Fifty percent of men and 25% of women experience hair loss by the time they are in their 70s. While this is purely a cosmetic issue, it can impact some people’s self-esteem and their quality of life.
There are four main causes of hair loss or what we call alopecia. The most common type in men and women is related to androgens like dihydrotestosterone. Androgen alopecia causes a gradual thinning of hair over time. The second type is called telogen alopecia where your hair literally sheds off rapidly. This can be caused by medications (oral contraceptives, chemotherapy, lithium, and cimetidine), anemia, thyroid disease, starvation, and childbirth. The third type is brittle hair alopecia where perming, coloring, hot combing and excessive blow drying makes the hair brittle and it breaks off. The fourth type is immune system related hair loss where the white blood cells attack the hair follicles resulting in hair loss all over the body or just in a patch here or there.
When you are pregnant, you have high concentrations or hormones that preserve hair. After you give birth, these hormones go back to normal and the excess hair you built up sheds off. Here it doesn’t cause baldness or thinning just a reversion back to a normal head of hair but it can be alarming to women to see how much hair is coming out. And yes, men have higher concentrations of testosterone than woman but women still have testosterone and when estrogen goes away in menopause, the effects of testosterone become more pronounced.
For men and women with androgren alopecia, minoxidil can be used topically to increase blood flow to the head and increase hair growth. Men can also use finasteride (propecia) to block testosterone from being turned into dihydrotestosterone but women should not take this medication or, if they are of child bearing age, even touch the tablets since it can cause birth defects. Women can use estrogen replacement therapy for androgen alopecia. For telogen or brittle hair alopecia, you can stop the medication that caused it or reverse the underlying cause like correcting anemia or stopping perming your hair and the hair will grow back normally. For immune system alopecia, topical corticosteroids like triamcinolone is the first therapy but immune suppressants pills like cyclosporine or biologic drugs may be needed but these can cause serious side effects. Wigs, hair pieces, and hair transplant surgery are also options. When you think about the benefits and the risks, keep in mind that you don’t need hair to be happy and healthy. Sometimes, accepting hair loss as a “right of passage” into a new phase of your life can save you side effects, money, and hassles.
Dr. Michael White at the UConn School of Pharmacy
