The fallout of hair loss: Suffering in silence

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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