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Causes

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The cause of your hair loss will vary with the type of hair loss you have.

Inherited thinning (androgenetic alopecia) affects approximately one-third of men and women. Male hair loss occurs at the forehead or on top of the head. Women have thinning on the top of the scalp. In pattern baldness, hair loss is inherited.

Hair fall (telogen effluvium) occurs when a stress to your body causes hair loss. A significant number of your scalp hairs are shed, usually 3 months after the stress occurs. Your hair may come out when you shampoo or comb it. Hair loss will decrease over 6 to 8 months and is temporary. Causes of this type of hair loss include:

• High fever
• Severe infection
• Childbirth
• Major surgery or illness
• Severe emotional stress
• Over- or underactive thyroid gland
• Iron deficiency or other types of anemia
• Severe calorie or protein restriction
• Some medications (please discuss this with your personal physician)

Alopecia areata is the occurrence of bald patches on the scalp, beard, and, possibly, elsewhere. Your immune system interferes with hair growth, resulting in a loss of hair. There may be a few bare patches or extensive patchy loss. Heredity can play a role. This type of hair loss is usually temporary.

Other causes of hair loss include:

• Tight hair styles or use of curling irons, dyes, or permanent waving 
• Age
• Ringworm of the scalp (common in children)

Diagnosis

Your doctor will look closely at your scalp and hair loss pattern, and ask you questions to determine the history and scope of the problem, such as:

• How much hair are you losing?
• When did you start losing your hair?
• Do your parents have hair loss?

There may be a need to gently pull out some hairs for tests, do a blood test, or look at a sample of your hair or scalp with a microscope.

Treatments

The goal of treatment is to stimulate hair growth or hide hair loss.

There are treatments for alopecia areata that are more effective in milder cases in which less then 50 percent of scalp hair is lost. Corticosteroids either in a topical or local injection or minoxidil, a topical foam, may be used to stimulate hair growth.

For hair loss due to illness, chemo- or radiation therapy, medication, thyroid imbalance, or stress, treatment is unnecessary. The hair will usually grow back when the illness or therapy ends.

Medications

The effectiveness of medications to treat hair loss depends on the cause of the loss, amount of hair lost, and individual response to the medication.

Minoxidil is an over-the-counter topical foam or liquid that is used to treat androgenic alopecia. You rub it into your scalp twice daily. You may have some hair regrowth, a slower rate of hair loss, and thinner, shorter hairs. Be aware that it can cause irritation of the scalp in some people. When you stop using it, new hair stops growing.

Finasteride is a pill, available by prescription. It is not approved for women since it can cause birth defects. Many men experience a slowing of hair loss, and some even see new hair growth. Rare side effects can include a decrease in sex drive and sexual function.

Corticosteroids, also known as steroids, are often used to treat alopecia areata. Injections into the scalp or topical applications may be used.

Anthralin in a cream or ointment form is a synthetic tarry substance. You apply it to your scalp and wash off daily. It may cause new hair growth for cases of alopecia areata, taking up to 12 weeks to work.

If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only. 

Surgery

Hair transplants and scalp reduction surgery are available to treat inherited thinning (androgenetic alopecia). In transplants, tiny plugs of skin, each containing one to several hairs, are taken from the back or side of your scalp. The plugs are implanted into the bald sections. Several sessions may be needed since hereditary hair loss continues over time.

Scalp reduction surgery decreases the area of bald skin on your head. Hairless scalp is removed and replaced with hair-covered scalp. Hair-covered scalp can also be folded over an area of bald skin in a technique called a flap. Scalp reduction is sometimes combined with hair transplants.

These surgical procedures are expensive and can be painful. Risks include infection and scarring. It takes 6 to 8 months before the quality of the new hair can be evaluated.

If you are interested in these procedures, discuss them with us. We will want to confirm the cause of your hair loss and review all treatment options.

Wigs, hairpieces, certain hairstyles, makeup, hats, or scarves are an alternative to medical treatment for your baldness. You may also choose to leave it untreated and unhidden.

Prevention

Inherited thinning (androgenetic alopecia) cannot be prevented. Hair loss that is caused by medicines, stress, poor diet, or hair care may be prevented by the following:

• Avoid medicines causing hair loss (discuss this with us).
• Reduce your stress.
• Eat a balanced diet with plenty of protein and iron.
• Avoid tight hair styles that pull the hair.
• Handle your hair gently, allowing it to air dry.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we may discuss your medical and family history and I will examine your scalp and hair loss pattern. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.