Are you losing hair and wondering why?

It’s frustrating enough but when you don’t know what’s causing it, the extra stress can make you want to tear your hair out (okay bad analogy…)

The purpose of this guide is to help you identify what kind of hair loss you have so you can take the proper course of action to begin treating it.

For the average person, their scalp contains anywhere between 100,000 and 150,000 strands of hair each going through their own growth cycle lasting 2-4 years. It’s completely normal to shed some hair everyday (about 100-150) but if you’re finding a substantial amount on your pillow, in the shower, or on your brush then it’s time to look into the causes.

The proper medical term for hair loss is alopecia and there are actually more than just a few types of conditions. In fact, the American Hair Loss Association says that several hundreds of diseases have alopecia as one of their primary symptoms. Of course the majority of people only experience the top five or so most common. We’ll cover those as well as some of the rarer types to cover all the bases.

Now let’s begin!

Androgenetic Alopecia

We’ll begin by covering the most common type that affects both men and women. A more common name for this one is male pattern baldness or female pattern baldness depending on your gender. Both are primarily caused by genetics and you’re probably most familiar with them already.

Male Pattern Baldness

Men are more susceptible to androgenic alopecia and the statistics can get depressing.

It’s the most common type by a long shot: roughly 95% of all cases of male hair loss are accountable to male pattern baldness. By the time you’re 35 you have a 66% chance of experiencing at least some form of MPB and by age 50 that increases to 85%. Almost 25% of men begin in their teenage years and before the age of 21 (this is when you develop your “mature” hairline).

There are two tell-tale signs:

  • A receding hairline
  • Thinning at the vertex

If you have the signature M-shape on your scalp, are a male, and have male family members who’ve also had balding it’s likely that you have this type due to a genetic predisposition.

How far it progresses you have a more control over. If it’s already progressed far enough you’d get the U-shaped horseshoe around the temples and the back due to miniaturization but none at the crown. Check out the Hamilton-Norwood scale below which was developed as a visual aid to help diagnose how far along you are.

Norwood Scale

The earlier you are in the stages, the easier it’ll be to reverse any hair fall. We’ve already written extensively about MPB and we highly encourage you to either begin here which gives you an in-depth introduction or here which is our ultimate guide on DHT, the male hormone primarily responsible for this type of hair fall.

Female Pattern Baldness

The much less talked about form of androgenetic alopecia is female pattern baldness which affects about 40% of all women.

The mechanism of action is similar – DHT, the androgenic hormone attacks the hair follicles, shortens their growth cycle, and produces gradually thinner hair until the follicle eventually withers away. Heredity also plays a major role in whether it will occur to you or not.  Check your family tree to see if there is a history.

The key point to remember is that it doesn’t affect women or manifest itself the same as it does in men.

For starters, it begins later in life for women, usually not until their 40s. The next major difference is that if follows a different pattern of hair loss. In women there is general thinning that is usually concentrated on the crown. The hairline rarely ever recedes unlike in men. It also rarely ever leads to a completely bald scalp leaving the sides, back, and hairline intact.

Check out the Ludwig classification scale which was developed to stage the degree of diffuse thinning in women.

Ludwig Classification For Female Pattern Baldness

Note that Type 0 in this case would be a women with a full head of hair without any noticeable thinning.

Telogen Effluvium

This is the second most common type of hair loss after androgenetic alopecia.

It’s characterized by temporary thinning that occurs when an increased number of hair follicles enter the telogen stage of their growth cycle causing the hair to shed faster than usual.

First let’s explain what the three stages of the hair growth cycle are before we go any further.

Hair Growth Cycle

About 90% of your follicles at any time are in the growing stage aka the anagen phase of the cycle lasting anywhere from 2-7 years. The remaining 10% are in the telogen phase which usually lasts up to six months. The transition phase in between, the catagen stage, only lasts for a relatively short time –  two weeks at most – and less than 1% of your hair is in this stage.

Those hairs in the 10% aren’t actually growing – they’re just waiting to shed. So when the percentage of follicles in the active growth phase drops and the amount waiting to shed increases you will lose hair faster than it can replace itself.

You can tell if your hair loss is caused by telogen effluvium if there is a small white lump of keratin (the protein that structurally makes up 90% of the hair fiber) at the end of the root that has fallen out. Diffuse thinning only occurs at the top of the scalp and there isn’t any recession of the hair line except in the rarest of cases.

