What Causes Hair Loss - Symptoms, Tests, Types, Treatment

Table of content

1. Hair loss- An overview

The mental agony and anxiety suffered by almost everyone following hair loss bear ample evidence of the vital importance and immaculate beauty of hair. A hairless head is like a barren land without vegetation/ like a dry useless river without water/ like a morbid garden without flowers.

Hair (particularly for an adult woman) is the 1st most visible part of beauty. It enhances her confidence and personality. Hair is an important part of appearance and sets the tone of the entire look.

The cost of hair loss is evident from the key role played by the hair to protect the head from excessive heat (due to sun exposure, particularly during summer)/from cool (during winter)/from moisture (during the rainy season).

From time immemorial humans have developed garments to clothe the body (to protect from heat and cold). Similarly, hair is a natural garment to protect the scalp from climatic adversities (excessive heat/cold/ moisture). The hair on the head serves primarily as a source of heat and a cool insulator. More importantly, hair protects the head from ultra-violation exposure.

Until otherwise mentioned, hair loss implies a gradual decrease or thinning of hair lying on the scalp/ head. While the problem of hair loss is involved, typically the hair on the head is implied (although, the growth of hair, as well as the problem of hair loss, may also occur in other parts of the body).

Hair loss (also known as alopecia or baldness) refers to the loss of hair partly or fully. The most common form of hair loss is gradual. The severity of hair loss may extend from small areas on the head to the entire body.

Conclusively, some people (especially old men) bother less about their hair loss and like to stay careless, untreated, and unhidden. Others (particularly adolescents) prefer to hide by suitable hairstyle/makeup/using wigs/putting hats, caps, or scarves.

2. Symptoms of hair loss

Symptoms are subjective phenomena observed and experienced by the patient (while signs are mostly objective phenomena detected by the doctor through suitable test results). Hair loss can appear with different symptoms in different ways depending on what is causing it. Symptoms of hair loss include:

2.1) Gradual thinning on top of the head

This is the most common symptom of hair loss (occurring in the case of both men and women in the wake of aging). Among most men, hair begins to recede from the forehead. Women typically retain the hairline on the forehead.

2.2) Circular or patchy bald spots

Another symptom of hair loss is a smooth coin-sized bald spot. The symptom of hair loss usually appears to affect just the scalp. But sometimes it occurs also in the beards or eyebrows. In some cases, the symptom is accompanied by itchy or painful skin before the hair falls.

2.3) Patches of scaling that spread over the scalp

This is a sign of ringworm. The symptom may arrive displaying broken hair with redness and swelling and at times oozing.

3. Diagnostic tests for hair loss

Diagnosis is identifying the root causative factors through applying various tests, observing symptoms, and also interrogating the patient about his feelings, family history, and personal history including his lifestyle.

If thinning of hair is noticed, it is essential to see a doctor who will first examine the scalp to ascertain the pattern of hair loss. Diagnosis is generally not needed in the case of female pattern baldness. However, if the need arises, the doctor may advise performing a blood test to check the level of thyroid hormones/ androgens/ iron/ other substances that can affect hair loss.

4. Causes and risk factors of hair loss

Causes are the agents directly responsible for the occurrence of the disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease. (For instance, aging is a vital risk factor for most diseases including hair loss. But it cannot be a cause).

4.1) Risk factors for hair loss

3 major risk factors increase the likelihood to invite hair loss over time. These are aging/ genetics / hormonal changes. When these 3 factors get combined, the risk becomes the highest.

4.1.1) Aging

Aging is an inevitable risk factor for all diseases including hair loss. As one age (man or woman), hair becomes thinner and the scalp becomes visible. With aging, the head including the entire body loses hair.

4.1.2) Genetics

The primary baldness genes lie on the X-chromosome (Each person has one pair of sex chromosomes in each cell. Females have 2 X- chromosomes. And males have one X- chromosome and one Y-chromosome) which men inherit from their mothers. However, other factors also are in play. The hereditary factor is slightly more dominant on the women’s side.

Recent research studies suggest that men (who have a bald father) are more likely to develop male pattern baldness (than those who don’t have a bald father).

Over and above, smoking and alcohol (the 2 expensive bad habits that have no social recognition) are other risk factors for most of the malignancies including hair loss.

