Pre-mature hair loss

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.

Need Hair

Dear Need Hair,

It's kind of you to be so concerned about your brother's hair loss situation. Unfortunately, it's impossible to diagnose any problem through the computer. The good news, however, is that you've come to the right place to get more information on possible reasons for hair loss. There are a number of possible causes, ranging from different medical conditions or treatments, life experiences, or even hairstyles. 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.

First, it can be helpful to talk about hair in general. Human hair grows in cycles that last from two to seven years. Each strand has its own seven-year cycle until it's finally shed as a normal part of washing or brushing. People can expect to lose between 50 and 100 strands of hair each day. But, if hair comes out by the handfuls or if there are sores or scabs on the scalp, then that may be cause for concern as it could be an indication of an underlying medical condition. In terms of permanent hair loss, which tends to be hereditary, the most common form is usually a thinning of hair on the top of the head, which can affect people of all genders as they continue to age. This thinning usually takes the form of a receding hairline for those assigned male at birth, and a widening of the hair part for those assigned female at birth, although older women can also experience a receding hairline as well. Additionally, some people with pattern baldness can become completely bald, while others don't and may experience hair loss that leaves circular or patchy bald spots on their scalp. While pattern baldness is permanent, there are some treatments available that a health care provider could recommend after diagnosing it.

Additionally, not all hair loss is permanent, as some of it can be temporary. And while pattern baldness doesn't always necessarily indicate an underlying medical problem, some types of temporary hair loss do. Some of the explanations for temporary hair loss include:

  • 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.
  • 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 such as 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 such as 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 such as diabetes, poor nutrition, lupus, thyroid disease, or the hair-pulling disorder known as trichotillomania. It could also signal alopecia areata, which is an incurable, but sometimes treatable, disease of the immune system that causes patchy hair loss.
  • 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.

If any of these situations apply to your brother, it may be a good idea to direct him back to a health care provider for further evaluation because severe hair loss (even if temporary) may be an indicator of a serious health condition. If he's a student, he may be able 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!

Last updated Jul 29, 2022
Originally published Sep 01, 1993

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