Hair loss

Hair loss is a big worry to many people, both male and female. If you have a worrying amount of hair in the basin after shampooing, you may think you are on the way to baldness, but this is not usually the case. The 50–100 hairs that everyone loses each day often become tangled with the rest of the hair, but are washed out when we shampoo. So we see what seems like a lot of hair in the basin after shampooing, but in reality these hairs have been shed earlier.

Of course, bald areas are an obvious sign of hair loss, but otherwise it can be difficult to tell whether your hair is getting thinner. To find out, try the tug test. Hold a small bunch of hair – about 15 or 20 hairs – between the thumb and index finger. Pull slowly and firmly. If more than six hairs come out there may be a problem.

How hair grows

The portion of the hair that we can see is called the shaft. Each shaft of hair protrudes from its follicle, which is a tube-like pouch just below the surface of the skin. The hair is attached to the base of the follicle by the hair root, which is where the hair actually grows and where it is nourished by tiny blood vessels.

Like the rest of the body, hairs are made of cells. As new cells form at its root, the hair is gradually pushed further and further out of the follicle. The cells at the base of each hair are close to the blood supply and are living. As they get pushed further away from the base of the follicle, they no longer have any nourishment and so they die. As they die, they are transformed into a hard protein called keratin. So, each hair we see above the skin is dead protein. It is the follicle, which lies deep in the skin, that is the essential growing part of the hair.

The thickness of each hair depends on the size of the follicle from which it is growing. At puberty in boys, hormones increase the size of the follicles on the chin, chest and limbs so that each hair becomes more thick and wiry. In the elderly, the follicles shrink and the hair becomes finer.

Stages of hair growth

Hair growth is not a continuous process. It has several stages.

The first phase is the growing stage. Hair grows at about 1 cm each month, and this phase lasts for anything between 2 and 5 years.
This is followed by a resting stage, during which there is no growth. This phase lasts about 5 months, and is called telogen.
At the end of the resting phase, the hair is shed and the follicle starts to grow a new one.
At any moment, about 90% of the hair follicles of the scalp are growing hairs in the first phase; only about 10% are in the resting phase.
If a follicle is destroyed for any reason, no new hair will grow from it.

What happens to cause baldness

Excessive hair loss can occur if any of the stages of hair growth become disrupted. For example, if follicles shut down (meaning that they stay in the resting phase and then shed the hair) instead of growing new hairs, there will be less hair on the head. Another reason might be interference with the formation of new hair cells at the root during the growing phase; this occurs with some anticancer drugs. If follicles have been destroyed (as they might be by, for example, a burn or by some skin diseases), there will be baldness in that area.

An individual can also look bald if the hairs are growing but are so fragile that they break just as they emerge from the follicle, or if they are very small and thin.

Scientists have now discovered two genes that may increase the risk of early baldness in men. One is known as the androgen receptor gene, inherited from the mother and already linked to male-pattern baldness. The other is on chromosome 20, and can be inherited from both mother and father. 14% of men carry both genetic variants (Nature Genetics 2008;40:1270–1).

Common beliefs about hair loss – true or false?

Some hairstyles can cause hair loss
True. Styles that put tension on the hairs – such as tight ponytails, plaits or corn-rows – can cause hair loss. Winding hair tightly onto rollers (particularly heated rollers) can have the same damaging effect.

Hair extensions can cause hair loss
True, if not done properly. If the hair extensions are too tight, they can pull on the hairs and cause bald patches (which in severe cases could be permanent).

Brushing the hair 100 times a day will stimulate the circulation and prevent hair loss
False. Vigorous brushing is more likely to injure the hairs and make the problem worse.

Hair needs to breathe, so wigs and toupees worsen loss of hair
False. Hair does not need to breathe. Only the root of the hair is alive and this gets its oxygen from the blood in the scalp. Wigs and hairpieces will damage hair only if they are too tight.

Frequent shampooing makes hair fall out
False. Shampooing simply gets rid of the hairs that have already fallen out.

Blow-drying and heated brushes can worsen hair loss
True. The reason is that extreme heat damages the proteins in the hairs, making them fragile and liable to break off. Brushing the hair during blow-drying causes more damage. Careless use of heated brushes or heated hair straighteners can even burn the scalp, so that the hair follicles are permanently damaged in that area.

