Non-scarring hair loss disorders are generally reversible, but that
doesn’t mean that you shouldn’t take them seriously. Here, we
describe some of the most common causes of non-scarring hair
loss, their symptoms, and their treatments.
Seeing circular bald spots:
Alopecia areata
As if there aren’t already enough difficult-to-pronounce terms in
this book, here’s another one: alopecia areata. Also called AA,
alopecia areata is an autoimmune disease that causes hair loss
(see the sidebar “What’s an autoimmune disease?”). AA is some-
times called spot baldness because it causes round spots of hair
loss. The disease, which is relatively common, tends to run in fami-
lies and affects about 1 to 2 percent of the population in the United
States. In about 2 percent of patients, the disease changes into a
more diffuse form of hair loss, covering wider areas of the scalp.
Alopecia areata occurs when a person’s white blood cells attack
and destroy the body’s hair follicles. After hair follicles are
attacked, they stop producing hair, causing the distinctive local-
ized bald patches that are the mark of alopecia areata. The hair
loss usually occurs over a short period of time.
Severe alopecia areata can take two forms:
Alopecia totalis: All hair on the scalp is lost.
Alopecia universalis: All hair on the scalp is lost, along with
hair on the eyebrows, eyelashes, and all other parts of the
body.
Less severe alopecia areata can take these forms:
Alopecia areata monolocularis: Baldness occurs in only one
place on the scalp.
Alopecia areata barbae: Hair loss occurs in patches in a
man’s beard.
AA can occur at any age, with most patients diagnosed between
the ages of 15 and 29 and nearly half being under age 20. An equal
number of men and women develop AA, and the disease occurs
equally in every race.
Diagnosing the disorder
Alopecia areata doesn’t follow a predictable path. Some patients
feel burning or itching in the area of balding, but others don’t.
Eighty percent of patients have only one bald spot. The bald
patches can be round or oval in shape, and expose smooth, bald
skin.
The disease normally affects only the scalp, but other body hair
also can be affected and aid in diagnosing the condition.
Interestingly, if you have fingernail abnormalities such as small pits
on the nail plate, you may also have alopecia areata. Atopic der-
matitis (an allergic skin condition) and vitiligo, a disease that
causes white patches on the skin, are also more common in people
with AA.
An important diagnostic clue to alopecia areata is the presence of
“exclamation point hairs” on the perimeter of the bald patch.
These hairs form as the body attacks the lower portion of the hair
follicle, and the damage produces a finely tapered end. As the hair
continues to grow, it looks like a tiny spear stuck in the scalp.
Eventually this hair will be lost, but its presence is a sign of alope-
cia areata in its active stage.
Your doctor may gently pull hair along the edge of a bald patch to
determine whether you have alopecia areata. Healthy hair doesn’t
come out when pulled gently, but hair afflicted with alopecia areata
is easily removed.
Exploring treatment options
If you’re diagnosed with alopecia areata, the good news is that in
90 percent of cases, hair grows back on its own and no treatment is
needed. The chances of regrowth are best when the condition is
localized to just a few places on the scalp and the patient is over
age 40. In younger patients, unfortunately, the condition tends to
be more severe. If the disease progresses to alopecia totalis or
alopecia universalis (refer to the earlier section, “Seeing circular
bald spots: Alopecia areata”), no surefire treatment is available.
Options for treatment include:
Steroids: One of the main functions of steroids is to reduce
inflammation, but in patients with AA, steroids are used to
stop the body’s immune cells from destroying hair follicles.
Your doctor may inject steroids directly into your bald
patches or may prescribe a topical steroid cream that you can
apply to the bald patches at home.
When the disease is too extensive to treat with multiple injec-
tions or topical creams, oral steroids are an option. Usually,
you only take them for a short period of time because of the
many side effects of long-term use, including osteoporosis,
very fragile skin, and diabetes.
Minoxidil: This medicine works because hair growth is a side
effect of the drug that may directly affect bald spots. You
apply it directly to the bald patches. Minoxidil is commonly
used to treat pattern baldness, but for unknown reasons it
also sometimes helps patients with AA.
Cyclosporine: This potent immunosuppressant specifically
inhibits T cells, the immune system cells that attack hair folli-
cles in AA. Cyclosporine is most often given orally. It’s more
commonly used to treat other conditions such as psoriasis,
and many physicians are hesitant to use it medicine to treat
AA because it can cause kidney damage, high blood pressure,
and suppress your body’s immune system.
DNCB: This chemical (full name dinitrochioro benzene) rapidly
produces skin sensitivity. In some people with severe alopecia
areata, continued application of DNCB (enough to produce a
continuing rash caused by the activation of white blood cells
to boost the local immune function). This caused hair
regrowth in some individuals. It doesn’t always work, how-
ever. You should take DNCB only under the strict supervision
of a doctor who’s experienced with this treatment.
Sunday, March 29, 2009
Chapter 5 Diseases that Cause Hair Loss
In This Chapter
Differentiating between scarring and non-scarring scalp diseases
Understanding how lupus can affect hair
Knowing what medications can cause hair loss
Exploring other causes of hair loss
Although the most common cause of hair loss in adults is pat-
tern thinning, it’s not the only cause. A number of medical
conditions can cause alopecia, the medical term for hair loss.
Alopecia can occur as a disease in which hair loss is the predomi-
nant feature, or it may be a side effect from a disease or treatment
of disease, such as alopecia caused by chemotherapy drugs.
Alopecia breaks down into two main categories, non-scarring and
scarring. If properly treated, a non-scarring disorder can subside
and hair can potentially grow back. With a scarring hair loss disor-
der, the hair follicles are permanently damaged; the chances of
hair regrowth after the disorder is treated are very slight.
This chapter looks at the common medical causes of alopecia and
their causes, courses, and cures.
Visit the following Web sites to see photos of the various disorders
discussed in this chapter:
http://dermatlas.med.jhmi.edu/derm/cd_lists.cfm
www.dermnet.com/moduleSearch.cfm
Differentiating between scarring and non-scarring scalp diseases
Understanding how lupus can affect hair
Knowing what medications can cause hair loss
Exploring other causes of hair loss
Although the most common cause of hair loss in adults is pat-
tern thinning, it’s not the only cause. A number of medical
conditions can cause alopecia, the medical term for hair loss.
Alopecia can occur as a disease in which hair loss is the predomi-
nant feature, or it may be a side effect from a disease or treatment
of disease, such as alopecia caused by chemotherapy drugs.
Alopecia breaks down into two main categories, non-scarring and
scarring. If properly treated, a non-scarring disorder can subside
and hair can potentially grow back. With a scarring hair loss disor-
der, the hair follicles are permanently damaged; the chances of
hair regrowth after the disorder is treated are very slight.
This chapter looks at the common medical causes of alopecia and
their causes, courses, and cures.
Visit the following Web sites to see photos of the various disorders
discussed in this chapter:
http://dermatlas.med.jhmi.edu/derm/cd_lists.cfm
www.dermnet.com/moduleSearch.cfm
Medical causes of female hair loss
Apart from genetics, female hair loss can stem from a variety of
medical causes. This section looks at those causes, from the gen-
eral to the more specific, including postpartum and menopausal
hair loss.
Underlying medical conditions
In women, many medical conditions may cause hair loss, including
the following:
Thyroid disease
Anemia
Iron deficiency
Weight loss induced by severe dieting or eating disorders
Medication use (particularly oral contraceptives, beta-blockers,
vitamin A, thyroid drugs, tranquilizers and sedatives, Coumadin,
and prednisone)
A variety of autoimmune diseases
See Chapter 5 for a full discussion of medical problems that cause
hair loss.
As a woman experiencing hair loss, you should first be evaluated
by a dermatologist to make sure that no underlying skin conditions
are contributing to the hair loss. They may require a treatment dif-
ferent and may require a biopsy to rule out the presence of certain
skin diseases like diffuse alopecia areata. Your family doctor can
do the required blood tests for the various diseases that may be
present. Dermatologists are the best to hone in on a diagnosis.
Blood tests check the following common contributors to female
hair loss and can help rule out some identifiable medical
conditions:
ANA (antinuclear antibody): Used to test for lupus or other
autoimmune diseases. This test is either positive or negative
and further testing may be required if the initial screening
tests are positive.
Iron: Levels serum iron, TIBC (total iron binding capacity),
and ferritin deficiencies in iron.
Estradiol: This sex hormone indicates the status of ovarian
output.
FSH (follicle-stimulating hormone): This sex hormone indi-
cates the status of ovarian output. This hormone reflects the
status of a woman’s ability to ovulate.
LH (luteinizing hormone): This is a sex hormone indicates
the status of ovarian outputa woman may be in her overall
aging process. When she ovulates, this hormone stimulates
the production of eggs.
Free testosterone: May help the doctor understand a
woman’s ability to convert testosterone into estrogen. Most
testosterone is bound to proteins in the blood and the free
testosterone is easily converted into estrogen.
SHBG (sex hormone binding globulin): Level indicates the
status of male hormones.
TSH (thyroid-stimulating hormone): Level indicates the pres-
ence of hyperthyroidism or hypothyroidism.
Total testosterone: Largely bound to proteins in the blood.
It’s important to note that even after a medical condition has been
corrected, your hair loss may still persist perhaps because of a
“switch” in your genetic makeup that’s turned on when the medical
insult occurs. After the hair loss starts, it may be difficult to turn
off this switch. The hope is that your hair loss will slow down after
your medical condition is treated or cured and any deficiency of
your overall hormone balance is corrected.
Baby blues: Postpartum hair loss
Pregnancy alters a woman’s overall hormone configuration in
many different ways. When hormones change, hair becomes a
target organ for change in some (but not all) women because the
rapid growth of the hair cells reflects changes in the overall hor-
monal environment in the woman’s body.
When you’re pregnant, your production of the sex hormone estro-
gen increases, which prolongs the growth (anagen) phase of the
hair cycle. During pregnancy, many women are delighted to dis-
cover that their hair is thicker and more lush. After the baby is
born, however, estrogen levels drop and more hair lapses into the
resting (telogen) phase. Consequently, your growing hair may fall
out, and because the resting cycle lasts two to six months, it may
take time to see the hair return to its growth phase.
Because hair grows at about
1
⁄2 inch per month and doesn’t start
growing again until the rest cycle is complete, it can take up to a
year for you to get your “old” hair back. In that period, you may
think you’re going bald; don’t worry, you aren’t. In nursing moms,
the resting period can take longer than a year, and it may take
more than a year for hair growth to return to previous levels.
Anemia and hypothyroidism also can contribute to postpartum
hair loss. You can find out more about these medical conditions
and others in Chapter 9.
Menopause-related hair loss
Over 50 percent of women going through the hormone fluctuations
associated with menopause experience significant hair loss. The
drop in estrogen levels in postmenopausal women may put the
hair in a prolonged resting phase; this phase is particularly impor-
tant for those women who have inherited female genetic hair loss.
Unfortunately, doctors don’t really understand the mechanisms by
which the withdrawal of estrogen causes hair loss in women, but
they know that it occurs. Women who lose estrogen support have
many changes in their bodies, of which hair is only one. There are
books written on the use of hormone supplements for managing
menopausal changes in the body, and this book is not meant to
deal with these complex issues.
medical causes. This section looks at those causes, from the gen-
eral to the more specific, including postpartum and menopausal
hair loss.
Underlying medical conditions
In women, many medical conditions may cause hair loss, including
the following:
Thyroid disease
Anemia
Iron deficiency
Weight loss induced by severe dieting or eating disorders
Medication use (particularly oral contraceptives, beta-blockers,
vitamin A, thyroid drugs, tranquilizers and sedatives, Coumadin,
and prednisone)
A variety of autoimmune diseases
See Chapter 5 for a full discussion of medical problems that cause
hair loss.
As a woman experiencing hair loss, you should first be evaluated
by a dermatologist to make sure that no underlying skin conditions
are contributing to the hair loss. They may require a treatment dif-
ferent and may require a biopsy to rule out the presence of certain
skin diseases like diffuse alopecia areata. Your family doctor can
do the required blood tests for the various diseases that may be
present. Dermatologists are the best to hone in on a diagnosis.
Blood tests check the following common contributors to female
hair loss and can help rule out some identifiable medical
conditions:
ANA (antinuclear antibody): Used to test for lupus or other
autoimmune diseases. This test is either positive or negative
and further testing may be required if the initial screening
tests are positive.
Iron: Levels serum iron, TIBC (total iron binding capacity),
and ferritin deficiencies in iron.
Estradiol: This sex hormone indicates the status of ovarian
output.
FSH (follicle-stimulating hormone): This sex hormone indi-
cates the status of ovarian output. This hormone reflects the
status of a woman’s ability to ovulate.
LH (luteinizing hormone): This is a sex hormone indicates
the status of ovarian outputa woman may be in her overall
aging process. When she ovulates, this hormone stimulates
the production of eggs.
Free testosterone: May help the doctor understand a
woman’s ability to convert testosterone into estrogen. Most
testosterone is bound to proteins in the blood and the free
testosterone is easily converted into estrogen.
SHBG (sex hormone binding globulin): Level indicates the
status of male hormones.
TSH (thyroid-stimulating hormone): Level indicates the pres-
ence of hyperthyroidism or hypothyroidism.
Total testosterone: Largely bound to proteins in the blood.
It’s important to note that even after a medical condition has been
corrected, your hair loss may still persist perhaps because of a
“switch” in your genetic makeup that’s turned on when the medical
insult occurs. After the hair loss starts, it may be difficult to turn
off this switch. The hope is that your hair loss will slow down after
your medical condition is treated or cured and any deficiency of
your overall hormone balance is corrected.
Baby blues: Postpartum hair loss
Pregnancy alters a woman’s overall hormone configuration in
many different ways. When hormones change, hair becomes a
target organ for change in some (but not all) women because the
rapid growth of the hair cells reflects changes in the overall hor-
monal environment in the woman’s body.
When you’re pregnant, your production of the sex hormone estro-
gen increases, which prolongs the growth (anagen) phase of the
hair cycle. During pregnancy, many women are delighted to dis-
cover that their hair is thicker and more lush. After the baby is
born, however, estrogen levels drop and more hair lapses into the
resting (telogen) phase. Consequently, your growing hair may fall
out, and because the resting cycle lasts two to six months, it may
take time to see the hair return to its growth phase.
Because hair grows at about
1
⁄2 inch per month and doesn’t start
growing again until the rest cycle is complete, it can take up to a
year for you to get your “old” hair back. In that period, you may
think you’re going bald; don’t worry, you aren’t. In nursing moms,
the resting period can take longer than a year, and it may take
more than a year for hair growth to return to previous levels.