There are many theorized and potential causes: stress, hormonal imbalances, nutritional deficiencies (covered further below), and side effects of certain medications to name a few.

Here are three different ways it can develop:

If the effluvium is caused by a sudden shock to your system and the follicles – take extreme stress or a traumatic event for example – the condition can quickly progress with symptoms appearing about two months after the triggering event. Assuming that whatever shocked the follicles has subsided, they will begin growing quickly soon after with normal hair density returning after a year.

Another way it can develop is if the follicles enter the telogen phase as expected but stay there instead of continuing on to the anagen phase with a new follicle and repeating the process. This means over time more and more follicles will enter the telogen stage and fewer and fewer will be left growing.  This way it develops more slowly with the condition lasting longer.

The third way is if the follicle goes through its normal cycle but they have a shortened anagen phase resulting in the shedding of short hair fibers that haven’t had the chance to actually grow full length.

The good news is that it’s reversible, it usually resolves itself, and affects no more than 50% of the scalp at one time.

Alopecia Areata

If you’ve noticed smooth, round patches of hair loss on your scalp it’s likely you have alopecia areata. This type is said to be the third most common and is known to affect men, women, or children with a 2% chance of developing it at some point in your life.

It also occurs to a lesser extant on facial hair, eyebrows, legs, or anywhere else hair grows on your body.

Why it develops or what triggers its formation is still a mystery. Nowadays it’s generally considered to be an autoimmune condition where the immune system mistakenly attacks your hair follicles believing them to be a threat to the body as if they were an invading pathogen.

Usually only one or two circular patches appear with a distinct shape but sometimes more extensive hair loss can occur.

  • If it’s limited to the scalp it’s called alopecia totalis.
  • If it’s just on the beard in men it’s called alopecia barbae.
  • If it spreads to the rest of the body it’s alopecia universalis.

There’s usually no pain or redness at the bald spots but a mild itch may develop in some cases.

Another signature characteristic is that the hair loss happens suddenly over the course of a few days compared to years for other types of alopecia.

This may all seem depressing but the good news is that it isn’t contagious and the loss is only temporary with the hair usually taking up to two years to regrow for a full recovery and sometimes in as little as 6 months depending on how soon inflammation subsides.

Alopecia Areata on Woman
Photo Credit: Carolyn Speranza / Source / CC BY 2.0
Alopecia Areata on a man
Photo Credit: Seth Tisue / Source / CC BY-SA 2.0

Scarring Alopecia

This type is also known by its medical name cicatricial alopecia and can occur in both men and women making up about 3% of all hair loss patients.

It’s characterized by permanent and irreversible loss of hair with the follicles and their ability to regenerate being destroyed by the immune system and replaced with scar tissue, hence its name.

There are two ways it can develop:

  • Slowly, as very small patches that go unnoticed but gradually expand over time.
  • Faster, where it’s accompanied by symptoms like pain or itchiness.

Rarely do the patches ever expand to cover the entire scalp. They’re usually contained and any symptoms experienced also subside after a short while although the hair won’t grow back.

It can be thought of as a more severe form of alopecia areata with the major difference in appearance being that the bald patches are a more ragged shape and have less defined edges. The actual areas affected may be smooth or have scaling and redness or even pus and slight pigmentation changes on the scalp

Because there’s no predefined pattern of hair loss, a biopsy is usually needed to confirm the diagnosis by looking for scar tissue deeper in the skin.

Nutritional Deficiencies

Being deficient in certain nutrients can lessen your hair’s ability to grow and in worst case scenarios even cause it to fall out. This is why we stress good hair always begins from the inside out with a good hair healthy diet.

Here are the biggest culprits:

Zinc

We’ve mentioned elsewhere how zinc is associated with four different types of hair loss:

  • Telogen Effluvium
  • Male Pattern Baldness
  • Female Pattern Baldness
  • Alopecia Areata

In all four cases, patients with hair loss usually had a significantly lower average of serum zinc in their blood compared to control groups. This was especially true for patients with alopecia areata.

Iron

Similar to zinc, iron deficiency is also associated with androgenetic alopecia, alopecia areata, and telogen effluvium.