Protein-containing conditioners and shampoos nourish the hair and help it to grow
False. Protein-containing conditioners only temporarily fill in defects on the surface of the hair shaft, making it smoother and thicker.

Hair dyes, perms and hairsprays worsen hair loss
False. Hair dyes, perms and hairsprays do not affect thinning hair. Perms and hairsprays can help to disguise the problem.

If your father has a full head of hair, you will not go bald
False. A tendency to baldness is inherited and probably involves a combination of genes. So you are not automatically in the clear even if your father has a full head of hair. It is not true, as sometimes claimed, that only genes from the mother’s side are involved.

Baldness means that you are more likely to have a heart attack
True to some extent. A study has found that men who had lost hair at the crown of the head had a 40% increased chance of coronary heart disease. Hair loss at the front of the head (a receding hairline) increased the risk by 28% (American Journal of Epidemiology 2008;167:676–83). So if you have male pattern baldness you should stop smoking, eat healthily, have your blood pressure checked and do some exercise.

Low levels of zinc in the body are a reason for hair loss
Probably false. There is no evidence that low zinc levels cause hair loss in people taking a balanced diet or that zinc supplements reduce hair loss.

Stress can cause hair loss
True. Scientists have now identified some chemicals that are produced in the body during periods of stress, which can affect hair growth (Journal of Investigative Dermatology 2004;123:455–7).

It is normal to lose hair from our early 30s
True. A person aged 20–30 years typically has 615 hair follicles per square centimetre. The number falls to 485 by 50 years of age and to 435 at 80–90 years of age. Also each hair is thinner. So, with ageing, hair becomes both finer and sparser.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Wednesday, October 5th 2011

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Comments on this article

Posted by Optional on 04/12/2011 at 06:14

Ihave bold spots all over my head and dont know what it is

Posted by lynn on 17/09/2011 at 07:15

my hair is growing white. gray hair....n iam 28yrs old iam so shy...what to do

Posted by ansar on 12/09/2011 at 10:44

my hair is very weak and falling hair every day and on my skull swelling and pain what are cure of this disease

Posted by Optional on 03/09/2011 at 06:03

I am facing continous hair loss problems for last 5 years now. Tried many brands who claim to have the perfect remedies but nothing seems to be working. If you have any suggestions then do fill me in .. Venkat from Chennai.

Posted by Frustrated female on 28/04/2011 at 05:47

I have been useing nioxin shampoo and scalp treatments for 2 yrs. St first the products seem to help, but it appears now I have no new growth at all. I would llike to get implants but it is expensive, it is even harder to camouflage thin spots. My hair thinning is on the top of my crown.

Posted by middle aged on 10/04/2011 at 06:05

I take certain vitamins which help with cell renewal and have stress reducing effects, i lost half my hair during a stressful job, i kept up the vitamins and exercise to counter act it, once i left the job, my hair grew back and i keep the supplement going to keep it that way. I think the supplements stopped it from going too far. I do my research thoroughly and try to get a good balance before buying anything, the old rule applies, not too much, not too little.

Posted by Optional on 08/03/2011 at 08:21

the hair on the front of my head is falling out

Posted by Optional on 20/02/2011 at 09:35

i have 3 bald patches in my head,and my scalp is really itchy.

Posted by Optional on 03/11/2010 at 09:56

i used H2O2, hydrogen peroxide to color my hair when i didnt know what it meant. it went greyish red. later it started to fall and never replaced by another. from then from my age of 12, till now, i have visible scalp, any idea to grow back. i guess it wont

Posted by Optional on 23/10/2010 at 10:18

after reading this it has put my mind to rest.........my hair loss has become worse over the last couple of weeks but only really after shampooing but after reading this I know now that it is ok! THANKS

Posted by Optional on 20/10/2010 at 03:05

i have a receded hairline. my hairline was never perfect & I only noticed it starting to recede when I was 18 or so. I'm now 28 & it has receded further back (at 18 I thought for sure at 25 or so I would have been really bald, but it has suprisingly happened slower then expected). Anyway it depresses me alot. Seeing bald men makes me more depressed (I have to give it to them, they are alot braver then I am), I'm lost as what to do, if I was 38 or 48 (then I could deal with it, but still in my 20's). I'm sick of thinking about it & can't find any positives about going bald.