Anemia and hypothyroidism also can contribute to postpartum
hair loss. You can find out more about these medical conditions
and others in Chapter 9.
Menopause-related hair loss
Over 50 percent of women going through the hormone fluctuations
associated with menopause experience significant hair loss. The
drop in estrogen levels in postmenopausal women may put the
hair in a prolonged resting phase; this phase is particularly impor-
tant for those women who have inherited female genetic hair loss.
Unfortunately, doctors don’t really understand the mechanisms by
which the withdrawal of estrogen causes hair loss in women, but
they know that it occurs. Women who lose estrogen support have
many changes in their bodies, of which hair is only one. There are
books written on the use of hormone supplements for managing
menopausal changes in the body, and this book is not meant to
deal with these complex issues.
Genetic hair loss in women
In women, there’s a distinct relationship between mother, sisters,
aunts, and grandmothers when it comes to thinning hair patterns.
When we take a careful history from women with thinning hair, far
more than half of the women we interview with balding or thinning
have female relatives with a similar problem. When one recognizes
this in the family history, we generally ask these women to inquire
on the course of the family balding patterns from a timeline
perspective.
Genetic hair loss is relatively uncommon in women and is generally
referred to as female pattern hair loss or female androgenetic alope-
cia. In women with this condition, the common pattern differs than
that of men. Whereas the pattern in men follows the Norwood clas-
sification (refer to the earlier section, “Norwood classifications for
measuring male pattern thinning”), the postmenopausal pattern in
women is characterized by diffuse thinning starting just behind a
normal hairline and extending to and beyond the swirl.
Unlike men, adult women with typical female postmenopausal
androgenetic alopecia often have significant levels of miniaturiza-
tion (decreased hair shaft thickness in some hairs and loss of hairs
within the follicular unit) in the back and side of the scalp.
Miniaturization causes hair shafts to become thinner over time
before falling out, and the higher degree of miniaturization present
indicates an unstable hair loss process throughout the scalp.
In some women, the genetic pattern of hair loss is associated with
an increase in male sex hormones (androsterone, testosterone, and
DHT), but in most cases of genetic hair loss, it occurs when the sex
hormone levels are normal.
Compared to men, the mechanism of balding in women is less well
understood because their hair loss isn’t as directly related to the
presence of DHT. The enzyme aromatase appears to have a role in
causing female hair loss and may partially explain the different pat-
tern when compared to men. The loss of estrogens in post-
menopausal women means that the protection against female
genetic alopecia is withdrawn, bringing on the thinning.
Women who develop pattern balding later in life also have a
genetic component to their hair loss, but the association is less
strong. The changes in hormones that occur around menopause
are an obvious contributing factor.
Because genetic hair loss presents itself differently in women than
in men, a different classification system is used. Doctors use the
Ludwig classification to describe the thinning that women experi-
ence. A Ludwig type I is associated with a mild widening of the part
width. Patients who fall into type II have increased thinning with
moderate widening of the part. Type III patients have significant
widening of the part width. Figure 4-3 depicts types I through III.
A minority of women develop pattern balding in a distribution
that’s similar to men. These patients are better classified using the
Norwood classification system. Because these women have hair
loss mainly limited to the front and top of the scalp that doesn’t
affect the back and sides, they may be candidates for hair trans-
plant surgery, which we discuss in Chapter 13. About 15 percent of
women have this patterned balding.
aunts, and grandmothers when it comes to thinning hair patterns.
When we take a careful history from women with thinning hair, far
more than half of the women we interview with balding or thinning
have female relatives with a similar problem. When one recognizes
this in the family history, we generally ask these women to inquire
on the course of the family balding patterns from a timeline
perspective.
Genetic hair loss is relatively uncommon in women and is generally
referred to as female pattern hair loss or female androgenetic alope-
cia. In women with this condition, the common pattern differs than
that of men. Whereas the pattern in men follows the Norwood clas-
sification (refer to the earlier section, “Norwood classifications for
measuring male pattern thinning”), the postmenopausal pattern in
women is characterized by diffuse thinning starting just behind a
normal hairline and extending to and beyond the swirl.
Unlike men, adult women with typical female postmenopausal
androgenetic alopecia often have significant levels of miniaturiza-
tion (decreased hair shaft thickness in some hairs and loss of hairs
within the follicular unit) in the back and side of the scalp.
Miniaturization causes hair shafts to become thinner over time
before falling out, and the higher degree of miniaturization present
indicates an unstable hair loss process throughout the scalp.
In some women, the genetic pattern of hair loss is associated with
an increase in male sex hormones (androsterone, testosterone, and
DHT), but in most cases of genetic hair loss, it occurs when the sex
hormone levels are normal.
Compared to men, the mechanism of balding in women is less well
understood because their hair loss isn’t as directly related to the
presence of DHT. The enzyme aromatase appears to have a role in
causing female hair loss and may partially explain the different pat-
tern when compared to men. The loss of estrogens in post-
menopausal women means that the protection against female
genetic alopecia is withdrawn, bringing on the thinning.
Women who develop pattern balding later in life also have a
genetic component to their hair loss, but the association is less
strong. The changes in hormones that occur around menopause
are an obvious contributing factor.
Because genetic hair loss presents itself differently in women than
in men, a different classification system is used. Doctors use the
Ludwig classification to describe the thinning that women experi-
ence. A Ludwig type I is associated with a mild widening of the part
width. Patients who fall into type II have increased thinning with
moderate widening of the part. Type III patients have significant
widening of the part width. Figure 4-3 depicts types I through III.
A minority of women develop pattern balding in a distribution
that’s similar to men. These patients are better classified using the
Norwood classification system. Because these women have hair
loss mainly limited to the front and top of the scalp that doesn’t
affect the back and sides, they may be candidates for hair trans-
plant surgery, which we discuss in Chapter 13. About 15 percent of
women have this patterned balding.
Examining Hair Thinning in Women
Women are generally more attentive to the appearance of their hair
and notice the see-through quality of thinning hair early on. Most
women with thinning hair don’t lose enough all at once to clog the
drain, so problems with styling may be the first sign of the female
genetic balding process. This is fortunate because the slow onset
of thinning allows women to adjust their styling to compensate for
their hair loss.
Most women are able to conceal thinning with a new hairstyle, up
to a point. Layering, a pulled-back style like a pony tail, or a bun
can hide thinning hair fairly well. Or women can use hair exten-
sions or other hair systems, which we discuss in Chapters 6 and 7.
Regardless of how well they may be able to hide it, hair loss is a
psychological challenge for women who fondly remember the lus-
cious, thick hair of their youth and see it coming out in bunches on
their hairbrushes. Thinning hair can make a woman feel older and
less sexy.
This section looks at genetic female pattern hair loss and other
causes of women’s hair loss.
Differentiating between
possible causes
There are a number of types of identifiable hair loss in women, and
they differ based on their causes. The cause of female hair loss is
reflected in the pattern, so doctors look to the pattern of loss to
get an idea of the cause and how to treat it.
About 10 percent of women experience the classic pattern of
genetic hair loss, which is an intact frontal hairline for the first
2
⁄3 inch or so and hair loss behind that persistent hairline. Another
recognizable pattern of genetic hair loss in women is hair loss con-
fined to the top of the head, sparing the leading frontal edge of the
hair line. Some women with genetic hair loss experience a diffuse
hair loss, which is a thinning of the hair all over the head (includ-
ing the sides and back of the head) and isn’t confined to any partic-
ular area. This is more common in postmenopausal women,
although it does show up in younger women as well.
Perimenopausal women frequently experience pattern thinning
that’s usually worse in the front of the thinning area, about 2 to 3
inches behind the hairline. Over time, it progresses as far back as
the swirl (the place in the crown where hair changes direction and
produces a vortex); the thinning areas may spare the sides and
back of the head. For perimenopausal women, thinning tends to be
diagnosed in the 30s or 40s. It is present but less frequent with
women in the 20s. The good news is that once the thinning is rec-
ognized in these women it is generally stable over time and does
not show the progressive nature of the male balding patterns, at
least until they reach menopause.
On the other hand, an advanced presentation of uniform hair loss,
called diffuse unpatterned alopecia (DUPA), leads doctors to narrow
the type of hair loss down to a few distinct possibilities, including
female genetic hair loss or senile alopecia.
Generalized thinning isn’t always genetic, and women should
undergo a complete medical examination including a wide variety
of laboratory tests. (We touch on these tests in this chapter in the
section “Medical causes of female hair loss” and in detail in
Chapter 5.)
and notice the see-through quality of thinning hair early on. Most
women with thinning hair don’t lose enough all at once to clog the
drain, so problems with styling may be the first sign of the female
genetic balding process. This is fortunate because the slow onset
of thinning allows women to adjust their styling to compensate for
their hair loss.
Most women are able to conceal thinning with a new hairstyle, up
to a point. Layering, a pulled-back style like a pony tail, or a bun
can hide thinning hair fairly well. Or women can use hair exten-
sions or other hair systems, which we discuss in Chapters 6 and 7.
Regardless of how well they may be able to hide it, hair loss is a
psychological challenge for women who fondly remember the lus-
cious, thick hair of their youth and see it coming out in bunches on
their hairbrushes. Thinning hair can make a woman feel older and
less sexy.
This section looks at genetic female pattern hair loss and other
causes of women’s hair loss.
Differentiating between
possible causes
There are a number of types of identifiable hair loss in women, and
they differ based on their causes. The cause of female hair loss is
reflected in the pattern, so doctors look to the pattern of loss to
get an idea of the cause and how to treat it.
About 10 percent of women experience the classic pattern of
genetic hair loss, which is an intact frontal hairline for the first
2
⁄3 inch or so and hair loss behind that persistent hairline. Another
recognizable pattern of genetic hair loss in women is hair loss con-
fined to the top of the head, sparing the leading frontal edge of the
hair line. Some women with genetic hair loss experience a diffuse
hair loss, which is a thinning of the hair all over the head (includ-
ing the sides and back of the head) and isn’t confined to any partic-
ular area. This is more common in postmenopausal women,
although it does show up in younger women as well.
Perimenopausal women frequently experience pattern thinning
that’s usually worse in the front of the thinning area, about 2 to 3
inches behind the hairline. Over time, it progresses as far back as
the swirl (the place in the crown where hair changes direction and
produces a vortex); the thinning areas may spare the sides and
back of the head. For perimenopausal women, thinning tends to be
diagnosed in the 30s or 40s. It is present but less frequent with
women in the 20s. The good news is that once the thinning is rec-
ognized in these women it is generally stable over time and does
not show the progressive nature of the male balding patterns, at
least until they reach menopause.
On the other hand, an advanced presentation of uniform hair loss,
called diffuse unpatterned alopecia (DUPA), leads doctors to narrow
the type of hair loss down to a few distinct possibilities, including
female genetic hair loss or senile alopecia.
Generalized thinning isn’t always genetic, and women should
undergo a complete medical examination including a wide variety
of laboratory tests. (We touch on these tests in this chapter in the
section “Medical causes of female hair loss” and in detail in
Chapter 5.)
Looking at Male Pattern Thinning 2
Type A pattern thinning
The set of figures in Figure 4-2 shows Type A pattern thinning.
Type A thinning is less common than the regular pattern covered
in the preceding section, occurring in less than 10 percent of men.
In this pattern, hair loss progresses from the front to the back, pos-
sibly reaching the crown of the head and stopping about where the
swirl exists. Type A pattern thinning is most dramatic in front, and
for that reason, Type A men tend to look quite bald even though
their hair loss is minimal. Actor Gene Hackman showed the Class A
pattern balding for most of his career, and as one followed him in
films, his balding pattern creeped from front to back in the
classic A pattern.
Evolutionary theories for male
pattern baldness
Can male pattern baldness be explained by sexual selection? In other words, are
males programmed to go bald in order to attract females? Scientists have suggested
that, in primitive societies, an enlarged forehead may have conveyed increased
maturity and social status — traits that historically have made men more attractive
to women.
In Sex, Time, and Power: How Women’s Sexuality Shaped Human Evolution, (2004),
author Leonard Shlain suggests that bald men made the best hunters in primitive,
hunter-gatherer societies. Thanks to their lack of hair, bald men could peer over the
bush and spy game animals without the animals’ recognizing them as men and flee-
ing. Being better hunters, the bald men were better providers, which made them
more attractive to women.
This theory is certainly something to think about when you notice your hair thinning:
Women may instinctively like it more than you think.
The set of figures in Figure 4-2 shows Type A pattern thinning.
Type A thinning is less common than the regular pattern covered
in the preceding section, occurring in less than 10 percent of men.
In this pattern, hair loss progresses from the front to the back, pos-
sibly reaching the crown of the head and stopping about where the
swirl exists. Type A pattern thinning is most dramatic in front, and
for that reason, Type A men tend to look quite bald even though
their hair loss is minimal. Actor Gene Hackman showed the Class A
pattern balding for most of his career, and as one followed him in
films, his balding pattern creeped from front to back in the
classic A pattern.
Evolutionary theories for male
pattern baldness
Can male pattern baldness be explained by sexual selection? In other words, are
males programmed to go bald in order to attract females? Scientists have suggested
that, in primitive societies, an enlarged forehead may have conveyed increased
maturity and social status — traits that historically have made men more attractive
to women.
In Sex, Time, and Power: How Women’s Sexuality Shaped Human Evolution, (2004),
author Leonard Shlain suggests that bald men made the best hunters in primitive,
hunter-gatherer societies. Thanks to their lack of hair, bald men could peer over the
bush and spy game animals without the animals’ recognizing them as men and flee-
ing. Being better hunters, the bald men were better providers, which made them
more attractive to women.
This theory is certainly something to think about when you notice your hair thinning:
Women may instinctively like it more than you think.
Norwood classifications for measuring male pattern thinning
Most people think that bald is just plain bald, but doctors measure
male pattern thinning by degrees using the Norwood classification
system. Dr. O’Tar Norwood devised this classification system in
the 1970s, answering the all-important question, “How bald am I?”
Norwood provides two classification systems, one for regular male
pattern thinning and one for Type A pattern thinning.
Regular male pattern thinning
Figure 4-1 shows the Norwood classification system for regular
male pattern thinning. Under the regular classifications, hair loss
is divided into seven patterns. Men may progress from one pattern
to the next, or they may develop any one of these patterns all at
once as the hair in that pattern thins to complete baldness in the
pattern identified on the chart.
