The Fallout of Hair Loss

Liz Rankin’s condition has gotten so bad that she hides the empties from her boyfriend, makes excuses to get out of camping trips and spends hours behind locked doors.

Rankin, a 27-year-old teacher from Seattle, isn’t suffering from any kind of addiction. Like 30 million other women in the United States, she’s coping with hair loss.

“Dealing with it gets really time-consuming,” says Rankin, who started losing her hair about six years ago. “I have to dry my hair a certain way, color it a certain way, part it a certain way. And it’s all a huge secret. I wouldn’t think of sharing it with any of my friends because it would open this world of questions. I even hide the garbage so my boyfriend won’t see my empty bottles of Rogaine.”

While many women spend countless hours lasering, waxing and tweezing away unwanted hair — laser hair removal alone has doubled in the last five years, according to the American Society for Aesthetic Plastic Surgery — others contend with the pain, frustration and isolation brought on by thinning or disappearing hair.

Unlike male-pattern baldness, which is usually genetic and much more widely accepted — thanks in part to the popularity of the shaved male head — female hair loss is triggered by a number of causes and often cuts to the heart of a woman’s femininity, self-image and self-esteem.

An isolating condition
“Hair loss can be life-altering,” says Candace Hoffman, 57, a Phoenix public relations specialist who wrote about her own hair loss and that of others in her book, “Breaking the Silence on Women’s Hair Loss.”  “I’ve gotten to the stage of my life where I’ve made peace with it, but it can be very isolating.”

Rather than confess their condition to others, women with hair loss often take great pains to hide it. Some have ended relationships or faded out of friendships; others have curtailed promising careers or even contemplated suicide.

Hoffman has androgenetic alopecia — commonly called male- or female-pattern baldness. The condition is related to hormones called androgens. In women, it generally causes thinning over the top and front of the scalp, as opposed to the receding hairlines and baldness seen in men.

Hoffman says her hair loss first became noticeable in high school and progressed substantially after she went through menopause. Instead of going into hiding, though, she cut her hair short and wrote a book about the condition, which she says causes many women to feel guilty, as if they somehow brought the hair loss on themselves.

“For many women, it’s like having a disfigurement,” Hoffman says. “It takes a lot to get over it, to build up your self-esteem enough to say, ‘I am more than my hair,’ especially in this society where you can’t go five minutes without seeing a TV commercial for some hair product.”

Her ‘crowning glory’
Our tangled relationship with hair may explain why women’s hair loss remains such a dirty little societal secret. A March 2008 review of hormonal therapy for female-pattern alopecia in the Dermatology Online Journal refers to it as a “common but puzzling condition” that strikes 10 percent of pre-menopausal women and 50 percent to 75 percent of women 65 years and older. As for treatment, the paper concludes that “the need for effective agents is highlighted by the paucity of effective treatments and the substantial psychosocial impact of alopecia on women.”

Hoffman, who interviewed more than 100 women for her book, says many doctors seem unsympathetic or unwilling to take the time to seek out answers, despite the emotional pain associated with the condition.

“If you go in and say to a doctor, ‘My hair’s thinning,’ they usually just hand you Rogaine and say, ‘Try that,’” she says. “Hair loss is not life threatening — it’s not the same as having a lump in your breast — but it can’t be given that kind of short shrift. We, as women, have to bring it up. And doctors need to be more receptive when women do bring it up.”

Dr. Hema Sundaram, a Washington, D.C., dermatologist, agrees.

“One physician who sent a patient to me couldn’t understand why this woman had traveled so widely trying to find a solution,” says Sundaram, author of “Face Value: The Truth About Beauty and a Guilt-Free Guide to Finding It.” “Not that all male physicians are insensitive, but it is sometimes difficult for them to understand how profoundly hair loss impacts women. Hair is very much a part of the female psyche.”

It’s also incredibly complex stuff, says New York dermatologist Dr. David Orentreich.

