Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
Why Is My Hair Falling Out?
Posted in Androgenic Alop... by Dr. Sharon Orrange on Jun 04, 2008

Once or twice a week a 40 year old woman comes in to my office asking me this question. Hair loss is very distressing but your primary care doctor can help you sort out the cause. The first question I ask my patients is this: is your hair breaking or falling out? Do you notice short broken pieces of your hair or do you wake up in the morning with long hairs on your pillow. You may also even be able to tug on your hair and see if you can easily pull out a hair (follicle and all). And you may notice increased amounts in the brush after a shower.

I won't discuss broken hairs which are usually an issue of brittle, dry hair from hair products, bleaching, coloring, etc. Increased hair loss from the scalp is a different issue. Let's walk through it.

What are the reversible medical causes of hair loss in women?

  • An under or overactive thyroid

  • iron deficiency anemia

  • Autoimmune diseases like Lupus, Rheumatoid arthritis

  • Polycystic Ovarian Syndrome (PCOS) or other disorders that cause too much systemic male hormone (which should be accompanied by abnormal periods, acne, among other things).

  • Medications with some common culprits being beta blockers, antidepressants, anticoagulants, and chemotherapy

  • The postpartum period is characterized by hair loss and can persist up to 15 months after delivery

  • Some skin conditions can do it so your scalp should be examined to make sure there isn't a dermatologic cause contributing to the hair loss.

  • A family history of similar hair loss is suggestive of androgenetic alopecia, or genetic hair loss, which I will discuss below.

If your primary care doctor has ruled those out then the answer to your hair loss is likely genetic. Here's the deal. Androgenetic alopecia is the most common type of hair loss, affecting approximately 30 to 40 percent of adult men and women. This will shock you but the incidence is the same among women as men although it may be camouflaged better in women. While it often affects women prior to the age of 40, the incidence increases around the time of menopause.

Why is this happening? Well hair loss in androgenetic alopecia is due to a genetically determined production of a shorter, thinner hair shaft. With normal hair growth each day up to 75 hairs are shed from the scalp and about the same number of follicles enter. Simply put with genetic hair loss the hair growth cycle continues, but new growth becomes thinner and shorter as follicles are miniaturized.

What will the hair loss look like in women? Unlike in men it is typically more diffuse and rarely complete in women. The front hair line is normal, with diffuse thinning typically just behind the frontal hairline or midscalp area to the vertex. The affected part is usually widened and more obvious. The presence of uneven lengths and texture is a classic sign of androgenetic alopecia.

What are my options for treatment? Once your hair loss has been determined to be genetic and not related to one of the above listed causes there are some options but not many. Oral finasteride (Propecia) and topical solutions of minoxidil (Rogaine) are the only drugs approved by the United States Food and Drug Administration for treatment of androgenetic alopecia in men. Only minoxidil is approved in women. There is some evidence that using Aldactone (spironolactone) at a dose of 100-200 mg a day showed benefit in women who haven't responded to the use of topical minoxidil and is worth asking about. As a last resort a referral to a dermatologist or plastic surgeon may be appropriate and though they are expensive available procedures include hair transplantation or flaps, and scalp reduction.

Last but not least, the psychological effects of this should not be underestimated. Reach out to others in your position and check out some additional resources that may be helpful: American Hair Loss Council ( and the American Academy of Dermatology (

Dr O.

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I was diagnosed with RA almost 5 yrs ago, the Past 6 months I have noticed my hair is coming out in handfuls! I asked my PCP and he put me on another multivitiamin and even asked my hair dresser, she had no clues. After reading ur post I understand it could be the RA? I see my rheumy in a couple of months, i will ask him. Thank you!
By debislack  Sep 19, 2008
Thankyou for the information Dr. O. I'm blessed with beautifull hair, but now I realize what I've suspected what could be going on with me. Your right, it's primary doctor care time, but I had dismissed that psychological ramifications are a consideration too. I joined yesterday to join a prayer group I never found. I also want to learn how to better care for myself.
By goofychic  Aug 01, 2008
I have had crohn's disease for 24 years, and the meds that I have had to take made my hair come out in hand fulls. When I'm on steroids I get so depressed beacuse when I wash my hair I have to get it out of my fingers, out of the drain and when I brush it there is lots of hair in the brush! I have looked up many meds and they all say the same, can cause "Hair Loss"..but doctors refuse to discuss it! Why? Just wondering...Marcie
By marcie54  Aug 01, 2008
Im so glad I saw this post. I noticed last week im losing my hair like crazy, i cant even brush it anymore cause im scared I wont have any hair left, my hair is already thin enough. Im going to have my mom book an appoitment with my doctor to see whats going on, but do you think by any chance im losing my hair because I starting taking diet pills?
By xshelbyyx  Jul 03, 2008
I wanted to pass along that I have had 2-3 patients who have tried Silica Gel with some good results with hair loss. There are NO studies on this but's worth a try...other than the cost I don't see a downside
Dr O.
By DrOrrange  Jun 29, 2008
I have had crohns colitis for 23 years, I have hair loss when on certain medication such as steroids, after being off them for a couple of months my hair starts growing back in. I don't go bald or anything but it does fall out very much when taking a shower, I know how women feel it makes our illness seem even worse. I don't know why when on steroids my hair grows so fast but gets very thin, and facial hair is a problem! some meds can really do strange things to our body which for me causes me to get so upset and nervouse.
By marcie54  Jun 07, 2008
Great info! Thanks for sharing
By BlueBerries  Jun 05, 2008
Also for our PCOS folks...combined estrogen/progesterone oral contraceptives can help the hair loss.... Dr O.
By DrOrrange  Jun 05, 2008
Topomax, The stuff is like hairbegone to me. Like what it does for my brain but don't like the clumps of hair that comes out. Not sure what to do about it.
By Owshen  Jun 05, 2008
THANK YOU!!! Just came out of the shower! My hair is falling out in clumps! I see the doctor next wed., so we'll just add this little tidbit to the list LOL!
By SaraMC  Jun 04, 2008
If the hair is lonh remember that as hair grows lingrt alot if it will attach itself to the new hair comming out of the same folicle sometimes it will detach and end up on pillow in brushes, shower drains etc If it still had the bulb attatched this is probly what is happening.
By ksteele26  Jun 04, 2008
This was of great interest to me as I had a total hysterectomy 3 years ago but I'm only 36 and have been losing hair ever since . My hair has thinned all over really but my parting is now quite large so have resorted to buying a cosmetic disguise online which has given me my confidence back a little .I have not tried minoxidil but would like to , had heard it was dangerous for women. It would be great if I could have my hair back as it used to be for just a while longer but to be honest had given up hope of that happening.
By flowella  Jun 04, 2008
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