The majority of men with pattern thinning follow the regular
pattern, with hair loss starting in the front and progressing slowly
(front and back) in two different areas (Class IV and V). On rare
occasions, a man may just bald in the crown with minimal frontal
balding (Class III Vertex). Over time, the frontal and crown areas
enlarge and merge, and the entire front, top, and crown of the head
may become bald (Class VI or VII).
Baldness in some men progresses such that they fall somewhere
between the different stages; in other men, hair loss comes to a
halt, and they remain in one stage without progressing to the next.
Although there’s no general agreement on the statistics for the fre-
quency of balding, it’s believed that advanced balding (defined as a
Norwood Class V, VI, or VII pattern) occurs in about 35 percent of
balding men.
In 95 percent of men, the
1
⁄2 inch of hair on the front of the forehead
is lost in the younger years, and the hairline recedes into a mature
male hairline (somewhere between a Class II or III pattern) with a
characteristic convex V-shape. This change from the concave juve-
nile hairline (also a typical female pattern hairline) to the convex
mature male hairline is common and not necessarily a sign of
oncoming baldness.
Balding starts at Class III in the Norwood regular classification
system (see Figure 4-1). The juvenile hairline is found in all pre-
pubertal boys, whereas a mature hairline appears in 95 percent of
Caucasian men ages 18 to 29.
Here’s an easy test to find out if your hairline is in its mature posi-
tion: Lift your eyebrows high and check the distance between the
highest crease on your forehead (in the middle) and the beginning
of your hairline:
If your hairline touches the highest crease, it’s in the juvenile
position.
If your hairline is
1
⁄3 to
2
⁄3 inch away from the highest crease,
it’s a mature male hairline.
If your hairline is more than
2
⁄3 inch from the highest crease,
you have frontal balding.
A very small percentage of men keep their juvenile hairlines for
many years (former Presidents Ronald Reagan and Bill Clinton are
examples of the lucky few). Some men have a persistent forelock,
thick hair at the central front of the forehead that remains despite
pattern thinning or balding around it — like an oasis in the desert
(talk-show host David Letterman is one example). The frontal fore-
lock doesn’t appear to be subject to the ravages of DHT (refer to
the earlier section, “Hormonal influences on hair” for an explana-
tion of DHT), and the frontal hair tends to retain its thickness
much like the hair on the sides and back of the head.
Unusual genetics: There appears to be a different genetics in
some parts of the head in some people. The
2
⁄3rd inch of the juvenile
hairline and the frontal forelock have, in some people, genetics
that do not reflect the rest of the frontal part of the head. On rare
occasions, we have seen men lose all of their hair in front and on
the top except for the frontal
2
⁄3rd inch of hair (just as they had it at
the age of 12). This pattern looks strange and each man that pre-
sented with this unique pattern of balding tended to exploit the
frontal
2
⁄3rd inch by letting it grow out 6–10 inches in length to comb
back over their balding head.
male pattern thinning by degrees using the Norwood classification
system. Dr. O’Tar Norwood devised this classification system in
the 1970s, answering the all-important question, “How bald am I?”
Norwood provides two classification systems, one for regular male
pattern thinning and one for Type A pattern thinning.
Regular male pattern thinning
Figure 4-1 shows the Norwood classification system for regular
male pattern thinning. Under the regular classifications, hair loss
is divided into seven patterns. Men may progress from one pattern
to the next, or they may develop any one of these patterns all at
once as the hair in that pattern thins to complete baldness in the
pattern identified on the chart.
The majority of men with pattern thinning follow the regular
pattern, with hair loss starting in the front and progressing slowly
(front and back) in two different areas (Class IV and V). On rare
occasions, a man may just bald in the crown with minimal frontal
balding (Class III Vertex). Over time, the frontal and crown areas
enlarge and merge, and the entire front, top, and crown of the head
may become bald (Class VI or VII).
Baldness in some men progresses such that they fall somewhere
between the different stages; in other men, hair loss comes to a
halt, and they remain in one stage without progressing to the next.
Although there’s no general agreement on the statistics for the fre-
quency of balding, it’s believed that advanced balding (defined as a
Norwood Class V, VI, or VII pattern) occurs in about 35 percent of
balding men.
In 95 percent of men, the
1
⁄2 inch of hair on the front of the forehead
is lost in the younger years, and the hairline recedes into a mature
male hairline (somewhere between a Class II or III pattern) with a
characteristic convex V-shape. This change from the concave juve-
nile hairline (also a typical female pattern hairline) to the convex
mature male hairline is common and not necessarily a sign of
oncoming baldness.
Balding starts at Class III in the Norwood regular classification
system (see Figure 4-1). The juvenile hairline is found in all pre-
pubertal boys, whereas a mature hairline appears in 95 percent of
Caucasian men ages 18 to 29.
Here’s an easy test to find out if your hairline is in its mature posi-
tion: Lift your eyebrows high and check the distance between the
highest crease on your forehead (in the middle) and the beginning
of your hairline:
If your hairline touches the highest crease, it’s in the juvenile
position.
If your hairline is
1
⁄3 to
2
⁄3 inch away from the highest crease,
it’s a mature male hairline.
If your hairline is more than
2
⁄3 inch from the highest crease,
you have frontal balding.
A very small percentage of men keep their juvenile hairlines for
many years (former Presidents Ronald Reagan and Bill Clinton are
examples of the lucky few). Some men have a persistent forelock,
thick hair at the central front of the forehead that remains despite
pattern thinning or balding around it — like an oasis in the desert
(talk-show host David Letterman is one example). The frontal fore-
lock doesn’t appear to be subject to the ravages of DHT (refer to
the earlier section, “Hormonal influences on hair” for an explana-
tion of DHT), and the frontal hair tends to retain its thickness
much like the hair on the sides and back of the head.
Unusual genetics: There appears to be a different genetics in
some parts of the head in some people. The
2
⁄3rd inch of the juvenile
hairline and the frontal forelock have, in some people, genetics
that do not reflect the rest of the frontal part of the head. On rare
occasions, we have seen men lose all of their hair in front and on
the top except for the frontal
2
⁄3rd inch of hair (just as they had it at
the age of 12). This pattern looks strange and each man that pre-
sented with this unique pattern of balding tended to exploit the
frontal
2
⁄3rd inch by letting it grow out 6–10 inches in length to comb
back over their balding head.
Looking at Male Pattern Thinning
Pattern thinning is a specific kind of hair loss that occurs gradually
over time. Both men and women can experience pattern thinning,
but they experience it differently. In men, pattern thinning some-
times goes by the scientific name androgenetic alopecia (ANA). You
hear a lot about ANA, as it’s the most common reason for hair loss
in men. Easily 98 percent of men who are balding have ANA.
Men with ANA usually first notice a thinning or receding hairline in
the front at a fairly young age. The pattern progresses to thinning
on the crown of the head that may slowly thin over a decade or
more. The pattern thinning process tends to begin during early or
mid-20s, possibly with some thinning in the teen years, but until
the thinning reduces the hair density by 50 percent most of it goes
unnoticed.
For the man with patterned hair loss, general areas thin but may
not become completely bald initially. Over many years, the hair
loss can progress to complete balding, but it’s also possible that
total loss of hair may not occur.
Male hair loss starts when hair shafts grow thinner in a process
called miniaturization. As fewer hairs remain after shedding starts,
men notice, especially in bright light, that their hair has a “see-
through” look. They generally start off denying what they are
seeing, and then eventually panic sets in.
Early evidence of pattern thinning
Because male pattern thinning is a genetic condition, a man who
comes from a family with many bald members is more likely to be
on the lookout for baldness symptoms than a man from a family
with full heads of hair. However, because of the nature of ANA,
genetics can play tricks on men.
In some families, balding isn’t transmitted to the offspring, while in
families with full heads of hair, the genes for balding may lie dor-
mant in one generation and then just appear in the next. All too
often, a young man can’t believe that he’s balding because he can’t
find relatives on either side of the family with balding; the reverse is
also true — a man with a full head of hair may see extensive balding
in his family line. It’s just a role of the genetic dice, we suspect.
Nine out of ten times, men first discover that they’re shedding
when their shower or bathtub drains get clogged with hair.
Regardless of details of the discovery, they may adopt a different
hairstyle to cover the signs of hair loss. Some men may abandon
combing their hair straight back and adopt a side-to-side combing
style that more easily hides thinning hair, continuing this sleight of
hand to a point when even this style doesn’t cut it. Some men just
comb their hair forward so that no one can see what’s happening
to the front of the head. Look at Rudolf Giuliani and John
McCain, who use comb-overs as their slight of hand that is not as
slight as they think.
Some men are all too aware of their family’s balding problem. They
may have teased their father or older brothers about their balding,
but it’s not so funny when it happens to them.
Those who look for signs of balding or thinning have the opportu-
nity to catch it early. Despite the drug company Merck’s promotion
of Propecia, many men are unaware that hair loss can be slowed,
stopped, or possibly reversed if they take this drug early enough in
the pattern thinning process. Treatment can be very successful if
the diagnosis is made when the hair loss first become evident,
hopefully before substantial thinning has occurred.
The only way to determine if you’re at the very beginning of the
balding process is to get your hair and scalp mapped out for minia-
turization, which is always present when the balding process
starts. Mapping requires the use of a video microscope, which
examines the hairs all over your head for miniaturization.
As experts in this field, we believe very strongly that if a man is
concerned that he may develop hair loss, he should see a doctor
to map the scalp hair for the frequency and distribution of minia-
turized hairs. Even early pattern thinning corresponds to the
balding patterns seen in the Norwood Classification Chart (see
Figure 4-1), so doctors can predict the eventual hair loss pattern
early on. Annual scalp hair mapping can detect the earliest signs
of genetic hair loss before balding can be detected by the naked
eye. It can also follow the benefits or lack thereof, of the treat-
ments for balding.
For men, the drug Propecia can be effective at stopping the balding
process or at least slowing it down. Unfortunately for women,
there’s no comparable drug other than Minoxidil, which works
only in a small percentage of women.
over time. Both men and women can experience pattern thinning,
but they experience it differently. In men, pattern thinning some-
times goes by the scientific name androgenetic alopecia (ANA). You
hear a lot about ANA, as it’s the most common reason for hair loss
in men. Easily 98 percent of men who are balding have ANA.
Men with ANA usually first notice a thinning or receding hairline in
the front at a fairly young age. The pattern progresses to thinning
on the crown of the head that may slowly thin over a decade or
more. The pattern thinning process tends to begin during early or
mid-20s, possibly with some thinning in the teen years, but until
the thinning reduces the hair density by 50 percent most of it goes
unnoticed.
For the man with patterned hair loss, general areas thin but may
not become completely bald initially. Over many years, the hair
loss can progress to complete balding, but it’s also possible that
total loss of hair may not occur.
Male hair loss starts when hair shafts grow thinner in a process
called miniaturization. As fewer hairs remain after shedding starts,
men notice, especially in bright light, that their hair has a “see-
through” look. They generally start off denying what they are
seeing, and then eventually panic sets in.
Early evidence of pattern thinning
Because male pattern thinning is a genetic condition, a man who
comes from a family with many bald members is more likely to be
on the lookout for baldness symptoms than a man from a family
with full heads of hair. However, because of the nature of ANA,
genetics can play tricks on men.
In some families, balding isn’t transmitted to the offspring, while in
families with full heads of hair, the genes for balding may lie dor-
mant in one generation and then just appear in the next. All too
often, a young man can’t believe that he’s balding because he can’t
find relatives on either side of the family with balding; the reverse is
also true — a man with a full head of hair may see extensive balding
in his family line. It’s just a role of the genetic dice, we suspect.
Nine out of ten times, men first discover that they’re shedding
when their shower or bathtub drains get clogged with hair.
Regardless of details of the discovery, they may adopt a different
hairstyle to cover the signs of hair loss. Some men may abandon
combing their hair straight back and adopt a side-to-side combing
style that more easily hides thinning hair, continuing this sleight of
hand to a point when even this style doesn’t cut it. Some men just
comb their hair forward so that no one can see what’s happening
to the front of the head. Look at Rudolf Giuliani and John
McCain, who use comb-overs as their slight of hand that is not as
slight as they think.
Some men are all too aware of their family’s balding problem. They
may have teased their father or older brothers about their balding,
but it’s not so funny when it happens to them.
Those who look for signs of balding or thinning have the opportu-
nity to catch it early. Despite the drug company Merck’s promotion
of Propecia, many men are unaware that hair loss can be slowed,
stopped, or possibly reversed if they take this drug early enough in
the pattern thinning process. Treatment can be very successful if
the diagnosis is made when the hair loss first become evident,
hopefully before substantial thinning has occurred.
The only way to determine if you’re at the very beginning of the
balding process is to get your hair and scalp mapped out for minia-
turization, which is always present when the balding process
starts. Mapping requires the use of a video microscope, which
examines the hairs all over your head for miniaturization.
As experts in this field, we believe very strongly that if a man is
concerned that he may develop hair loss, he should see a doctor
to map the scalp hair for the frequency and distribution of minia-
turized hairs. Even early pattern thinning corresponds to the
balding patterns seen in the Norwood Classification Chart (see
Figure 4-1), so doctors can predict the eventual hair loss pattern
early on. Annual scalp hair mapping can detect the earliest signs
of genetic hair loss before balding can be detected by the naked
eye. It can also follow the benefits or lack thereof, of the treat-
ments for balding.
For men, the drug Propecia can be effective at stopping the balding
process or at least slowing it down. Unfortunately for women,
there’s no comparable drug other than Minoxidil, which works
only in a small percentage of women.
Environmental issues
Can you eat yourself into a full head of hair? Probably not, but envi-
ronmental factors, including what you eat, can cause hair loss. The
following list breaks down some of the more prominent factors:
Selenium: The presence of selenium in food and water is
common around the world, but continued intake of selenium
to the point of selenium toxicity produces hair loss, among
other effects.
Lead, cadmium, mercury, iron, aluminum, and copper:
These are the most common environmental causes of hair
loss. Many of these substances are found in fish, reflecting
environmental contamination in the world’s oceans. Lead may
also be found in hair dyes and paint. Just how much of these
elements must be present to cause hair loss is unknown, and
a direct connection is hard to prove. Some labs will analyze
hair for the presence of these minerals, but their presence
doesn’t necessarily mean they caused hair loss.
Air pollution and smoking: These factors may also exacer-
bate the genetic process carried by potentially balding men.
Scientists believe toxins and carcinogens found in polluted air
can stop hair growing by blocking the mechanisms that pro-
duce the protein from which hair is made.
