Why The Heck Is My Hair

Falling Out?
Unexplained, excessive hair loss can be worrying and scary. The
good news is, there's often a way to fix it. Here are 9 causes of
hair loss in women, and how to treat them.






1. Telogen effluvium
Telogen effluvium is a phenomenon that occurs after pregnancy, major surgery, drastic weight
loss, or extreme stress, in which you shed large amounts of hair every day, usually when
shampooing, styling, or brushing. It can also be a side effect of certain medications, such as
antidepressants, beta-blockers, and nonsteroidal anti-inflammatory drugs. During telogen
effluvium, hair shifts faster than normal from its growing phase into the "resting" phase before
moving quickly into the shedding, or telogen, phase.
The symptoms: Women with telogen effluvium typically notice hair loss 6 weeks to 3 months
after a stressful event. At its peak, you may lose handfuls of hair.
The tests: There are no tests for telogen effluvium, but your doctor may ask you about recent
life events and look for small "club- shaped" bulbs on the fallen hairs roots. The bulbs mean the
hair has gone through a complete cycle of growth, suggesting that the cycle may have sped up
due to stress.
What you can do: In some cases, such as pregnancy or major surgery, you may have to bide
your time until the hair loss slows. If medication is the culprit, talk to your doctor about
lowering your dosage or switching drugs. If its stress-related, do your best to reduce anxiety.

2. Hereditary hair loss
Hair loss that is genetic is known as androgenetic alopecia and, according to the American
Academy of Dermatology, is the most common cause of hair loss. The gene can be inherited
from either your mother's or father's side of the family, though you're more likely to have it if
both of your parents had hair loss.
The symptoms: Women with this trait tend to develop thinning at the hairline behind the
bangs, says Pamela Jakubowicz, MD, a dermatologist at Montefiore Medical Center in New York
City. The condition develops slowly and may start as early as your 20s. You may be vulnerable
if your mother also has this pattern of thinning. In some cases, the hair loss may be diffuse,
meaning it's spread across the entire scalp.
The tests: Your dermatologist will examine the pattern of hair loss to determine if its
hereditary and may order blood work to rule out other causes, Dr. Jakubowicz says. A biopsy of
your scalp is sometimes done to see if the hair follicles have been replaced with miniaturized
follicles, a surefire sign of hereditary hair loss.
What you can do: Slow the hair loss by applying minoxidil (Rogaine) to the scalp twice a day.
The drug works on both women and men, although women should use a lower-strength
formula to prevent unnecessary side effects. Women should not use minoxidil if they are
pregnant or nursing. Men may be treated with finasteride (Propecia), an oral medication.

3. Hypothyroidism
Millions of people, most of them women, suffer from thyroid disease. When your body produces
too little thyroid hormone, the hormone responsible for metabolism, heart rate, and mood, you
are said to have hypothyroidism, or an underactive thyroid. If your body makes too much of the
hormone, youre said to havehyperthyroidism, or an overactive thyroid. Thyroid hormone is
responsible for everything from your basal metabolic ratethe rate at which your body uses
oxygen and energy to functionto the growth of your hair, skin, and nails. But when you dont
have the right amount, you may notice changes in bodily functions.
The symptoms: Hypothyroidism (too little hormone) may cause a host of symptoms, including
unexplained weight gain, fatigue, constipation, depression, and difficulty concentrating. Hair,
nails, and skin may become more brittle and break more easily. Its more common in women,
especially over the age of 50, says Theodore C. Friedman, MD, MPH, chief of the division of
endocrinology, metabolism, and molecular medicine at Charles Drew University in Los Angeles
and coauthor of The Everything Guide to Thyroid Disease. It affects about 5 percent of the US
population but is nearly 10 times more frequent in women.
Hyperthyroidism (too much hormone) may cause inexplicable weight loss, heart palpitations,
nervousness, irritability, diarrhea, moist skin, muscle weakness, and a startled appearance of
the eyes. You may also experience hair loss as metabolism speeds up. Hyperthyroidism is much
less common than hypothyroidism and affects about 1 percent of the US population.
The tests: A blood test measures thyroid-stimulating hormone, which is produced by the
pituitary gland in an attempt to coax the thyroid to make thyroid hormone. Excess TSH usually
indicates hypothyroidism, while abnormally low levels suggest hyperthyroidism.
What you can do: Your doctor may prescribe a thyroid hormone medication to restore levels
to normal. Regular TSH tests might be done to ensure an adequate dosage.

4. Lupus
Lupus is a chronic autoimmune disease in which the bodys own immune system attacks healthy
tissues. The condition affects about 1.5 million people and tends to strike women during their
childbearing years.
The symptoms: Lupus often causes extreme fatigue, headaches, oral ulcers, and painful,
swollen joints. Many people develop a butterfly-shaped rash across the bridge of the nose and
become more sensitive to the sun. Other symptoms include fever; swelling in the feet and
hands and around the eyes; chest pain; and anemia. Many people also experience hair loss,
which may be mild and occur while shampooing or brushing your hairor it may be more
severe, coming out in patches and accompanied by a rash on the scalp, says Arthur Weinstein,
MD, director of the division of rheumatology at the Washington Hospital Center. Because these
symptoms occur in many other conditions, lupus is often called the great imitator.
The tests: A rheumatologist will examine joints and other tissues for signs of inflammation,
such as heat, pain, swelling, and redness. A blood test to measure levels of anti-nuclear
antibodies (ANA) may also indicate lupus. Rheumatologists will also determine if patients have
four of 11 diagnostic criteria set by the American College of Rheumatology, though fewer
criteria along with a skin biopsy may sometimes indicate lupus, Dr. Weinstein says.
What you can do: See a rheumatologist if your hair loss is accompanied by joint pain, fatigue,
and other symptoms of lupus, which is treated with oral medications such as prednisone. If you
also have a rash on the scalp, you need to see a dermatologist, who is likely to prescribe a
topical cream.

