When a person notices they’re losing their hair, their first question is usually, “Why?!” The assumption many automatically make is ‘male pattern baldness‘ (which occurs in women too, by the way). However, you might not be aware that there are many reasons why someone’s hair would fall out.

Recently, I sat down with Dr Alan J. Bauman – Founder, CEO & Medical Director of Bauman Medical in Boca Raton, Florida – and picked his brain on this very subject. Dr Bauman’s reputation precedes him: as a hair transplant surgeon with decades of experience and more than 8,000 surgeries behind him, he’s pioneered some of the most advanced technologies in the treatment of hair loss and is internationally recognised as a leader in his field. He’s also one of the founding faculty members of the recent Global Hair Loss Summit, where he provided unprecedented insight into his knowledge in this field and regenerative medicine.

If anyone can detail the top causes of hair loss, it’s him. I’m sure some of the entries below will surprise you.

The Genetic Roll Of The Dice

They say you can’t choose your family and the same goes for your genetics. You get what you’re given and for many people (men and women), that includes Androgenetic Alopecia (AGA), more commonly known as ‘male pattern baldness’.

There are around 200 genetic markers that impact on your hair and hair growth. Your mother or your father – or both – pass these genes down and if you’re unlucky enough to be the recipient of a particular gene that’s responsible for AGA, your follicles will be more sensitive to your body’s natural hormones.

This gene progressively miniaturises the follicles and you’ll notice the typical ‘pattern baldness’ of a receding hairline, thinning hair and/or balding at the crown.

What Can Be Done?

If you have family members with this kind of hair loss, you can undergo a genetics test to determine how likely you are to lose your hair. If the risk is moderate to high, you can seek specialist advice and start preventative treatment early, before you lose volumes of hair.

Autoimmune Conditions

A number of autoimmune diseases such as alopecia areata, alopecia universalis, lupus, Hashimoto’s disease, Graves’ disease, Crohn’s disease, rheumatoid arthritis and psoriasis can cause partial or complete hair loss. In patients with alopecia areata, the body’s immune system mistakenly attacks the hair follicles, causing the hair to fall out, sometimes in clumps, leaving bald patches of varying sizes on the scalp. It can also result in total baldness and the loss of eyebrows, eyelashes, body hair and pubic hair.

It’s important to note that in some cases it’s not the disease itself but the medications used to treat it that causes hair loss.

What Can Be Done?

See your doctor first for a referral to a specialist or an immunologist. At Dr Bauman’s practice, eyelash, eyebrow and even pubic hair transplants are offered alongside traditional hair transplantation.

What Are You Taking?

Take a look in your medicine cabinet. What are you taking on a regular basis? I’m not just talking about prescribed drugs but also supplements. A host of medications list hair loss as a side effect. They include cholesterol-lowering drugs, blood thinners, some blood pressure meds, some antacids, psoriasis pills, anticonvulsants, gout medication, acne treatments like isotretinoin, antifungals and steroids.

It’s well known that anti-cancer drugs lead to hair loss, and not just on the head. Full body hair loss is common.

Sometimes, coming off a medication can cause hair loss. For instance, some birth control pills can contribute to healthy, thick, glossy hair, but once ceasing them, can result in the opposite effect for a while.

What Can Be Done?

Check the possible side effects of any existing medication and if you’re concerned then consult your doctor to see if there is anything that can be done without compromising your treatment plan.

What Are You Eating? (Or Not Eating?)

It seems like there’s a new diet in town every day, doesn’t it? The problem with fad diets – yes, Paleo, South Beach and Ketogenic, I’m looking at you – is that they’re usually highly restrictive on one or more elements. Whether it’s vastly reducing carbs, eliminating grains or skipping dairy, strict, inflexible diets can lead to deficiencies in vitamins, minerals, antioxidants, protein, iron or other elements.

When your body’s depleted of certain nutrients, hair follicles can be forced into a kind of ‘hibernation’ phase. The hair strands are shed and no new hair grows in their place.

What Can Be Done?

Get help from a dietitian or nutritionist to ensure you eat a balanced diet that will give you the antioxidants, iron, zinc, Vitamin B, protein and biotin you need to promote a healthy head of hair.

