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Hair Loss


Female Pattern Hair Loss

(Androgenetic Alopecia)

The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is seen as hair thinning predominantly over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most commonly seen after menopause, although it may begin as early as puberty. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Genetically, hair loss can come from either parents side of the family.

There are two different types of hair loss, medically known as anagen effluvium and Telogen effluvium. Anagen effluvium is generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicle. Telogen effluvium, is due to an increased number of hair follicles entering the resting stage.

The most common causes of Telogen Effluvium are:

Physical stress: surgery, illness, anemia, rapid weight change.
Emotional stress: mental illness, death of a family member.
Thyroid abnormalities.
Medications: High doses of Vitamin A, Blood pressure and Gout medications.
Hormonal causes: pregnancy, birth control pills, menopause.

When the above causes of telogen effluvium are reversed or altered you should see the return of normal hair growth.

(50% of women will experience female pattern baldness by the age of 50)

Up to 50% of Women Experience Hair Loss at Least Once in their Lifetime 

Hair Loss Can’t Be Reversed, but it Can Be Covered!

“Hairpieces look quite natural, sometimes better than your own hair,” says Dr. Wexler, a dermatologist and past-president of the Canadian Dermatology Association, (Reader's Digest, Best Health). "Hair extensions are lighter in weight than hairpieces and a good option if there is enough existing hair to work with. Women can also fill in thin spots with a hair-fibre powder or thickener, available in some drugstores, online and from salons. Shake or spray the fibres over your scalp and they are supposed to stay in place until the next shampoo."


Genetics: The most frequent cause of female pattern baldness is genetics, a predisposition for hair loss inherited from both biological parents. It is not uncommon to see hair loss or thinning in women as they enter their 50's. The medical term for genetic hair loss is androgenetic alopecia.

Over-styling: Vigorous styling and hair treatments, including use of hot styling tools over the years can cause hair to fall out. Examples of extreme styling include tight braids, hair weaves or corn rows as well as chemical relaxers to straighten hair, hot-oil treatments or any kind of harsh chemical or high heat. These practices can affect the hair root and hair may not grow back.

Hypothyroidism: Or underactive thyroid. When your thyroid is not working properly and pumping out hormones you can experience hair loss.

Autoimmune-related Hair Loss: This is also called alopecia areata or alopecia universalis (total hair loss on body) and basically is a result of an overactive immune system. “The immune system sees that hair as foreign and targets it by mistake.”

Lupus: Other autoimmune diseases such as lupus can also cause hair loss. Unfortunately, hair loss of this type is “scarring”, meaning the hair will not grow back.

Trichotillomania: Trichotillomania, classified as an “impulse control disorder” causes people to compulsively pull their hair out, resulting in alopecia. The mean age of onset is 12 for girls and 8 for boys. This condition is 7 times more common in children than adults. But among adults, it is ten times as common in women as in men. The prevalence of trichotillomania is estimated to be approximately 2% of the population.


Physical Stress: Any type of physical trauma – surgery, car accident, severe illness, even the flu, can cause temporary hair loss. This type of hair loss is called telogen effluvium. With the stress, you hair cycle is shocked into the shedding phase. Hair loss often becomes noticeable three-to-six months after the trauma.

Pregnancy: Pregnancy is one example of the type of physical stress that can cause hair loss, along with hormones. The hair loss is seen more commonly after the baby has been delivered rather than actually during pregnancy.

Female Hormones: Just as pregnancy hormone changes can cause hair loss, so can switching or going off birth-control pills. This can also cause telogen effluvium, and it may be more likely if you have a family history of hair loss. The change in the hormonal balance that occurs at menopause may also have the same result.

Emotional Stress: Emotional stress is less likely to cause hair loss than physical stress, but it can occur during divorce, after the death of a loved one, or while caring for an aging parent. Usually emotional stress won’t precipitate the hair loss but will exacerbate a problem that’s already there.

Anemia: Almost one in 10 women aged 20 through 49 suffers from anemia due to an iron deficiency.

Diet and Nutrition: A lack of protein and iron can contribute to hair loss, as can eating disorders like bulimia and anorexia. Sudden weight loss is a form of physical trauma that can result in thinning hair. Although relatively uncommon, low levels of vitamin B are another correctible cause of hair loss.

Prescription Drugs: Certain medications can trigger hair loss, including blood thinners, blood pressure drugs known as beta-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, and possibly antidepressants.

Polycystic Ovary Syndrome: This syndrome is an imbalance in male and female sex hormones. An excess of androgens can lead to ovarian cysts and hair thinning among other things.

Anabolic Steroids: Anabolic steroids, used by some athletes to bulk up muscle, can have the same impact on the body as polycystic ovary disease.

Hormonal Considerations: Hormonal changes are a common cause of female hair loss. Many women do not realize that hair loss can occur after pregnancy or following discontinuation of birth control pills. It is important to remember that the hair loss may be delayed by three months following the hormonal change and another three months will be required for new growth to be fully achieved.

Chemotherapy: Some chemotherapies and radiation therapies cause hair loss. The drugs destroy rapidly dividing cells, such as cancer cells and also hair.


