Hair Loss: Causes and Treatment Options

Amir Aboutalebi, MD, FAAD

What is alopecia?

Alopecia is the medical term that describes any type of hair loss. Many people conflate the term “alopecia” with alopecia areata, which is actually a very specific type of patchy hair loss caused by an autoimmune response to the hair follicle. Alopecia, generally speaking, refers to any cause of hair loss ranging from alopecia areata to hereditary hair loss. 

Different types of alopecia:

There are several different types of alopecia or hair loss. Broadly speaking, alopecia may be split into two categories, scarring hair loss and non-scarring hair loss. 

Scarring types of hair loss are less common and typically caused by an immune response to the hair follicle, leading to signs and symptoms such as redness, scaling, itching or burning of the scalp. These types of hair loss eventually lead to loss of the follicle, scar tissue formation, and irreversible hair loss. 

We are more familiar with non-scarring types of hair loss. The most common amongst these are telogen effluvium and androgenetic (or hereditary) hair loss. Telogen effluvium describes a generalized shedding of the hair that typically follows some sort of physiologic stressor such as severe infection, chronic illness, surgery, significant weight loss, or childbirth. Hair loss typically starts 3 months after the inciting event and lasts for approximately 6 months. Fortunately, the prognosis is good, and it’s generally expected to have full regrowth of the hair.  T

he type of alopecia we’re most familiar with is hereditary or androgenetic hair loss. I like to explain to patients that although genetics plays a strong role in our hair growth and loss patterns, the term “hereditary” may be a bit misleading. “Hereditary” implies that if your parents and grandparents had a full head of hair, you should as well. However, as human beings, up to 80% of us may suffer from hereditary hair loss at some point, but the onset, rate and severity of this loss will vary between individuals. The genetics of hair loss is complex, and it’s the interplay of several different genes that determines how sensitive our follicles are to normal circulating levels of hormones called androgens. 

Treatment of hereditary hair loss?

Before undergoing treatment for any type of hair loss, it’s important that you consult with your physician first. A physical examination and lab testing may be necessary to rule out any underlying medical causes of your hair loss. 

When treating hereditary hair loss, several options exist. A great over the counter treatment is minoxidil 5% foam or liquid, typically marketed under the brand name Rogaine. This medication may be applied to the scalp once or twice daily. Treatment benefits may be delayed 6 months, and you may experience increased shedding in the meantime. Higher concentrations of minoxidil are available by prescription. Minoxidil may thicken many of the existing microscopic hairs leading to a thicker appearance to the scalp. Recently, oral minoxidil has also been used as an effective treatment modality. 

Other oral medications that exist for the treatment of hair loss include spironolactone and finasteride. Spironolactone is used for female pattern hair loss and relies on reducing androgen levels (mentioned above). Similarly, in men, there is finasteride which works by blocking androgen effects on the hair follicle. While generally safe, these medications do carry their respective side effect profiles, which should be discussed with your doctor. 

Hair loss may be a sensitive topic given the heavy emphasis on hair and its aesthetic qualities. There are a lot of companies that capitalize on these insecurities, marketing expensive and ineffective products. I caution patients to maintain reasonable expectations. There is no quick fix, and it’s not possible to turn back time completely to have the hair we had when we were 18. Fortunately, however, we exist at a time where more and more is being discovered about hair loss and its effective treatment. As always, seek appropriate medical advice so that you may go forward in your evaluation and treatment confidently and safely. 

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