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Losing Hair — Losing Identity
by Tara Hayes

On a sweltering day in July, a group of coworkers gathered together outdoors to complete a company project. The noon rays drummed their exposed skin, scalps especially. Yet while a balding man showed off a specialty hat he had ordered over the Internet (“It keeps me from going pink up there”), a woman nearby with a similar problem made no comment. She kept her long hair loose and uncovered, despite its being too thin at the top to protect her head from the sun.

No one wants to lose their hair. Men certainly (and rightfully so) have anxiety about the prospect of a receding hairline and shiny patches of scalp. But for women, hair loss is often more than an inconvenience or slight blow to vanity. We don’t address it freely in public and for most of us, sporting a hat or a shaved head just isn’t the look we want. Fairy tales and myths are filled with women whose hair is their identity: the eponymous Goldilocks, Rapunzel and her “golden stair,” and Medusa with her powerful mane of hissing snakes. A woman’s hair is part of who she is.

If you are a woman experiencing hair loss, as the person who knows your hair better than anyone, don’t let a doctor tell you you’re not. “If a woman comes in and says she’s losing hair, she is,” says Dr. Russell Caldwell, a dermatologist with the University of Washington’s Hair Loss Clinic (offered every other Wednesday morning from 8:30 a.m. to 12:00 p.m.). “The thing that is a little bit startling is how often a woman will go to a doctor who doesn’t believe them because they still have a lot of hair.” Still having hair is not the point, says Dr. Caldwell: “If you’re experiencing hair loss, you really need to find out why.” There may be an underlying medical condition.

Much as men dislike losing their hair, most understand the cause: male-pattern baldness, which is the case 90 percent of the time, says Dr. Claire Haycox of Valley Dermatology in Sequim: “It’s a slam-dunk diagnosis.” Just as many women as men (50 percent after age 50) experience hereditary loss; it’s the most common cause of hair loss overall. But what can be an obvious condition in men appears more subtle and diffuse in women, tending to an overall thinning or patchiness while maintaining the hairline. Yet outside of hereditary causes, hair loss in women tends to be much more complicated, says Dr. Haycox, who started the UW clinic before moving her practice to the peninsula; more than three-fourths of her patients are women.

There are more than 100 possible causes of hair loss, and the factors involved are especially varied for women. The best approach is to speak with a dermatologist to determine the cause. If necessary, you can be referred to a dermatologist who specializes in your specific condition.

While the number of potential causes of hair loss can be overwhelming, most patients will fall into one of the categories described below. An initial evaluation of the patient’s medical and family history; diet, weight and drug factors; blood tests and a scalp examination will indicate the cause almost all of the time, says Dr. Caldwell.

CAUSES

Women, like men, may inherit androgenetic alopecia from either their mother or father. (“I never use the term female-pattern baldness,” says Dr. Haycox, “because women [hearing the word bald] often start to cry.”) In this case, most patients experience a general thinning rather than an increase in shedding; it is normal to shed 50 to 100 hairs per day.

For women who do notice a sudden increase in shedding — leaving more hair in the shower drain, on their pillow or on the headrest in their car — the diagnosis is often telogen effluvium, a condition in which a physiological stressor (such as medication, surgery, childbirth, sudden weight loss, or metabolic factors like iron deficiency and thyroid problems) causes the hair to fall out.

A third cause is an autoimmune disorder called alopecia areata, in which white blood cells mistakenly attack the hair follicles, resulting in patchiness or, in more rare cases, a more complete loss of head and body hair. Onset of alopecia areata usually occurs in childhood and the hair may or may not come back on its own. Only 10 percent of hair loss cases involve rare dermatologic conditions of the scalp.

Other women find their hair brittle or breakable, which is usually a sign of damaging hair care practices.

TREATMENTS

Topical treatments such as Rogaine (aka Minoxidil), along with supplements, may be helpful in slowing or stopping hereditary hair loss. Hair transplantation, though expensive, is also an option. “For years women just didn’t get transplants because surgeons were wary of the different diagnoses for women,” says Dr. Haycox. But now the treatment can be very successful in the well-selected patient.

With telogen effluvium, the solution is usually simple and satisfying; removing the underlying stressor will correct the problem. Hair growth will resume even if the hair has fallen out after a physically traumatic event like surgery or childbirth. In the case of iron deficiency, supplements or a change in diet may be all that is needed to get hair growing again.

Other types of hair loss are more difficult to treat. For the autoimmune disorder alopecia areata, thin areas can be injected with a steroid like cortisone to promote growth, although this won’t prevent other areas from losing hair and extensive forms of the disorder are difficult to treat. Similarly, rare dermatologic disorders, though treatable with systematic medications, can be hard to resolve.

If treatment or styling is the cause, avoiding permanent damage by making timely changes in hair treatments can make all the difference.

For some conditions there may not be a satisfactory medical treatment, and in such cases, a woman may opt for a cosmetic solution through styling, wigs or hair studios. Ted Lingren, owner of American Image (aihair.com), emphasizes the instant gratification his clients get when using his products — human hair that is integrated into the scalp in different ways, depending on the extent of loss. Clients maintain their look with monthly retouching. “If there was a true potion or lotion [to cure hair loss], all the doctors and I would be out of business,” says Lingren, though he always recommends that his clients see their physician first because his products can’t resolve underlying medical problems.

Aside from cosmetic treatment, talking with others in a similar situation is a good way to deal with the psychological and emotional challenges of hair loss. Dr. Haycox is the medical director for the local group of the National Alopecia Areata Foundation, whose members provide each other with support and tips.

Anyone experiencing hair loss knows the condition is not trivial. Because hair is so much a part of a woman’s identity, any woman suffering hair loss should actively seek out its cause and treatment for her own health and peace of mind.

Tara Hayes is a frequent contributor to Seattle Woman.

©2007 Caliope Publishing Company