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Hair loss: The Optum Store Guide

16 minute read
Man checking for hair loss in front of the mirror

Whether you’re male or female and have mild thinning or actual balding, there’s help. Learn about the causes of hair loss, whether it could be a sign of other health problems, and the newest treatments.

Jennifer Howze

By Jennifer Howze

Losing your hair can be worrying and confusing. And unlike late-night infomercials would have us believe, it isn’t something that happens only to older men.

Around 30% of women will experience hair loss sometime in their lives, according to Harvard Medical School. And about 25% of bald men experienced hair loss before age 21. Overall, up to 70% of men experience some hair loss as they age, according to the Cleveland Clinic.

Hair loss can be caused by genes (you may inherit the condition), diseases or medications. It can even be triggered by major life events (such as pregnancy or a divorce) or hairstyles that stress the roots and scalp.

Dealing with hair loss is especially challenging because it’s visible. For many people, hair is tied to their identity. Losing it can feel like losing part of oneself. Add to that the fact that hair loss can signal a larger health problem and it can lead to the kind of stress that, well, makes you want to pull your hair out.

Thankfully, there is help and hope. And taking early action may shorten the period of hair loss and get growth back to normal more quickly. Here, learn about the causes, risk factors and best treatments, depending on what’s at the root of it all.

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The basics of hair growth and hair loss

It may seem like our hair grows all the time, especially in places we don’t necessarily want it to, such as the tops of our toes or out of our ears. But in fact, all hair on the body has a 3-stage growth cycle, which includes a falling-out period:

  • Stage 1: In the anagen phase, hair grows. Around 85% to 90% of your hair is in this phase at the same time. The amount of time that hair grows in this phase depends on where it is on the body. Hair on your scalp spends a bounteous 2 to 6 years growing, while the hair on your thighs enjoys mere months.
     
  • Stage 2: Next comes the catagen phase, or the transition phase. In this stage, the follicles shrink, and it lasts for a few weeks.
     
  • Stage 3: After the follicles shrink, hair enters the telogen phase, also known as the resting phase. This stage is when hair falls out, and it lasts for 3 or 4 months. Then the cycle starts over again.

Hair loss disrupts this normal cycle. Depending on the cause of the hair loss, follicles may be affected in ways that shorten or lengthen the time spent in a certain phase. Or the follicles may become so damaged that they can no longer grow hair at all.

What is alopecia?

You may have heard of alopecia. Simply put, it means hair loss in places on the body where it would normally grow.

We often think about hair loss as occurring just on the scalp, but it can also affect eyebrows, eyelashes, beards, or other parts of the body where hair usually grows. It might be temporary, long-term or even permanent, depending on the causes and treatments. It can also show up in a variety of ways, including thinning, patchy hair loss or complete baldness.

Should I worry about hair loss?

People naturally lose approximately 50 to 100 individual hairs every day. But if you notice a sudden or increasing difference in the thickness of your hair, it’s a good idea to seek a doctor’s advice, especially if it’s bothering you. (Learn more about the difference between normal shedding and actual hair loss.)

Here are some signs you may be experiencing hair loss and may want to check with a doctor:

  • Your scalp is more visible at the hairline.
  • Your natural part seems to be widening and thinning.
  • Your ponytail isn’t as thick.
  • You have more hair than usual coming off in your brush or circling the drain while showering.

Here’s a quick list of things that cause hair loss, which we’ll explore in more detail:

  • Genetics
  • A reaction to a stressful event such as a divorce or a death
  • Inflammation, such as with alopecia areata (an autoimmune condition) or scarring alopecia
  • Physical damage to the follicles
  • An imbalance of hormones or nutrients
  • A reaction to medication

What kind of doctor should I see about hair loss?

A general practitioner or your family doctor can help diagnose hair loss and possibly treat it. But dermatologists are specially trained in addressing hair loss and will be able to tell you whether you’re experiencing male- or female-pattern hair loss (the most common version for both genders). They’ll also be able to tell you if the loss might be related to something else. The doctor will examine you, take a thorough history and possibly run tests to determine the cause.

Need help right now? Just answer a few questions about your medical history and an Optum provider can tailor a treatment for you. Low-cost medication can be delivered discreetly to your door. Get started.

What are the main types of hair loss and treatments?

There are several types and causes of hair loss.

Male-pattern and female-pattern hair loss

In both men and women, pattern hair loss (androgenetic alopecia) is caused by the same thing: androgens. Androgens are hormones that control a host of processes in the body, including hair growth. The most common androgen is testosterone.

In the body, testosterone is turned into dihydrotestosterone (DHT), which experts think is related to growth and hair loss. The processes behind androgenetic alopecia are not entirely clear, although there is a genetic component and evidence that it runs in families.