Posted by emma on 11/10/2010 at 01:11

i have found this site very helpful as i have tried many other sites and found them hard to understand, so thank you very much

Posted by Maria on 02/10/2010 at 04:12

I have recently stared noticing a lot of hair falling out while I'm brushing, washing or blow drying my hair. I'm a little bit concerned, because I die my hair almost every month

Posted by Optional on 29/08/2010 at 10:29

i am 19 yrs old i have had alot of stress and when i brush my hair it is falling out some in small cluncks and sometimes it is just 2 or 3 nw that most of the stress is taken of me i thought that my hair would stop falling out but it hasn't everytime i brush my hair my brush is covered and i am pulling the loss hair out what should i do i have been 2 the doctors and they just say it is stress but i no it isn't i have died my hair alot in the past but my hair has never fallen out as much has it does now is it because of how many times i have died my hair

Posted by Mitch Schmitt on 23/08/2010 at 11:48

Is there any truth that some chemicals in hair perm products can be absorbed into the skin and affecting medications including heart meds?

Posted by Joshua Song on 16/08/2010 at 12:17

ive been born with few hair. the doctors dont really know what the problem is. im not completely bald.. but my head is like many strands of hair. i dont know if theres a way to cure this or what but its been like this since my birth. since i am not completely bald people stare, and make funny comments. i have never seen anyone with the similar problem as me. So far, it seems like im the only one in america with this problem.

Posted by naschti on 12/08/2010 at 02:41

am aged 32,female,wear a wig! feel a lot of hair loss, that's why only wash my hair ONCE a week! don't brush or blow dry my hair anymore! could it be after childbirth, that the hair is falling out? (my baby is 14 month already!)is there a specific shampoo, vitamine or therapy for the hair?

Posted by Optional on 25/07/2010 at 03:59

my hair is rough and a bit curly is there any how i can soften them

Posted by Optional on 13/06/2010 at 06:15

My hair was falling out in masses, my friend recommended an asian herbal hair oil. Been using oil for 6 months and had fantastic results. Hair loss has reduced by 80%. Oil is a bit smelly but works wonders. Definately worth trying. can get it over the internet.

Posted by santanu chatterjee on 28/04/2010 at 03:43

Hair started reducing at the age of 25 years. 50% loss taken place at the age of 30 years.

Posted by Stargirltrini on 23/04/2010 at 06:56

my hair has been droping for almost two months now, at first I had long thick curl hair now my hair is really really thin, its like I could count the grains of hair on my head.....i am tryin eveything plz help

Posted by Optional on 29/03/2010 at 10:38

MY HAIR IS HARD,DRY&ROUGH;.WHAT SHOULD I APPLY TO IT?

Posted by Optional on 10/03/2010 at 10:50

I was 19 when i noticed ALOT of hair faling out. Now I cant do any hairstyles because it shows my balding. Im scared, becuase im losing more and more hair. What can I use for this problem? ive been to a docter but she didnt give me much help..

Posted by Optional on 09/03/2010 at 03:35

My daughter is suffering from alopecia areata. She has lost a large amount of hair from the back of her head from the nape to about half way up. There is no hair at all and the rest of her hair is qute thin now. Being only 15 she is suffering greatly with this and it is causing her a great deal of stress, on top of her GCSE's which she is taking this summer. I have been unable to find any solution to this problem and we just have to hope her hair will come back by itself. What I would like to be able to do is put her in touch with other girls in the same position so they could at least talk to each other and give each other some support.

Posted by Optional on 02/03/2010 at 12:25

so this is basically saying, if your going bald you have a good chance of a heart attack. nice one. keep your opinons to yourself, embarrassing problems.com. complete waste of time

Posted by :) on 20/02/2010 at 04:07

Hiii, when i split my hair into two straight down from the centre the scalp line is there and in the middle is a little, little circle. what can this be? thanks :)

Posted by Carla on 28/01/2010 at 06:18

I am 15 and have bauld patches on the top and back of my head , which left me with no hair line . I find this difficult to cope with at such a young age . Which left me with no self esteem . Micheal my mummy said it's just ur roots .

Posted by Tom on 17/12/2009 at 03:30

I've heard about a hypnotherapist who has helped women with alopecia grow their hair back successfully. I expect she can do it for men too, i don't know. I think her name was Sally Stubbs.

Posted by garry on 28/11/2009 at 02:23

I have thining hair in the front and on the top of my head.

Posted by michael on 18/10/2009 at 07:13

my hair comes out with white things on the end of it. wat is this. i am 17 years old