Hair Loss and Medication

Taking certain medicines can cause hair loss in some people while the same medicine may not cause hair loss in others. Stopping a certain medicine can also cause hair loss in some, but not in others. In addition, certain medications can cause hair fall the first time they are taken, but not subsequent times (once the body adjusts to the medicine, the hair loss stops), or they don't cause hair loss the first time but do subsequent times (possibly due to the medicine accumulating in your system).

Sound complicated?

It is difficult to categorically say that one particular medicine causes hair loss and another doesn't, as medicines can react differently in different people.

So what particular groups of medications have been reported to cause hair loss?

The most common ones are:

· Chemotherapy medications. These can cause temporary hair loss by stopping the hair growth almost immediately (called anagen effluvium). They can also produce changes in hair texture, hair type, and pigmentation.

· Antidepressants. In particular, lithium-based medicines can temporarily disturb the hair cycle and cause hair loss.

· Thyroid medicines. Both an underactive (hypothyroid) and an overactive {hyperthymic) condition can cause the hair to fall out, as can the initial use of a thyroid medicine. Often, when a person starts taking thyroid medicine, the physician will need to vary the dosage until the correct balance is found. Some people experience hair loss during this process, up until three to six months after the dosage has been stabilized.

· Oral contraceptive pill. Either stopping or starting the pill may cause hair cycle disturbances. Oral contraceptives can affect the hormone levels, which often control hair growth.

· Other groups of medicines. Other medicines that can cause hair loss include blood pressure medications (blood thinners and beta blockers); cholesterol medicines; medications for ulcers, gout, arthritis, and Parkinson's disease; and anticonvulsants (for epilepsy).

· Vitamins and supplements. Some of these can cause hair loss such as taking too much vitamin A (in excess of 25,000 IU per day) and taking excessive quantities of "natural" testosterone boosters.

Hair loss and nutrition

Recent published research has shown that your hair needs a plentiful supply of protein, energy-producing molecules (glucose), and certain vitamins and minerals for optimal growth to occur. As the hair follicle is a nonessential tissue and, therefore, one of the last tissues to receive nutritious substances (or the first to have them reduced), any long-term deficiencies may lead to premature hair loss. Also, hair is one of the fastest-growing tissues in the body (it grows about a half inch each month), so any long-term reduction in certain nutrients to the hair follicle may disturb the hair cycle. Any nutritional disturbance to the hair follicle can cause the growing (anagen) phase of the hair cycle to become shorter, leading to an increase in shedding, and cause the resting (telogen) phase to become longer, slowing regrowth.

Protein deficiency can be a frequent cause for hair loss because insufficient levels of protein will reduce an essential raw material for hair growth. Protein helps the body build the hair fibers, which consist of 80 to 95 percent protein. This is especially relevant for vegetarians or people who eat infrequently during the day.

Eating infrequently or missing meals can adversely affect your hair cycle. If you do this over time, the amount of energy available at your hair growth site may be deficient, causing the hair to fall out prematurely.

The most common nutritionally related hair loss occurs while dieting. Severe weight loss due to dieting can often cause a temporary increase in hair shedding due to metabolic changes in the body. It has been reported that losing an excess of fifteen pounds of weight in a month can be a trigger for hair loss. The loss usually begins two to four months after the onset of the diet; however, the hair tends to regrow to its original fullness another two to six months after the weight has been stabilized.

The good news is that, usually, any short term deficiencies cause only temporary hair loss. Once corrected, hair will regrow normally. However, long-term shortages can occasionally lead to permanent hair loss as well as the acceleration of genetic hair loss, if present.

Heavy metals such as mercury, found in contaminated fish, can cause hair loss. Again, a blood test would generally help find out whether this is relevant to your condition.

Health-related causes of hair loss

So many health factors can influence your hair cycle. During your evaluation, besides asking about your general health, the hair-loss specialist should also ask you whether you have a family or personal history of a thyroid condition or anemia, two of the most common causes of hair loss next to genetics. Also, you should be asked whether you have had any recent blood tests taken within six to nine months (if you have, take a copy on your initial visit or send a copy at a later date). This will help the specialist know what other tests to suggest.

Other important health influences on your hair cycle include any recent surgery near the time the hair loss started; as anesthesia can disturb the hair cycle, as can the reason why you had the surgery in the first place. A high fever can also be a factor. A temperature greater than 101 degrees Fahrenheit (40 degrees Celsius) can cause the hair to shed.

Obviously, numerous other general health factors can be important. For example, lupus (an autoimmune disease), digestive problems, and infections may be relevant to your condition. The most important health influences are often the ones that occurred approximately four to sixteen weeks before you noticed your hair falling out.

To try to determine the possible health factors that could have caused your hair loss, write down any illnesses that you have had, either chronic (over a period of time) or short term. Make a note of when the illnesses started, how long they lasted, and any medications that you took (or are taking) for them. Then work forward three months or so to see whether that was when your hair loss began. If you noticed that your hair began to fall out approximately three months after an illness, that illness might be one of the causes of your hair loss.

Questions the hair loss specialist will ask

During the initial evaluation the specialist should ask you a series of questions to help him or her find out what could be causing the loss or thinning of your hair. Not all questions you are asked will seem relevant, though often the answer is needed to rule out certain things.

How Long Have You Been Losing Hair?