Androgenetic hair loss typically occurs because of a combination of natural hormone changes (such as menopause) and genetics. And although there is often a hereditary component, you can also develop it without any family history.

Rarely, there can be other causes, such as a tumor, that affect androgen production. A doctor will determine whether you need to consider these less frequent causes when they take your medical history and examine you.

With both male- and female-pattern hair loss, the growth period shortens, and the follicles can shrink until they stop producing hair entirely. The individual strands can also become shorter, thinner and lighter.

Although the cause is the same, there are some differences in how male- and female-pattern hair loss develops and how they're treated.

Male-pattern hair loss: In men, hair loss can begin any time after puberty. It typically starts at the temples or creates an “M” shape at the hairline, with thinning on top. Its progression is usually slow, spanning years or decades. But men may eventually experience complete baldness if it’s left untreated. There’s no cure, but it can be slowed down.

There are several treatment options for male-pattern hair loss, including:

  • Minoxidil (known by the brand names Rogaine® and Theroxidil®). This is an over-the-counter medication to treat hair loss, which comes in 2% and 5% solutions. It’s applied twice a day, either with a dropper or rubbed in as a mousse.

    Your doctor can recommend the kind and strength that’s best for you. You have to keep using minoxidil to maintain any regrowth, and you’re unlikely to revert completely to your former fullness. But it is the most common treatment for male-pattern hair loss. Side effects can include an itchy or irritated scalp.

  • Finasteride (Propecia®, Proscar®). This is a prescription pill that can slow hair loss in up to 90% of the men who take it, according to research published in The Lancet. And it may encourage new growth if taken at the first signs of loss. It takes about 3 to 6 months before you begin to see results, and it can be used along with minoxidil.

    Its side effects can be more serious than those of minoxidil. They can include a drop in libido, erectile dysfunction, breast tenderness and depression. In some users, these side effects may continue after stopping the medication.

    As with minoxidil, you have to keep taking it to maintain the results. Finasteride is not recommended for women because of the risk of birth defects.

  • Hair transplant. This is a longer-lasting treatment and is usually recommended only for people with dramatic hair loss. The days of obvious hair plugs are mostly in the past. The technology has gotten better over the past few decades, resulting in much more natural-looking hair.

    Most doctors use follicular unit transplantation: A strip of scalp with healthy hair growth is trimmed and harvested. The strip is divided, and tiny grafts of up to four follicles are placed where needed. (Doctors may also use follicular unit extraction, in which follicles are taken individually from the scalp, rather than removed as a strip and divided.)

    The process can be automated as well, using robotics to harvest and place the hair. You’ll need enough hair to harvest and the ability to grow hair in thinning areas.

  • Platelet-rich plasma (PRP). For this treatment, doctors take your blood and process it to separate the platelets from the plasma. Then they inject the plasma into your scalp. Platelets promote cell regrowth, and they may stimulate a special type of cell in the follicle that plays a role in hair growth.

    The whole process, from preparing the blood to injecting it, takes about 30 minutes. Within a few months, the hair begins to regrow, and some people even see thickening or regrowth. PRP can also be used in conjunction with transplants.

    Patients need to follow a regular regimen of injections to keep seeing results. It’s less effective in people with thyroid issues, lupus or other underlying disorders, as well as those on blood thinners.

  • Laser devices. Tools such as the HairMax® LaserComb can help improve hair density, and some have been approved by the U.S. Food and Drug Administration (FDA). You can use them at home. The devices work by using low-intensity light — called low-level laser therapy — to stimulate growth during the anagen phase.

Female-pattern hair loss: This is the most common cause of hair loss in women, and it often begins in middle age. Female-pattern hair loss is common as women get older. It’s often due to aging, genetics or possibly the hormonal changes associated with menopause. Usually, the hair part widens and the hair thins overall, making the scalp more visible.

Women rarely lose all their hair, even if they don’t get treatment. As with male-pattern hair loss, there is no cure. Treatments can slow its progression.

As with men, women can benefit from hair transplants, laser devices and PRP, too. Plus, there are a couple of treatment options for women that are just for women:

  • Minoxidil (Rogaine for Women®, Theroxidil® and other versions). This is the only medication approved by the FDA to treat female-pattern baldness. It’s available over the counter, and it comes in 2% and 5% strengths. It can be applied with a dropper or as a foam. It also poses minimal risk when breastfeeding, according to the Mayo Clinic.

    It takes about 2 months before results start to appear. As with men, the results don’t last if you stop using the product. Side effects can include skin irritation, a change in hair color and texture, or excessive hair growth on the face.

  • Spironolactone (Aldactone®). This medication, which is sometimes used to lower blood pressure, can reduce the androgens that increase hair loss in women.