Doctors hope that science will discover ways to treat pollu-
tant contributions to hair loss with topical lotions to block the
effects of the pollutants on the hair follicles.
ronmental factors, including what you eat, can cause hair loss. The
following list breaks down some of the more prominent factors:
Selenium: The presence of selenium in food and water is
common around the world, but continued intake of selenium
to the point of selenium toxicity produces hair loss, among
other effects.
Lead, cadmium, mercury, iron, aluminum, and copper:
These are the most common environmental causes of hair
loss. Many of these substances are found in fish, reflecting
environmental contamination in the world’s oceans. Lead may
also be found in hair dyes and paint. Just how much of these
elements must be present to cause hair loss is unknown, and
a direct connection is hard to prove. Some labs will analyze
hair for the presence of these minerals, but their presence
doesn’t necessarily mean they caused hair loss.
Air pollution and smoking: These factors may also exacer-
bate the genetic process carried by potentially balding men.
Scientists believe toxins and carcinogens found in polluted air
can stop hair growing by blocking the mechanisms that pro-
duce the protein from which hair is made.
Doctors hope that science will discover ways to treat pollu-
tant contributions to hair loss with topical lotions to block the
effects of the pollutants on the hair follicles.
Lack of blood supply
Some doctors assert that a lack of blood supply contributes to hair
loss. Bald skin gradually loses some of its blood supply and as a
result becomes thin and shiny. These changes, however, come only
after the loss of hair and is not the cause of the hair loss.
Hair follicles are some of the most rapidly metabolizing cells in the
body. Growing hair requires the proper oxygen and nutrition that
comes with a good blood supply in a healthy body. When hair folli-
cles are transplanted into skin grafts or scar tissue, both of which
may have a relatively poor blood supply, the presence of the
grafted hair causes the local blood supply to increase. The end
result is that as the hair grows, so does the blood supply.
loss. Bald skin gradually loses some of its blood supply and as a
result becomes thin and shiny. These changes, however, come only
after the loss of hair and is not the cause of the hair loss.
Hair follicles are some of the most rapidly metabolizing cells in the
body. Growing hair requires the proper oxygen and nutrition that
comes with a good blood supply in a healthy body. When hair folli-
cles are transplanted into skin grafts or scar tissue, both of which
may have a relatively poor blood supply, the presence of the
grafted hair causes the local blood supply to increase. The end
result is that as the hair grows, so does the blood supply.
Stress
When the body experiences stress caused by a traumatic experi-
ence, nutritional deficiency, or illness, the rate of hair loss can
increase. For example, a 39-year-old patient of Dr. Rassman lost his
4-year-old child to cancer and within just a few months, the man lost
all but the permanent wreath of hair around his head. He probably
had the genetics for this balding pattern, but only expressed that
pattern when it was induced by this extreme stressful situation.
Women’s hair seems to be more sensitive to the effects of stress
than men’s hair. This may be because women with a genetic predis-
position to hair loss usually have a higher percentage of fragile
miniaturized hair, which is hair with thinner than normal hair shaft
thickness. But unlike in men, the hair loss in women is often not
permanent or complete.
Stress generally causes a type of hair loss referred to as telogen
effluvium, which is very different from androgenetic alopecia (dis-
cussed earlier in this chapter). Telogen effluvium is the reversible
shedding of hair in the resting phase when the body senses, for
reasons that are not clear, that it needs to divert its energies.
Therefore, stress temporarily changes the amount of hair that’s
shed, but the lost hair is likely to grow back. Turn to Chapter 5 for
more explanation of telogen effluvium.
ence, nutritional deficiency, or illness, the rate of hair loss can
increase. For example, a 39-year-old patient of Dr. Rassman lost his
4-year-old child to cancer and within just a few months, the man lost
all but the permanent wreath of hair around his head. He probably
had the genetics for this balding pattern, but only expressed that
pattern when it was induced by this extreme stressful situation.
Women’s hair seems to be more sensitive to the effects of stress
than men’s hair. This may be because women with a genetic predis-
position to hair loss usually have a higher percentage of fragile
miniaturized hair, which is hair with thinner than normal hair shaft
thickness. But unlike in men, the hair loss in women is often not
permanent or complete.
Stress generally causes a type of hair loss referred to as telogen
effluvium, which is very different from androgenetic alopecia (dis-
cussed earlier in this chapter). Telogen effluvium is the reversible
shedding of hair in the resting phase when the body senses, for
reasons that are not clear, that it needs to divert its energies.
Therefore, stress temporarily changes the amount of hair that’s
shed, but the lost hair is likely to grow back. Turn to Chapter 5 for
more explanation of telogen effluvium.
Hair loss over time
The mere presence of the necessary genes and hormones for hair
loss isn’t enough to cause baldness. Susceptible hair follicles also
have to be exposed to the responsible hormones. The onset of hair
loss varies from one individual to another and is influenced by
genetic expression, the levels of testosterone and DHT in the
bloodstream, and age.
Hair loss doesn’t occur all at once, but is cyclical. People who are
losing their hair experience alternating periods of slow hair loss
and rapid hair loss, and even periods when hair loss stabilizes. The
factors that cause the rate of loss to speed up or slow down are
unknown.
Most men who have extensive balding develop much of it by age
30. Twenty-five percent of men will show clinical balding by age 30,
and half of the male population will show some degree of clinical
balding by age 45 to 50. Balding slowly continues into the next
decade or two, and then the process seems to slow down as men
approach 60 to 65. As this is a genetic process, it is probable that
the men who bald later in life rather than earlier also have a form
of genetic hair loss, just not the obvious process we see in the
younger men with classic pattern balding.
Men who continue the balding process well into their 30s and 40s
typically don’t lose their hair as quickly or as completely as men
who start balding in their early 20s. About 7 percent of men who
are balding develop the most complete form of balding (called the
Class VII pattern; see Figure 4-1), in which only the wreath of hair
exists around the head. Those men with Class VII balding patterns,
usually show those patterns before they reach 30 years old. This
wreath of hair is permanent hair in most men and measures about
21
⁄2 inches in the mid-back of the head when the balding process
reaches completion. Most men who show balding don’t advance to
full balding.
To make matters more confusing, the age of onset discussed above
reflects the majority of men, yet there are still some men who start
the process later in life (in their 30s, 40s, and even 50s).
The most common balding patterns are seen at the frontal hairline
where frontal and temporal recession occurs, moving slightly
upward toward the top of the head. A bald spot may appear in the
crown and when it does, it seems to widen slowly as men age.
Sometimes, the crown balding area merges with the frontal reces-
sion, clearing a wide bald channel in the center of the head that we
jokingly call the “runway.” Genetics determine the final pattern.
loss isn’t enough to cause baldness. Susceptible hair follicles also
have to be exposed to the responsible hormones. The onset of hair
loss varies from one individual to another and is influenced by
genetic expression, the levels of testosterone and DHT in the
bloodstream, and age.
Hair loss doesn’t occur all at once, but is cyclical. People who are
losing their hair experience alternating periods of slow hair loss
and rapid hair loss, and even periods when hair loss stabilizes. The
factors that cause the rate of loss to speed up or slow down are
unknown.
Most men who have extensive balding develop much of it by age
30. Twenty-five percent of men will show clinical balding by age 30,
and half of the male population will show some degree of clinical
balding by age 45 to 50. Balding slowly continues into the next
decade or two, and then the process seems to slow down as men
approach 60 to 65. As this is a genetic process, it is probable that
the men who bald later in life rather than earlier also have a form
of genetic hair loss, just not the obvious process we see in the
younger men with classic pattern balding.
Men who continue the balding process well into their 30s and 40s
typically don’t lose their hair as quickly or as completely as men
who start balding in their early 20s. About 7 percent of men who
are balding develop the most complete form of balding (called the
Class VII pattern; see Figure 4-1), in which only the wreath of hair
exists around the head. Those men with Class VII balding patterns,
usually show those patterns before they reach 30 years old. This
wreath of hair is permanent hair in most men and measures about
21
⁄2 inches in the mid-back of the head when the balding process
reaches completion. Most men who show balding don’t advance to
full balding.
To make matters more confusing, the age of onset discussed above
reflects the majority of men, yet there are still some men who start
the process later in life (in their 30s, 40s, and even 50s).
The most common balding patterns are seen at the frontal hairline
where frontal and temporal recession occurs, moving slightly
upward toward the top of the head. A bald spot may appear in the
crown and when it does, it seems to widen slowly as men age.
Sometimes, the crown balding area merges with the frontal reces-
sion, clearing a wide bald channel in the center of the head that we
jokingly call the “runway.” Genetics determine the final pattern.
Hormonal influences on hair
Hormones are very powerful biochemical substances produced by
various glands throughout the body. The primary male sex hor-
mone is testosterone. Testosterone and other related hormones
that have “masculinizing” effects are produced primarily in the tes-
ticles. These same hormones are the cause of many changes that
occur in puberty in boys. The hormones that cause acne and beard
growth also can trigger the beginning of baldness. Testosterone is
also produced in women from the adrenal glands and the ovaries,
and it is produced in lower concentrations than the testicles pro-
duce the hormone in men. In women, most of the testosterone is
converted into estrogen.
The hormone believed to be most directly involved in androge-
netic alopecia is dihydrotestosterone (DHT). DHT is formed by the
action of the enzyme 5-alpha reductase (5AR) on testosterone, and
it binds to special receptor sites on the cells of hair follicles to
cause the specific changes associated with balding.
The presence of androgens (steroid like substances), testosterone
(considered an androgen), and DHT cause some hair follicles to
regress and die. In addition to the testicles, the adrenal glands
located above the kidneys produce androgenetic hormones; this is
true for both sexes. In females, ovaries are the major source of hor-
mones that can affect hair. Androgenetic hormones stimulate many
of the male sex characteristics we see in adult men. Androgens like
testosterone, are converted into estrogens in women, which make
women develop their typical female sex characteristics.
various glands throughout the body. The primary male sex hor-
mone is testosterone. Testosterone and other related hormones
that have “masculinizing” effects are produced primarily in the tes-
ticles. These same hormones are the cause of many changes that
occur in puberty in boys. The hormones that cause acne and beard
growth also can trigger the beginning of baldness. Testosterone is
also produced in women from the adrenal glands and the ovaries,
and it is produced in lower concentrations than the testicles pro-
duce the hormone in men. In women, most of the testosterone is
converted into estrogen.
The hormone believed to be most directly involved in androge-
netic alopecia is dihydrotestosterone (DHT). DHT is formed by the
action of the enzyme 5-alpha reductase (5AR) on testosterone, and
it binds to special receptor sites on the cells of hair follicles to
cause the specific changes associated with balding.
The presence of androgens (steroid like substances), testosterone
(considered an androgen), and DHT cause some hair follicles to
regress and die. In addition to the testicles, the adrenal glands
located above the kidneys produce androgenetic hormones; this is
true for both sexes. In females, ovaries are the major source of hor-
mones that can affect hair. Androgenetic hormones stimulate many
of the male sex characteristics we see in adult men. Androgens like
testosterone, are converted into estrogens in women, which make
women develop their typical female sex characteristics.
Baring hair at the beach
The beach is an excellent place to observe hair patterns. Have you ever noticed
that men with hairy backs and shoulders often have a bald head or a hair replace-
ment system?
This indicates that the gene for hair on the back and shoulders is separate from the
gene for hair on the scalp. Although DHT acts like fertilizer for shoulder and back
hair, it causes reduction of head hair in many men.
The beach is an excellent place to observe hair patterns. Have you ever noticed
that men with hairy backs and shoulders often have a bald head or a hair replace-
ment system?
This indicates that the gene for hair on the back and shoulders is separate from the
gene for hair on the scalp. Although DHT acts like fertilizer for shoulder and back
hair, it causes reduction of head hair in many men.
Early in the 20th century, a psychiatrist discovered the specific
relationship between testosterone and hormone-induced hair loss.
The doctor noted that the identical twin brother of one patient was
profoundly bald while the mentally ill twin had a full head of hair.
The doctor decided to determine the effect of treating his patient
with testosterone, and injected him (the hairy twin) with the hor-
mone. Within weeks, the hairy patient began to lose all but his
wreath of permanent hair, just like his twin. The doctor stopped
administering testosterone, but his patient never regained his head
of hair.
Testosterone and DHT
The cause of pattern thinning in men is primarily related to two
sex hormones, testosterone and DHT. The body converts testos-
terone into the hormone DHT by way of an enzyme found in vari-
ous tissues throughout the body.
In men with the genes for ANA, DHT increases the resting (telogen)
phase and decreases the growing (anagen) phase of hair. (We
explain the growth cycle more in the earlier section, “Examining
uniform hair loss.”) Consequently, as a man ages, less hair grows at
any given time, and the hair starts to thin as a normal consequence
of aging, especially in men with ANA. Eventually, baldness occurs.
In men who haven’t inherited the ANA balding genes, the combina-
tion of DHT and testosterone doesn’t cause hair loss and may have
a lesser impact on aging hair.
Some areas of the scalp are more susceptible than others to the
affects of DHT. For example, the hormone doesn’t usually affect
hair on the back and side of the head, which is why these areas
retain hair. The term “male pattern thinning” is used because hair
loss occurs in a pattern — the back and side of the head retain hair
but the crown and frontal areas may lose it. The loss may be con-
fined only to the frontal area or the crown area based upon the
genetics that are inherited from the family tree.
DHT does play a role in the growth of beard hair; body hair; and
eyebrow, nose, and ear hair, but doctors don’t clearly understand
that role. Sometime after puberty, male hormones trigger a biologi-
cal clock that makes hair grow in these areas.
In men, the enzyme 5AR activity is higher in the balding area.
Women have half the amount of 5AR overall as compared to men
but have higher levels of the enzyme aromatase, especially in their
frontal hairlines. Aromatase decreases the formation of DHT, and
its presence in women may help to explain why female hair loss is
somewhat different than hair loss in males. (The section
“Examining Hair Thinning in Women” later in this chapter takes an
in-depth look at female hair loss.)
The only way to stop DHT is to block it with finasteride or dutas-
teride, drugs that interfere with DHT production. (See Chapter 9 for
more on DHT and the drugs that fight hair loss.)
At present, only finasteride has been approved by the Federal Drug
Administration (FDA). Dutasteride is still being evaluated for its
safety and effectiveness for hair loss in young men. There are some
reports that dutasteride has significant effects on male sperm pro-
duction; as such, it may not be approved for men experiencing hair
loss. Blocking DHT in women with dutasteride hasn’t been shown
to prevent or reverse female hair loss or hair thinning. Its safety
with regard to breast cancer, particularly in women who carry the
breast cancer producing BRCA genes, is not understood.