This type of deficiency is especially common in women. Iron is stored in the blood binding to a protein called ferritin. When that time of the month comes they lose more iron due to blood loss than men.

One study found that of nine women who had some form of telogen effluvium, eight of them had lower mean serum levels of ferritin and thus iron, in their blood compared to women without diffuse hair loss suggesting you have an increased risk if you’re deficient.

Biotin

Biotin is known to increase the strength of hair and nails and is an essential nutrient for hair growth. While it’s unlikely you’re deficient assuming you live in a first world country and have plenty of access to food, being deficient is known to cause hair loss which can be reversed by simply increasing your intake.

Vitamin D

Unless you live near the equator or are constantly outdoors, everyone seems to be naturally deficient in Vitamin D. That said, a deficiency here has been linked to alopecia areata and research suggests increasing your intake or simply getting more sunshine can be an effective form of treatment.

Involutional Alopecia

The volume of your hair and its thickness naturally decreases as you age. This is because the percentage of hair follicles that are in the telogen phase of the growth cycle increases, while the percentage in the anagen phase decreases. Active hair growth has slowed and the end result is a thinner head of hair.

This type is nearly exclusive to older folks (60+ years of age) in contrast to androgenetic alopecia which is also a natural condition except it occurs much earlier in life. So unless you match the age requirement and haven’t experienced other types of hair loss it’s very unlikely you have this one.

The best way to combat involutional alopecia and brittle hair overall is by eating hair healthy foods well into old age to give your hair the nutrients and minerals it needs to grow at its fullest potential.

Tinea Capitis

This type is a fungal infection caused by ringworm when it occurs on the scalp. It’s relatively rare in adults and most often seen in children with the condition disappearing by puberty. Oftentimes it only affects parts of the scalp instead of the whole with the hair breaking off at the affected areas in a round shape leaving behind tiny black or pigmented dots. The skin can also appear scaly, swollen, or have redness from inflammation caused by the infection.

Keep in mind that tinea capitis is contagious but once cured the hair will grow back.

tinea capitis
Photo Credit: Grook Da Oger / Source / CC BY S.A. 4.0

Anagen Effluvium

Whereas telogen effluvium is caused by an increased count of hairs in the telogen phase of the hair’s life cycle, anagen effluvium is increased shedding that occurs during the anagen phase, or the growth stage of the life cycle.

This type of hair loss is most commonly associated with radiation therapy or chemotherapy for the treatment of cancers and other types of illnesses. You will literally be able to pull out clumps of your hair by hand with no pain.

A lot of medications used for cancer treatments kill off cells that multiply quickly – these include the cells responsible for growing your hair in addition to malignant cells. This means that a lot of patients undergoing chemo suffer with temporary hair loss. In almost all cases the hair will begin growing back within 1-3 months after treatment is finished although it may come back with a different texture or color than before.

Traction Alopecia

This condition is unrelated to the growth cycle of the actual hair follicles themselves.

Instead it happens when the follicles are put under physical stress or are under a constant state of tension for longer periods of time. Think ponytails, pigtails and tight buns or braids. For this reason traction alopecia is more of a problem for women who often style their hair these ways.

You can usually identify this type by shorter hairs at the hairline as a result of the skin on the scalp being pulled back to create these hairstyles.

Since it’s temporary and can easily be reversed by simply avoiding physical damage to the hair, you should begin by repair any breakage that has occurred in order to allow your hair to grow back healthier and stronger.

Trichotillomania

This condition is a psychological disorder characterized by the compulsive need to pull at the hair of the scalp and sometimes the eyelashes, eyebrows, or other parts of the body that grow hair.

Basically it comes down to dysfunctional impulse control where the act of pulling at the hair relieves “stress” for the person to put it in the most simplest of terms.

But even if you don’t have trichotillomania, be wary of physical damage to your hair. Over time the stress your hair is subjected to can weaken the cuticle or shaft and cause it to fall prematurely like in traction alopecia.

Wrap Up

And there you have it! Our goal is to update this guide continuously and develop the ultimate resource for all types of conditions so people can quickly identify which kind they have and then begin treating it.

If you’d like to stay in touch with the latest from us the best way would be to follow us on Pinterest or Twitter (@maxmylooks).

We hope you found this guide useful!

Feature Image Photo Credit: Dion Gillard / Source / CC BY 2.0