    Doctors frequently pair it with a prescription for birth control pills in women of childbearing age, because women shouldn’t become pregnant while taking spironolactone due to the risk of birth defects. Spironolactone can also decrease libido, as well as cause weight gain, depression and fatigue.

Want to learn more about women and hair loss? Get the facts now. 

Telogen effluvium

A dramatic event can bring about a type of hair loss called telogen effluvium (TE): This happens when a large number of follicles enter the resting phase all at once. The trigger might be an illness, such as COVID-19, or another major event that stresses the body, such as childbirth or surgery.

One sign of TE: Hair begins coming out in clumps about 3 months after the event. Dermatologists see a lot of cases of telogen effluvium. Luckily, it rarely leads to complete baldness. While it can be troubling, it means your body is prioritizing smartly: Instead of focusing on growing hair, it shuts down that task in order to zero in on other things.

Certain medications may also trigger TE. Some examples are anticoagulants, antidepressants, beta-blockers, retinoids and interferon. When the medication is stopped, the hair should start to regrow after a few months.

TE can be treated with minoxidil. But ultimately, it’s a matter of time: You have to wait for the resting follicles to wake up and start growing hair again. That can take 6 months or longer.

Alopecia areata

Alopecia areata is an autoimmune condition in which the body attacks the hair follicles. Hair loss from alopecia areata often takes the form of round patchy or bald spots. It can occur anywhere on the body, including the eyebrows.

Alopecia areata may start during childhood or the teenage years. Doctors don’t know exactly what causes it, although about 20% of people who experience it have a family member with alopecia, according to the Genetic and Rare Diseases Information Center. To diagnose it, your doctor will examine the patch and possibly run blood tests.

Doctors treat alopecia areata with several medicines, some of which target the inflammation associated with the condition. These include:

  • Minoxidil
  • Corticosteroid creams or injections
  • Anthralin cream 

Traction alopecia

Sometimes your hairstyle can cause hair loss. Styles that pull on the follicles — such as cornrows, weaves, braids and tight ponytails or buns — can damage the scalp, leading to hair loss. If styles can be safely adjusted early enough, the hair will regrow.

By considering alternate styles, removing braids after 2 or 3 weeks and not using accessories that pull, you can avoid this type of loss.

Scarring hair loss

Scarring hair loss (also called cicatricial hair loss) is hair loss that destroys the hair follicle and results in permanent hair loss. It’s associated with a variety of factors, but it does not always have a single known cause. Below are two versions of scarring hair loss.

Lichen planopilaris. This is a rare form of hair loss in which a common skin disease called lichen planus affects the scalp. In addition to the scalp, lichen planus can occur on your skin, inside your mouth or on your nails and genitals.

Doctors don’t know what causes it, although it may be triggered by hepatitis C or a reaction to metal tooth fillings. It may also be caused by an autoimmune reaction in which white blood cells start attacking the skin.

People with lichen planopilaris develop a red and irritated scalp, flakiness, burning, tiny bumps on the scalp and patchy hair loss. Over time it can destroy the hair follicles and cause permanent hair loss. To diagnose lichen planopilaris, doctors biopsy the skin and examine it under a microscope.

There’s no cure for lichen planopilaris, and sometimes it can clear up on its own. Treatment focuses on controlling the symptoms. Doctors may prescribe corticosteroids in the form of a cream, injection or pill. Other options include the antimalarial medication hydroxychloroquine (Plaquenil®) and applications called retinoids that are derived from vitamin A.

Central centrifugal cicatricial alopecia (CCCA). This condition affects Black women almost exclusively. It typically starts at the crown of the head and radiates out in a circular pattern. (“Centrifugal” means moving away from the center.)

It tends to start around age 30 to 40 and can result in permanent hair loss by scarring the scalp so that hair doesn’t grow back. Researchers theorize that CCCA may be the result of genetics, as CCCA tends to run in families. Another theory: CCCA may be caused by an autoimmune disorder in which the body attacks the hair follicles.

Certain styling practices, including the use of hot combs, relaxers and tight hairstyles, may also play a role.

Doctors can use a variety of treatments to stop the inflammation that damages the hair follicles. These include:

  • Topical solutions, such as shampoos, that are applied to the area where you’re losing hair to address inflammation, itching or redness.
  • Minoxidil, which can encourage hair growth, and medications that suppress the immune system, which can slow the progression of CCCA.
  • Changing your hairstyling practices so that you’re not stressing your follicles.

Polycystic ovary syndrome (PCOS)

Women with PCOS produce a higher-than-normal amount of male hormones. As a result, they experience something called virilization. That means they develop male traits such as thicker hair growth on the face and body, including on the chest, stomach and back. They also develop a deeper voice, less regular periods, smaller breasts, a larger clitoris and hair loss on the scalp.

Because PCOS is caused by having too many male hormones, antiandrogens such as spironolactone can help.