Smoking reduces the amount of blood that flows to the scalp. And this triggers a reduction in hair growth. Alcohol also puts retardation on hair growth.

4.1.3) Hormonal changes

The hormonal process of testosterone converting to DHT (which harms hair follicles) happens in the case of both men and women. Such hormonal imbalance may invite many health problems including hair loss (Testosterone is the primary male sex hormone. It plays a key role in the development of male reproductive tissues, such as the testes and the prostate. DHT or Dihydrotestosterone is a male hormone. And hair follicles indicate the sheath of cells and connective tissues that surround the hair root)

4.2) Causes of hair loss

People usually lose 100 hair a day. This is quite normal and does not cause noticeable thinning of scalp hair. Because new hair is also growing at the same time. Hair loss starts only when the cycle of hair growth and shedding is disrupted leading to the destruction of the hair follicle. As a result, the tiny scalp cavities (from which hair grows) become exposed to DHT.

The following causes mostly contribute to hair loss.

4.2.1) Medical conditions

4.2.1.1) Severe prolonged hyperthyroidism and hypothyroidism can cause hair loss. The loss is diffuse and involves the entire scalp (rather than discrete areas). The hair appears uniformly sparse (Hyperthyroidism means overactive thyroid. It occurs when the thyroid gland produces too much hormone thyroxin. The hormone accelerates the body’s metabolism causing hair loss and other health problems. Hypothyroidism means underactive or low thyroid. It is a thyroid disorder in which the thyroid gland does not produce enough thyroid hormone. It can also invite a lot of health problems including hair loss).

4.2.1.2) People with diabetes are more likely to develop an autoimmune disease alopecia areata (It is also known as spot baldness. It is a condition in which hair is lost from some or all areas of the body) in which the body attacks its hair follicles leading to patches of hair loss on the head (in addition to other parts of the body). A person's genetic makeup (combined with other risk factors) can trigger this form of hair loss. Again people with alopecia areata may face a higher risk to develop thyroid diseases.

4.2.1.3) Some people have both diabetes as well as thyroid disease which contributes to rapid hair loss.

4.2.1.4) Androgenic alopecia  (common balding occurring in men and women) is the result of testosterone metabolites in genetically susceptible hair follicles. In addition to thyroid disease, anemia, secondary syphilis (Syphilis is a sexually transmitted infection. There are 4 stages of syphilis: primary/ secondary/ latent/ tertiary. Symptoms of secondary syphilis include skin rash/ swollen lymph nodes/ fever), chemotherapy (Chemo is usually applied as medical treatment to fight cancer. It can be delivered as an injection or oral pill. As a side effect, hair loss occurs all over the body. However, hair grows back later on), and deficiency in minerals, protein, and vitamins can trigger hair loss.

4.2.1.5) In women, pregnancy hormone changes and switching to birth control pills can cause hair loss. This can also cause telogen effluvium (It occurs when some stress causes hair roots to be pushed prematurely into the resting state. The condition can be acute or chronic). This is more likely if there is a family history.

4.2.1.6) Medication and supplements (that contain retinoids) can cause hair loss. Also, some types of antibiotics as well as antifungal medication, taken over a long period, can cause hair loss.

4.2.1.7) Other medical conditions for hair loss include scalp infections like ringworm/ scarring hair loss (it is also known as cicatricial alopecia. It is a loss of hair accompanied by scarring. It can be caused by a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue leading to permanent hair loss)/ lichen planus (Is a condition that can cause swelling and irritation in the skin/ hair/ nails/ mucous membranes. Symptoms appear in terms of itchy flat bumps)/ some types of lupus (It is a long term autoimmune disease in which the body’s immune system becomes hyperactive and attacks normal healthy tissues. Symptoms include swelling and inflammation of the skin) can cause permanent hair loss. 

Another vital factor contributing to hair loss is Radiation therapy (also known as radiotherapy. It is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors). It generally causes hair loss in the body part (where it is applied). If radiation is applied to the head, one will lose hair only on the scalp.

4.2.2) Other conditions

A physical or emotional shock can cause a sudden loosening of hair. Under such conditions, handfuls of hair may come out when combing or washing the hair (or even after gentle tugging). This sort of hair loss usually occurs with the overall thinning of hair.