The Ludwig Scale

Designed to categorize female pattern baldness. There are 3 categories of hair loss:



  • Frequent shampooing contributes to hair loss.
  • Hats and wigs cause hair loss.
  • 100 strokes of the hair brush daily will create healthier hair.
  • Permanent hair loss is caused by perms, colors and other cosmetic treatments.
  • Women are expected to develop significant hair loss if they are healthy.
  • Shaving one’s head will cause the hair to grow back thicker.
  • Standing on one’s head will cause increased circulation and thereby stimulate hair growth!
  • Dandruff causes permanent hair loss.
  • There are cosmetic products that will cause the hair to grow thicker and faster.
  • Stress causes permanent hair loss.
  • Hair loss does not occur in the late teens or early twenties.
  • Hair loss affects only intellectuals.
  • There is a cure for Androgenetic Alopecia.

These are only a few of the common myths heard by physicians and other hair loss specialists on a daily basis. The American Hair Loss Council suggests that you first have your hair loss diagnosed by a competent dermatologist who sees hair loss patients on a regular basis. Once you know the diagnosis you will have a better understanding of exactly which treatment option may be best for you.

Right Hair Piece for Hair Loss

Level 1:

  • Thin or fine hair: Women’s Toppers
  • Thinning at the front or templates: Clip-in Bangs and Fringes

Level 2:

  • Moderate Hair Loss at the Part or Crown: Small or Large Base Toppers

Level 3:

  • Substantial to Complete Hair Loss: 100% Hand Tied Wigs

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Chemotherapy & Medical Hair Loss

(Prepared for the American Hair Loss Council by Zoe Draelos, M.D. and Mike Mahoney, AHLC Executive Director)

Chemotherapy consists of the administration of drugs that destroy rapidly reproducing cancer cells. Cancer cells are some of the most rapidly reproducing cells in the body, but other cells, such as those which contribute to the formation of hair shafts and nails, are also rapidly reproducing. Unfortunately, while chemotherapy drugs preferentially destroy cancer cells, the drugs also can destroy those cells responsible for normal growth of hair and nails. Cancer patients sometimes shed the hair and nails during treatment. Chemotherapy drugs are poisonous to the cells of the hair root responsible for hair shaft formation. Usually, the hair is lost rapidly in large quantities during treatment.

No hair growth stimulants, shampoos, conditioners or other cosmetic treatments can prevent or retard Chemotherapy related hair loss. The good news, however, is that once chemo­therapy is completed, the hair usually grows back.

How and When Hair Growth Occurs

  • Adequate hair growth may take six months to one year.
  • Returning hair may be different from the hair that was lost. Due to the absence or alteration of pigment the hair may grow back white, gray or a different color. Eventually, as the pigment cells return to normal, the original color should return.
  • It is common for the new hair returning to be finer in texture initially, but like color, the texture should return to its original thickness. It is sometimes difficult to be patient, but as the body is returning to normal and getting over the significant insult, time is a necessary ingredient.

Hair Care Tips for New Hair Growth

  • Shampoo hair twice weekly with a mild shampoo such as those intended for dry or damaged hair.
  • The scalp should also be thoroughly massaged to remove any scale.
  • Follow shampoo with a conditioner for fine or limp hair.
  • Avoid high heat from blow dryers to the hair and skin.
  • Keep hairstyling to a minimum due to the new hair being prone to breakage. Brushing, combing, hair pins and curling should all be minimized. Curling appliances should be avoided as the scalp is very tender following chemotherapy.
  • Hair styling aids such as mousse, hair spray, hair spritz, styling gel and sculpturing gel may be used in moderation. It is  best to select products with normal to light holding ability as the high hold products may not be completely removed with mild shampoos. Hair styling aids can build up on the hair shaft resulting in dullness and possibly scalp disease.

Chemical Curling or Permanent Waving

Chemical treatment of the hair is best avoided until the hair is at least three inches long. It is difficult to get nice curls if the hair is much shorter even with a healthy head of hair. For best results use a mild body wave with short processing time. The hair should be wrapped loosely on the largest size curling rod possible. Looser curls will be less damaging to the recovering hair shaft, and will thus minimize hair shaft breakage.

WARNING! Many patients cannot tolerate the permanent wave solution on their scalp for some times up to one year following chemotherapy. This extreme sensitivity of the scalp is not unusual during the regrowth period. In such cases perma­nents should not be attempted.

Hair coloring may also be irritating to the sensitive scalp and should be avoided until the scalp sensation returns to normal. Once the scalp is healed, the hair may be colored.

PERMANENT HAIR COLORINGS ARE THE MOST DAMAGING TO THE HAIR SHAFT and should be minimized in favor of semi-perma­nent hair colorings which are gradually washed away with four to six shampooings.

BLEACHING to lighten the hair color should not be attempted at this time. Additionally, the hair should be altered only 3 shades from its regrowth color as more drastic color changes could increase hair shaft breakage.

The period of time following chemotherapy treatment is a time of healing and rebuilding for the body. Hair growth will gradually return, and with time most patients regain a healthy head of hair. Following some of the enclosed hair care tips will insure that the regrown hair looks and feels its very best!

Children and Chemotherapy

A word of caution to parents with children under­going chemotherapy. The absence of hair can be used in a positive manner. It can signal to others “handle with care.” While undergoing chemo­therapy the child has a low blood count and can be bruised easily.

The insistence of parents, although well meaning, for a child to wear a wig or prosthesis can signal the message “YOU’RE NOT O.K. THE WAY YOU ARE!” A child should have all of the options but the choice should be his or hers. Hugs and tender loving care along with your physician’s sugges­tions for care are all that is necessary from the parents.