Topic Overview

My hair is falling out. Am I going bald?

Everyone experiences some hair loss every day. In fact, it is normal to lose up to 100 hairs a day. However, for many people, hair loss becomes worrisome. Excessive hair loss can be caused by factors such as genetics, disease, injury, or old age, all of which affect the normal growth cycle of hair.

Why am I losing my hair?

The most common type of hair loss is androgenetic alopecia, also called male-pattern hair loss and female-pattern hair loss. In this case, you inherit the tendency to go bald from either or both of your parents. In both women and men, genes trigger a sensitivity to a class of hormones called androgens

, including testosterone, which causes hair follicles to shrink. Shrinking follicles, the sheath that surrounds the root of a hair, produce thinner hair and eventually none at all. In men with androgenetic alopecia, hair loss occurs in a typical pattern on the forehead area and on top of the head. In women with androgenetic alopecia, hair loss occurs throughout the scalp with overall thinning of hair.

See an illustration of a hair follicle and typical male and female pattern baldness

Are there other types of hair loss?

Other, less common types of hair loss can cause clumps of hair to fall out or hair thinning and may be caused by an illness. These include the following:

• Alopecia areata is an autoimmune disease in which inflammatory cells attack hair follicles, resulting in distinct, round patches on any area of the scalp or body. Severe cases involve extensive bald patches of hair or complete loss of hair on the scalp or body, although in some cases there is hair thinning without distinct patches of baldness. Hair that grows back may be white at first and later regain the original color.
• Trichotillomania is an impulse control disorder (as are compulsive gambling and compulsive stealing), in which there is an inability to resist urges to pull out one's scalp hair, eyelashes, eyebrows, or other hair. There is usually mounting tension before pulling and a feeling of relief afterward. Trichotillomania often results in noticeable hair loss.
• Traction alopecia involves hair loss around the edge of the hairline and is especially noticeable around the face and forehead. It is caused by hairstyles that pull hair too tight; for example, tight braids or tight ponytails can cause hair loss.
• Telogen effluvium involves widespread hair thinning over the scalp or other areas of the body. It is caused by changes in the growth cycle of hair. Large numbers of hairs enter the resting phase of hair growth, which causes shedding and thinning. This change in the growth cycle of hair is often caused by mental stress or physical stress, such as poor nutrition, injury, or surgery. This is a noninflammatory condition, so the skin appears normal.

How will my doctor identify what is causing my hair loss?

The most common type of hair loss, androgenetic alopecia, occurs in distinct patterns that can be recognized by your doctor. Tests, such as hair and scalp analysis or general blood tests to identify a disease source, may be done if the diagnosis of your hair loss is unclear.

What can be done about hair loss?

Many people seek treatment for hair loss, and there are several different types of treatment, which vary in effectiveness. Examples of treatment include taking medication to reduce hair loss, wearing a hairpiece, or having hair transplant surgery to cover bald areas. Research on medications that promote hair growth is ongoing, and more effective medications may become available soon.

Hair loss usually does not directly affect your physical health, although it may be a sign of a medical problem and it can be upsetting and influence your self-esteem.