what was going on and no one i could talk to.
Alopecia areata is a disease that attacks your hair follicles (the part of your skin that makes hair). In most cases, hair falls out in small, round patches about the size of a quarter. This causes only a few bare patches. Some people may lose more hair. In only a few people, the disease causes total loss of hair on the head or loss of all body hair.

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.

Dr. Schweiger Dermatologist NYC Bernstein Medical – no actual diagnostic dermatology, just the most disinterested sales pitch for FUT. All the tests and diagnostic work they list on the site as part of the consult is garbage. I gave him my recent CBC which showed hematology problems, he didn’t even look at it. He magnified a tiny area of my scalp for 20 seconds and said it was normal, I have scabs! Said I probably suffered from hormonal imbalance and my hair would grow back and kept blaming it on hair extensions that I haven’t worn in a long time. His prognosis, a $9,000 FUT. I paid $325 for the visit. He was truly going through the motions even his assistant looked embarrassed!


I am so sorry you’ve been so down. I’ve had some other troubles lately that have been bringing me down so the hair loss almost seems so much less important right now. I may lose my home to foreclosure in the next month so I’m focused right now on getting that resolved and trying to stay out of foreclosure. Then I can go back to focusing on my hair again! ha!
For the first time in my life also, I have been experiencing a lot of scalp pain. I think it is because this time, it is not slow and diffuse like it was in my teenage years, at the onset of PCOS. Quitting the pill after 5 years of dependency meant a major hormonal shock to the system which provoked both a mix of both Telogen Effluvium (shock loss), and Androgenic Alopecia (the testosterone from the PCOS back in full form, killing hair follicles).
^ Lenane P, Pope E, Krafchik B (February 2005). "Congenital alopecia areata". Journal of the American Academy of Dermatology (Case Reports. Review). 52 (2 Suppl 1): 8–11. doi:10.1016/j.jaad.2004.06.024. PMID 15692503. We believe AA should be classified not only as an acquired but also a congenital form of nonscarring hair loss. It may well be more common than is thought because of lack of recognition
Some of the skin disorders like lupus and sarcoidosis can cause hair loss. In case of lupus, the hair tends to get brittle and may fall out in patches. Lupus hairs or short, broken hairs usually appear above the forehead. Hair loss is not permanent in general here. Some individuals with lupus also develop a form of lupus known as discoid or cutaneous lupus that affects the skin. Scars that sometimes develop on the skin of the scalp may lead to hair loss.
Also, re: the Proscar, I think that it may already be helping some as I think my shedding may be tapering off a bit more. I am losing a few less hairs Per day now. Maybe? I don’t know, but I am trying to stay positive!! I have no real regrowth. Just wisps, extremely fine hair, almost hard to see. Kind of transparent. I am not expecting miracles, but trust me…. THe moment I feel I have any true results to share with you girls, I will definitely be posting them! There aren’t many success stories out here. We need more. I guess people don’t come out here as much if they are experiencing good things w their hair?
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.
I want to first write that I am not a fan of hair transplants for women, I personally think that most women with androgenetic alopecia are NOT candidates for this procedure. Having said that, I get emailed all the time from women looking for a good hair transplant surgeon. If you are deadset on having a consultation, please visit the International Alliance of Hair Restoration Surgeons. The IAHRS (http://www.iahrs.org) is an organization that selectively screens skilled and ethical hair transplant surgeons. Read my thoughts about hair transplants here.
my daughter is 19 and has been diagnosed with androgenetic alopecia. She has been to several dermatologists. They don’t understand the problem. I am planning to bring her to Dr. Geoffrey Redmond. I read his website. He surely knows how to treat this kind of hair loss. I spoke to his receptionist… they are very accomodating and profesional. So, as much as I would like to believe, that Dr. Redmond will be able to fix this altogether, I do understand he is not a miracle worker. But, I do believe, if anyone can understand this
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.
My dermatologist recently prescribed 100 mg spironolactone for a month and told me to increase the dose to 200 mg after that. He also told me to use Rogaine for men. The Rogaine instructs that it not be used in the front of the scalp (where a lot of my hair loss is) but to only use it on the crown of the head. Can I safetly use it in front? Also, how do you deal w/ putting foam on your head 2 xs a day? My hair is thin with no body. If I add foam I’ll need to restyle it. Am I missing something? I don’t mind taking a pill but the Rogaine has me freaked so I haven’t started it. Any suggestions? I’m having a hard time thinking of using Rogaine the rest of my life.
My dermatologist recently prescribed 100 mg spironolactone for a month and told me to increase the dose to 200 mg after that. He also told me to use Rogaine for men. The Rogaine instructs that it not be used in the front of the scalp (where a lot of my hair loss is) but to only use it on the crown of the head. Can I safetly use it in front? Also, how do you deal w/ putting foam on your head 2 xs a day? My hair is thin with no body. If I add foam I’ll need to restyle it. Am I missing something? I don’t mind taking a pill but the Rogaine has me freaked so I haven’t started it. Any suggestions? I’m having a hard time thinking of using Rogaine the rest of my life.
Oops forgot to mention also went to Dermatologist who said it is probably just stress related but I really don’t stress ever. I am going back for a scalp biopsy just to be sure nothing going on there. I did lose 12 kg over a 15 week period last year (ending about May – hair loss started in July) but it was done properly eating well and just increasing my exercise level so not sure if this is related other than that I am totally lost as to why I am BALD.
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
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. 🙂