Hair dying and coloring can also lead to hair loss. Both permanent and temporary hair color products contain harmful substances: peroxide (is a group of compounds with the structure R-O-O-R. The O-O group in peroxide is called peroxo group. The most common peroxide is hydrogen peroxide) and ammonia (is a compound of nitrogen and hydrogen with the formula NH3).

Ammonia swells and opens the hair cuticles (inner skin) and peroxide gets inside it to change the hair color. This makes the hair weaken and leads to breakage.

A high level of androgen (male sex hormone) contributes to hair loss in men.

An unhealthy lifestyle including unhealthy foods and drinks and lack of physical activity largely contributes to hair loss

5. Types of hair loss

Type plays a key role in selecting the correct treatment option. Depending on the length of time of suffering caused by hair loss, it may be categorized into 2 types.

5.1) Temporary hair loss

All hair fall cases are temporary (except for aging and genetic factors). The contributing factors behind temporary hair loss are pregnancy/ medication/ physical stress/ deficiency in protein, vitamins, and minerals. When these contributing factors cease to exist, hair growth can be regained.

5.2) Permanent hair loss

Hair loss is caused by genetic factors and old age is permanent and has no cure. However, with medication, dietary control, and quality sleep (free of stress and anxieties), hair falling speed may be slowed down. Again, depending on gender, hair loss can be further categorized into 2 types.

5.2.1) Female pattern baldness

It's also called androgenic alopecia which affects women. It is similar to male pattern baldness except that women can lose hair following menopause (This is the time in most women’s lives when menstrual periods stops permanently and they are no longer able to bear children. It occurs between 49- 52 years of age).

Hair loss in women can occur suddenly or develop gradually over time. Causes behind sudden onset include illness/ diet/ medication/ childbirth.

Female pattern baldness is hereditary and is more common after menopause. The hormonal problem among women also plays a key role in hair loss.

5.2.2) Male pattern baldness

In the case of male pattern baldness, hair loss begins at the temples or crown of the head. Some men may have a single bald spot. Male pattern baldness is most common among men. Others experience their hairlines receiving M’ form. In the case of some men, the hairline will continue to recede until all or most of the hair is gone.

There is no cure for male pattern baldness. However, some medications can slow it down (such as Minoxidil which needs to be applied to the scalp. But if one discontinues, hair loss will return).

6. Prevention of hair loss

Prevention is better than cure- runs the adage. As such, one should abide by the following rules to prevent or delay hair loss (rather than cure it by medications that have side effects).

• Regularly wash hair with a mild shampoo (1-2 times a week).
• Combing hair is good for hair health. But it should not be too often as an excess of anything is bad.
• Avoid brushing wet hair until and unless it gets dry in a natural way. Because when hair is wet, it is in its weakest condition. So, to curb the chances of hair loss, it is wise not to brush wet hair. It is also important to use a wide-toothed comb to avoid hair loss. Because comb with thickly set teeth tears wet hair. If the need arises, one can use fingers running through the hair (instead of using the comb).
• Clean comb/ hairbrush by immersing in Savlon mixed warm water (at least once a week). It will wash away all the dirt and harmful substances accumulated inside the comb/ hairbrush. 
• Protect hair from sunlight as well as ultraviolet light. It is wise to put on a cap/ hat/helmet while going out in hot sun exposure. Because too much sun exposure can damage the hair.
• Do scalp massage with essential oils
• Always stay well hydrated.
• Apply fresh lemon juice to the scalp (15 minutes before shampoo use).
• Rub green tea into the hair.
• Consume protein, vitamin, and mineral-rich diets (such as eggs/dairy products/ milk/ yogurt/ cheese, etc. Dairy products are also rich in biotin. These are excellent to fight hair loss).
• Avoid tight hairstyles (such as braids/ ponytails/ artificial hairstyles). All these hairstyle habits pull hair or tug hair follicles which can eventually result in baldness.
• Treat the hair gently while brushing/ washing/ rubbing.
• Avoid unnecessary rubbing/ twisting/ pulling the hair. A wide-toothed comb will help prevent pulling out hair.
• Avoid harsh treatment (such as curling/ applying hot rollers and hot oil treatments).
• Also, avoid medications/ supplements that could cause hair loss.
• Avoid smoking/ alcohol in addition to all unhealthy foods and drinks.
• One should be cautious and avoid constant heating and drying of the hair. Because heat weakens the hair proteins. Constant heating and drying reduce the strength of hair roots and increase the fragility of hair that causes hair loss. 
• People with oily hair, mostly experience dandruff during summer on account of sweating which increases the chances of hair fall. For the same reason, people wearing a helmet during summer experience considerable hair loss. Because during summer sweat accumulates in the pores and weakens hair roots leading to hair loss. So, one should always remain alert against sweating accumulated on the scalp.