Iron deficiency

The mineral iron is vital for hair growth and health, and in some people an iron deficiency can cause hair loss. Women of childbearing age who menstruate may be especially at risk. Your doctor can do a blood test to see if your iron level is low.

If you do have an iron deficiency, your doctor will likely recommend that you take a supplement and include more iron-rich foods in your diet. Red meat, beans, spinach and other leafy greens are good sources of iron. Note that iron from plants isn’t absorbed as easily as iron from meat. (Curious about other supplements that can promote healthy hair? Read this.)

Thyroid imbalance

A thyroid imbalance can be a pretty common source of hair loss as well, and experts say it’s important to consider it as a possible cause. Your thyroid produces hormones that help regulate your metabolism.

If there is too little or too much thyroid hormone in your body, you can experience hair loss as a symptom. But hair loss is most common in cases of hypothyroidism, in which the thyroid gland produces too little of the hormone. This results in thinning hair or hair that falls out in clumps. Your doctor can do a blood test to check your thyroid level.

Once you begin thyroid hormone treatment, your hair growth-and-rest cycles should stabilize, and your hair will begin to grow back.

Chemotherapy

As you probably know, chemotherapy can result in hair loss (although not all chemotherapy medications have this effect). Chemo medications attack the cells that grow hair during the anagen phase. Hair loss can happen anywhere from a couple of days to a couple of weeks after a chemotherapy treatment.

Chemotherapy patients can experience total hair loss or thinning or patchy hair loss. Usually, the hair regrows once the treatment ends, although it might temporarily grow back with a different color or texture (curly rather than straight, for example).

A scalp cooling cap worn during the infusion can help prevent chemotherapy-related hair loss. These are closely fitted caps filled with a cooling liquid that reduces the amount of blood flow to the scalp, thus reducing the amount of medicine that affects the follicles. For patients at risk of cancer in the scalp area, however, this isn’t an option. And although minoxidil won’t keep your hair from falling out, it can help with regrowth after chemotherapy.

Will I get better?

There is every reason to think your hair loss can improve. Researchers are constantly making strides in understanding how hair grows, why it stops, and how to get everything back on track. While it depends on the type of hair loss you have, in some cases hair loss can not only be slowed but reversed. The sooner you seek help, the higher the likelihood that your doctor can identify the underlying cause and begin the appropriate treatment.

Whatever type of hair loss you’re experiencing, there is no need to feel embarrassed or reluctant to reach out for help. Hair loss can be stressful, and you don't have to deal with it alone. Experts can help you explore its causes and decide on the proper actions to take.

Young man running his hand through his hair for a story about hair loss
Struggling with hair loss?

Get discreet care from the comfort of home. No appointments are required and medication can be delivered straight to your door. Plus, we're open 24/7.

Our expert panel

Garry Choy, MD
Optum expert; deputy chief medical officer, clinical systems, Office of Chief Medical Officer and Medical Affairs, UnitedHealth Group, Irvine, California

Leo Galland, MD
Board-certified internal medicine doctor specializing in chronic disorders, New York City

Susan Huang, MD
Board-certified dermatologist, Irvine, California

Rajani Katta, MD
Dermatologist and author of Glow: The Dermatologist’s Guide to a Whole Foods Younger Skin Diet, as well as a member of the Voluntary Clinical Faculty of both the Baylor College of Medicine and the McGovern Medical School, University of Texas Health Sciences Center at Houston

Additional sources

Hair loss statistics: Harvard Medical School (2020). "Treating Female Pattern Hair Loss"

Male pattern hair loss: American Academy of Dermatology (2021). "What is Male-Pattern Hair Loss, and Can It Be Treated?"

Finasteride safety study: The Lancet (2021). "Safety and Efficacy of ALRV5XR in Men with Androgenic Alopecia"

Finasteride side effects: Neurobiology of Stress (2020). "Post-Finasteride Syndrome"

Hair transplants: Clinical, Cosmetic and Investigational Dermatology (2015). "Hair Restoration Surgery: Challenges and Solutions"

Minoxidil for women: Skin Therapy Letter (2014). "5% Minoxidil: Treatment for Female Pattern Hair Loss"

Traction alopecia: University of Iowa Hospitals and Clinics (2017). "Traction Alopecia: A Type of Hair Loss"

Minoxidil and breastfeeding: Mayo Clinic (2021). "Minoxidil (Topical Route)"

Laser devices: Lasers in Surgery and Medicine (2014). "Low-Level Laser (Light) Therapy (LLLT) for Treatment of Hair Loss"

CCCA: Journal of the American Medical Association (2020). "Central Centrifugal Cicatricial Alopecia"; Skin of Color Society. "Central Centrifugal Cicatricial Alopecia (CCCA)"