According to the British Association of Dermatologists (BAD), male pattern hair loss affects around half of men over the age of 50. But a similar condition can cause female baldness, too, with approximately 40% of women aged 70 and over experiencing female pattern hair loss. Both types are genetic and can lead to advanced baldness.
It’s natural to shed 50 to 100 hairs per day, and while that may seem like a lot, the average human head is home to between 90,000 to 150,000 hairs. In a healthy hair growth cycle, new hairs replace lost ones so efficiently that you’re unlikely to notice shedding.
However, that’s not always the case — you may lose more hairs than your scalp replaces. If you notice a build up of hairs around the drain in your shower after shampooing or you find more strands in your brush, you could be experiencing some form of hair loss. It may be temporary or permanent.
But what causes hair loss? And what treatments are available?
In this comprehensive guide to hair loss, we’ll answer these and other key questions.
Visit a doctor or dermatologist if you believe you may be losing more hair than usual. They will examine your scalp and discuss your medical history to try to identify a reason for your shedding, such as one of the following causes.
Pattern baldness is the most common cause, inherited from one or more parents. It’s likely that you will show signs of pattern hair loss if it runs in the family.
Specific sex hormones, such as dihydrotestosterone (DHT), can trigger hereditary hair loss at any age — even during puberty. The condition may start to show as a sudden stop in the hair growth cycle, with new hairs taking longer to develop.
Another potential catalyst for hair loss is hormonal changes, often due to:
- Becoming pregnant
- Giving birth
- Coming off the contraceptive pill
Alternatively, physically or emotionally traumatic situations, illnesses, and surgery can trigger balding too. In these cases, though, hair may start to regrow over time without the need for treatment.
The following medical conditions can trigger hair loss:
- Alopecia areata (causing the body’s immune system to attack follicles)
- Ringworm and other scalp infections
- Thyroid disease
- Lichen planus, lupus, and other conditions that cause scarring
- Trichotillomania, otherwise known as hair-pulling disorder
Medications may be responsible too, specifically those that treat:
- High blood pressure
- Heart problems
You may start losing more hair than usual if you suffer a severe emotional or physical shock. This could be due to:
- Sudden death of a loved one
- An extremely high fever
- Drastic weight loss
Other causes may not be due to medical conditions or treatments. One possibility is traction hair loss, which could be to blame if you wear tight hairstyles putting intense pressure on the follicles. Alternatively, you may start losing hair if your diet lacks essential nutrients like iron and protein.
A doctor or dermatologist will diagnose your hair after an in-depth examination and discussion about your health background. If you have shed a lot of hair without an obvious explanation (e.g. traction alopecia), you may have an underlying issue that needs to be resolved.
Your doctor or dermatologist may recommend something simple, such as changing your diet or prescribing a different medication. A dermatologist can perform a biopsy to collect a sample of your skin tissue if they believe your hair loss is due to autoimmune or similar problems.
However, it may take even the most well-trained specialists time to identify the cause of your hair loss.
Various treatments for hair loss are available:
Medications are often a first step in treating hair loss, with over-the-counter options including topical treatments applied directly to the scalp. Minoxidil is the most common, available as Rogaine. However, you would need to keep using this consistently to achieve and maintain new hair growth. Minoxidil can be used alongside other treatments, but may trigger side effects such as skin irritation.
Alternatively, you could try a prescription medication instead of an over-the-counter treatment. Finasteride is a popular option for men affected by pattern baldness, and must be taken daily. It may lead to increased hair growth and restore lost hair, but it can cause a number of undesirable side effects. For example, it may affect the libido and sexual function. Research into the connection between finasteride and prostate cancer is ongoing.
You could be given a corticosteroid, such as prednisone. These are designed to replicate the hormones produced by the adrenal glands. They can cause immune-system suppression and a decrease in inflammation in people affected by alopecia areata.
However, it’s vital that you remain vigilant when taking corticosteroids for hair loss. They can lead to:
- Fluid retention
- An increase in blood pressure
- Raised blood sugar
It’s also believed that corticosteroids can increase your risk of:
- Losing calcium from bones (potentially causing osteoporosis)
- Sore throat
- More bruising (due to thinning skin)
Medications may be unsuitable for you, or you could choose to avoid them. In any case, various surgical procedures are available.
Hair transplantation is increasingly common. Surgeons extract healthy donor follicles from the back and sides of the scalp. They implant these into thinning or bald areas to stimulate new growth. If you have advanced pattern hair loss, you may need multiple transplants.
Follicular Unit Extraction (FUE) is the most popular form of hair transplantation. This restores growth without visible scarring.
A scalp reduction procedure involves cutting away the bald area of the scalp then closing it with a piece covered with hair. Alternatively, the surgeon may simply fold a section of scalp with healthy hair growth over a bald area.
Another option is tissue expansion, performed across two surgical procedures. In the first, the surgeon positions a tissue expander beneath an area of the scalp that’s covered with hair and adjacent to the bald section. The expander will stretch the piece covered with hair over a number of weeks. During the second surgery, the expander will be removed and the expanded section of scalp will be pulled over the bald region.
Hair transplant surgery carries risks, like any other form of surgery. Potential risks include:
You may need further surgery if the results don’t meet your initial expectations.
You can prevent your hair loss from getting worse in various ways.
Avoid tight hairstyles that put excessive pressure on your hair and follicles, such as braids and ponytails. They can cause permanent damage. Similarly, avoid pulling or twisting your hair hard.
Another preventative measure is to wash your hair with a gentle shampoo formulated for babies. This could make a difference if you usually use products that contain harsh chemicals.
Also, don’t wash your hair every day unless it’s incredibly oily. And don’t rub your hair too vigorously with a towel to dry it — pat it gently instead.
Cut back on the heated tools you use to dry and style your hair, such as blow dryers and hair straighteners. Switch them to the lowest settings available if you can’t avoid heated styling tools altogether. You may also find your hair health improves if you eliminate or minimise colouring products, bleaches, and restyling treatments (e.g. perms).
Some preventative measures and treatments for hair loss are more effective than others. Medications may stimulate new growth in one patient but not another. Eating more iron and protein could prevent hair loss from progressing further, or it may not.
However, the latest techniques can achieve incredible results: the FUE2 method has success rates of 90 – 95%, and new hair will grow back within 12 – 18 months after the treatment.