Dear Dr. Garner,
I am losing my hair and have several bald spots about my head. I don’t know who to turn to. It is getting so bad that I can’t hide the areas any more. Who can I turn to for help?
Balding Lady in Boro Park

Dear Balding,
You are not alone in your problem. Research has shown that up to two-thirds of the female population will have hair loss problems at some stage of their life. I understand your frustrations, as hair loss, particularly in women can lead to emotional stress and be a traumatic experience for women. Factors that are related to the hair loss in women are not usually simply genetic or heredity factors. Hair loss in women may be triggered by many different issues, such as:

• Pregnancy.
• Constant worry and stress.
• Chemotherapy.
• Certain diets.
• Thyroid hormone deficiency
• Medications - (blood thinners, high blood pressure medication, birth control pills, and cholesterol lowering medications).
• Autoimmune disease, such as lupus or arthritis.

Unlike men who have hair loss in the temple area and top of the scalp, women usually experience hair loss in a more generalized pattern. In your case, you describe multiple bald spots.

“Alopecia areata” is a fancy sounding name which essentially describes what you have. It is related to an autoimmune process. In this disease, the body begins to attack itself. It is the cause of various forms of arthritis including lupus and rheumatoid arthritis. As the body attacks the hair follicles, the hair starts to fall out. This type of baldness may be successfully treated with medication. Such medication includes steroids, which slow down the response that the body attacks the hair cells. Anti-cancer medication has also been successful.

Hair loss is a very important part of someone’s medical history, because it may be the first sign of a more generalized disease. It may help point to malnutrition, or underlying poor health, cancer, or anemia or diabetes. It is very important for a woman to tell her doctor of the problems.

Most people assume that dying hair, and getting perms may hurt the hair. This is not true. It is possible to damage hair, by pulling on it constantly, or getting tight braids or cornrows, but most hair is resilient to hair styling.

There is a condition where women pull out their hair. This is associated with depression or deep-seated dissatisfaction. Counseling can aid in curing the patient. The person often swallows her hair, which can lead to what is known as a “hair ball” in the stomach. This can cause obstruction and be quite serious.

Hair loss that women experience may relate to declining levels of estrogen (female hormone). Prior to menopause, estrogen neutralizes the effect of the male hormones such as testosterone (male hormone), which are also in a woman’s body. After menopause, or severe exercise, or any condition that lowers the amount of estrogen, the balance is lost, and the male hormone predominates. This adversely affects hair follicles. Studies have shown that this disorder occurs mostly in women having a genetic predisposition to this form of female hair loss.

An interesting fact is that when stress is the cause of hair loss, the actual hair loss does not occur for around three months after the stress. This is related to the cycle of life for the hair follicles. It takes about three months for the existing hair to fall out and not be replaced properly.

Is there any treatment for women’s hair loss?

The answer depends on the type of hair loss that is present. In your case, I believe that help in treating the autoimmune disease will restore the hair.
Other causes require specific treatment as well. For example, some hair loss is due to infection and can be treated with anti-fungal medicine. When there is a hormone imbalance, correcting this by prescribing hormones will cause the hair to regrow.

Some medicine may stop or prevent the development of common baldness. Minoxidil or Rogaine is available without a prescription. It is applied to the scalp twice a day. Studies have shown that this stops hair loss and causes moderate regrowth in most cases.

Last month, a new tool was approved — a special laser. The principle behind the laser is that the follicles that die do so because they lack blood supply and nutrition. The laser restores the blood flow and causes a regrowth. The FDA approved this last month for this use, as it has been shown to be effective in clinical trials and safe. The final word is not back on this, but it seems to have much promise.

Finally, if adequate treatment is not available for a particular type of hair loss, in addition to hairstyles or wigs, hair transplant techniques have improved significantly and are becoming a successful route to follow to treat baldness in women not responsive to medication.

Just a quick note on chemotherapy. Women frequently ask me about hair loss during chemotherapy, particularly those undergoing treatment for breast cancer. While hair does fall out during chemotherapy, it tends to grow back in a more luxuriant and full consistency.

I hope that this article serves to take the embarrassment out of hair loss for women and spurs them to seek treatment for this very treatable problem.

Next week we hear from a patient who has severe migraine headaches and has received little help from traditional medicines. We will talk about a very new method that has kept migraine headaches away for up to five years. Until then, have a great week and be well, and I’ll see on The Prayer Channel’s “Ask the Doctor” show.