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. 
for the next 10 years i dealt with it. noticing my hair getting thinner with every passing year. a quick side note, my father is bald and my mother has always had beautiful, thick wavy locks. taking in to account that the supposed gene for hair is carried maternally, i was confused because my maternal grandmother who passed at age 86 had the most abundant set of thick hair i’d ever seen. it just didn’t make sense to me and only served to depress me more. my mother has since developed traction alopecia, due to her pulling her hair tightly back daily, for work, for years. she has since kept her hair short, but mine looks worse. back to where i left off. at 34 i decided to go to one of the hair restoration places. they took pictures and walked me through the process. it was an odd place, though. small, small place. one guy. said i was a good candidate. he showed me pictures of what my hair loss would possibly look like in another 10 years. i started sobbing. it felt more like a scare tactic than anything so i left, and decided against it, for the time being. still haven’t gone back.
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.
In 2010, a genome-wide association study was completed that identified 129 single nucleotide polymorphisms that were associated with alopecia areata. The genes that were identified include those involved in controlling the activation and proliferation of regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, and Eos (also known as Ikaros family zinc finger 4), as well as the human leukocyte antigen. The study also identified two genes, PRDX5 and STX17, that are expressed in the hair follicle.[18]
I have recently noticed my hair thinning about a year ago. I was 19 when it stated and I am now 20. I have seen well over 10 different doctors including dermatologist, gynecologist and your normal everyday doctor. They have done thousands of dollars worth of blood work on me and they have yet to figure out what is going on. I went from loosing 20 hairs a day to 100 and talk about wanting to cry every night. I have lost over 50% of my hair and everyone including my parents blow me off like it completely normal. My doctors have strung me out in every medicine and when that didn’t work they thought it was all in my head. They told me that it’s normal to lose hair and that it will eventually stop. I’ve had doctors laugh and blow me off, I’ve had doctor to prescribe me depression medicine and a psych. I feel like I’m alone and no one understands what I’m going through. I went from being the funny outgoing person who didn’t care what people think to a self conscious and antisocial person I don’t know. It’s been the worst year of my life, sometimes it feels like a nightmare. I just hope the next doctor I see will give me hope that one day I’ll have my think pretty long hair that I use to have.

“While nutritious eating isn’t going to bring your hair back by any means, eating plenty of protein-rich foods and healthy fats can make the hair that you still have look thicker and shinier.” Skimping on the B vitamins in particular can interfere with the formation of hair cells and, therefore, hair growth. The best sources of Bs are protein-packed foods like chicken, fish, eggs, and pork, as well as leafy greens such as spinach. (These foods are also good for melting belly fat, so it’s a win win).
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