7. Cure for hair loss

Nothing is more frustrating than hair loss which taints the facial beauty. To overcome the problem, medical researchers have come up with a variety of treatment options. A few of them are stated below.

7.1) Medication

7.1.1) Treatment for male pattern baldness

In fact, there is no permanent cure for male pattern baldness. However, some medications can slow it down. Minoxidil is an effective medication that can slow the pace of hair loss. 

Among other medications,  Finasteride (Propecia) and Dutasteride (Avodart) are excellent to treat hair loss in men. However, they are not approved for women.

Side effects include: headaches, hot flashes, decreased sexual urge, especially during 1st year of use.

7.1.2) Treatment for female pattern baldness

Minoxidil (Rogaine) is the only drug approved by the US FDA (Food and Drug Administration) to treat female pattern baldness. It is available in 2% or 5% formulas and can be applied to the scalp every day.

Minoxidil can restore a significant amount of hair loss. Also, it can make the hair possess a thicker appearance.

Side effects of Minoxidil include redness/ dryness/itching/ hair growth in unwanted areas.

Another option to treat female pattern baldness is to use Minoxidil Topical Solution. It is also known as OTC (Over the Counter) and can be used in androgenic alopecia (However, men can also use it). The drug comes in foam or liquid form. It can be applied to the scalp every day.

Side effects include: Scalp irritation/ Hair growth (on other parts of the face or hands)/Tachycardia (rapid heart rate)

Spironolactone pills (also known as Aldactone) works to treat hair loss by addressing hormones. Specifically, It binds to Androgen Receptors (It is also known as NR3 C4. This is a nuclear receptor/ subfamily- 3/ group- C/ member- 4. It is a type of nuclear receptor that is activated by binding any type of androgenic hormone including testosterone and DHT in the cytoplasm. And then translocation is made into the nucleus ).

Some studies assert that women develop thicker hair after taking omega-3 fatty acids (It is a fatty acid found in fish oil) and antioxidants (It is the 1st line of defense against the damage of healthy cells).

7.2) Vitamins to fight hair loss

Vitamins are essential for overall health in addition to hair growth. Vitamin- A stimulates the healthy production of sebum (It is a waxy oily matter secreted by the sebaceous glands in the skin. Sebum helps lubricate and waterproof the scalp skin as well as the hair) in the scalp. And vitamin-E improves the blood circulation of the scalp (which helps hair follicles remain productive). Again vitamin- B  helps hair maintain its healthy and natural color.

7.3) Proteins and minerals to fight hair loss

Eating foods rich in proteins and minerals (such as eggs/ lean meat/ fish/ soy) promotes hair health and curbs hair loss.

7.4) Tools

If low iron is contributing to hair loss, then the doctor may prescribe an iron supplement

7.5) External applications

Scalp massaging with essential oils will help the hair follicles remain active. One can also add lavender in an almond or sea-same oil.

Massaging the foam/ solution (using the formula with 5% concentration) into the scalp 1-2 times daily will be helpful, especially for male pattern baldness

Garlic/ onion/ ginger juice is excellent for hair health. One may rub the juices on the scalp, leave it overnight and then wash it in the morning. The procedure may continue at least for a week to get a wonderful result.

It is also good to rub green tea into the hair. Studies have revealed that rubbing green tea may help curb hair loss. One needs to brew 2 bags of green tea in 1 cup of water, cool it, and then apply the mixture to the hair. It is essential to rinse the hair thoroughly after an hour. The practice should be followed at least for a week to see the result.

7.6) Other options

Laser combs and helmets are medically approved procedures to treat hair loss. They use light energy to stimulate hair re-growth. 

