Ask the Geriatrician

Question: What causes hair loss? How can my primary care doctor help treat it?

Answer: Most hair loss is due to a benign inherited condition called androgenic alopecia. (Unless of course you have teenagers living in your house, then the cause is much more obvious). This type of hair loss comes with age and affects about one- third of all people, and affects men and women equally. It is not related to any type of sickness and has no physical consequences; however, the emotional consequences can be severe. In men, the hair loss follows a familiar pattern, with the temples and front hair line receding, and the vertex of the scalp also affected. In women, it is usually more evenly distributed and often is easier to hide.

When people notice hair loss, they will often visit their doctor to make sure they are not sick, and try to find out if anything can be done about it. There are a few medical conditions such as underactive thyroid, anemia, and other unusual hormone problems that can lead to hair loss. Your doctor can test for them to make sure, but most of the time hair loss is not due to a sickness. So if there is any good news about this, it is that hair loss is only cosmetic in most cases and it can be effectively treated.

You are born with every hair follicle you will ever have, and each hair has a life cycle. A person with a normal scalp sheds 75 hairs every day. The growth phase for a hair is 2-3 years, after which it enters a resting phase. After 3-4 months of rest it falls out and a new cycle begins.

The most effective treatments for hair loss are medicines, including over-the-counter minoxidil and prescription finasteride. Minoxidil is a scalp treatment (the 5% is better than the 2%.). If the hair loss is not extensive and has not been there for over 5 years, it can not only keep hair from falling out, but strengthens and lengthens the life of individual hairs so that some of the thinning areas can improve. It can take 6–12 months to see the full effect of using minoxidil, and you have to use it every day. Minoxidil is not a cure for hair loss, only a treatment, so if you stop, everything goes back to the way it was. It is equally effective for men and women, but you have to be careful to use it like the label says, because—like any other medicine—if you don’t it can make you sick. 

Finasteride is only for men because it works by reducing a form of testosterone that women do not have. Not only does it not work for women, but it can be dangerous to women of childbearing age, particularly to a developing male infant. It is a once-a-day pill, and the results are about the same as minoxidil, but pills are easier to use than a topical scalp product. 

Vitamins, herbs, tonics, potions, lotions and other kinds of snake oil things are pretty much useless and are often dangerous (and best avoided). Use the real stuff instead of the fringe products and you will likely have better results.

Stanley Savinese, D.O., is a physician who specializes in family medicine, geriatrics and palliative medicine. He has an office in Glen Mills, and can be reached at (610) 579-3555.

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