Hair loss

Although hair loss, also known as alopecia, is rarely serious, it can cause some distress. Understanding why it happens and whether you can manage it can help you feel better.


Day-to-day hair loss

We usually lose between 50 and 100 hairs every day. Very often, we don't even notice it's happening. Sometimes it might seem like we're losing more hair than usual, but this doesn't usually last more than a couple of days.

Human hair can be in one of three stages:

• Growing phase (anagen)

• Intermediate phase (catagen)

• Shedding phase (telogen)

There's usually a good balance on the head of hairs in these three different stages, with 85 percent of hairs being in the anagen phase. Hairs in the growing stage replace hairs in the shedding stage to keep our hair looking the same.


What is pattern baldness?

Pattern baldness is by far the most common type. It's a natural process that affects mostly men as they age (where it's known as androgenetic alopecia or male pattern baldness) although women can also experience it (it's then called female pattern hair loss). Around 50 percent of men over the age of 50 experience hair loss, however the severity of hair loss varies from one person to another. This type of hair loss is permanent.

A combination of hormonal and genetic factors are thought to be at play. Male-related hormones (also known as androgens), like dihydrotestosterone, can cause hair follicles to shrivel and produce lighter-coloured hair that's shorter in length until they stop growing hair completely. Men have higher levels of androgens, but some conditions may cause women to have more androgens than usual.

This type of hair loss often runs in families and can be inherited from both parents.


How do I know if my hair loss is because of pattern baldness?

You'll likely notice:

• A receding hairline in men

• General thinning of the hair, especially at the top of the head

• Lighter-coloured hair

You may also have:

• A family history of hair loss from either parent

• If you're a woman, a condition that causes you to produce more testosterone, like polycystic ovaries syndrome (PCOS)


What else causes hair loss?

While pattern baldness is the most common type of hair loss, there are other medical conditions that can cause hair to fall out.

Such causes can include:

• Iron or protein deficiencies caused by extreme dieting

• Sudden or extreme weight loss

• Illness

• Stress or a traumatic event

• Cancer therapy

• Certain conditions like lupus, thyroid disease and diabetes


When should I see a doctor?

If you're unsure why you're experiencing hair loss, it's best to talk to your doctor. You may be asked to have blood tests to check iron levels, thyroid function tests, or blood sugar levels, among other things.

Make an appointment with your GP if you notice any of the following:

• Burning or itching in the scalp

• Patches of hair loss

• Hair falling out in clumps

• Losing more hair than usual on a daily basis

• If you're worried about your hair loss


Are there any treatments available?

If your hair loss is due to a medical condition, then treating the condition itself can result in hair loss stopping or in the hair growing back.

Depending on the cause, there are also some medicines that can be used to treat your hair loss. Minoxidil and finasteride are the main treatments for pattern baldness. However, both of these treatments need to be used continuously to maintain any new hair growth. If you stop the treatment, you'll find that your hair is likely to begin falling out again after a few months. Before starting any medicines, discuss it with your pharmacist or GP to make sure that they are suitable for you. These two medicines are not available on the NHS.

For men aged 18 or over, finasteride tablets can be used for the treatment of male pattern baldness. These are available as a generic or as the branded version Propecia. This treatment only works for as long as you are taking the pills. Finasteride tablets need to be prescribed for you. You can access them online from the Boots Hair Loss Online Clinic and in selected Boots stores offering the service. Depending on how you wish to access the treatment, you'll need to complete a consultation online or in store, so that a clinician or a pharmacist can check whether it's suitable for you. Access to treatment is subject to availability and clinician or pharmacist approval (charges apply). Finasteride can also be obtained privately from your GP. Women should not take finasteride.

Minoxidil can be used to prevent further hair loss and help hair regrowth in men and women with pattern hair loss. It's available without a prescription from pharmacies and comes as a foam or a lotion. You'll need to watch out for any irritation of the scalp and you should avoid using it over any cuts or scratches. You can get 2 percent or 5 percent strength.


Is there anything else I can do?

Again, this depends a lot on why you developed hair loss in the first place.

Sometimes, there's nothing you can do. Often, hair will grow back on its own. This is especially true if you didn't experience complete hair loss, but instead had a higher rate of daily hair loss (telogen effluvium).

Pattern hair loss is a normal part of ageing for lots of men, but it usually happens slowly. This should help you adjust and adapt your hair style through the years.

Experiencing hair loss may make you feel upset. If it's causing you distress, let your GP know – they may be able to refer you for counselling. There are some things you can do to disguise your hair loss, particularly when it happens in patches:

• Apply spray preparations that contain coloured fibres. These sprays wash away very easily, for example with sweating, in the rain or in a shower. You'll need to reapply them every time after you brush or wash your hair

• Wear a wig or a hair piece. There is a range of quality of the hairs or fibres used to make the wigs, from synthetic fibres to using a mix of synthetic and human hair to using real hair only

• Use hair extensions, however be wary of applying too much weight to the remaining fragile hairs

• Ask a hairdresser to help you find a suitable hairstyle that covers over any bald patches

• Use tattoos or an eye pencil to draw on or fill in eyebrows


Some people find it easier to accept the condition and don't attempt to disguise their hair loss. Pattern hair loss is a normal part of ageing. Here are some things you may find useful to know:

• Remember that exposed skin on the scalp is very vulnerable to getting sunburned. Wear a hat or apply sunscreen with at least SPF15 before leaving the house

• Some prefer shaving off any remaining hair to get an even look


Other things you can do are:

• Stop smoking as chemicals in cigarettes can worsen the condition

• Eat a balanced and varied diet to make sure you get all the necessary nutrients

• Join a patient support group like Alopecia UK. You can find more information online at www.alopecia.org.uk


Next steps

• Visit your GP to understand the reason for your hair loss

• Speak to your pharmacist to explore the different treatment options available for hair loss

• Join a support group if you feel that you need help with dealing with your hair loss