Hair Loss

Hair loss (alopecia) is a fairly common problem. Hair loss itself is obviously not a life-threatening condition but rather a cosmetic issue. However, for many people it is a very substantial issue. In addition, hair loss can accompany some other diseases that are often curable.


First we should know that hair loss can be divided into diffuse and focal. Diffuse hair loss means a total loss of all hair while focal is connected to hair loss only in a particular area or areas of the head. Focal hair loss is also referred to as alopecia areata.


The causes of hair loss are numerous and it is not easy to always diagnose the true one. Many times it is necessary to use a variety of standard and special examinations and despite that the diagnostic outcome may be poor.


Situation associated with long-term stress and psychological strain lead often to hair loss. Similarly, hair loss (often in a limited focal form) usually follows after a sudden terrifying moment associated with fear such as a car accident. The reasons are not entirely clear; it is probably related to changes in metabolism in stressing situations.

Testosterone effect

The male sex hormone testosterone is responsible for hair loss in many men. It can begin almost any time after puberty and spares neither young men. Hair of the forehead disappears as the first and the process gradually proceeds towards the top of the head (or vice versa). Women after menopause with reduced ratio of estrogen to testosterone experience hair loss as well but to lesser extent.


Hair loss is usual during conventional chemotherapy. Many cytostatic agents used to treat cancers are highly toxic. As side effect these drugs damage hair follicles and that leads to hair loss. Some good news is that after the end of chemotherapy hair growth usually resumes after certain time.

Thyroid disorders

Both overactive and underactive thyroid gland conditions are connected to possibility of excessive hair loss.

Iron deficiency

This condition is typical for menstruating women and it is a very common cause of hair loss. Iron deficiency leads to overall deterioration manifested by fatigue, iron deficiency anemia and also excessive hair loss. The solution is increased intake of iron, usually in form of an iron supplement.

Protein deficiency

Lack of proteins, the basic components of tissue is manifested, among other things, by deterioration in quality of hair. Hair is brittle and easily falls out.

Autoimmune Diseases

A number of diseases caused by immune system pathology may be associated with hair loss. Lupus erythematosus is a typical example of such autoimmune disease. Hair loss is rather limited in form of alopecia areata and it is associated with increased production of cytokines. Cytokines are substances that are increasingly produced during inflammation processes.

Malignant diseases

Malignant diseases, especially in advanced stages, may be associated with increased production of pro-inflammatory cytokines that can cause, among others, even hair dmage and hair loss.

Psychiatric disorders

We shall mention even this cause. Some mentally ill people tend to pull their hair and they are not always able or willing to confess.

Infectious diseases

Some serious infections may be associated with loss of hair. Typical is alopecia areata occurring in late stages of syphilis. Advanced stages of this sexually transmitted disease are, however, very rare in developed countries.

Radiation sickness

Damage done to hair follicles by a strong dose of radiation leads to hair loss. Fortunately, it is not a common cause nowadays.

Diagnostic approach

Diagnosis can be quite a complex process and involves medical history (information about stressing situations), search for presence of infections, tumors, autoimmune diseases, etc. Part of the examination should be blood test evaluating thyroid hormones levels, blood protein levels and iron concentration.


Treatment depends on the underlying cause. It is caused by deficiency of any substance? We can supply it. Is the cause an autoimmune disease or a tumor? Then we try to treat it by standard procedures. If hair loss is due to chemotherapy, it is necessary to wait until hair growth is restored. The hair loss is solvable also by so-called hair auto-transplantation, but that is rather an expensive procedure.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources