Diagnosising Hair Loss – Tips and Tricks for the Home Investigator

Androgenetic alopecia – also known as pattern hair loss, can happen to anyone.  It is most likely to occur in men starting in their late teens through their fourth or fifth decade, and in a woman from her teen years into post-menopause years.  Despite how common it is, it can be difficult to diagnose.  If you think you might be at risk, here are a few simple ways to help diagnose it.

Family History

Do the women OR men in your family have hair loss?  Does balding occur in your brothers, your Mom, or your Aunt Millie?  Family history is not a perfect predictor of hair loss, but because of the way the genetics work, it increases the chances that it might affect you.  Technically, the genetic inheritance for pattern hair loss (AKA androgenetic alopecia) in general is called “autosomal dominant” – which means that you can get the gene from either Mom or Dad.  However, it also seems to have the medical genetic characteristic called “incomplete penetrance.”  This means that you might have the gene and not necessarily manifest the symptoms.  Confusing and frustrating? – You bet.  Still, looking at your close relatives is still a solid indication of the direction your hair might be heading as you age.

Pattern

No – not like when you are sewing.  The pattern of your hair loss can help you to diagnose what might be causing it.  For instance, men who lose their hair generally follow the pattern described by a doctor named Norwood.  They lose hair in the temples (a little is normal for a mature male, by the way) and the “bald spot” at the back of the head, and then it all thins out on top from there, eventually becoming squeaky bald like Mr. Clean.  For women, androgenetic alopecia makes the hair volume decrease diffusely all over the head, but is most noticeable behind the hairline on the top and sides (like along the central part).  Patchy hair loss, like an area that all falls out and then re-grows, is indicative of other types of alopecia, like alopecia areata, and should be examined by a doctor who specializes in hair.  Diffuse hair loss all over the head can be normal!

Hair Count

We all lose hair through the natural process of shedding and re-growth.  However, it can also herald the onset of androgenetic alopecia in both men and women.  So how much hair loss is too much?  A good way to determine this is to conduct a hair count.  To do this you need to collect all the hair from your brush, shower drain, and pillow for one week.  Collect each day in a bag from just those sources and then average the daily counts.  An average count should be less than or about 100 per day.  Sound tedious?  It is, but it can also provide a solid benchmark and a much-needed reality check for those paranoid persons among us who worry that their hair loss might represent something more serious than a “seasonal shed.”  This is also good information if your shedding had a sudden onset and you are seeking medical advice since a doctor may ask you to conduct a hair count for a week to obtain this daily average.

Want an additional indication as to whether or not the hair you are holding represents a shed hair versus a broken one?  Look or feel for the nubbin at the end of the hair shaft.  If it is there, it usually indicates that your hair was released as part of the natural re-growth cycle.

If these little home tests have you more worried than reassured, the next step is to seek help from a medical professional.  Not all doctors are trained to know what constitutes abnormal hair loss, so it is worth seeking the opinion of a dermatologist or hair doctor if you are very concerned.  Labs (bloodwork), a hair-pull test, scalp exam, and even a biopsy can all elucidate trickier hair loss conditions.  The important take-home message is to seek help early, since treatment efficacy greatly depends on prompt and accurate diagnosis, and no one wants to live with hair loss if it can be prevented.

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