When Should I Worry About Hair Loss?

Urgent Indications

Seek prompt medical attention if:

• Sudden, rapid hair loss over days to weeks
• Hair loss with scalp symptoms - pain, burning, itching, scaling, redness
• Patches of complete baldness (alopecia areata)
• Hair loss with systemic symptoms - fever, weight loss, fatigue
• Scarring alopecia - permanent hair follicle destruction

Indications for Evaluation

Schedule an appointment if:

• Progressive thinning over months, especially if bothering you
• Family history of early baldness and you want early intervention
• Hair loss in unusual pattern (not typical male pattern)
• Associated symptoms - fatigue, weight changes, cold intolerance
• Recent medication changes or significant stress
• Age under 30 with noticeable thinning

Normal Hair Growth Cycle

• Anagen (growth phase): 2-6 years, 85-90% of scalp hair
• Catagen (transition): 2-3 weeks, follicle shrinks
• Telogen (resting): 2-4 months, then hair sheds
• Normal shedding: 50-100 hairs per day
• Total scalp hair: Approximately 100,000 follicles

Etiology

Androgenetic Alopecia (Male Pattern Baldness)

Most common cause - affects 50% of men by age 50:

• Mechanism: DHT (dihydrotestosterone) shrinks hair follicles
• Pattern: Receding hairline, thinning crown, eventual vertex balding
• Genetics: Hereditary - can inherit from either parent
• Progression: Gradual over years to decades
• Hamilton-Norwood scale: Classifies stages I-VII

Telogen Effluvium

Diffuse shedding 2-4 months after triggering event:

• Triggers: Major surgery, severe illness, high fever, childbirth, crash diets
• Medications: Beta-blockers, retinoids, anticoagulants, antidepressants
• Prognosis: Usually self-limited, regrows within 6-9 months

Alopecia Areata

Autoimmune condition causing patchy hair loss:

• Appearance: Round or oval patches of complete baldness
• Exclamation point hairs: Broken hairs at patch edges
• Variants: Alopecia totalis (entire scalp), universalis (entire body)
• Course: Unpredictable - may regrow spontaneously or progress

Medical Conditions

• Thyroid disorders: Hypothyroidism or hyperthyroidism
• Nutritional deficiencies: Iron, zinc, biotin, protein
• Autoimmune diseases: Lupus, dermatomyositis
• Infections: Fungal (tinea capitis), bacterial folliculitis
• Hormonal: Low testosterone, pituitary disorders

Diagnostic Evaluation

Physical Examination

• Pattern assessment: Distribution and extent of hair loss
• Pull test: Gentle traction to assess shedding
• Scalp examination: Inflammation, scaling, scarring
• Hair shaft examination: Miniaturization, breakage

Laboratory Testing

• Thyroid function: TSH, free T4
• Complete blood count: Rule out anemia
• Iron studies: Ferritin, iron, TIBC
• Testosterone levels: If symptoms suggest hormonal issues
• Scalp biopsy: If diagnosis uncertain or scarring suspected

Treatment Approaches

FDA-Approved Treatments for Male Pattern Baldness

• Minoxidil (Rogaine): Topical 5% foam or solution twice daily - stimulates growth, slows loss
• Finasteride (Propecia): Oral 1mg daily - blocks DHT conversion, 85% maintain/improve hair
• Timeline: Requires 6-12 months to see results, lifelong use to maintain
• Side effects: Finasteride - sexual dysfunction in 2-5%, usually reversible

Emerging Therapies

• Dutasteride: More potent DHT blocker (off-label use)
• Low-level laser therapy: FDA-cleared devices, modest efficacy
• Platelet-rich plasma (PRP): Injections to stimulate follicles
• Topical finasteride: Reduced systemic absorption

Surgical Options

• Hair transplantation: FUT (strip) or FUE (individual follicles)
• Best candidates: Stabilized hair loss, adequate donor hair
• Results: Natural-looking, permanent when done well
• Cost: $4,000-$15,000 depending on extent

Prevention and Hair Health

• Gentle hair care: Avoid excessive heat, tight hairstyles, harsh chemicals
• Balanced nutrition: Adequate protein, iron, biotin, zinc
• Stress management: Chronic stress contributes to telogen effluvium
• Sun protection: Wear hat to protect scalp
• Avoid smoking: Accelerates hair loss
• Early treatment: More effective before extensive loss occurs