Alopecia areata is characterized by a localized area of complete hair loss (Figure 5). This may extend to the entire scalp (alopecia totalis) or the entire body (alopecia universalis)12,13 (Figure 6). Alopecia areata is probably secondary to an autoimmune reaction involving antibody, T-cell, and cytokine-mediated losses.14–16 The trait appears to be polygenic, affecting 0.1 to 0.2 percent of the population, with men and women equally affected.14 On microscopic evaluation, “exclamation-point” hairs are found, in which the proximal hair shaft has thinned but the distal portion remains of normal caliber (Figure 7). Spontaneous recovery usually occurs within six to 12 months, with hair in areas of re-growth often being pigmented differently.1,13 Prognosis is not as good if the condition persists longer than one year, worsens, or begins before puberty. Persons with a family history of the disorder, atopy, or Down syndrome also have a poorer prognosis.1 The recurrence rate is 30 percent, and recurrence usually affects the initial area of involvement.12 Thyroid abnormalities, vitiligo, and pernicious anemia frequently accompany alopecia areata.1,12,14

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.


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.
I had Melanoma a few years ago, a wide-excision surgery and lymph node(s) removal. I also had sleep apnea and then surgery for that. Also had a hysterectomy 10 years ago for excessive bleeding,I’ve had the clotting factor tests w/normal results though even though even having my blood taken will cause me to bleed alot and bruise.Each time I’ve had surgery, I’ve had to stay in Recovery a looong time because of the bleeding.(hence the clotting tests) Have been anemic most of my adult life too.I am under a lot of stress(have always been) I mention all this in case it rings a bell w/anyone else. 

"This is an oral, prescription-only medication with the brand name Propecia that’s also FDA approved to treat hair loss," says Spencer. Male pattern hair loss occurs when a hormone called dihydrotestosterone (DHT) prevents hair follicles from getting the nutrients they need. Finasteride works by blocking the production of DHT, which protects the follicles.
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. 

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The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
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.
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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The condition affects 0.1%–0.2% of the population,[26] and occurs equally in both males and females. Alopecia areata occurs in people who are otherwise healthy and have no other skin disorders.[7] Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen at any ages.[9] Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as asthma, allergies, atopic dermatitis, and hypothyroidism.
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. 

“There’s people selling pills and creams and lotions and whatever else, and sometimes you can’t even trust what ingredients they have in there,” he warned us when we spoke to him over the phone. Key takeaway: The hair loss industry is crazy dishonest, so we eliminated any treatments (especially homeopathic methods) that aren’t based in concrete, peer-reviewed science.
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.

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!


Thank you Diana. If you find out any more information, I would appreciate it. I have a dermatologist across the street from the Skin and Cancer Institute. I’m still not sure who to start with, the dermatologist or an endocronologist. I left a message for my PCP today to see if she is comfortable working with female hair loss or if not if she could refer me to someone who specializes in it. I will let you know what I hear back. In the meantime, thanks for your support. Take care.
Hair is a cutaneous appendage - just like sweat glands and oil glands.  As a result, dermatologists treat ALL forms of hair loss not just the most common form, androgenetic alopecia. There are many forms of alopecia - alopecia areata, telogen effluvium, lichen planopilaris, congenital hypotrichosis.....to name a few. The treatment and management of all hair loss disorders is an integral part of a dermatologist's training and board certification.  -Dr. Keaney
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.

