A Woman's Guide to Hair Loss and Excess Hair

• What is hair?
  • Types of hair
  • Anatomy of a hair
  • Melanin: The arbiter of hair color
  • Varied forms of hair
• The growth of hair
  • Body hair
  • Eyebrows and eyelashes
• Special Bonus Section:
• Your guide to a healthy head of hair
• Hair loss (alopecia)
  • Permanent hair loss
  • Temporary hair loss
  • Wigs and hairpieces
• Excess hair
  • Removing excess hair
• Hair and scalp disorders
  • Disorders of the hair shaft
  • Disorders of the hair follicle region
  • Scalp-related conditions
  • Loss or reduction of melanin
• Resources
• Glossary

Hair loss (alopecia) is one of the most common female hair disorders, with more than a third of women experiencing it during their lifetimes. Behind those numbers are people deeply distressed as they see their hair noticeably thinning over time or bald  patches appearing on their scalps. Although hair loss is common in both men and  women, and some of the causes and results are the same for both genders, certain aspects of hair loss are significantly different for women. For example, although many men are upset at the loss of their hair, male baldness is acceptable in society in a way female baldness isn’t, with the exception of hair loss due to chemotherapy, when some women select temporary baldness over the wearing of a wig or other form of head covering.

Hair loss can be temporary or permanent, patchy or generalized, and may be isolated to the scalp or involve multiple body sites. Within each of these categories are a number of conditions, each with specific causes and treatments.

Determining the cause of hair loss

The initial observation of hair loss often comes from patients who notice an increase in cast-off hair in their combs or  brushes when styling, on their pillows after a night’s sleep,  or in the shower or sink as they wash their hair. But shedding is the “what,” not the “why” of alopecia. The next step is to visit your primary care provider or a dermatologist. Here are  some possible diagnostic steps: 

Medical history. Your physician will ask when you first noticed your hair loss and whether your have a family history of  hair loss. He or she will also inquire about natural hormonal changes (puberty, pregnancy, menopause) and your history  of hormone use (birth control pills, hormone replacement  therapy, or others). Other possibly relevant issues include  any recent or chronic illnesses, new physical complaints, new  medications, and recent surgeries. 

Scalp examination. Your clinician will look for signs of  inflammation or infection, the pattern of your hair loss, and  assess the overall condition of your scalp. He or she might  use tools such as a Woods light (which uses ultraviolet A  light to detect fungal infections of the scalp or skin) or a skin  scraping, or dermoscopy (a noninvasive imaging technique that screens for early signs of skin cancer). 

Physical exam. The doctor will also evaluate hair loss on the body and check for nail pitting (tiny indentations on the  fingernails and toenails), which occurs with alopecia areata. 

Blood tests. Your physician may order some routine blood  tests, including serum ferritin (iron), thyroid-stimulating   hormone, and possibly some additional tests, depending on your other symptoms. 

Hair count. This is a means of assessing daily hair loss. You will be asked to collect your shed hair for two weeks, place each day’s loss in individually dated envelopes, and note the  days you shampooed. 

Hair pulling and clipping. These techniques are designed to assess the hair shaft itself and its stage of growth cycle. For a hair pull, your dermatologist removes samples of entire hair shafts including the roots; clippings are samples of hair shafts. 

Scalp biopsy. This is the removal of a sample of scalp or skin  tissue for microscopic analysis.