Hair Loss - Symptoms, Causes & Treatments
Losing hair is normal - in fact, most of us lose up to 100 hairs every day without even noticing.
Alopecia (the medical term for hair loss), however, can be concerning and have a profound impact on your self-esteem.
Hair loss, whether permanent or temporary, can be caused by a range of potential issues like age and genetics as well as certain medications or health conditions.
Whilst it isn’t usually cause for too much concern, unexplained hair loss should always be investigated by a doctor in case there’s an underlying cause.
Hair loss can be a symptom of another medical condition, the side effect of medication or a problem on its own.
In fact, there are many different types of alopecia with varying symptoms, including:
Involutional alopecia refers to the gradual thinning of hair through age.
This is a completely natural process that will affect most people to some extent, symptoms of which include:
- Overall thinning of the hair
- Hair that doesn’t grow as long
Androgenetic alopecia is a genetic condition commonly referred to as male or female pattern baldness.
This is very common in men, starting as early as the teens or 20s in some cases
Symptoms of male pattern baldness include:
- Gradually receding hairline that forms an ‘M’ shape
- Circular area of hair loss on the back of the head that expands over time
- Progression to total baldness in some cases
Female pattern baldness is less common and doesn’t tend to be as severe as male pattern baldness. The symptoms include:
- Signs of thinning hair on the top of the head - this may look like a widening through the centre part
- Hairline typically doesn’t recede as in male pattern baldness and total baldness is highly unlikely
- Sometimes facial hair can become coarser (in the case of increased androgens)
Alopecia areata is an autoimmune disease that tends to start with patchy hair loss (the hair comes out in circular-shaped clumps).
An autoimmune disease is a condition in which your immune system attacks your body by mistake.
Symptoms of alopecia areata include:
- Small circular bald patches on the scalp or other parts of the body
- Patches that get larger and grow together into a bald spot
- Hair can grow back and fall out again
- A lot of hair loss over a short time period
- Red, brittle or pitted nails
In a small number of cases, alopecia areata can lead to alopecia totalis (complete loss of hair on the scalp).
Alopecia universalis is a type of alopecia areata which causes total absence of hair all over the body.
This will typically start before the age of 30. Symptoms of alopecia universalis include:
- Total baldness
- Absence of body hair
- Absence of eyelashes and eyebrows
Scarring alopecia, also known as cicatricial alopecia, is a rare inflammatory condition that can cause irreversible damage to the hair follicles.
This causes permanent hair loss as the follicles are replaced with scar tissue. Symptoms of scarring alopecia include:
- Bald patches on the scalp
- Itchy, burning or painful scalp
- Pus or discharge from the scalp
- Patches of rough, scaly skin
- Blisters and crusting
Telogen effluvium is a form of temporary hair loss caused by a change in the number of hair follicles that are growing hair.
This can be triggered by hormones, stress, physical trauma, diet or certain medications. Symptoms of telogen effluvium include:
- Thinning hair, most commonly at the top of the scalp
- Noticeable hair loss during washing or brushing hair
- Hair typically grows back within 3 to 6 months
Trichotillomania, also known as hair-pulling disorder, is a mental health disorder that causes an uncontrollable urge to pull out your own hair, including eyebrows and eyelashes. Symptoms include:
- Repeatedly pulling your own hair out
- A feeling of increasing tension when trying to resist pulling hair
- A sense of relief after the hair is pulled
- The urge to bite or chew pulled-out hairs
The cause of hair loss depends on the type. Some alopecia types like androgenetic alopecia (male or female pattern baldness), are caused by genetics.
Knowing you’re at risk of genetic hair loss can be helpful.
For example, if you’re a man and have noticed that other men in your family have experienced male pattern baldness, starting hair growth treatments early can help to prevent your own hair loss in the future.
In the case of some other types of hair loss, the direct cause isn’t completely understood.
For instance, we know that alopecia areata is an autoimmune disease, but it isn’t fully clear what causes the immune system to attack the hair follicles.
Sometimes, hair loss can be caused by certain medications or treatments.
Cancer treatments like chemotherapy are most commonly known to cause hair loss, but other medicines like beta-blockers, blood thinners, NSAIDs (non-steroidal anti-inflammatory drugs), statins (a type of medicine used to lower cholesterol) and antidepressants can cause hair loss too, albeit rarely.
Hair loss can also be a symptom of an underlying medical problem like a thyroid disorder, polycystic ovary syndrome or iron deficiency anaemia.
