Troubled Tresses: The Truth about Hair Loss

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Whether hair loss happens slowly or suddenly, it's upsetting at best, worrisome at worst.

What can you do when your crowning glory lacks luster?

Learn why you're losing your locks.

"There are three types of hair loss. Increased shedding causes loss of volume. You see hair on your pillow, in the shower, and your hairbrush. With alopecia, you see the scalp through thinning or patches devoid of hair. Loss of volume can also be combined with alopecia," says Antonella Tosti, M.D., a dermatologist with the University of Miami Health System.

It all starts with the hair follicles beneath your skin. They regulate the growth of your hair shaft, the part we see.

hair lossWhy am I losing my hair?

Shedding happens for several reasons: aging, stress, certain medications, or harsh hair treatments. Some people experience it after having COVID-19.

Androgenetic alopecia, Dr. Tosti says, is "androgen-dependent." Your hormones are responsible for this type of hair loss.

"People are genetically predisposed to male or female pattern balding, a type of alopecia that becomes more common with aging."

Some women experience temporary hair loss from hormonal changes after childbirth, a condition known as postpartum alopecia. Another condition, alopecia areata (AA), is an autoimmune disease that causes severe patchy hair loss.

Depending on your situation, you may be able to slow down or reverse your hair loss. The first step is getting diagnosed by a dermatologist.

There is no quick fix

Topical minoxidil has been helping heads for more than 20 years. The FDA-approved treatment doesn't make hair grow but will prevent thinning from getting worse. Men, Dr. Tosti says, should use a five percent Minoxidil solution twice a day; women can use a two percent solution twice a day or a five percent foam once a day. She recommends using minoxidil before trying other remedies.

"It's difficult to predict what will work on each patient. A combined treatment approach is usually best," she says.

The spectrum of hair loss treatments ranges from sensible to silly. Ask a dermatologist what makes sense for you and take a "before" picture of your scalp to track your progress.

Reliable hair loss treatments

Finasteride is taken orally to treat hair loss in men with androgenetic alopecia or male pattern hair loss. It is FDA-approved.

Oral minoxidil was originally developed for high blood pressure. Though not yet FDA-approved, some doctors suggest oral minoxidil for hair loss. It must be used under medical supervision to monitor for possible side effects.

Platelet-rich plasma (PRP) therapy isn't inexpensive or fast because it requires having your blood drawn, processed, and reinjected. PRP promotes hair growth because platelets release growth factors that stimulate the follicle to grow the hair and increase the thickness of the hair shaft. PRP is more effective if used in combination with other treatments.

Microneedling encourages cell growth in the follicle by rolling a device covered with tiny needles over the scalp. It is used for delivering drugs and platelet-rich plasma to the follicles. One study concluded that microneedling when used with minoxidil, was more effective than minoxidil alone in men with alopecia. The process must be repeated periodically.

Low-level laser therapy (LLLT) uses lasers to stimulate cellular activity and hair growth in men and women. Commonly called a laser cap or laser comb, a 2013 study deemed LLLT safe and effective. Ask your dermatologist for recommendations to make sure you purchase a safe, effective device.

Janus kinase (JAK) inhibitors reverse hair loss in people with moderate to severe alopecia areata. First developed to treat rheumatoid arthritis, these drugs will hopefully soon be approved by the FDA.

Want to skip straight ahead to hair plugs?

"Hair transplantation is useful but not beneficial enough on its own," Dr. Tosti says.

There's a reason some highly publicized and heavily marketed remedies are absent from Dr. Tosti's treatment list.

"People are looking for miracles on the internet; this doesn't happen even with the best treatments. If it looks really good -- be skeptical."

What about at-home treatments for hair loss?

Scalp massage.

It feels good and reduces stress, but there's no evidence showing that it increases blood flow and invigorates hair growth.

"There's no data proving that it works. Blood flow is not the problem behind hair loss," Dr. Tosti says.

Hair supplements.

You may have heard that biotin, collagen, and other natural ingredients promote hair growth. While there's not much research to support this, Dr. Tosti says it's OK to take supplements along with other proven treatments.

Certain supplements can skew bloodwork results, so stop taking supplements three days before having any lab tests done.

Shampoos and conditioners.

Since hair loss typically starts underneath the skin, thickening or "volumizing" shampoos and conditioners aren't worth the money.

"Shampoos cannot affect hair growth. I recommend shampoos depending on the hair type and condition. There is not a 'standard recommendation'," Dr. Tosti says. The same holds true for ayurvedic oil, though it does add shine.

Helpful hair hacks

Depending on the reason or stage of your hair loss, simple lifestyle modifications may help.

Turn down the heat.

Avoid blow dryers, curling irons, or hair dryers that generate high heat. If you must blow-dry your hair, use the cool setting.

Use a gentle touch.

Fragile hair doesn't like harsh handling. Wash and brush your hair less often, use a detangler or wide tooth comb if necessary, and towel dry gently. Some people also believe a silk pillowcase protects the hair better than a cotton pillowcase.

Don't try this at home (or at the salon).

Tight ponytails damage the hair follicle, and tight barrettes can cause breakage. Dr. Tosti cautions against tight braids, too.

"People who wear them can develop traction alopecia. Any hairstyle that feels painful is wrong." Keratin or straightening treatments may be popular, but you should avoid them to prevent severe damage, likewise for hot-oil treatments and perms. Hair coloring is OK, as long as the dye is washed out properly. "Definitely double wash and rinse; the scalp should be well cleaned."

Check your medication.

Certain medications cause hair loss, including some for arthritis, cancer, depression, heart issues, and gout. To avoid aggravating your hair loss, ask your doctor if a different medication with fewer side effects would work just as well.

Keep it cool.

If you're receiving chemotherapy, ask your doctor about scalp cooling therapy to reduce your risk of hair loss.

To schedule a consultation with Dr. Tosti, call the UHealth appointment line at 305-498-0598.


Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.


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