Pre-mature hair loss

Originally Published: September 1, 1993 - Last Updated / Reviewed On: April 1, 2014
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Hi Alice,

My brother seems to have a problem which he or anybody at his age should not be having. My brother is 20 years old and he has a hair loss problem. He recently went to a dermatologist and asked the doctor why he is losing his hair at such a young age, and the doctor was unable to give him an understandable reply. The doctor said to my brother that he is baffled by the situation. The doctor checked his body, measured his blood pressure, and heart rate and everything was normal or above average. This is the reason that I am here, Alice. I want to know what factors or reasons are contributing and causing my brother's hair to fall out at an enormous rate at such a young age. (Since the doctor he went to doesn't even know.) Let me give you some background information about my brother so you can have a better idea of his health and from there can possibly rule out a concise explanation for his problem. My brother works out (lifting weights twice a week, eats very intelligently (ignoring fatty foods and snacks), doesn't have stress or any pressure like that and sleeps 6-7 hours a day. Also, very few members in our family have a hair loss problem at such a young age, if you, Alice are thinking the problem is hereditary. Well that is everything that I can say about my brother. I hope you can now rule out a reason(s) for his problem and if possible, give him some solutions to his hair loss problem. I don't know if he is using the wrong shampoo or his hormone is unbalanced. Alice, I hope you can really help my brother out.

P.S. His head and scalp are very clean, never been injured or hurt in any way whatsoever. His hair is very normal.

Signed,
Need Hair

Dear Need Hair,

You must be very close to your brother to have such concern for his situation. Maybe you're also curious about whether this could happen to you. Well, first it is impossible to diagnose any problem through the computer. However, you've come to the right place to get more information on possible reasons for hair loss. After reading this, you, and your brother, might narrow down possible causes of his hair loss. Then, you can decide on the next steps, if any.

OK, so… human hair grows in cycles that last from two to seven years. Each strand has its own seven-year cycle until it is finally shed as a normal part of washing or brushing. People can expect to lose between 100 and 200 strands of hair each day. Now, it's cause for concern if hair comes out by the handfuls, or if there are sores or scabs on the scalp. Also, some hair loss is permanent and some is temporary.

The most common permanent hair loss is called pattern baldness (androgenetic alopecia). Males with pattern baldness start to lose hair in the front, sides, and crown of their heads. Women with pattern baldness typically find their hair thinning around the front and the crown of their heads. While pattern baldness can start anytime after puberty, it's most common for it to begin in a person's 20's. Some people with pattern baldness become completely bald, others don't. Pattern baldness is usually hereditary, although not always. Although pattern baldness is permanent, there are some treatments available that a doctor could recommend after diagnosing it.

While pattern baldness doesn't indicate an underlying medical problem, some types of temporary hair loss do. So, if your brother thinks he is dealing with one of the below-mentioned conditions, it'd be a good idea to see another doctor for a complete medical work-up. Here is some information on types of temporary hair loss:

  • Trauma. Sometimes, hair falls out weeks or months following psychological stress or trauma to the body (i.e., childbirth, major surgery, illness, etc.). This is called telogen effluvium.
  • Alopecia areata. When small round patches of hair fall from the scalp, it could be a sign of alopecia areata — an incurable, but sometimes treatable, disease of the immune system. This usually occurs in childhood or young adulthood, although it could occur at any age. While it's usually hereditary, not always.
  • Hairstyles and treatments. Hair loss can occur when hair is tightly styled or  damaged by heat from hot rollers or dryers. Also, when chemical treatments (i.e., perms, dye, straighteners) are used improperly they can burn the scalp or cause hair to break mid-strand.
  • Medical treatments and medications. Certain medical treatments like radiation and chemotherapy for cancer can result in hair loss. Some medications are known to cause hair loss, including some birth control pills, and those prescribed for hormone replacement therapy, depression, arthritis, heart problems, and high blood pressure.  
  • Recreational drugs. Use of some drugs like anabolic steroids and amphetamines is also linked to hair loss.
  • Underlying medical conditions. Hair loss can also be a symptom of an underlying medical condition like diabetes, lupus, or thyroid disease. It could also signal poor nutrition. 
  • Fungal infection. Sometimes people lose hair as a result of a fungal infection to the scalp (ringworm or tinea capitis). In these cases, the scalp gets flaky or scaly and hair breaks of at the scalp.
  • Trichotillomania. Lastly, a condition in which people are driven by an internal urge to pull their own hair out, can also explain some people’s hair loss.

What are your thoughts after reading these descriptions? Out of these conditions are there any that might be applicable to your brother? Importantly, do you have a hunch he may be dealing with something other than pattern baldness?

If so, it's a good idea to direct him back to a doctor for a complete medical workup, because severe hair loss (even if temporary) may be an indicator of a serious health condition. In this case, he could go back to the previous doctor with some educational material for him OR he could choose another doctor. If your brother is a student at Columbia he can make an appointment at Medical Services (Morningside) or the Student Health Service (CUMC). If he's a student elsewhere, it may be a good idea to encourage him to make an appointment at his school’s health center.  

Again, it's a testament to your relationship with your brother that you're concerned about his hair health. Hopefully the information you learned will provide some new clarity and lead you both in the right direction. One final word, in our society, we place a lot of value on hair and hair loss can be a big blow to self-esteem. Yet, amount of hair, or lack thereof, does not determine a person's character.

Alice