Many of my over-50 age patients complain that their hair seems to be thinning.  I assure them that it is normal to experience some hair thinning as we get older.  However, there are some things I like to check first to be sure that we aren’t missing an underlying condition that needs to be addressed which might stop the hair loss.

With that in mind, let’s look at several conditions I like to test for when patients have thinning hair.

Hair Thinning/Loss and Possible Underlying Causes    

On a daily basis, most people lose between 50-100 hairs a day from normal shedding and replacement with new hair.  Most of us have about 100-150,000 hairs on our head and this amount of hair loss is not noticed.  When we do start to notice hair thinning, it may be hereditary, as in male or female pattern baldness, or it may reflect a hidden condition such as the following:

• Heredity.  Both men and women can inherit “pattern” baldness from relatives.  However, this type of hair thinning/loss usually also combines with aging and hormone imbalances.

• Hormones.  As men and women get older both estrogen and testosterone decreases can cause hair loss.  Bioidentical hormone replacement may help restore normal hair growth, or it may be helpful to stimulate the body to produce more of its own hormones with natural hormone boosters.
• Thyroid condition. Hair loss/thinning may also be a sign of low thyroid.   Thyroid levels should be checked and may require replacement through prescription thyroid medication or Cytomel, a natural thyroid replacement.

• Alopecia areata.  These are patches of hair loss on the scalp.  Immune system disorders like lupus and psoriasis may be responsible and may need to be tested.  This can also occur from a psychologic disorder of hair pulling (see below).

• Scalp infection, skin disorders:  Sometimes infections of the scalp, like ringworm, or fungal infections, can cause hair loss.  Hair usually regrows after treating the infection.  Other conditions like psoriasis that makes the scalp itch can make hair fall out more than usual.

• Medications:  Medications that treat diabetes, infertility, cancer, arthritis, depression, heart conditions and high blood pressure, birth control pills may lead to hair loss.  This could be a side effect of the drug and/or may only be temporary during treatment.  If you must be on certain drugs long term, ask your doctor if there is a replacement drug that doesn’t have this side effect.  Or, look into alternative natural treatments if they are possible to use for your condition.

• Stress.  Traumatic emotional life stressors like death, divorce, environmental disasters can result in hair loss about 6 weeks to a few months after the event.  Physical stressors, like that which occurs from serious weight loss or illness, can even cause hair to fall out. These hair loss/thinning occurrences generally right themselves and hair regrows once you’ve recovered from the stress.

• Psychologic disorder. “Trichotillomania” is a big psychological word that refers to a psychologic disorder of repetitive hair pulling.  This can result in patches of baldness.

• Hairstyles/Styling Tools.  Some hair thinning/loss can be caused by certain hairstyles.   This is what’s called “traction” hair loss from constant tight pulling of the hair as is seen in corn rows, or wearing tight ponytails or topknots. Popular hair extensions that are woven or glued in can result in hair loss as well.  Hot hair irons and chemical relaxers, bleaches, permanent wave solutions can break off hair that makes it appear thinner too.

• Nutrition.  You may be deficient in B vitamins and/or protein.  Be sure you are getting enough vitamins through daily food intake and supplements, especially if you are dieting.

What You Can Do About Hair Thinning/Loss

When patients come to me with hair loss or thinning complaints, I first assess them for any of the conditions above and address as many of those that may exist. Generally, hair thinning/loss will be as a result of one, or a combination, of these causes.  Here are a few other things that I tell my patients they can do on their own to minimize hair loss/thinning.

• Check stress.  Learn how to decompress from stressful situations.  It’s important for not only your hair’s sake, but for your overall health as well.  Get enough sleep, take some quiet time for yourself to read or meditate, take a quiet walk, anything that helps you relax.

• Nutrition.  Along with stress, B vitamins can deplete rapidly.  In addition, as we get older everyone does not get enough B12 through food, and should be supplemented at 100 mcg a day. These vitamins really help the health of your hair as well as help keep your nerves steady.

• Hair Loss Products. If your hair loss is due to heredity, you can try finasteride or minoxidil (Rogaine) to help slow down any further hair loss.  However, only about 30% to 40% of people get any real hair regrowth from these products and must be used continuously to maintain results.  These products work by stimulating shrunken hair follicles that increases their size, helping to regrow thicker looking hair. Minoxidil can be used by both men and women, and is an over-the counter solution that is applied topically on the scalp.  Finasteride (Propecia) is a prescription-only pill that is primarily prescribed for men with male pattern hair loss.  It is not generally prescribed to women for hair loss to avoid possible hormonal imbalances. Women of childbearing age who wish to become pregnant should not use it.

I understand how frustrating and emotionally upsetting hair thinning/loss can be. However, as I advise my patients, hair thinning/loss is a sign of an underlying condition that, once treated, often results in regrowth of hair.  It’s important then to report any significant hair loss to your physician so that whatever may be causing it can be addressed.

Stay Well,
Jay Brachfeld, M.D.

9 Causes of Hair Loss in Women, http://abcnews.go.com/Health/WomensHealth/reasons-losing-hair/story?id=13320129

Hair loss, http://www.mayoclinic.com/health/hair-loss/ds00278/dsection=causes

Understanding Hair Loss, http://www.rogaine.com/women/understanding-hair-loss?

Hereditary Pattern Baldness, http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9440.html