Steroids and similar products
Anabolic steroids, the kind bodybuilders sometimes (illegally) use,
can cause hair loss if you’re genetically predisposed to it. And
there’s a direct link between taking human growth hormone (HGH)
and hair loss — probably caused by the same underlying mecha-
nisms as steroid use. Women body builders who take steroids
develop some male sex characteristics and some experience hair
loss.
HGH has become a trendy anti-aging tool. More and more men are
using it as a fountain of youth. Some men combine steroids and
HGH because they make them feel better and stronger. But we have
seen many men on HGH in our offices with “unexplained hair loss.”
No real mystery there.
Many men who take steroids also take Propecia (a DHT blocker) to
offset the negative effects of DHT. Propecia blocks DHT and causes
a rise in systemic testosterone by up to 18 percent. Indirectly,
Propecia may help muscle building if DHT levels go down (from the
Propecia) and testosterone levels go up to compensate.
Testosterone is a much stronger hormone than DHT, and the sum
of the effects of the rise in serum testosterone from taking a DHT
blocker such as Propecia and the steroids may very well produce
more hair loss, not less.
Everyone is different, so we can’t conclude if the muscle mass that
the men are seeking from steroid use can be offset. Recently,
Propecia was found to mask the blood measurements for other
steroids when used in athletes, which is why its use is banned for
professional athletes.
Fitness-focused individuals may take the following products for
their physical benefits, but these products can also cause hair loss:
Whey-based nutritional supplements: The use of growth hor-
mones in some dairy cows affects the milk they produce and,
in turn, the whey (a byproduct of cheese production). Even if
a person doesn’t take steroids, these products may have some
steroid-like impact from the milk source. People who take
whey-based nutritional supplements may experience steroid-
related side effects if the cows were treated with steroids. It is
unclear how much of these steroids, if any, will survive transit
through the stomach to be eventually absorbed into the body.
DHEA: Some people take DHEA, which is found in the nutri-
tional section of many health food and vitamin stores and
doesn’t require a prescription. The DHEA sold in stores is
reportedly made by the adrenal glands and claims to help
reduce body fat stores while promoting sugar metabolism. It
also can cause hair loss. Other available supplements claim
testosterone or steroid-like characteristics. The desire for
men to add body mass and/or prevent hair loss drives them
to seek out such products.
Dose-pack steroids: A short course of steroids for medical
reasons (4–5 days) should not have an impact producing
hair loss.
Prednisone: People who are on this steroid for chronic med-
ical problems (arthritis, various autoimmune diseases) will
experience hair loss.
Hair loss is also a risk for women who use steroids, if they’re pre-
disposed to the condition. Women usually take steroids for dis-
eases that occur later in life, such as autoimmune disease,
temporal arteritis, rheumatoid arthritis.
relationship between testosterone and hormone-induced hair loss.
The doctor noted that the identical twin brother of one patient was
profoundly bald while the mentally ill twin had a full head of hair.
The doctor decided to determine the effect of treating his patient
with testosterone, and injected him (the hairy twin) with the hor-
mone. Within weeks, the hairy patient began to lose all but his
wreath of permanent hair, just like his twin. The doctor stopped
administering testosterone, but his patient never regained his head
of hair.
Testosterone and DHT
The cause of pattern thinning in men is primarily related to two
sex hormones, testosterone and DHT. The body converts testos-
terone into the hormone DHT by way of an enzyme found in vari-
ous tissues throughout the body.
In men with the genes for ANA, DHT increases the resting (telogen)
phase and decreases the growing (anagen) phase of hair. (We
explain the growth cycle more in the earlier section, “Examining
uniform hair loss.”) Consequently, as a man ages, less hair grows at
any given time, and the hair starts to thin as a normal consequence
of aging, especially in men with ANA. Eventually, baldness occurs.
In men who haven’t inherited the ANA balding genes, the combina-
tion of DHT and testosterone doesn’t cause hair loss and may have
a lesser impact on aging hair.
Some areas of the scalp are more susceptible than others to the
affects of DHT. For example, the hormone doesn’t usually affect
hair on the back and side of the head, which is why these areas
retain hair. The term “male pattern thinning” is used because hair
loss occurs in a pattern — the back and side of the head retain hair
but the crown and frontal areas may lose it. The loss may be con-
fined only to the frontal area or the crown area based upon the
genetics that are inherited from the family tree.
DHT does play a role in the growth of beard hair; body hair; and
eyebrow, nose, and ear hair, but doctors don’t clearly understand
that role. Sometime after puberty, male hormones trigger a biologi-
cal clock that makes hair grow in these areas.
In men, the enzyme 5AR activity is higher in the balding area.
Women have half the amount of 5AR overall as compared to men
but have higher levels of the enzyme aromatase, especially in their
frontal hairlines. Aromatase decreases the formation of DHT, and
its presence in women may help to explain why female hair loss is
somewhat different than hair loss in males. (The section
“Examining Hair Thinning in Women” later in this chapter takes an
in-depth look at female hair loss.)
The only way to stop DHT is to block it with finasteride or dutas-
teride, drugs that interfere with DHT production. (See Chapter 9 for
more on DHT and the drugs that fight hair loss.)
At present, only finasteride has been approved by the Federal Drug
Administration (FDA). Dutasteride is still being evaluated for its
safety and effectiveness for hair loss in young men. There are some
reports that dutasteride has significant effects on male sperm pro-
duction; as such, it may not be approved for men experiencing hair
loss. Blocking DHT in women with dutasteride hasn’t been shown
to prevent or reverse female hair loss or hair thinning. Its safety
with regard to breast cancer, particularly in women who carry the
breast cancer producing BRCA genes, is not understood.
Steroids and similar products
Anabolic steroids, the kind bodybuilders sometimes (illegally) use,
can cause hair loss if you’re genetically predisposed to it. And
there’s a direct link between taking human growth hormone (HGH)
and hair loss — probably caused by the same underlying mecha-
nisms as steroid use. Women body builders who take steroids
develop some male sex characteristics and some experience hair
loss.
HGH has become a trendy anti-aging tool. More and more men are
using it as a fountain of youth. Some men combine steroids and
HGH because they make them feel better and stronger. But we have
seen many men on HGH in our offices with “unexplained hair loss.”
No real mystery there.
Many men who take steroids also take Propecia (a DHT blocker) to
offset the negative effects of DHT. Propecia blocks DHT and causes
a rise in systemic testosterone by up to 18 percent. Indirectly,
Propecia may help muscle building if DHT levels go down (from the
Propecia) and testosterone levels go up to compensate.
Testosterone is a much stronger hormone than DHT, and the sum
of the effects of the rise in serum testosterone from taking a DHT
blocker such as Propecia and the steroids may very well produce
more hair loss, not less.
Everyone is different, so we can’t conclude if the muscle mass that
the men are seeking from steroid use can be offset. Recently,
Propecia was found to mask the blood measurements for other
steroids when used in athletes, which is why its use is banned for
professional athletes.
Fitness-focused individuals may take the following products for
their physical benefits, but these products can also cause hair loss:
Whey-based nutritional supplements: The use of growth hor-
mones in some dairy cows affects the milk they produce and,
in turn, the whey (a byproduct of cheese production). Even if
a person doesn’t take steroids, these products may have some
steroid-like impact from the milk source. People who take
whey-based nutritional supplements may experience steroid-
related side effects if the cows were treated with steroids. It is
unclear how much of these steroids, if any, will survive transit
through the stomach to be eventually absorbed into the body.
DHEA: Some people take DHEA, which is found in the nutri-
tional section of many health food and vitamin stores and
doesn’t require a prescription. The DHEA sold in stores is
reportedly made by the adrenal glands and claims to help
reduce body fat stores while promoting sugar metabolism. It
also can cause hair loss. Other available supplements claim
testosterone or steroid-like characteristics. The desire for
men to add body mass and/or prevent hair loss drives them
to seek out such products.
Dose-pack steroids: A short course of steroids for medical
reasons (4–5 days) should not have an impact producing
hair loss.
Prednisone: People who are on this steroid for chronic med-
ical problems (arthritis, various autoimmune diseases) will
experience hair loss.
Hair loss is also a risk for women who use steroids, if they’re pre-
disposed to the condition. Women usually take steroids for dis-
eases that occur later in life, such as autoimmune disease,
temporal arteritis, rheumatoid arthritis.
Common Causes of Hair Loss
A number of diseases and conditions cause hair loss, but most
people go bald because of the influence of genetics, hormones,
and time. Stress may cause additional loss, more so in women than
in men.
Looking at Grandpa’s head
In the genetic hair loss lottery, Grandpa’s important, but doctors
actually look a few generations back on the entire family tree —
men and women — in order to determine if you’ve inherited a
genetic type of pattern baldness.
Everyone inherits genetic tendencies from their parents. As you
may or may not recall from biology class, pairs of DNA segments
called chromosomes carry the information that contains the poten-
tial for different characteristics. A gene is a single bit of chemically
encoded hereditary instruction located on a chromosome.
The genetics of androgenetic alopecia (ANA), also called androge-
netic alopecia or male pattern baldness, is complicated. At least
four genes are responsible for hair loss. When several genes need
to be present for a trait such as hair loss, the trait is said to be
polygenic. Genes that are located on the X or Y chromosomes are
called sex-linked, and genes on the other 22 pairs of chromosomes
are called autosomal.
Currently, doctors believe that the genes governing common bald-
ness are autosomal (not tied to the sex chromosome) and there-
fore can be inherited from the mother’s or the father’s side of the
family. The commonly held notion that baldness comes only from
the mother’s side of the family is false, although for reasons not
fully understood, the predisposition inherited from an affected
mother is of slightly greater importance than that inherited from
an affected father. Doctors also believe that the genes involved in
androgenetic alopecia are dominant, meaning that only one gene of
a pair is needed for the trait to show up in the individual. So even if
only one of your parents passed on the baldness gene, you’re likely
to have some hair loss.
The inherited gene isn’t always ‘expressed,’ so it’s possible to
carry the gene for balding and never become bald. It can skip a
generation or two, so only looking at the generation before you
doesn’t tell you what may happen on your head.
The ability of a gene to affect you is called expressivity.Expressivity
occurs depending on a number of factors, the major ones being
hormones and age, although stress and other factors may also play
a role. Put simply, a man whose father and uncles are severely bald
may have minimal hair loss because the expression of the baldness
gene is limited. If you are confused by this explanation, imagine the
experts who try to clarify the unexplainable by putting together
the many variables and not coming up with a logical, scientific
process.
The end goal of gene identification is to manipulate genes to pre-
vent or reverse common baldness. But doctors first need to find
and fully understand which genes cause the balding process and
why are these genes expressed one way in you and another way in
your brother.
people go bald because of the influence of genetics, hormones,
and time. Stress may cause additional loss, more so in women than
in men.
Looking at Grandpa’s head
In the genetic hair loss lottery, Grandpa’s important, but doctors
actually look a few generations back on the entire family tree —
men and women — in order to determine if you’ve inherited a
genetic type of pattern baldness.
Everyone inherits genetic tendencies from their parents. As you
may or may not recall from biology class, pairs of DNA segments
called chromosomes carry the information that contains the poten-
tial for different characteristics. A gene is a single bit of chemically
encoded hereditary instruction located on a chromosome.
The genetics of androgenetic alopecia (ANA), also called androge-
netic alopecia or male pattern baldness, is complicated. At least
four genes are responsible for hair loss. When several genes need
to be present for a trait such as hair loss, the trait is said to be
polygenic. Genes that are located on the X or Y chromosomes are
called sex-linked, and genes on the other 22 pairs of chromosomes
are called autosomal.
Currently, doctors believe that the genes governing common bald-
ness are autosomal (not tied to the sex chromosome) and there-
fore can be inherited from the mother’s or the father’s side of the
family. The commonly held notion that baldness comes only from
the mother’s side of the family is false, although for reasons not
fully understood, the predisposition inherited from an affected
mother is of slightly greater importance than that inherited from
an affected father. Doctors also believe that the genes involved in
androgenetic alopecia are dominant, meaning that only one gene of
a pair is needed for the trait to show up in the individual. So even if
only one of your parents passed on the baldness gene, you’re likely
to have some hair loss.
The inherited gene isn’t always ‘expressed,’ so it’s possible to
carry the gene for balding and never become bald. It can skip a
generation or two, so only looking at the generation before you
doesn’t tell you what may happen on your head.
The ability of a gene to affect you is called expressivity.Expressivity
occurs depending on a number of factors, the major ones being
hormones and age, although stress and other factors may also play
a role. Put simply, a man whose father and uncles are severely bald
may have minimal hair loss because the expression of the baldness
gene is limited. If you are confused by this explanation, imagine the
experts who try to clarify the unexplainable by putting together
the many variables and not coming up with a logical, scientific
process.
The end goal of gene identification is to manipulate genes to pre-
vent or reverse common baldness. But doctors first need to find
and fully understand which genes cause the balding process and
why are these genes expressed one way in you and another way in
your brother.
Telling the difference between genetic baldness and everything else
There’s more than one category of hair loss. Can your doctor tell
just by looking at you what kind of hair loss you have? Yes, some-
times. Hereditary hair loss patterns, the most common type of hair
loss in men, have developed into a classical clinical descriptive sci-
ence. Genetic hair loss appears in distinct patterns, and these pat-
terns are almost 100-percent diagnostic for male pattern baldness.
The later section, “Norwood classifications for measuring male pat-
tern thinning” covers the most common baldness patterns. Also,
we discuss the types and causes of pattern balding in the later sec-
tion, “Common Causes of Hair Loss.”
In women, balding patterns also exist (see the section, “Genetic
hair loss in women,” later in this chapter), and a knowledgeable
doctor may be able to tell what’s causing the hair loss just by
looking.
Examining uniform hair loss
A small segment of people lose scalp hair uniformly (diffusely),
rather than losing hair in specific scalp areas. Uniform hair loss
isn’t as easy to detect as other types of hair loss because the hair
is steadily lost all over the head. It’s much easier to detect a bald
spot resulting from hair loss in a specific area of the scalp from
diseases that cause uniform hair loss to the normal genetics of that
particular person.
Hair loss occurs normally and usually occurs at the end of one of
the normal hair cycles that all hair goes through. These hair cycles
are as follows:
Anagen: The growth stage, which lasts three years on average
but may be as short as a year and as long as seven years).
Catogen: The stage when the hair prepares to go into the next
phase and undergoes changes in its anatomy, falling out at the
end of this part of the cycle.
Telogen: The sleep phase when a percentage of the hair disap-
pears (lasts from two to five months on average). About 10
percent of all of the hairs on our head are in the telogen part
of the cycle at any one time.
At the end of the telogen phase, a new hair bud appears, signaling
the beginning of anagen. (Chapter 2 has more about hair growth
phases.)
The hair apparatus starts off producing a baby hair below the skin,
which grows longer and longer until the final terminal hair (a full
mature hair reflective of what we style every day when we comb
out hair) emerges from the pore in the skin. In some adults, the
anagen phase may never start, signaling that the hair follicle may
have died. If a new hair doesn’t grow to replace the lost hair, the
total hair count drops.
Hair grows in natural occurring groups called follicular units (FU). A
single FU contains from one to four terminal hairs and one vellus
hair (a fine hair amidst the clump of terminal hairs). When a hair
isn’t replaced after its telogen phase, the number of hairs in the FU
decreases, but the number of FUs remains the same. So an FU
starting with four terminal hairs may end up with only two or three
terminal hairs as we age or as we undergo some form of balding.
When this happens across the whole scalp, the total hair count
decreases proportionally.
The older the patient is, the more likely it is that doctors see this
uniform hair loss process. About one third of men over age 70 have
this diffuse hair loss, which is called senile alopecia. The name
doesn’t reflect the mental status of those afflicted, but rather it
essentially means that the condition is most common in the eld-
erly. Because hair also becomes finer with age, severe thinning
reflects a loss of both hair bulk (in each hair shaft) and hair densi-
ties. (For more on hair bulk and density, turn to Chapter 2.) There’s
no cure for senile alopecia.
Young men may experience uniform hair loss in the form of a con-
dition called diffuse unpatterned alopecia (DUPA). Doctors believe
that DUPA and senile alopecia are similar but for the age of occur-
rence. DUPA impacts men in their 20s and 30s and doesn’t seem to
be responsive to drugs used to treat the classic type of male pat-
terned hair loss. We cover treatment drugs in Chapter 9.
Identifying dying hair cells
Apoptosis is a cell’s internal “suicide” mechanism that causes cell
death. The phenomenon has recently been studied very carefully,
and what doctors know is that during the transition from anagen to
catagen (that’s the growth phase to the changing phase), some-
thing happens in the hair follicle development.
The cells within the hair follicles communicate with each other,
and certain chemicals secreted in the hair follicle determine which
hairs will survive for another growth cycle and which will die.
Experts believe that the lifespan of each hair follicle — and possi-
bly each follicular unit — is genetically programmed.
Because some of the hair follicles within the FU survive while
others die, there’s some hope that the chemical inducers that
determine the survivors can be identified and manipulated to pre-
vent hair loss. We have identified some of the molecules that stim-
ulate the process but others still need to be isolated. Maybe when
all of the molecules are identified and isolated, we can stop the
balding process from occurring.
Saving dying hair cells
The causes of cell death are complex. Research has shown that the
cells that produce apoptosis-causing chemicals are found in every
part of the hair follicle. It’s possible that different types of hair loss
are influenced by different chemical problems in the pathways that
control cell death.
Although the medical community is identifying many of these
chemical pathways, it’s no closer to finding a cure for apoptosis
than we would like. Interestingly, apoptosis typically doesn’t occur
in cancerous cells, which are thought to be immortal, escaping
their natural destiny of living a given number of cell cycles. For
example, in breast cancer, a gene called BRCA causes the produc-
tion of a particular enzyme that blocks apoptosis. Imagine if it were
possible to bottle that enzyme to use on hair that’s dying off or,
even better, create a cocktail that could make all the cells in the
body immortal! At least we can dream.
just by looking at you what kind of hair loss you have? Yes, some-
times. Hereditary hair loss patterns, the most common type of hair
loss in men, have developed into a classical clinical descriptive sci-
ence. Genetic hair loss appears in distinct patterns, and these pat-
terns are almost 100-percent diagnostic for male pattern baldness.
The later section, “Norwood classifications for measuring male pat-
tern thinning” covers the most common baldness patterns. Also,
we discuss the types and causes of pattern balding in the later sec-
tion, “Common Causes of Hair Loss.”
In women, balding patterns also exist (see the section, “Genetic
hair loss in women,” later in this chapter), and a knowledgeable
doctor may be able to tell what’s causing the hair loss just by
looking.
Examining uniform hair loss
A small segment of people lose scalp hair uniformly (diffusely),
rather than losing hair in specific scalp areas. Uniform hair loss
isn’t as easy to detect as other types of hair loss because the hair
is steadily lost all over the head. It’s much easier to detect a bald
spot resulting from hair loss in a specific area of the scalp from
diseases that cause uniform hair loss to the normal genetics of that
particular person.
Hair loss occurs normally and usually occurs at the end of one of
the normal hair cycles that all hair goes through. These hair cycles
are as follows:
Anagen: The growth stage, which lasts three years on average
but may be as short as a year and as long as seven years).
Catogen: The stage when the hair prepares to go into the next
phase and undergoes changes in its anatomy, falling out at the
end of this part of the cycle.
Telogen: The sleep phase when a percentage of the hair disap-
pears (lasts from two to five months on average). About 10
percent of all of the hairs on our head are in the telogen part
of the cycle at any one time.
At the end of the telogen phase, a new hair bud appears, signaling
the beginning of anagen. (Chapter 2 has more about hair growth
phases.)
The hair apparatus starts off producing a baby hair below the skin,
which grows longer and longer until the final terminal hair (a full
mature hair reflective of what we style every day when we comb
out hair) emerges from the pore in the skin. In some adults, the
anagen phase may never start, signaling that the hair follicle may
have died. If a new hair doesn’t grow to replace the lost hair, the
total hair count drops.
Hair grows in natural occurring groups called follicular units (FU). A
single FU contains from one to four terminal hairs and one vellus
hair (a fine hair amidst the clump of terminal hairs). When a hair
isn’t replaced after its telogen phase, the number of hairs in the FU
decreases, but the number of FUs remains the same. So an FU
starting with four terminal hairs may end up with only two or three
terminal hairs as we age or as we undergo some form of balding.
When this happens across the whole scalp, the total hair count
decreases proportionally.
The older the patient is, the more likely it is that doctors see this
uniform hair loss process. About one third of men over age 70 have
this diffuse hair loss, which is called senile alopecia. The name
doesn’t reflect the mental status of those afflicted, but rather it
essentially means that the condition is most common in the eld-
erly. Because hair also becomes finer with age, severe thinning
reflects a loss of both hair bulk (in each hair shaft) and hair densi-
ties. (For more on hair bulk and density, turn to Chapter 2.) There’s
no cure for senile alopecia.
Young men may experience uniform hair loss in the form of a con-
dition called diffuse unpatterned alopecia (DUPA). Doctors believe
that DUPA and senile alopecia are similar but for the age of occur-
rence. DUPA impacts men in their 20s and 30s and doesn’t seem to
be responsive to drugs used to treat the classic type of male pat-
terned hair loss. We cover treatment drugs in Chapter 9.
Identifying dying hair cells
Apoptosis is a cell’s internal “suicide” mechanism that causes cell
death. The phenomenon has recently been studied very carefully,
and what doctors know is that during the transition from anagen to
catagen (that’s the growth phase to the changing phase), some-
thing happens in the hair follicle development.
The cells within the hair follicles communicate with each other,
and certain chemicals secreted in the hair follicle determine which
hairs will survive for another growth cycle and which will die.
Experts believe that the lifespan of each hair follicle — and possi-
bly each follicular unit — is genetically programmed.
Because some of the hair follicles within the FU survive while
others die, there’s some hope that the chemical inducers that
determine the survivors can be identified and manipulated to pre-
vent hair loss. We have identified some of the molecules that stim-
ulate the process but others still need to be isolated. Maybe when
all of the molecules are identified and isolated, we can stop the
balding process from occurring.
Saving dying hair cells
The causes of cell death are complex. Research has shown that the
cells that produce apoptosis-causing chemicals are found in every
part of the hair follicle. It’s possible that different types of hair loss
are influenced by different chemical problems in the pathways that
control cell death.
Although the medical community is identifying many of these
chemical pathways, it’s no closer to finding a cure for apoptosis
than we would like. Interestingly, apoptosis typically doesn’t occur
in cancerous cells, which are thought to be immortal, escaping
their natural destiny of living a given number of cell cycles. For
example, in breast cancer, a gene called BRCA causes the produc-
tion of a particular enzyme that blocks apoptosis. Imagine if it were
possible to bottle that enzyme to use on hair that’s dying off or,
even better, create a cocktail that could make all the cells in the
body immortal! At least we can dream.
Defining Different Types of Hair Loss
How do you define hair loss? Do you consider you’re balding when
you’ve lost 5 hairs, 5,000, or 50,000? Can you slow the balding
process, stop it altogether, or should you just increase your base-
ball hat collection and live with it?
Hair falls out of your head every single day, at a rate of about 100
to 150 hairs if you are a Caucasian (Asians lose 80–120 per day and
Africans 60–100 per day). You aren’t going bald if your hair is
coming out at these rates because that is the rate that new hair
grows up from the scalp. If the hair that falls out isn’t replaced by
the same number of new hairs, then you have a balding problem.
Hair loss isn’t noticeable in the average person until more than 50
percent is lost, which is around 50,000 hairs, more or less.
Why does hair loss occur at all? You were born with your hair, and
by simple logic, you should die with it, right? Not one organ in the
human body dies as a natural course of aging, yet hair follicles
commit mass suicide over time. Other human organs may change
over time and become less functional, but they don’t disappear
altogether. Is hair loss a type of genetic adaptation? No one knows.
This section looks at the different types and causes of hair loss,
including the cause of 99 percent of all cases of male balding: male
pattern baldness.
you’ve lost 5 hairs, 5,000, or 50,000? Can you slow the balding
process, stop it altogether, or should you just increase your base-
ball hat collection and live with it?
Hair falls out of your head every single day, at a rate of about 100
to 150 hairs if you are a Caucasian (Asians lose 80–120 per day and
Africans 60–100 per day). You aren’t going bald if your hair is
coming out at these rates because that is the rate that new hair
grows up from the scalp. If the hair that falls out isn’t replaced by
the same number of new hairs, then you have a balding problem.
Hair loss isn’t noticeable in the average person until more than 50
percent is lost, which is around 50,000 hairs, more or less.
Why does hair loss occur at all? You were born with your hair, and
by simple logic, you should die with it, right? Not one organ in the
human body dies as a natural course of aging, yet hair follicles
commit mass suicide over time. Other human organs may change
over time and become less functional, but they don’t disappear
altogether. Is hair loss a type of genetic adaptation? No one knows.
This section looks at the different types and causes of hair loss,
including the cause of 99 percent of all cases of male balding: male
pattern baldness.
Chapter 4 Types of Hair Loss and Pattern Thinning in Men and Women
In This Chapter
Defining the various types of hair loss
Understanding how heredity and disease can cause hair loss
Looking at how your lifestyle impacts your hair
Exploring causes of pattern thinning in men and women
People have different ideas about what constitutes hair loss
and what causes it. Some people see three or four hairs in the
sink after combing and panic. Others don’t think they’re losing
their hair until the back bald spot meets the middle bald spot and
there’s nothing left to comb. When it comes to figuring out why
they’re going bald, some people assume it’s genetic, and therefore
unavoidable, whereas others are less accepting and look into every
possible way to save their hair.
In this chapter, we define male and female balding patterns, explain
why balding occurs, describe how pattern baldness is recognized
and classified, and give you some ideas on how your lifestyle can
affect your hair.
Defining the various types of hair loss
Understanding how heredity and disease can cause hair loss
Looking at how your lifestyle impacts your hair
Exploring causes of pattern thinning in men and women
People have different ideas about what constitutes hair loss
and what causes it. Some people see three or four hairs in the
sink after combing and panic. Others don’t think they’re losing
their hair until the back bald spot meets the middle bald spot and
there’s nothing left to comb. When it comes to figuring out why
they’re going bald, some people assume it’s genetic, and therefore
unavoidable, whereas others are less accepting and look into every
possible way to save their hair.
In this chapter, we define male and female balding patterns, explain
why balding occurs, describe how pattern baldness is recognized
and classified, and give you some ideas on how your lifestyle can
affect your hair.
Part II The Root of Hair Loss: How and Why It Happens
In this part . . .
All hair loss isn’t the same. People lose hair due to
hereditary factors, illnesses, and a number of other
reasons. In this section, we look at how and why hair loss
occurs as well as what you can do to prevent it.
All hair loss isn’t the same. People lose hair due to
hereditary factors, illnesses, and a number of other
reasons. In this section, we look at how and why hair loss
occurs as well as what you can do to prevent it.
Caring for Children’s Hair
Want to get a head start on healthy heads of hair for your kids?
You can do this by teaching them how to properly wash and dry
their hair. Help them learn non-destructive styling techniques
(until they reach the age where their friends know way more than
you do about hair — and everything else).
Many babies have little hair to work with, and what hair they have
is often very fine, delicate, and easily damaged. As a child grows,
new hair grows that’s often thicker than the baby hairs seen in the
first year of life.
In many infants, the new hair grown at about one year may have
a completely different texture or color than what was previously
present!
Probably the most damage to children’s hair comes from the
styles used to make them look cute or to keep their hair out of
their faces! Ponytails, pigtails, and braids can pull out the hair at
the roots and produce traction alopecia (see Chapter 5 for more
on traction alopecia). This hair loss condition is very common
among African American children, who often have multiple pigtails
that pull on the scalp in many areas, or Caucasian children with
wild or very curly hair. Unfortunately, this type of hair loss is often
permanent.
People take so much pride in the way their children look that they
often treat the kids like dolls, using hairstyles that are counter to
the hair’s natural growing tendencies and that can harm the hair
over time. To avoid damaging a young person’s hair, follow these
recommendations (most of the rules discussed earlier in this chap-
ter apply just as much to children as they do to adults):
Don’t keep rubber bands in the hair overnight.
Rotate hairstyles so that one area isn’t always receiving
traction. For example, do a ponytail one day, braids the next,
and then leave it loose with a headband for a day or two.
Use a good conditioner to make the hair slide more easily
when you’re combing out knots. For longer hair, use detan-
gling agents along with a good conditioner to minimize the
formation of knots in the first place.
As with adult hair, always start at the end of the hair and work
toward the scalp, not the other direction. (Hardly anyone
does this properly, but now you know!)
When working on knots, hold the hair between the ends and
the scalp tightly in one hand as you comb the hair so that the
child doesn’t feel the pain of the comb pulling on the hair.
Use a plastic comb rather than a brush to prevent static
electricity from building on the hair as it dries. Static elec-
tricity will make the hair stand up with more exposure to the
elements like sun, heat, and wind.
Never back comb the hair, as this is guaranteed to damage
children’s delicate hair shafts.
Encourage children’s involvement in hair care. Show
them how to properly wash and dry their hair and comb
out tangles, and help them choose a flattering and easy care
hairstyle.
Fostering independence in proper hair grooming should be
your goal.
Inspect your children’s hair on a regular basis, especially
when they start school. Hair lice is practically a rite of pas-
sage for school-aged children and is easily spread from child
to child. Early detection and treatment is important in mini-
mizing any effects that head lice can have on the hair, such as
permanent patches of hair loss.
Make hair care fun. Hair care should be an enjoyable
experience.
Get off to a good start by using no-tears shampoos and patting
hair dry to eliminate the pain and suffering of hair washing.
Play with suds, styling dramatic and funny do’s.
Managing your children’s hair gives you an opportunity to
share an important common experience. Throughout your
children’s lives, hair will be important, and if you use their
hair to help instill pride in their looks, you help enhance their
self-esteem.
You can do this by teaching them how to properly wash and dry
their hair. Help them learn non-destructive styling techniques
(until they reach the age where their friends know way more than
you do about hair — and everything else).
Many babies have little hair to work with, and what hair they have
is often very fine, delicate, and easily damaged. As a child grows,
new hair grows that’s often thicker than the baby hairs seen in the
first year of life.
In many infants, the new hair grown at about one year may have
a completely different texture or color than what was previously
present!
Probably the most damage to children’s hair comes from the
styles used to make them look cute or to keep their hair out of
their faces! Ponytails, pigtails, and braids can pull out the hair at
the roots and produce traction alopecia (see Chapter 5 for more
on traction alopecia). This hair loss condition is very common
among African American children, who often have multiple pigtails
that pull on the scalp in many areas, or Caucasian children with
wild or very curly hair. Unfortunately, this type of hair loss is often
permanent.
People take so much pride in the way their children look that they
often treat the kids like dolls, using hairstyles that are counter to
the hair’s natural growing tendencies and that can harm the hair
over time. To avoid damaging a young person’s hair, follow these
recommendations (most of the rules discussed earlier in this chap-
ter apply just as much to children as they do to adults):
Don’t keep rubber bands in the hair overnight.
Rotate hairstyles so that one area isn’t always receiving
traction. For example, do a ponytail one day, braids the next,
and then leave it loose with a headband for a day or two.
Use a good conditioner to make the hair slide more easily
when you’re combing out knots. For longer hair, use detan-
gling agents along with a good conditioner to minimize the
formation of knots in the first place.
As with adult hair, always start at the end of the hair and work
toward the scalp, not the other direction. (Hardly anyone
does this properly, but now you know!)
When working on knots, hold the hair between the ends and
the scalp tightly in one hand as you comb the hair so that the
child doesn’t feel the pain of the comb pulling on the hair.
Use a plastic comb rather than a brush to prevent static
electricity from building on the hair as it dries. Static elec-
tricity will make the hair stand up with more exposure to the
elements like sun, heat, and wind.
Never back comb the hair, as this is guaranteed to damage
children’s delicate hair shafts.
Encourage children’s involvement in hair care. Show
them how to properly wash and dry their hair and comb
out tangles, and help them choose a flattering and easy care
hairstyle.
Fostering independence in proper hair grooming should be
your goal.
Inspect your children’s hair on a regular basis, especially
when they start school. Hair lice is practically a rite of pas-
sage for school-aged children and is easily spread from child
to child. Early detection and treatment is important in mini-
mizing any effects that head lice can have on the hair, such as
permanent patches of hair loss.
Make hair care fun. Hair care should be an enjoyable
experience.
Get off to a good start by using no-tears shampoos and patting
hair dry to eliminate the pain and suffering of hair washing.
Play with suds, styling dramatic and funny do’s.
Managing your children’s hair gives you an opportunity to
share an important common experience. Throughout your
children’s lives, hair will be important, and if you use their
hair to help instill pride in their looks, you help enhance their
self-esteem.
Maintaining a Healthy Scalp
There’s a common misconception that balding means there’s
something wrong with the scalp. But because hair actually starts
growing from below the scalp, the scalp itself has little to do with
hair loss or hair health.
When hair loss occurs because of male genetic hair loss (or any
other cause), the blood supply to the area drops because it isn’t
needed where there isn’t any hair. When surgeons transplant new
hair, the circulation in the scalp improves as the new hair grows
out (in effect recruiting the blood supply it needs). (You can find
more about hair transplantation in Part V.)
We generally tell patients that if they shampoo with a good com-
mercial product and use a conditioner once a day, the skin of the
scalp should remain moist and well taken care of.
You can impact your scalp circulation in a number of ways, some
of which may affect your hair indirectly. Things that are bad for the
scalp and its circulation include:
Smoking: As shown in ultrasound studies, smoking reduces
scalp circulation. Because this occurs with each cigarette,
over time smoking may contribute to whatever hair loss is
occurring on the head. Most doctors strongly believe this con-
nection, although definitive scientific proof is lacking.
Sun exposure: Repeated sunburns on the scalp may impact
structures deep in the scalp causing the hair producing cells
to shrink. Combining genetic hair loss and intense ultraviolet
light may speed up the balding process.
Skin cancer: Skin cancer comes in three different types, two
of which can be deadly by spreading throughout your body
(malignant melanomas and squamous cell cancers). These
cancers almost always appear in sun exposed skin.
Melanomas can rapidly spread beyond the confines of the
local area and they can be very small flat, mole like, frequently
black tumors. The third type of cancer, basal cell cancer) usu-
ally remains local but it often produces ulcers on the skin, and
they can grow to a significant size.
When balding occurs, the scalp is exposed to the impact of
ultraviolet light from direct sunlight, and the skin changes
from a smooth, uniform colored skin, to a skin that has spots
and discolorations throughout. Hair protects the scalp from
direct sunlight and can produce enough shade to reduce the
risks of skin cancers.
Dermatologic conditions: A variety of conditions can impact
the skin and scalp. See Chapter 5 for more.
Folliculitis: This is an infection of the hair follicles. It appears
as acne or red or white bumps on the scalp skin and may have
to be treated with soaks, antibiotics, or a minor surgical inci-
sion. It should never be picked or scratched, as this may
increase the incidence of permanent scarring and may spread
the infection from an infected hair follicle to one that is not
infected.
Folliculitis rarely causes permanent hair loss, but it may cause
the hair to prematurely enter the telogen (sleep) phase of the
hair cycle.
Chlorine and salt water: Frequent swimming in chlorine pools
or salt water without shampooing and conditioning afterward
has the ability to cause hair and scalp damage from the heavy
salt or chlorine exposure. The salt can dry the scalp.
Many patients believe that dandruff may cause balding, but this is
not true. Other patients report having an itchy or tingling scalp,
and they believe it’s a precursor of the balding process. This com-
plaint is actually quite common and may be a sign of early genetic
hair loss.
something wrong with the scalp. But because hair actually starts
growing from below the scalp, the scalp itself has little to do with
hair loss or hair health.
When hair loss occurs because of male genetic hair loss (or any
other cause), the blood supply to the area drops because it isn’t
needed where there isn’t any hair. When surgeons transplant new
hair, the circulation in the scalp improves as the new hair grows
out (in effect recruiting the blood supply it needs). (You can find
more about hair transplantation in Part V.)
We generally tell patients that if they shampoo with a good com-
mercial product and use a conditioner once a day, the skin of the
scalp should remain moist and well taken care of.
You can impact your scalp circulation in a number of ways, some
of which may affect your hair indirectly. Things that are bad for the
scalp and its circulation include:
Smoking: As shown in ultrasound studies, smoking reduces
scalp circulation. Because this occurs with each cigarette,
over time smoking may contribute to whatever hair loss is
occurring on the head. Most doctors strongly believe this con-
nection, although definitive scientific proof is lacking.
Sun exposure: Repeated sunburns on the scalp may impact
structures deep in the scalp causing the hair producing cells
to shrink. Combining genetic hair loss and intense ultraviolet
light may speed up the balding process.
Skin cancer: Skin cancer comes in three different types, two
of which can be deadly by spreading throughout your body
(malignant melanomas and squamous cell cancers). These
cancers almost always appear in sun exposed skin.
Melanomas can rapidly spread beyond the confines of the
local area and they can be very small flat, mole like, frequently
black tumors. The third type of cancer, basal cell cancer) usu-
ally remains local but it often produces ulcers on the skin, and
they can grow to a significant size.
When balding occurs, the scalp is exposed to the impact of
ultraviolet light from direct sunlight, and the skin changes
from a smooth, uniform colored skin, to a skin that has spots
and discolorations throughout. Hair protects the scalp from
direct sunlight and can produce enough shade to reduce the
risks of skin cancers.
Dermatologic conditions: A variety of conditions can impact
the skin and scalp. See Chapter 5 for more.
Folliculitis: This is an infection of the hair follicles. It appears
as acne or red or white bumps on the scalp skin and may have
to be treated with soaks, antibiotics, or a minor surgical inci-
sion. It should never be picked or scratched, as this may
increase the incidence of permanent scarring and may spread
the infection from an infected hair follicle to one that is not
infected.
Folliculitis rarely causes permanent hair loss, but it may cause
the hair to prematurely enter the telogen (sleep) phase of the
hair cycle.
Chlorine and salt water: Frequent swimming in chlorine pools
or salt water without shampooing and conditioning afterward
has the ability to cause hair and scalp damage from the heavy
salt or chlorine exposure. The salt can dry the scalp.
Many patients believe that dandruff may cause balding, but this is
not true. Other patients report having an itchy or tingling scalp,
and they believe it’s a precursor of the balding process. This com-
plaint is actually quite common and may be a sign of early genetic
hair loss.
Avoiding Hair Damage
Hair is under constant assault, not only from the elements (sun,
wind, and rain) but also from you, its owner. There are endless
ways to torture your hair into submission — and in some cases the
damage can be permanent. In this section, we look at the things
that make your hair cry uncle and things you can do to counteract
the damage you may have already inflicted.
Because you’re constantly producing new hair, you can get a fresh
start, a second chance at caring for your hair if you did things
wrong in the recent past. This means that you replace the old dam-
aged hair with new freshly growing hair, but it will take months for
this process to occur (hair grows at
1
⁄2 inch per month). Improper
use of permanent dyes or hair setting agents can damage all of the
hair on top of your head.
You may have to wait a year or two for new growth to replace that
which must be cut away, but the hair will grow back, as long as you
haven’t inflicted permanent damage on the hair root. The longer
you want your hair, the longer the wait.
Hair in thinning areas is often finer than hair on other parts of your
head. Thinning hair also grows more slowly. If hair in the frontal or
crown areas where hair is starting to miniaturize (the step before it
disappears permanently) is damaged in any way, its growth may
stop completely until it has time to recover — and at that point,
the hair may be about to disappear permanently.
Unfortunately, the period where hair begins to thin is the time
people often start trying to make their thinning hair look better by
dyeing it. Aggressive dying may finish off the balding process
ahead of time.
Most people do dastardly things to their hair on a daily basis; here
are just a few of the worst offenses:
Drying with a blow-dryer: Deep in the cortex are air pockets
that give hair an added bounce. These air pockets have mois-
ture in them, and if you blow-dry your hair at a high tempera-
ture, you can boil the moisture and cause the hair shaft to
explode! So a moderate temperature is essential when you
blow-dry your hair.
Using hot rollers: These curl-creators may be the single most
damaging thing for hair because they apply heat directly to
your hair.
Exposing hair to direct sunlight: Heat decreases the amount
of moisture in your hair, causing problems similar to those of
blow-drying. Exposing your hair to high doses of ultraviolet
light from direct sunlight can cause significant damage to the
disulphide bonds in the keratin.
Rubbing too hard to dry hair: If you rub your hair roughly
with a towel, the friction pulls out hair and may produce
mechanical damage to the remaining hair shafts.
Hacking it with dull scissors: Dull scissors can split apart the
cuticle, leaving broken hair with split ends that tend to peel
down the hair shaft.
Back brushing: Think of your hair as a one-way street which
runs from the scalp to the tip of the hair follicle. When you
brush or comb the hair against the scales, going from the tip
of the follicle to the scalp, you can irreversibly damage the
shaft and break the hair. Intact, unbroken cuticle cells are
glossy and smooth and give hair its shine and luster. Back
brushing changes the character of the cuticle so that it loses
its shine and luster.
Using a metal comb or brushing too hard: Plastic combs
create much less friction than metal combs and are a better
choice. Combing or brushing wet hair can fracture the hair
shafts, but conditioners can help by detangling and allowing a
comb to be passed through the hair without tugging on it,
which may cause it to fracture. When combing, start at the
ends and work your way up to the scalp, making sure to stay
with the grain by combing downward away from the scalp.
Perming: As we explain in the earlier section, “Perming your
hair,” the perming process breaks apart the scales so that
water can be absorbed and the hair can be reshaped. Leaving
perm solution on for too long or perming too often can perma-
nently damage the hair shaft.
Bleaching or coloring: The earlier section, “How dyes work,”
explains how bleaching or coloring your hair can damage the
cuticle and increase the porosity of the hair shaft, weakening
the hair by allowing it to absorb too much moisture.
Putting rubber bands around it: Rubber bands can cause
traction alopecia by putting too much pressure on the hair
shafts. In fact, constant pulling of the hair from any source can
cause traction alopecia.
Using hair sprays: Hair spray coats the cuticle and changes
its porosity, and it makes hairs bind to each other and pull at
the points of contact. They can produce traction from the con-
stant pulling that may fracture the hair cuticle and the spin-
dles below, exposing the cortex to possible environmental
damage.
Most hair sprays are water-soluble, so if you wash your hair daily
after using hair sprays, the hair spray chemicals and bonds they
form are usually washed away, decreasing the chance of damage.
An occasional bad hair day doesn’t mean you’ve permanently dam-
aged your hair; bad hair days usually are caused by a reduction in
static electricity in your hair, which is due to weather conditions
and not by anything you’ve done to your hair.
You guarantee that your hair will recover poorly from damage from
the various hair treatments you subject it to if you don’t give it an
opportunity for repair with good washing and conditioning. Once
the cuticle cracks or breaks and the cortex is damaged, only a
good hair cut (removing the damaged hair by cutting it off) will
allow you to get the healthy hair look you want.
