The Root of Hair Loss
One common concern that I address in primary care is hair loss. This is something brought to me by women of various ages, and often literally: patients will bring plastic baggies full of hair, or scroll through multiple pictures on their phone of their brush or shower drain. I get it - it’s alarming! But most of the time, thankfully, it’s totally normal.
Hair exists in 3 different phases - growing, resting, or shedding. Each individual hair follicle cycles through these phases independently, so not every hair follicle sheds at the same time. This is why despite the baggies full of lost hair, the patient in the office is typically not bald or even balding. There are external factors though that can cause a higher proportion of hair to shift from one phase to another. Stress is an example - a major shock to the body, such as childbirth, will cause a lot of hair to shift from the anagen (growth phase) to the telogen (shedding) phase. This is called telogen effluvium. Thankfully most women fully recover after suffering through a short period of excessive frizzies.
Most of the time women are concerned that something deeper is going on. While it is appropriate to check blood work, such as thyroid and iron levels, I rarely find any lab abnormalities. Occasionally I will diagnose skin conditions such as aloprecia areta, which cause patches of baldness on the scalp. There is also a female pattern hair loss, such as men commonly experience, which is seen as thinning hair along the front or crown of the scalp. Other causes for hair loss include medications, supplements, dietary restrictions, or use of hair products.
The treatment for hair loss or thinning hair depends on the underlying cause, which commonly is telogen effluvium as described above. Biotin supplements are heavily advertised as solutions for hair loss, but there has been no evidence to suggest this helps. The main intervention that has shown to be effective is minoxidil shampoo. This is the active ingredient in Rogaine, and is available over the counter. Generally safe, this treatment has to be continued to maintain effects.
If you feel you are experiencing excessive hair loss, try to remain calm and reassure yourself it’s likely temporary. If you have patches of hair loss, skin changes to your scalp, or other symptoms going on that concern you then absolutely make an appointment to discuss and start an evaluation. But don’t feel like you need to bring a baggie of proof…I promise, I will believe you :)