Losing weight rapidly can also cause your hair to fall out due to stress on the body and lack of nutrients.
As well as this, prolonged periods of psychological stress can cause hair loss too.
Stress is thought to push the hair follicles into a resting phase, therefore preventing the growth of new hair.
Hair loss can even be caused by repeatedly pulling your hair back into tight ponytails, buns, or braids.
This is known as traction alopecia and can also occur if you wear hair extensions or weaves, or if you regularly wear rollers in your hair overnight.
When visiting a doctor about unexplained hair loss, they’ll likely ask you some questions about your lifestyle, overall health and review any medications you’re taking to see if there’s an obvious cause.
They’ll also examine your scalp to see how exactly your hair is falling out; this will help them to identify the type of hair loss you’re experiencing.
If the cause remains unknown, your doctor may issue tests to check for any potential nutritional deficiencies or underlying health conditions.
When to speak to your doctor:
If you’re dealing with something as common as male pattern baldness, it’s unlikely you’ll need to visit your GP about your hair loss.
You should, however, make an appointment with your GP if you experience any of the following:
- Sudden hair loss
- Bald patches
- Hair loss in clumps
- Itchy or burning scalp
- Worrying about your hair loss
Hair loss is treated depending on its cause or type. If your hair loss is a symptom of a medical issue, such as iron deficiency anaemia, treating this will eventually help your hair to grow back normally.
If your alopecia isn’t caused by something else, there are plenty of hair loss treatment options available to help, from medical interventions to home remedies.
One of the most popular over-the-counter treatments for hair loss is minoxidil, a topical treatment belonging to a group of medicines called vasodilators, which work by expanding the blood vessels and improving blood flow to the affected area.
Minoxidil also works by stimulating the hair follicles from the resting phase to the growth stage.
Prescription medications can also help with hair loss.
Finasteride (sold under the brand name Propecia) is a medication used to treat male pattern baldness.
It works by stopping testosterone (a sex hormone) from turning into dihydrotestosterone (DHT), a hormone which can stop your hair from growing.
You can only buy finasteride for hair loss with a private prescription, it cannot be obtained on the NHS.
For more uncommon types of hair loss, like alopecia universalis or alopecia areata, specialist treatments may be required such as corticosteroids and immunotherapy.
Unfortunately, severe types of hair loss are much more difficult to treat and the hair may not come back.
If you don’t want to try over-the-counter or prescription-strength medicines for hair loss, or they’re deemed unsuitable for you, there are alternative options which could help with very little risk involved.
These supplements contain vitamins and minerals that are thought to contribute to the normal growth of healthy hair, including B vitamins like biotin, folic acid and vitamin B12.
You can also find combined supplements designed for your hair, skin and nails. Hair transplants are a highly effective treatment, especially for male or female pattern baldness.
However, these are typically very expensive as they aren’t available on the NHS, and it can take several months to achieve the desired outcome.
If hair loss treatments haven’t worked for you, wigs may be your next best option.
Whilst custom-made wigs can be expensive, they’re designed to look exactly like real hair and stay securely in place.
Plus, you’ve got the benefit of being able to change hair colours, styles and lengths whenever it suits you.
Preventing or minimising hair loss starts with taking good care of your hair at home. Keeping your hair clean and nourished with high-quality shampoos and conditioners is a great place to start.
You should also try to prevent bleaching your hair too much, as this can cause significant breakage.
If you want your hair to grow thicker, you could try massaging your scalp to improve blood flow and stimulate hair growth.
Not only will this help your hair look its best, but it’ll also relieve stress and tension.
Castor oil is also said to help with hair growth. Whilst scientific evidence is limited, some people do notice an improvement in the thickness of their hair after regularly massaging castor oil into the scalp.
Looking after your general health could also help to improve the thickness of your hair.
You should particularly make sure you’re getting enough protein and iron in your diet, as these both contribute to healthy hair growth.
Living with alopecia
Living with hair loss can be difficult, especially in cases of total hair loss caused by the likes of alopecia universalis or cancer treatment.
If alopecia is negatively affecting your confidence, joining a support group can be very helpful.
You’ll meet a group of people who are in the same boat as you, and you’ll be able to talk about your feelings and experiences with people who truly understand.
If your mental health has significantly worsened since losing your hair, make an appointment with your GP so they can assess your needs and refer you to a therapist if necessary.
There’s also plenty of help online for people living with alopecia; visit Alopecia UK for help with building confidence, managing unhelpful thoughts and dealing with difficult situations.