For alopecia, the ‘cause’ is the path to the ‘cure’; that is, understanding why someone has alopecia is critical to helping the hair to grow back. That is because there are many different health conditions that can cause hair loss.
An easy way to remember the most common causes of alopecia is the pneumonic H-A-I-R:
H- Hormones. Too many male hormones, not enough female hormones or drastic shifts in hormones (as occurs immediately after childbirth) are common causes for hair loss. Imbalances of thyroid hormone, adrenal and pituitary hormones can also lead to unexpected hair loss. Major stress events can also trigger temporary hormone imbalances that can cause hair loss. These life events can work through your genes (called epigenetics) to change how your body functions, including hair growth. The stress and anesthesia of major surgeries have sometimes been linked to temporary hair loss. Fortunately, many of these imbalances can be detected in routine blood testing and your doctor can then prescribe therapies to help rebalance your hormones.
A- Auto-immune. Our immune systems are only supposed to defend us, and are never to attack us. But in auto-immune diseases, part of the immune defense system goes rogue and focuses its power on our bodies. If the joints are attacked by our own immune system, we call this arthritis (like Rheu-matoid Arthritis), and when the hair follicles are attacked, we refer to this as alopecia. The most common form of auto-immune alopecia is alopecia areata in which near perfect circles of patchy hair loss form on the scalp. Many treatments are available such as creams and injections into the bald patches which have the collective effect of reducing the immune attack on the follicles. After the immune attack stops, the hair can regrow. Auto-immune conditions may also be associated with imbal-ances in the gut, so dietary and other natural therapies can be used to rebalance an unhealthy intestinal system as part of the treatment of alopecia areata.
I- Infection/Intoxication. Topical bacterial and fungal infections of the scalp can also damage the hair and the hair follicles. Your doctor can take a culture or sample of the affected area, identify the causative organism, and then prescribe a treatment to end the infection. Covid patients have also complained of significant hair loss that starts weeks or months after their recovery. These patients typically regain their hair, but not all nor completely in some cases.
Many environmental and industrial toxins can also cause hair loss. Other common toxins like tobacco and excessive alcohol intake can lead to hair loss, too. If your job or hobbies involve chemical exposures, your doctor can order a toxicology test to determine if your exposure is significant enough to trigger hair loss. While prescription medications have many benefits, some also have toxic side effects which can include hair loss. Your doctor or pharmacist can help you determine if one or more of your medications may be triggering unexpected hair loss, and suggest an alternative if available.
R- Radical lifestyle. Poor diet, inadequate sleep, harsh hair styling, strong chemical hair treatments and coloring can all damage hair directly or the hair follicles. Healthy hair is a sign of a healthy body. So, if the mirror is showing you signs of hair loss, look a little deeper into your lifestyle and take the opportunity to improve the pillars of good health: your diet, your sleep, your stress responses, and your exercise regimen.
There are many causes of hair loss, and fortunately, there are many solutions. Work with your healthcare professionals to determine why you are losing hair and put a plan together to bring those healthy locks back. Perhaps the most important component of regrowing your hair is a heaping dose of patience. Remember that hair grows as does the tree: slow but strong.
Michael Hirt, MD, is a Harvard trained physician and the owner of The Center for Integrative Medicine in Tarzana. He can be reached at (818) 345-2828.