Are you losing hair and wondering why?
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.
Now let’s begin!
What Causes Hair Loss?
Before we get to specific conditions, let’s identify some common causes of hair loss. These are the underlying factors that interfere with the proper growth cycle of hair follicles causing them to fall out earlier than expected.
• Genetics – Certain genes inherited from both parents can predispose you to conditions like androgenetic alopecia and alopecia areata (more on them below).
• Hormones – Partly related to genetics, elevated levels of androgenic hormones like DHT can cause hair loss in both men and women.
• Stress – Extreme levels of stress is known to cause temporary hair loss in some people.
• Childbirth – Known as postpartum alopecia, many women experience shedding or losing clumps of hair after childbirth. This is related to a change in hormones namely decreasing levels of estrogen and progesterone which encourage hair growth.
• Disease – Some illnesses cause temporary hair fall such as lupus, anemia, and thyroid disease. Once treated, barring the appearance of a scar the hair will return to normal.
• Medications – Many chemotherapy drugs, anticoagulants (blood thinners), and some blood pressure medications (beta blockers), are known to cause telogen effluvium as one of their symptoms.
• Birth Control Pills – Can trigger a condition known as telogen effluvium during or after the period taking them.
• Styling Methods – These are related to physical forms of damage which weaken hair. Examples include bleaching, dyeing, braiding, using heat styling tools like hot curlers, using rollers, excessive pulling, and even excessive shampooing.
• Diet – Extreme calorie restriction for extended periods of time, low-protein diets, and diets that are chronically low in several key nutrients can contribute to thinning hair.
We mentioned some forms of hair loss above. Now let’s cover specific conditions.
Androgenetic Alopecia
We’ll begin by covering the most common type that affects both men and women. This one is better known as male pattern baldness (MPB) or female pattern baldness (FPB) 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.
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 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.
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.
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.
Yet another form of alopecia areata which is confined to the outer edges of the scalp and follows a wave pattern is known as ophiasis. The name comes from the Greek word for snake, ophis, because it is said to resemble its shape.
There’s usually no pain or redness at the bald spots of alopecia areata 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 the condition isn’t contagious and the loss is only temporary. The hair usually takes up to two years to regrow for a full recovery and sometimes in as little as 6 months depending on how soon inflammation subsides.
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.
Another form of scarring alopecia especially common in black women is central centrifugal cicatricial alopecia (CCCA). Thinning begins at the crown and radiates outward gradually in a circular pattern. Biopsies often find scarring in the area of the scalp around the hair follicles which leads to permanent hair loss.
Yet another, rarer form of the condition is known as lichen planopilaris. It is caused by a skin infection called lichen planus that can affect the scalp and cause patchy spots of progressive and permanent hair loss.
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.
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.
Scalp Folliculitis
This is a fairly common skin condition caused by a bacterial or fungal infection which inflames the hair follicles. The primary symptom is small clusters of red or white bumps filled with pus that look like acne.
These pustules usually appear near the frontal hairline and are often itchy or feel tender. Blisters can develop which break open and become crusted sores. In extreme cases this leads to scarring and irreversible hair loss.
The exact cause of scalp folliculitis is not well understood but it’s thought to be the result of one or a combination of inflammatory reactions in response to microorganisms inhabiting the scalp such as yeasts, mites, and the cutibacterium acnes species of bacteria.
It can be treated using shampoos with antifungal ingredients like ketoconazole or ciclopirox. In severe cases, a doctor can prescribe topical or oral antibiotics to treat and halt the inflammation.
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.
A unique form of traction alopecia called trichorrhexis nodosa is characterized by weakened points or nodes along the hair shaft that make it easier to break off. Although there can be other underlying medical conditions that cause it, it’s primarily believed to be the result of the overuse of chemical treatments and heat styling tools.
Another type is known as chignon alopecia. It is characterized by the loss of hair at the crown caused by excess traction created by wearing and maintaining buns for extended periods of time. In some cases, women were even misdiagnosed by doctors as having alopecia areata which gives you an idea of how severe the loss can be.
Since this condition is temporary and can easily be reversed by simply avoiding physical damage to the hair, begin by repairing 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.
Hypotrichosis
This is another rare condition characterized by the absence of hair growth from birth. Because people born with this condition never grow hair to begin with (or only grow sparse amounts), it isn’t technically a form of hair loss although it appears to be.
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.
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We hope you found this guide useful!
Feature Image Photo Credit: Dion Gillard / Source / CC BY 2.0
