“I can see through my hair.” I often hear this as a dermatologist. The first question I always ask is whether short hairs versus long hairs are found on the pillows, on the bathroom floor, in the shower, or in the brush/comb. I ask this question primarily because short hairs are evidence of breakage while longer hairs lost can point to other hair loss conditions.

Breakage:

If someone is experiencing breakage, I further ask about the hair care regimen and products. Hair grows at an average set rate and length that is inevitable, however, retention of length depends on factors including moisture content of the hair and daily hair care. If your hair is processed with color, perms, relaxers, texturizers, etc., this changes the inherent pH of the hair and can allow for dehydration and a dry, fragile hair shaft. Daily wear and tear on fragile hairs further leads to breakage and split ends. If enough hair is involved, the ends of your hair will appear uneven and the density will become thinner the further down the hair you travel. A quick way to test for breakage at home is to grab a strand of hair and do a quick bend and tug. If the hair snaps, there is a fragility factor. Also look at the entire length and at the end to assess for splitting and frayed areas. Lastly, place a sheet of white paper behind your hair and have someone take a photo. If you can see a large portion of white paper through your hair, that is breakage. The more breakage, the more visible the paper until it starts tracking up higher in the hair.

Shedding:

If long hairs are found on the brush, floor, pillow, clothing, etc., there may be a concern for a shedding condition called telogen effluvium. Telogen effluvium is an excessive shedding phase that is reversible and does not destroy the follicles (non-scarring). Triggers include starting and stopping medications, especially hormones and supplements, health conditions (anemia, thyroid, malnutrition, pregnancy, birth), and sudden stressors (illnesses, surgeries, crash diets, stressful event).  My patients will report diffuse shedding and thinning hair all over the scalp. The solution is to find the stressor and remove it. If it was a one-time event, when the stressor has finished, the telogen effluvium must run its course and fade out. I always counsel patients that it is an unknown amount of time for which the hairs will exit out of this effluvium and enter back into their normal cycles. If the shedding is occurring for a long time or if the patient feels more than 50% of their hair density has been lost, I will intervene with medicine to stop or slow down the natural process and help prevent further shedding.

A similar story of long hairs shedding rapidly can also occur from another shedding condition called anagen effluvium, commonly seen with medications that stop rapid cell growth and often with chemotherapy. This condition is also non-scarring and is reversible. Interestingly, with regrowth after these medicines, the hair may return a different color or have a new curl pattern.

Genetics:

Lastly, I evaluate an interaction of factors such as age, nutritional status, and family history. Male and female pattern baldness is prevalent, and I not only ask about hair loss in male family members but also about hair loss among female members.  I check hormone levels to make sure there are no internal factors driving this condition. There are a few topical and systemic (oral pills) regimens that will help. Often, these regimens regrow hair, thicken the hair, and help hold off the patient’s hair loss for years as long as they continue their treatment regimen.

Other reasons:

A close look at the scalp is necessary as all hair thinning is not due to breakage, shedding, or genetics.  There are inflammatory, scarring (follicles turn to scar tissue and cannot grow a hair), and permanent hair loss conditions that do warrant medications to slow or stop the process, and I specialize in diagnosing and treating these conditions. Early assessment and diagnosis is important to prevent diffuse permanent hair loss. Other permanent hair loss disorders can occur from tight braids, removing glue-in weaves, continually wearing wraps or headbands around the edges, and chemical burns. We will talk about these conditions and how to prevent them in future articles.

In conclusion, hair thinning is very common either for medical or cosmetic reasons. If you’re experiencing hair thinning, seek guidance from your local cosmetologist and dermatologist for treatment of medical conditions and to help correct moisture imbalance so you can regain your thick healthy hair.