Shred Your Bod, Lose Your Hair

When your resistance and weight training regimen is too high in intensity, you produce more endogenous testosterone. That converts to DHT, which can cause your hair follicles to stop producing hair. I know, I know, it’s totally unfair. The very things you want from working out – lean muscle mass, healthy libido, increased energy and brain function – could be what sends you partially bald. Look for balance.

What Can Be Done?

To stave off the conversion of testosterone to DHT, you need to inhibit the production of the enzyme 5-AR (5-alpha-reductase). 5-AR inhibitors include finasteride, dutasteride and herbal supplements such as Saw Palmetto. Or, dare I say it, ease off on the shredding.

A Healthy Head Of Hair, Up In Smoke

If you needed just one more reason to quit the cancer sticks, hair loss could be what gets you over the line. Smoking actually speeds up ageing-related changes in your body and as such, restricts blood flow to your skin and your hair follicles. That means vital oxygen and nutrients can’t get through to where they’re needed.

Studies have shown that the more a person smokes, the worse his or her baldness will be. Oh, and before you reach for the e-cigs, be aware that vaping affects your blood flow in exactly the same way.

What Can Be Done?

Quit. If you can’t manage it through sheer willpower (and few can), talk to your doctor about the quit smoking options available to you. And do it for your whole body health, not just because your hair is falling out.

Your Sleep Is Out Of Whack

So many of us forget that sleep is one of life’s basic necessities. The odd late night here and there doesn’t hurt but if you’re chronically sleep deprived, experience jet lag on a regular basis, work night shifts or you have a condition like insomnia, your hair may suffer.

Scientists believe that when your body’s circadian rhythm is disturbed, your hair follicle cycle can be interrupted. The result can be shedding and even full-blown hair loss.

What Can Be Done?

See a sleep specialist for a diagnosis of sleep apnoea, insomnia or other disorders and get treatment. Try to alter any negative lifestyle habits such as gaming into the early hours or using your phone for extended periods in bed.

Frazzled Nerves

It’s no surprise that stress wreaks havoc on our bodies; sometimes in acute ways that we fully expect such as headaches and rashes, while other impacts are chronic and play out over a much longer period.

Stress is responsible for elevated cortisol levels. Cortisol is the stress hormone; its evolutionary function is to prioritise bodily functions that are literally necessary for survival. Since hair growth obviously doesn’t fall into that category, a chronically stressed body can shut down a person’s hair follicles, worsening any existing or pending genetic hair loss.

Remember, stress doesn’t only refer to burning the candle at both ends at work or dealing with a messy divorce. There’s also physiological stress such as long-term yo-yo dieting, working out too hard in the gym and habits around epically bad sleep deprivation.

What Can Be Done?

Dealing with stress is easier said than done. But proactive steps you can take include consulting with your doctor or a psychiatrist, trying meditation/mindfulness, or simply setting aside some time each day to do something that relaxes you – whether it be a long walk, exercise or simply reading a good book.

Happy Scalp, Happy Hair

If your scalp is inflamed, you might notice it through flakiness, redness, itchiness and hair fall. To have healthy hair, you must have a healthy scalp. Hair loss scientists are discovering evidence that links scalp inflammation with poor hair growth, genetic hair loss and a range of other scalp and hair health issues.

What Can Be Done?

See your doctor or hair loss specialist if you have symptoms as you could have scalp folliculitis or scalp dermatitis. Treatment can include medicated shampoos and conditioners through to antibiotics, topical steroidal and non-steroidal treatments and injectable drugs.

The COVID Effect

Honestly, what else can we blame on COVID-19? Now it’s responsible for hair loss too? Dr Bauman reports seeing an increasing number of patients presenting with ‘shock hair loss’, also known as ‘dread shed’.

This is not exclusive to Coronavirus though; a person who suffers any fever-related illness for a period of weeks or months can experience a disruption to the normal cycling of their hair follicles. The hair starts to fall out around two-to-six weeks after the fever begins, reaches its worst around six-to-eight weeks in and then continues for another eight weeks.

This type of hair loss, which involves hair falling out in clumps, is called ‘post-febrile telogen effluvium’. Fortunately, patients don’t go completely bald. Eventually, hair begins to regrow.

What Can Be Done?

At the first sign of shedding due to prolonged fever, seek advice from a hair loss specialist as treatments can be used to reduce or halt the shedding and also speed up regrowth.