Often the trigger of hair loss occurs between four and sixteen weeks (an average of three months) previous to you seeing the hair falling out. For instance, if you see a hair falling out when washing your hair in, say, June, that hair probably stopped growing in March. This is because when the hair goes into the resting (telogen) phase, it usually takes this amount of time for it to move into the falling out (exogen) stage.

Has the Hair Loss Been Continuous?

The answer to this question will indicate whether the cause has been continuously, or only periodically, affecting the hair cycle. Continuous influences could be genetic or a chronic general health condition. Periodic loss could indicate a dietary or stress influence.

Good hair loss specialists care

Good hair loss specialists should be genuinely concerned about your condition. You're worried about losing hair, and this can often lead to anxiety and depression. The last thing you need is to be told that "It's all in your head" or "You've still got plenty of hair, so don't worry." The amount of hair that you've lost is relative to you, not other patients of the specialist.

Also, you want to make sure that every possibility is explored in finding why you are losing your hair. Because hair loss is not a life-threatening illness, many physicians are indifferent - yet hair loss often affects your quality of life, so it's important that your concerns are taken seriously.

What a scalp specialist should look for

It is important for the specialist to look at the scalp to see whether there is any flaking, itching, redness, acne-like breakouts, or other lesions. Although a lot of scalp conditions don't cause hair loss and are just cosmetically annoying, some can increase hair shedding or indicate what is causing the hair-loss problem.

You should be asked whether you have any periodic scalp tenderness (called trichodynia). The scalp can be sensitive for many reasons, so it is important for the specialist to ascertain the possible cause.

If you are in doubt about any scalp condition, or if your scalp feels constantly tender for any length of time (such as more than a few days), I suggest you see a specialist.

What to expect from a hair loss specialist

As there could be many things causing your hair loss, it is important that the specialist you see spends time with you. The specialist should look at your hair and scalp, take a full medical/lifestyle history, suggest blood tests, help you cope with your condition, and discuss all of your treatment options. Sometimes, the specialist needs to eliminate one factor before moving on to the next. Remember, many different factors may cause your hair to fall out. It is important to find each one so that any treatment you receive will be more effective.

This may sound obvious, but you would be surprised by how many people have said that a specialist they had seen either didn't look at their hair at all or only quickly glanced at it. The specialist should look at both your hair and scalp to see the distribution of your hair thinning, which can often indicate why it is falling out. By comparing the partings at different positions — for instance, the crown area, front area, sides, and back — differences in hair quantity can be seen and the amount of thinning can be determined. The distribution of hair could indicate the presence of a genetic condition or traction hair loss (also known as hair breakage), among other conditions. The specialist should also do a pull test in different areas of your scalp to see how much hair is coming out.

Also, the specialist may look at the hair under a regular microscope (usually a trichologist will do this) or take a biopsy of the scalp (only a physician is able to do this).

Thoughts on dermatologists

Although dermatologists are physicians that treat the skin, hair, and nails, not all specialize in hair loss. Therefore, before making an appointment, make sure that the dermatologist is up-to-date with the most recent hair loss research and takes the psychological impact of hair loss as seriously as he or she should.

Hair loss can cause a lot of emotional stress, and a dermatologist may not be able to give enough time during the appointment to discuss these emotional concerns. Find out whether a properly trained nurse or receptionist in the dermatologist's office has the role of helping you with emotional support.

Dermatologists are able to prescribe medicines that are not over the counter, such as Propecia for men or corticosteroids for conditions such as alopecia areata or psoriasis. Dermatologists can also do biopsies of the scalp, if the condition warrants that approach.

Choosing a hair-loss specialist

You feel that your hair is thinning and/or falling out. Now what should you do? Well, the first step is to find out why your hair is falling out. This will help point you in the right direction for choosing the treatments that are best for you. Therefore, make an appointment to see a hair-loss specialist such as a dermatologist or a qualified trichologist.

When searching for a hair-loss specialist, ask questions. Many people are afraid to ask the practitioner's office staff questions, for fear of sounding ignorant or being difficult. However, if you're worried about losing your hair, then you want to see someone who knows what he or she is talking about.

When you call an office, before making an appointment make sure that the replies to your questions make sense and that the person on the other end of the phone is helpful. Rightly or wrongly, if the secretary or receptionist is uncooperative, then it may indicate that the office in general (including the hair-loss specialist) could be unsupportive. Let's face it. If you need to call the office in the future about making further appointments or refilling prescriptions, the last thing you want to deal with is an unfriendly receptionist. The effort a company puts into their first point of contact can tell you a lot about them...

When professionals say the wrong thing

Some of the things I've heard that have been said to people with hair loss have been extremely hurtful. You would think that a physician or specialist would have a better bedside manner or show some empathy, but unfortunately some practitioners don't grasp the fact that many people with hair loss are worried and upset.

I've heard of one hair-loss specialist who said to a woman, "You're halfway through your life, and you've lost half your hair ... that seems fair." You can imagine why she ran out of his office crying!

Another physician not only showed no sympathy for a man's hair loss but also doubled the insult when he said, "It's a shame you're so short. People wouldn't be able to see your hair loss if you were taller." As you might expect, he wasn't too pleased.

Hair loss often contributes to a loss of self-esteem and increased anxiety and depression, so comments of this sort really aggravate people's concerns. What can you do if something like this is said to you? I suggest leaving the office immediately and complaining to the board through which the practitioner is licensed. Also, look for a professional who has been personally recommended to you by a friend. Lastly, try not to let it affect you. It is the specialist who has a problem - not you.