Another option is platelet-rich plasma therapy. The treatment procedure involves drawing blood, spinning it down, and then injecting the patient’s platelets back into the scalp to stimulate hair growth.

The hair shaft contains and needs significant water. So, it is good to drink at least 8 cups of water daily ( to stay hydrated to help the growth of healthy hair).

Heavy stress pushes a large number of hair follicles into a resting place causing thinning of hair and in consequence hair loss. As such, De-stress (by practicing meditation and yoga) considerably reduces stress and ultimately restores hormonal balance to stimulate hair growth. 

Conclusively, taking care of hair health right from the childhood stage (through preventive measures and following a healthy lifestyle) is more important than medications to treat hair loss. Because, medications have more or less some side effects, but prevention doesn’t have any. Moreover, long-term medications involve costs in terms of both money and health risks (in most cases).

8. How shampoo treats hair loss

The role of shampoo (in treating hair loss) has been separately discussed. Because almost everyone (whether having a hair loss problem or not) is familiar with shampoo (of different brands and types) and its uses. Some use shampoo to treat hair loss and dandruff. While others use it for beautifying the hair appearance.

In some shampoos, there are  DHT Blockers that work for hair loss. (Because the condition is caused by sensitivity to a hormone DHT I .e... Dihydrotestosterone. The drug blocks the adverse effect of this hormone DHT. Hence, shampoo containing the essential drug is useful to treat hereditary baldness. It can even reverse the male pattern baldness).

Examples of DHT Blockers include palmetto and green tea. 

If the hair loss is due to dry scalp, using shampoo will be helpful that contains ingredients aloe vera/argan oil/ olive oil (Aloe vera is a succulent plant species. And argan oil is a plant oil produced from the kernels of argan tree).

Medical researchers have come up with the 6 best hair loss shampoos  (for both men and women) to treat hair loss.

8.1) Ultrax Labs Hair Surge

The shampoo (just after use) remains on the scalp until it is entirely absorbed. The shampoo has been proved effective and is guaranteed by money return (if proved ineffective).

8.2) Revita Hair Growth Stimulating Shampoo

The shampoo is prepared with natural ingredients. It is cleansing/ therapeutic/ highly effective.

8.3) Nizoral A D (Anti Dandruff) Shampoo

The shampoo fights dandruff and hair loss. It also reduces hair follicle inflammation and blocks Androgen Receptors to defer hair loss.

8.4) Lipogaine Big 5 All Natural Shampoo

It is prepared with a formula based on medical science. It is useful for both men and women and safe for all types of hair.

8.5) Alpecin Caffeine Shampoo

The shampoo revives dormant hair roots and reduces dandruff. It also treats other scalp problems.

8.6) Classic Lipogaine Big 3 Hair Loss Prevention Shampoo

The shampoo is prepared with a gentle formula. It is safe for both men and women and all types of hair.

Conclusively, whatever shampoo is used, there are 4 common essential ingredients. Research studies reveal the fact that the 4 common essential ingredients not only slow down hair loss but also stimulate new growth.

9. Key global information of hair loss

• Hair loss is one of the most common problems worldwide affecting 1/3rd of the total world population.
• On average, everyone loses 100 hair every day.
• In general, hair grows ½ inch per month.
• Common male pattern baldness accounts for more than 95% of hair loss  (in men)
• About 85% of men experience a major hair fall problem (after crossing 50 years of age)
• About 2/3rd of women experience hair loss after menopause.
• Globally, the percentage of bald people is the highest in Japan (followed by the Czech Republic)
• In the USA, 66% of men will experience some degree of hair loss (by age 35 years) and 83% of men will experience significant hair loss (by age 50 years)

10) Popular questions and answers on hair loss (Q= Question. A = Answer)

10.1) Q:  Why does hair fall occur with aging still after following a healthy lifestyle?

A: Aging is an uncontrollable risk factor for all types of malignancies and health problems including hair loss. As people get older, their hair becomes thinner and grey. In consequence, hair breaks easily (as compared to young age). Deficiency in proteins, vitamins, minerals, and other hormonal factors cause hair follicles to shrink (restricting the mechanism for new hair growth)

10.2) Q: Is hair loss a hurdle for marriage?

A: Almost in every country as well as in every community (where arrange marriage is found common), the 2 most important criteria for choosing a life partner are: a good job and a good look. Everyone (irrespective of male or female) desires to have a good-looking life partner having thick, black, smooth, silky hair essential to make one young and smart.

10.3) Q: Can children face hair loss?

A: Hair loss is not a problem only for the adults and the old. In the US, about 3% of the children (who visit the pediatricians) are suffering from hair loss problems. Hair loss problems even at 26 months of age may appear frightening. However, correct pediatric medications can alleviate the problem.

10.4) Q: How much hair fall in a day is normal?

A: According to the specialists, people, in general, lose 50-100 hair per day which is considered normal. More is abnormal.

10.5) Q: Does frequent combing cause hair loss?

A: According to the hair specialists regular combing is good for hair health. But excess of anything is bad. Frequent combing (coupled with the use of a thickly set toothed comb) will separate hair from its roots. Because hair fiber is very sensitive to excess physical stress.

10.6) Q: Does shaving stimulate hair growth?

A: The simple answer is No. There is found no causal relation between shaving the head and preventing baldness. The diameter of hair fiber can’t be increased by shaving. However, shaving essentially removes the weak and damaged hair as well as the dirt accumulated for a long time on the scalp.

10.7) Q: How do I know that I am getting stronger or weaker hair?

A: At first run the fingers through the hair (numbering 50- 60 ) and then pull. Pulling out 5- 8 hairs (with this method) is quite normal and reasonable. If you have lost more than the normal limit, then there is every ground to assert that you are losing more hair than you should. The implication is that the hair root is weaker.

10.8) Q: Can consuming too much sugar make hair fall out?

A: When people eat sugar (or carbs), the sugar floods the blood causing a spike of insulin and androgen which binds the hair follicles and causes hair to fall.

10.9) Q: Does dandruff cause hair loss?

A: Dandruff accumulated on the scalp does not directly cause hair loss. These white skin flakes (accumulated on the scalp) arouses itching. Prolonged itching with heavy pressure results in scratch and injury on the scalp as well as the hair root that ultimately leads to hair loss.

10.10) Q: Is hair loss permanent?

A: Except for hair loss due to genetic factors and old age, hair loss is temporary. If the cause of hair loss is pregnancy/ medication/ physical stress/ deficiency of protein or vitamin or minerals, then the hair loss is temporary (which can be regained following recovery to healthy medical status.)

10.11) Q: Can shampoo reduce hair loss?

A: Shampoo contains some ingredients which help fight hair loss and stimulate hair growth.

10.12) Q: What is the best shampoo to reduce hair loss?

A: Ingredients (contained in the shampoo) are more important than the trademark of shampoos (available in the market). The best shampoo must contain the ingredients: DHT Blockers (like palmetto/ green tea/ olive oil)

11. Concluding remarks

11.1) When sudden hair loss is noticed, it is essential (before going to the doctor) to look into the change if any (such as a change in food habits/ new medication/ new oil or new shampoo used for hair). It is also important to see whether any stress or anxiety is disturbing uninterrupted sleep. Because a slight change in food and other habits may cause a drastic change in hair health.

11.2) If the question of time frame arises to see a visible result of treatment, variations can be expected from person to person. It takes approximately 5- 7 months to get any visual difference because of the hair growth cycle. Each hair growth phase takes at least 5 months to complete. Since individuals might have a different hair loss cause, so the time frame for a cure will also vary.

11.3) Hair loss with aging is found common in the case of most people. So, there is no reason to worry about hair loss in old age. Putting on a wig/ cap/hat/ helmet/scarf / ‘Pagri’/ ‘Hijab’ can make a hairless person smart with a beautiful look

12. Tips for hair loss

• H= HAIR (loss problem is most visible as compared to other health problems).
• A= ADULT ( women’s most conspicuous part of beauty is hair).
• I= INEVITABLE( risk factor, for all diseases including hair loss, is aging).
• R= RISK (hair loss is the highest when aging/genetics/hormonal changes occur together).
• L= LOSS (hair on the head is more frustrating than the loss of hair on other body parts).
• O= OLD (people, in general, bother less about hair loss)
• S= SEVERITY (hair loss may extend from a small part of the head to the entire body).
• S= SCALP (is naturally protected by the hair from excessive heat/cold/moisture).