Finally people who understands what I am going through …I am in a desperate search for doctors in the Miami/Boca Raton, Florida area. Can anyone help? I dont know yet what has been causing my hair loss…I had been loosing some hair throighout the years, and sometimes it gets lees severe but lately has just gotten worse and there is no stopping it seems. I had mt Tyroid checked by PCP a coulpe months ago and my iron level also looked normal …getting desperate. Would appreciate some help.
You can buy minoxidil over the counter, for about $25 for a three-month supply. But you’ll also need to invest some patience. Minoxidil can take six months or even a year to work. Dr. Avram estimates that the drug, which must be applied twice a day, stops hair loss in 80 percent of the women who use it properly and it can actually stimulate hair regrowth in about half the users.
My current solution is this : I have bought clip in hair extensions from Sally’s Beauty Supply store (about 100$) I actually just trim them myself and dye the hair left on my head and the extensions using an ammonia free hair dye (L’oreal or Garnier) in order for them to blend. I use a lot of root lifter and fill in the balding spots with Toppik (dark brown) and top it off with a shine spray. I’m telling you, most people have NO clue of my problem. I feel this is the best way to feel like a woman as I continue on this quest to solve my hair loss problem. I’d be happy to tell more of you about the regimine … high maintenance yes, but you know what, we all have to do what we need to do.
Trying to figure out exactly what is causing your hair loss is going to require a little detective work on the part of your physician. Several lab tests are going to need to be done. I’ll make sure to make another post this week about the standard lab tests that should be ordered to start the process. Hopefully you don’t have to bring the list to the doctors office, he/she should know already. I get concerned when women have to bring a list of tests that should be ordered to their doctor. My feeling is that if they don’t know what to order then how are they going to be able to accurately read the results. But… a good doctor is a good doctor, and if you have one that really cares and takes a strong interest in your hair loss with a willingness to work with you in finding the cause then great.
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.
In the field of aesthetic medicine and cosmetic surgery, Dr. Williams advances the philosophy and disciplines of prevention, longevity and anti-aging medicine. He is a Diplomate of the American Board of Hair Restoration Surgery, Fellow of the International Society of Hair Restoration Surgery, and a board certified primary care physician. He is and member of the American Academy of Cosmetic Physicians, and a Fellow and active member with numerous leadership committees with the International Society of Hair Restoration Surgery. Dr. Williams is the founder and principle physician and surgeon at the Irvine Institute of Medicine and Cosmetic Surgery-Orange County Hair Restoration. Finally, he is a contributor to U.S. News & World Report medical blog.

I’m 55.. gee, had to count with my fingers, lol~ but since I had started puberty I started losing my hair. I managed through the difficult years of Junior High and High school (2 college yrs) by having perms done. The many different ways of trying to cover it. At 14 being told its male hair baldness was pretty much saying nothing you can do. All my life I stayed away during the day time, or with hats, I even worked nights. Tried many items, then later in life diagnosed with PCOS, which makes sense, why would a young girl just starting puberty start going bald. My siblings had too much hair, my sister looked like Bernadette Peters, with twice the hair. About 4 yrs ago a life long friend, called me at 2 am, said turn on HSN, I did, and it was a color fill in~we both purchased it and I absolutely love it! I look normal enough to walk past you, just don’t stare too long, lol, its called Truhair by Ashley Scott. Cant be without it. I use the Rogaine womans 5%, this helps my hair from keep falling, use it every night before bed, I take 5000 vitamin d and 10,000 biotin~ I wish I had these items back when I was teenager, would have saved me decades of embarrassment and heartache. My bald spot/thinning spot looked like a monks cap. I feel the best I have in many, many years. My 23 yrs. daughter had 3.7 ovarian cancer, spread everywhere and she survived, but now..after her 5 yrs remission, she started losing her hair. I feel so horrible for her. I know its from chemo and she ended up having a full hysterectomy, and I’m trying to get her to see a Endorinologist, as I’m sure with hers its her hormones. I finally also gave this affliction to our Lord and the thinning has decreased significantly ! I’m going to keep praying! and also praying for a cure ! the torment of losing your hair is real and devastating.
The main type of hair loss in women is the same as it is men. It's called androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic "M" shape; hair at the top of the head also thins, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman's hairline rarely recedes, and women rarely become bald.
I am 31; as a child I had beautiful brown smooth hair with a hint of a wave. As soon as I hit puberty at 13 (1st period on my 13th b-day), my hair turned wavier. Same year, I remember looking down on my legs horrified at the hair I had developed. Only 1 thought came to me: “NOT NORMAL!” Body hair on women is a tricky subject, though, with media heavily influencing what’s considered ‘normal’. My mom, similarly hairy, just told me it’s genetic and normal.
^ Petukhova L, Duvic M, Hordinsky M, Norris D, Price V, Shimomura Y, Kim H, Singh P, Lee A, Chen WV, Meyer KC, Paus R, Jahoda CA, Amos CI, Gregersen PK, Christiano AM (July 2010). "Genome-wide association study in alopecia areata implicates both innate and adaptive immunity". Nature. 466 (7302): 113–7. Bibcode:2010Natur.466..113P. doi:10.1038/nature09114. PMC 2921172. PMID 20596022.
I’m a dermatologist and am more interested in telogen effluvium these days because I have it bad–and this time it’s not because I just had a baby. I’m learning more about the gut-skin-hair connection and am suspicious that it has to do with the bacterial flora in your gut. You can learn more about changing your gut flora at BodyEcology.com. Her book is intense but I’ve decided to give it a try after recommending it and seeing it work so well with acne patients.

