Excessive Hair loss? - see a Dermatologist

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From the NY Times:

When Hair Loss Strikes, a Doctor Is a Girl's Best Friend

Ahntholz for The New York Times

Dr. Piliang, a dermatologist at the Cleveland Clinic, examining a

woman's scalp. Americans spent an estimated $176 million on hair loss products

last year.

By LESLEY ALDERMAN

Published: January 15, 2010

A couple of years ago my hair started falling out. Not in clumps, but I noticed

more hairs than usual in my comb and in the bath drain.

I went to a trichologist (a hair specialist, not an M.D.) who tested my blood

(all fine), told me some thinning was natural for a woman in her mid-40s and

sent me home with expensive shampoo and a serum to use on my scalp. I used the

potions. I took vitamins. I stopped brushing my hair.

I was a wreck. If someone had told me there was a cure in a remote village in

the mountains of Bhutan, I would have put on my hiking boots and boarded a

plane.

No one wants to lose their hair, but for women it is especially traumatic. Men

can shave their heads and look hip, even sexy. Most women don't want to be bald.

Though it is more common — and visible — in men, many women lose their hair.

According to the American Academy of Dermatology, 30 million women in this

country have hereditary hair loss, compared with 50 million men. But many

additional women experience thinning hair that results from menopause or health

problems.

If your hair is coming out, be advised that of the multitude of treatments on

the market for women, few are worth your money, says Dr. Piliang, a

dermatologist at the Cleveland Clinic.

Americans spent an estimated $176 million on hair loss products last year, and

chances are some of that money was not well spent. Don't let charming salon

owners, seductive ads or fancy gimmicks convince you otherwise.

So why did my hair fall out? After doing some research on my own, I decided it

was either a bad bout of stress or the antidepressant I was taking at the time

to treat the stress.

I'll never know for sure, because both stress and certain antidepressants can

cause hair loss. But after a couple of months, my hair stopped coming out and my

life was back to normal.

In this column, I'll explain what generally causes hair loss among women and

what treatments tend to work. Please post your own experiences online, so other

women can learn from them.

Each day you lose about 50 to 100 hairs but, when all is well with your body, an

equal number is growing back. Lifestyle upsets, including severe stress (death

in the family, divorce, job loss) and changes in your diet (crash programs, lack

of protein), can cause your hair to shed more rapidly than normal.

Besides antidepressants, beta blockers and anti-acne prescriptions can also

temporarily disrupt the growth cycle of your hair. And take note: medications

with testosterone, which women may take to increase their sex drive, can also

cause hair loss. (Ask any balding man and he'll be sure to tell you that his

abundance of testosterone is to blame.)

Certain medical issues can also impair hair growth. An overactive or underactive

thyroid gland can cause hair loss. So can iron deficiency. When women go through

menopause and their estrogen levels fall, their hair often begins to thin. Many

women also lose some hair a few months after giving birth because of the

hormonal changes the body experiences.

That's the background. Now for some guidance:

BE PROACTIVE If your hair is thinning, see a dermatologist who specializes in

hair loss right away. No matter what the cause, the sooner you address the

problem the better for you and your hair. The dermatologist will take your

medical history, run blood tests and may even do a scalp biopsy (don't worry, it

takes about five minutes).

" A scalp biopsy is the gold standard for diagnosing hair loss, " said Dr. Marc

Avram, a dermatologist in private practice with offices in Manhattan and

Brooklyn. " The test examines the follicles themselves and can help determine

whether the hair loss is genetic, inflammatory, infectious or due to an unusual

physical or emotional shock to the system. "

If the blood test reveals that you have low iron, for instance, your doctor will

put you on a supplement. If your hair loss seems to be the result of menopause,

you and your doctor can discuss whether hormone replacement therapy would be a

good idea.

" Low estrogen causes the hair density to decrease and the hair strands to become

smaller. Estrogen makes the hair thicker and longer, " Dr. Piliang said.

The dermatologists I spoke with estimated that about half of the women they saw

for hair loss had an identifiable trigger that could be addressed with

medication, hormones or better nutrition.

THE TREATMENTS If no trigger is present, it's likely you have androgenetic

alopecia, a hereditary condition that causes the hair follicles to get

progressively thinner over the years. The most effective topical medication for

the condition is minoxidil (brand name Rogaine), the only treatment for hair

loss in women that has been approved by the Food and Drug Administration.

You can buy minoxidil over the counter, for about $25 for a three-month supply.

But you'll also need to invest some patience. Minoxidil can take six months or

even a year to work. Dr. Avram estimates that the drug, which must be applied

twice a day, stops hair loss in 80 percent of the women who use it properly and

it can actually stimulate hair regrowth in about half of users.

Your doctor might also suggest the prescription pill finasteride, sold under the

brand name Propecia and also in generic versions. Although the drug is not

federally approved for use in female patients, some doctors have observed good

results in postmenopausal women. But women who are planning to have children

should not take this drug because it can cause birth defects.

Some of Dr. Avram's patients report success with laser combs, devices that are

intended to stimulate hair follicles. The combs costs $300 to $500 and are

available online. Only one such comb, the Laser Comb brand, has been approved by

the Food and Drug Administration, and only for male pattern hair loss.

" Theoretically, light could thicken hair follicles, " Dr. Avram said, " but there

are no independent, long-term studies that show laser combs work or don't work. "

If treatments are not helping and your scalp is more visible than you'd like it

to be, you might consider hair transplantation. The latest procedures work well

and produce natural-looking results (gone are the days of hair plugs). But the

transplants can cost $8,000 to $12,000 and are not reimbursed by most insurance

companies.

BEWARE THE GIMMICKS Lots of over-the-counter products claim to promote hair

growth, but only probably only those with minoxidil do. Shampoos and vitamins

might make your hair look and feel healthier, but they won't put more hairs on

your head.

" There are no specific vitamins that grow hair, " said Dr. Zoe Draelos, a

consulting professor of dermatology at the Duke University School of Medicine.

Unless you are nutritionally deficient, you probably don't need a vitamin

supplement and if you do, a simple multivitamin is enough.

The saw palmetto plant is often said to help hair growth, but there is little

clinical evidence concerning its efficacy.

Finally, be skeptical of any hair expert who claims to be able to determine the

cause of your hair loss simply by analyzing your strands. " You can't figure out

someone's overall health from their hair, " Dr. Draelos said.

Fads and gimmicks probably won't hurt you, but they will waste your time and

your money. When it comes to hair loss, a prompt medical consultation is the

key.