“In the past when women came in with thinning hair, it was attributed to emotional stress or anemia,” he says. “It wasn’t really understood that women experienced hair loss in a fashion that is similar to the hair loss we see in men.”

But androgenetic alopecia, or AGA, is just one piece of the puzzle. Polycystic ovaries can cause hair loss on the scalp. (They also can cause facial and body-hair growth.) Hair loss also can be triggered by diseases such as lupus. Women sometimes lose hair following substantial and rapid weight loss or a high fever, or after going through major surgery or extreme stress.

Alopecia areata, a condition in which a person’s own immune system attacks hair follicles, causes women to lose not only patches of scalp hair but sometimes eyebrows, eyelashes and pubic hair. Even tight hairstyles that pull on the scalp such as braiding, ponytails and hair extensions can contribute to hair loss, as can psychiatric disorders such as trichotillomania, or compulsive hair-pulling.

“Just because a woman has a family history of AGA doesn’t mean that she doesn’t also have anemia or some other cause of hair loss,” says Sundaram, who uses blood tests, which include measurements of hormone levels, and scalp biopsies to evaluate her patients. “There are many conditions that can cause hair loss so it’s important for the clinician to fully investigate.”

Some conditions — such as hair loss after childbirth — are relatively common.

“After my pregnancy, my hair came out in clumps,” says Eryn Staats, a 30-year-old audiologist from Columbia, Ohio. “But my OB/GYN told me it kind of goes with the territory.”

Hair loss after chemotherapy is also a given, although in most cases the hair loss isn’t limited to the scalp.

“They say you’ll lose hair everywhere — your face, your head, your legs, your eyebrows and eyelashes, but nobody ever says the ‘P’ word,” says Lynn Sansone, 53, a speech and language therapist in Wright City, Mo., who was diagnosed with breast cancer in March. “But it’s coming back now. It’s different, but it’s growing.”

Help for hair loss
While hair loss due to chemotherapy or a trauma such as childbirth, surgery or stress will usually sort itself out — that is, the hair will eventually stop shedding and start growing again — androgenetic alopecia can be much more debilitating and difficult to treat.

For some women, doctors prescribe oral medications such as birth-control pills, which, due to their wide array of ingredients, can either trigger alopecia or treat it. Aldactone, a steroid derivative that works as an anti-androgen and blocks the hormones that drive hair loss, is another treatment option. Women also can opt for devices such as hand-held laser combs, which in 2007 gained Food and Drug Administration approval for the promotion of hair growth in men.

For the last five years, Rankin has used the topical medication Rogaine, the only FDA-approved ingredient for women’s hair loss in the United States. (The medication Propecia is FDA-approved for men but is occasionally prescribed “off-label” for women who are not pregnant or potentially pregnant due to the risk of birth defects.) Rankin also is contemplating a hair transplant, a surgical technique that’s become much more sophisticated over the years.

“In the early days hair transplants might have had anywhere from a dozen to 20 hairs in a graft, but the technique has changed,” says Orentreich, whose father, Dr. Norman Orentreich, performed the first hair transplant in the United States in 1952. “Now the grafts are one or two hairs. Generally women thin, they don’t grow bald, so planting enough hair can make a big difference visually for a woman.”

Hair transplants are only performed after a woman’s hair loss has stabilized, however, and the procedure can be financially out of reach for some. The American Society for Aesthetic Plastic Surgery lists the 2007 average price at $5,874. Results also can take up to a year, which may seem like a lifetime to a woman bombarded by countless commercials for “miracle-grow” cures or shampoos that promise thick, lustrous locks.

But there is additional hope on the horizon. Last month's Harvard Health Letter reports that new drugs designed to preserve the health of hair follicles are in the pipeline, along with new ways to create hair follicles from scratch.

For Rankin and the millions of other women dealing with hair loss, a viable, reliable solution can’t come too soon.

“I don’t want to look like a Pantene model,” she says. “I just want to look like me.”

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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