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. 

Finasteride inhibits an enzyme that converts testosterone to DHT, or dihydrotestosterone, the hormone that causes hair loss in men, and unlike minoxidil, this drug can actually help hair grow back, as well as prevent further loss. All you have to do is take one pill a day, and according to Dr. Evan Rieder, dermatologist in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, two-thirds of men taking this treatment will see improvements in hair density over time.
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.
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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.
Hi Everyone I thought I was the only person with major hairloss because everywhere I look all I see is beautiful heads of hair. I am 34 years old and my hair started thinning 7 months ago at first I thought it was just my ponytail getting thinner but my hair became horrible with split ends and dryness too (I have always had extremely healthy hair and never had split ends) – I thought I had burnt my hair using a straightener and that’s why it was thinning. However it has gotten worse and worse and I finally visited a doctor. I have had full blood tests for thyroid issues, hormone levels, cholesterol etc etc all were perfectly normal, I had a thyroid antibody test which was at the high end of normal but still within normal range, I had a thyroid function test which was within normal limits however he thought I did have some slight inflammation ie thyroiditis. My doctor said this isn’t causing the hair loss either. I have loads of energy, don’t get tired, eat well am normal weight range the only other thing I have noticed is my eyelashes seem stunted in growth (not thinned out though) and my eyebrows have thinned on the outer edges. My last two nails on both hands have a dark (looks like they have lifted slight) strip just below the white nail part. I am booked to have a stress test, pelvic ultrasound and to see an endocrinologist also to rule out all other possible reasons for hairloss. I am now getting to the point of embarrassment to go out it is soooo thin on top particularly on one side of temple and majorly down the centre where I used to part my hair. HELPPPPPP!!!!!

Tinea capitis is a fungal infection of the scalp, usually caused by Microsporum or Trichophyton species of dermatophytes19 (Figure 11). It usually occurs in prepubertal patients. The most severe form of tinea capitis is a kerion, a fluctuant, boggy lesion with overlying hair loss. Tinea capitis can result in widespread hair loss with increased fragility of the hairs and frequent breakage. If fungal infection is suspected, a potassium hydrochloride slide or culture can be obtained. A Wood's lamp fluoresces several types of fungi; however, the most common fungus in the United States (i.e., Trichophyton tonsurans) does not fluoresce, lessening the value of this test. Treatment includes oral antifungal agents such as griseofulvin (Grifulvin), itraconazole (Sporanox), terbinafine (Lamisil), and fluconazole (Diflucan), with the newer agents having fewer side effects.20 Oral steroids may be necessary if a patient has a kerion, to decrease inflammation and potential scarring.
“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.
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