Alopecia is the absence or slowing of hair growth in an area of the body where hair formerly grew. It may be caused by physical damage to the hair itself or to the hair follicles, but it is most often the result of changes in the natural growth cycle of hair. In some types of alopecia, the growth cycle is disrupted by some temporary situation such as a chemical imbalance or stress. However, the vast majority (95 percent) of cases of hair loss in both men (male pattern baldness) and women (female diffuse baldness) are genetic in origin. This is called androgenetic alopecia.

• Male pattern baldness. Thinning or absence of hair at the hairline and top of the head.
• Female diffuse baldness. A gradual thinning of hair, especially on the top of the head. Hairline generally remains intact.
• Broken hairs, or hairs easily removed
• One or more round or oval bald patches

Androgenetic alopecia is caused by a genetic tendency for certain hair follicles to produce a substance that reacts with male hormones. As you get older, this reaction eventually causes the follicle to shut down. Female diffuse baldness progresses more slowly than male pattern baldness because of the small amount of male hormones in a woman's body. A hormone imbalance may make the problem worse.

Temporary hair loss may result from any shock to the body's systems, including starvation, systemic infection, childbirth, thyroid or immunologic disorders, drugs (especially chemotherapy for cancer), or stress. Hair follicles can be destroyed permanently by scarring from burns, severe scalp infections, X-ray therapy, or skin disorders. Damage may also result from tight hairstyles over a long period of time, chemical treatments such as hair coloring or permanents, or the habitual pulling out of the hair. A fungal condition called tinea capitis ("ringworm of the scalp") also results in hair loss. The causes of alopecia areata, or patchy hair loss, are not well understood. It tends to happen in times of stress.

If the cause of your hair loss is uncertain, your provider may suggest thyroid function tests or a blood test to rule out immune system problems. A biopsy, in which a small sample of scalp tissue is taken to be examined microscopically, is occasionally recommended.

Appropriate treatment options depend upon the type of alopecia. Aggressiveness of the treatment depends on the patient's attitude and must be weighed against potential side effects. In many temporary forms of alopecia, the condition will begin to normalize without treatment. Surgery may be indicated for highly motivated patients with male pattern baldness for whom medical therapies are contraindicated or ineffective. Options include hair transplants, scalp reduction, and strip or flap grafts.

• Male pattern baldness—minoxidil lotion, 2% to 5% applied twice daily; finasteride, 1 mg per day orally. Either drug must be used indefinitely to maintain regrown hair. If you use these medications, your health care provider should monitor you for side effects.
• Female baldness—minoxidil lotion, 2% applied twice daily. Must be used indefinitely to maintain regrown hair.
• Alopecia areata—the most effective treatments involve steroid drugs, such as cortisone.
• Tinea capitis—antifungal mediations such as griseovulfin, orally for 8 weeks, in combination with antifungal shampoo two to three times per week for 8 weeks. Complete entire course of treatment to prevent relapse.

Surgical options include hair transplants, scalp reduction, and strip or flap grafts.

These therapies have limited success in treating male pattern baldness.

• Reduce your intake of pro-inflammatory foods (saturated fats, dairy products, and other animal products) and eat more fresh vegetables, whole grains, essential fatty acids, and, in particular, protein (non-animal sources of protein include nuts, legumes, and soy).
• Biotin (300 mcg per day) and trace minerals, such as those found in blue-green algae (2 to 6 tablets per day), help hair growth.
• Androgenetic alopecia: vitamin B6 (50 to 100 mg per day), zinc (30 mg per day), and gamma-linolenic acid (1,000 mg twice a day) helps to inhibit 5-alpha reductase.
• Hormone imbalance: essential fatty acids (1,000 mg twice a day), B6 (50 to 100 mg per day), vitamin E (400 IU per day), and magnesium (200 mg twice a day) enhance hormone production.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

• Combine the following in equal parts and use as tea (2 to 3 cups per day) or tincture (20 to 30 drops two to three times per day): ginkgo (Ginkgo biloba), rosemary (Rosemarinus officinalis), prickly ash bark (Xanthoxylum clava-herculis), black cohosh (Cimicifuga racemosa), yarrow (Achillea millefolium), and horsetail (Equisetum arvense)
• Androgenetic alopecia: Green tea (Camelia sinensis), 2 cups per day, and saw palmetto (Serenoa repens), 100 mg twice a day
• Hormone imbalance: Chaste tree (Vitex agnus cactus), 200 to 300 mg per day, has a normalizing effect on the pituitary.
• Viral origin or immune system cause: Herbs that support immune function can help treat the underlying cause of this type of alopecia. Echinacea (Echinacea angustifolia), astragalus (Astragalus membranaceus), and Siberian ginseng (Eleutherococcus senticosus)

Stress reduction techniques can increase blood flow to the scalp.

Therapeutic massage increases circulation and reduces stress. Scalp massage using essential oils of rosemary, lavender, sage, thyme, and cedarwood may be helpful in increasing circulation. Add 3 to 6 drops of essential oil to 1 tbsp. of jojoba or grapeseed oil. Massage into scalp daily.

A small percentage of men using finasteride may experience a decreased sex drive or difficulty in achieving an erection.

If you are pregnant, postpone treatment until after your baby is born.

Guendert DV. Management of Alopecia. February 1, 1995. Department of Otolaryngology, UTMB. Accessed at Neuropathy Research at the Medical College of Georgia http://www.mcg.edu/ on January 13, 1999.

Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy: successful treatment for alopecia areata. Arch Dermatol. 1998;134:1349-1352.

Lebwohl M. New treatments for alopecia areata. Lancet. 1997;349:222-223.

Whiting DA. The Diagnosis of Alopecia. Dallas, Tex: University of Texas. Baylor Hair Research and Treatment Center. Accessed at Neuropathy Research at the Medical College of Georgia, http://www.mcg.edu/ on January 13, 1999.