5. Iron deficiency anemia
Women who have heavy periods or dont eat enough iron-rich foods may be prone to iron
deficiency, in which the blood doesnt have enough red blood cells. Red blood cells transport
oxygen to cells throughout your body, giving you the energy you need.
The symptoms: Iron deficiency anemia causes extreme fatigue, weakness, and pale skin. You
may also notice headaches, difficulty concentrating, cold hands and feet, and hair loss. Any
type of exertion may leave you short of breath.
The tests: A blood test to measure ferritin, the protein that stores iron in your body, is usually
needed to diagnose iron-deficiency anemia. Your doctor may also check your blood level of
hematocrit, which gauges how much of your blood is made up of red blood cells.
What you can do: Eat iron-rich foods such as beef, pork, fish, leafy greens, fortified cereals,
and beanspreferably, along with foods rich in vitamin C, which enhances iron absorption.
Women need 18 mg of iron a day, 8 mg after menopause; ask your doctor if you should take
an iron supplement. You can also find supplements specifically for hair loss, Dr. Fusco says. Key
ingredients may include biotin, silica, and L-cysteine, in addition to iron.


6. Polycystic ovarian syndrome
As many as five million women in the United States suffer from polycystic ovarian syndrome.
The condition, which can begin as early as age 11, is caused by a hormonal imbalance in which
the ovaries produce too many male hormones. PCOS often causes infertility.
The symptoms: PCOS can cause facial hair growth, irregular periods, acne, and cysts on the
ovaries. And while you may experience hair loss on your scalp, you may notice more hair
elsewhere on the body, Dr. Fusco says.
The tests: Your doctor is likely to do a blood test to look for elevated levels of testosterone
and DHEAS (dehydroepiandrosterone), a by-product of testosterone.
What you can do: Most cases of PCOS are treated with birth control pills such as Yasmin,
which contains a potent anti-androgen that blocks testosterone. If you cant use birth control
pills, your doctor may prescribe spironolactone (Aldactone), which also blocks male hormones.
Losing weight can also help by decreasing the effect of the male hormones.

7. Skin conditions of the scalp
An unhealthy scalp can cause inflammation that makes it difficult for hair to grow. Skin
conditions that lead to hair loss include seborrheic dermatitis (dandruff), psoriasis, and fungal
infections such as ringworm.
The symptoms: Seborrheic dermatitis causes the scalp to shed its skin, so youll notice greasy,
yellowish scales on your shoulders or in your hair. It may be the result of yeast
called Malassezia, hormonal changes, or excess oil in the skin. Psoriasis, an autoimmune
condition that causes excessive skin cell turnover, produces a very thick white scale on the
scalp that can bleed if pulled off. With ringworm, a fungus you contract by touching an infected
person or animal, youll notice red patches on your scalp, which may be diffuse, Jakubowicz
says.
The tests: A physical exam of the scalp will help determine which condition you have. A fungal
culture and possibly a biopsy of the scalp may pinpoint ringworm.
What you can do: Each condition usually requires a prescription: a medicated shampoo for
seborrheic dermatitis, medications or light therapy for psoriasis, and oral antifungals for
ringworm.

8. Alopecia areata
Alopecia areata is an autoimmune disorder in which the immune system attacks hair follicles. It
affects about 4.7 million people in the United States and occurs equally in men and women. The
cause is unknown, but it may be triggered by stress or illness.
The symptoms: The condition can occur in three forms. Alopecia areata commonly causes
round, smooth patches of baldness on the scalp, eyebrows, or legs, Dr. Fusco says. Total hair
loss on the head is known as alopecia totalis, while hair loss that occurs all over the body is
called alopecia universalis. "Some patients have reported that before the bald spot occurred,
they felt something in that areaa tingling or an irritation," Dr. Fusco says.
The tests: Observing the pattern of hair loss can usually determine if you have alopecia
areata, and blood tests for iron stores, ANAs. and hormones are usually done to rule out
underlying conditions that may cause hair loss.
What you can do: Alopecia areata is usually treated with intralesional corticosteroids, Dr.
Fusco says. In some cases, minoxidil (Rogaine) may also help. Its also important to reduce
stress.

9. Excessive styling
Too much shampooing, styling, and dyeing can harm your tresses. Heat and chemicals weaken
the hair, causing it to break and fall out. Often, its a combination of treatmentskeratin,
coloring, and blow-drying, for instancethat does the damage.
The symptoms: If the fallout is occurring from external damage caused by styling, it will
simply break, and you wont see those club-shaped telogen bulbs at the ends.
The tests: Dr. Jakubowicz does a pull test: She takes a small handful of about 50 strands, pulls
gently, and checks to see whether the hair that comes out has bulbs on the ends.
What you can do: Avoid using appliances that overheat your hair. Set your hair dryer on cool
and low settings, and minimize your use of flat irons. Dont dye your hair more than one or two
shades its normal color: The more severe the color change, the more chemicals you require,
which can make hair break. If you use hair gel or hair spray, dont wait for it to dry before you
comb through it, because the hair will harden and be more likely to break. The condition of
your hair doesnt just affect your looksits an important indicator of your health. If youre
experiencing hair loss, talk to your dermatologist.