When hair is damaged, it appears dull and feels rough, losing that
silky feel. Fortunately, with time, the hair grows out and you can
cut away that damaged hair as the younger part of the hair near
the base of the scalp replaces the old hair.
wind, and rain) but also from you, its owner. There are endless
ways to torture your hair into submission — and in some cases the
damage can be permanent. In this section, we look at the things
that make your hair cry uncle and things you can do to counteract
the damage you may have already inflicted.
Because you’re constantly producing new hair, you can get a fresh
start, a second chance at caring for your hair if you did things
wrong in the recent past. This means that you replace the old dam-
aged hair with new freshly growing hair, but it will take months for
this process to occur (hair grows at
1
⁄2 inch per month). Improper
use of permanent dyes or hair setting agents can damage all of the
hair on top of your head.
You may have to wait a year or two for new growth to replace that
which must be cut away, but the hair will grow back, as long as you
haven’t inflicted permanent damage on the hair root. The longer
you want your hair, the longer the wait.
Hair in thinning areas is often finer than hair on other parts of your
head. Thinning hair also grows more slowly. If hair in the frontal or
crown areas where hair is starting to miniaturize (the step before it
disappears permanently) is damaged in any way, its growth may
stop completely until it has time to recover — and at that point,
the hair may be about to disappear permanently.
Unfortunately, the period where hair begins to thin is the time
people often start trying to make their thinning hair look better by
dyeing it. Aggressive dying may finish off the balding process
ahead of time.
Most people do dastardly things to their hair on a daily basis; here
are just a few of the worst offenses:
Drying with a blow-dryer: Deep in the cortex are air pockets
that give hair an added bounce. These air pockets have mois-
ture in them, and if you blow-dry your hair at a high tempera-
ture, you can boil the moisture and cause the hair shaft to
explode! So a moderate temperature is essential when you
blow-dry your hair.
Using hot rollers: These curl-creators may be the single most
damaging thing for hair because they apply heat directly to
your hair.
Exposing hair to direct sunlight: Heat decreases the amount
of moisture in your hair, causing problems similar to those of
blow-drying. Exposing your hair to high doses of ultraviolet
light from direct sunlight can cause significant damage to the
disulphide bonds in the keratin.
Rubbing too hard to dry hair: If you rub your hair roughly
with a towel, the friction pulls out hair and may produce
mechanical damage to the remaining hair shafts.
Hacking it with dull scissors: Dull scissors can split apart the
cuticle, leaving broken hair with split ends that tend to peel
down the hair shaft.
Back brushing: Think of your hair as a one-way street which
runs from the scalp to the tip of the hair follicle. When you
brush or comb the hair against the scales, going from the tip
of the follicle to the scalp, you can irreversibly damage the
shaft and break the hair. Intact, unbroken cuticle cells are
glossy and smooth and give hair its shine and luster. Back
brushing changes the character of the cuticle so that it loses
its shine and luster.
Using a metal comb or brushing too hard: Plastic combs
create much less friction than metal combs and are a better
choice. Combing or brushing wet hair can fracture the hair
shafts, but conditioners can help by detangling and allowing a
comb to be passed through the hair without tugging on it,
which may cause it to fracture. When combing, start at the
ends and work your way up to the scalp, making sure to stay
with the grain by combing downward away from the scalp.
Perming: As we explain in the earlier section, “Perming your
hair,” the perming process breaks apart the scales so that
water can be absorbed and the hair can be reshaped. Leaving
perm solution on for too long or perming too often can perma-
nently damage the hair shaft.
Bleaching or coloring: The earlier section, “How dyes work,”
explains how bleaching or coloring your hair can damage the
cuticle and increase the porosity of the hair shaft, weakening
the hair by allowing it to absorb too much moisture.
Putting rubber bands around it: Rubber bands can cause
traction alopecia by putting too much pressure on the hair
shafts. In fact, constant pulling of the hair from any source can
cause traction alopecia.
Using hair sprays: Hair spray coats the cuticle and changes
its porosity, and it makes hairs bind to each other and pull at
the points of contact. They can produce traction from the con-
stant pulling that may fracture the hair cuticle and the spin-
dles below, exposing the cortex to possible environmental
damage.
Most hair sprays are water-soluble, so if you wash your hair daily
after using hair sprays, the hair spray chemicals and bonds they
form are usually washed away, decreasing the chance of damage.
An occasional bad hair day doesn’t mean you’ve permanently dam-
aged your hair; bad hair days usually are caused by a reduction in
static electricity in your hair, which is due to weather conditions
and not by anything you’ve done to your hair.
You guarantee that your hair will recover poorly from damage from
the various hair treatments you subject it to if you don’t give it an
opportunity for repair with good washing and conditioning. Once
the cuticle cracks or breaks and the cortex is damaged, only a
good hair cut (removing the damaged hair by cutting it off) will
allow you to get the healthy hair look you want.
When hair is damaged, it appears dull and feels rough, losing that
silky feel. Fortunately, with time, the hair grows out and you can
cut away that damaged hair as the younger part of the hair near
the base of the scalp replaces the old hair.
Relaxing your hair
People with curly or kinky hair use relaxing treatments to make
their hair more manageable; it’s most common among African
Americans or others with unmanageably curly hair. Relaxing is a
similar process to perming because the disulphide bond and
reforming process in the setting stage is identical, but it’s different
in that the goal is to straighten the hair, not to curl and shape it.
The shape of the hair shaft of the very curly or kinky hair adds a
mechanical problem to the straightening process.
Unfortunately, some people are so aggressive with hair straighten-
ing chemicals that they do permanent damage to some or all of
their hair. Overusing the setting agents can damage the hair above
the skin at the hair shaft level or below the skin in the living parts
of the hair follicle and cause the hairs to break off. We’ve seen
almost complete permanent hair loss from an overly aggressive
use of these setting agents. Damage can be limited by making sure
you follow the directions on the use of these chemicals to the
letter.
Hot irons may be used in conjunction with relaxing treatments to
straighten kinky hair, causing injury to the underlying anatomy of
the hair. It’s actually easier and less dangerous to straighten very
kinky long hair by putting wet hair under a paper bag and using a
hot iron on top of the bag. The paper minimizes the damage to the
cuticle because it insulates the hair from the high temperatures of
the hot iron.
their hair more manageable; it’s most common among African
Americans or others with unmanageably curly hair. Relaxing is a
similar process to perming because the disulphide bond and
reforming process in the setting stage is identical, but it’s different
in that the goal is to straighten the hair, not to curl and shape it.
The shape of the hair shaft of the very curly or kinky hair adds a
mechanical problem to the straightening process.
Unfortunately, some people are so aggressive with hair straighten-
ing chemicals that they do permanent damage to some or all of
their hair. Overusing the setting agents can damage the hair above
the skin at the hair shaft level or below the skin in the living parts
of the hair follicle and cause the hairs to break off. We’ve seen
almost complete permanent hair loss from an overly aggressive
use of these setting agents. Damage can be limited by making sure
you follow the directions on the use of these chemicals to the
letter.
Hot irons may be used in conjunction with relaxing treatments to
straighten kinky hair, causing injury to the underlying anatomy of
the hair. It’s actually easier and less dangerous to straighten very
kinky long hair by putting wet hair under a paper bag and using a
hot iron on top of the bag. The paper minimizes the damage to the
cuticle because it insulates the hair from the high temperatures of
the hot iron.
Perming your hair
Many men and women who are experiencing hair thinning opt for a
perm to give their hair a fuller look. You can find more on ways to
conceal hair loss in Chapter 8.
Perming your hair correctly is an art. The process is actually quite
intricate. Chew on this info when sitting in the salon next time you
get a perm!
Permanents use strong alkaline chemicals to break down the disul-
fide bonds in your hair and open the cortex of the hair fibers
within the cuticle so they’re able to take on water and reshape
themselves anatomically. After the bonds are broken down, the
hair can be reformed by using perm rods (the wider the rod, the
looser the curl).
Neutralizers that reset your hair in the new curled pattern are
applied after rinsing away the setting agent. The neutralizers con-
tain oxidizing agents like hydrogen peroxide, which harden the
cement that bonds the hair fibers with its keratin and reform the
disulphide bonds to their new shape.
When setting agents are on your hair, your hair is very vulnerable
to damage. Changes in the temperature (a person running out of
the salon to say hello to someone passing by in the street) can
cause damage. The longer the chemicals are in the hair shaft, the
more chance there is of damage to the cuticle, and a damaged hair
cuticle can leave hair more susceptible to damage from the
perming chemicals.
Although the setting agent is washed out before your hair is neu-
tralized, some of the solution will remain in the cortex and con-
tinue to have an influence on the hair bundles. For this reason, it’s
important not to wash your hair for three days after perming, or it
may lose the perm prematurely.
Fine hair is more likely to be damaged by repeated perming treat-
ments because the cuticles are thin and the shaft cement and the
hair bundles don’t contain much bulk for repeated reshaping.
Some people just don’t perm well; their hair is resistant to the
process, requiring more chemicals and possibly more risks in the
perming process. Stronger chemicals increase the risks, so expert-
ise is critical. Permanent damage to the hair and to the growth
center below the skin surface increases in probability as stronger
chemicals are used to perm or relax the hair. (The next section
covers relaxing treatments.)
perm to give their hair a fuller look. You can find more on ways to
conceal hair loss in Chapter 8.
Perming your hair correctly is an art. The process is actually quite
intricate. Chew on this info when sitting in the salon next time you
get a perm!
Permanents use strong alkaline chemicals to break down the disul-
fide bonds in your hair and open the cortex of the hair fibers
within the cuticle so they’re able to take on water and reshape
themselves anatomically. After the bonds are broken down, the
hair can be reformed by using perm rods (the wider the rod, the
looser the curl).
Neutralizers that reset your hair in the new curled pattern are
applied after rinsing away the setting agent. The neutralizers con-
tain oxidizing agents like hydrogen peroxide, which harden the
cement that bonds the hair fibers with its keratin and reform the
disulphide bonds to their new shape.
When setting agents are on your hair, your hair is very vulnerable
to damage. Changes in the temperature (a person running out of
the salon to say hello to someone passing by in the street) can
cause damage. The longer the chemicals are in the hair shaft, the
more chance there is of damage to the cuticle, and a damaged hair
cuticle can leave hair more susceptible to damage from the
perming chemicals.
Although the setting agent is washed out before your hair is neu-
tralized, some of the solution will remain in the cortex and con-
tinue to have an influence on the hair bundles. For this reason, it’s
important not to wash your hair for three days after perming, or it
may lose the perm prematurely.
Fine hair is more likely to be damaged by repeated perming treat-
ments because the cuticles are thin and the shaft cement and the
hair bundles don’t contain much bulk for repeated reshaping.
Some people just don’t perm well; their hair is resistant to the
process, requiring more chemicals and possibly more risks in the
perming process. Stronger chemicals increase the risks, so expert-
ise is critical. Permanent damage to the hair and to the growth
center below the skin surface increases in probability as stronger
chemicals are used to perm or relax the hair. (The next section
covers relaxing treatments.)
How dyes work
Hair dyes can be either permanent or semi-permanent. Both are
easy to apply at home, reasonably inexpensive, and very popular,
but can also be damaging to your hair, especially if they’re not
used properly.
Settling for semi-permanent
Semi-permanent dyes are acidic and are made of small molecules
that can pass through the scales of the cuticle and into the hair
cortex. These dyes are water-soluble and easily washed out. They
may last from one to six weeks, depending on what dyes are used,
but they lose color faster with frequent washings. Semi-permanent
dyes are generally safe and can be used at home. Because they
don’t contain bleach, they can’t lighten hair, but they can darken
graying hair.
If you decide you’re unhappy with your new semi-permanent color,
many home ingredients can help you rinse out the dye. Common
hair rinse ingredients found around the house include tea, beer
(which is also thought to add body to the hair and make it more
manageable), lemon juice, and heavily diluted honey (50 drops in a
pint of water). Rinse with any of these remedies after washing your
hair if you want the dye out faster. The sooner you wash out the
dye, the quicker it will come out.
You may not want to walk around with your hair smelling of
beer, so you can follow up the rinse with a more pleasant smelling
shampoo.
Going platinum
Bleaches oxidize the melanin granules in the cortex of the hair,
causing them to lose their color. This is an irreversible chemical
alteration in the hair itself and can’t be washed out. The most
common bleach for hair is hydrogen peroxide, which can be used
in conjunction with dyes to achieve the desired color.
Bleaches are often alkaline solutions, just like the neutralizing solu-
tions used for perms, which open the scales on the cuticle (for
more on perms, see the later section, “Perming your hair”). When
you bleach dark hair, the small concentrations of phaeomelanin
are resistant to the bleach so it’s not unusual to see a red tinge on
bleached dark hair.
The powerful bleach needed to obtain the platinum blond look will
almost certainly damage the hair cuticle, especially if it takes sev-
eral applications to achieve the desired color, each adding more
damage to the cuticle. The hair loses its silky feel because of the
cuticle damage.
Bleaching also makes hair more porous, which can produce
uneven shading. As new hair grows in its original color at the scalp
level, the entire head of hair often must be bleached again to cover
it, producing more potential damage to the older part of the hair
shaft. Some people just bleach their roots, targeting the hair close
to the scalp but leaving the hair that emerges from the scalp in its
original color.
With repeated bleaching, wet combing is difficult because the hair
cuticle isn’t smooth and has many damaged scales. Back combing
(or teasing) this hair just compounds the problem, producing
mechanical damage and hair breakage as the scales are knocked
off. Bleached hair also swells very easily because it’s so porous,
and hair is much weaker when it’s wet.
Putting on permanent coloring
Permanent hair coloring can be applied to the whole head or just
in select areas for streaks or highlights. Before hair can be perma-
nently dyed, all the existing color has to be removed by a strong
hydrogen peroxide (in a concentration of 30 to 40 percent) that
bleaches out all the melanin granules. This may produce some per-
manent damage to the keratin in the hair cortex, leaving the hair
with a lifeless look.
Ammonia is the alkaline chemical applied to open the cuticle and
allow the hair color to penetrate the cortex of the hair. It also acts
as a catalyst (accelerating the chemical reaction) when the perma-
nent hair color comes together with the peroxide.
Various alcohols and conditioners may also be present in perma-
nent hair color. The conditioners close the scales on the cuticle
after coloring in order to seal the new color to the cortex. Closing
the scales of the cuticle is important to maintain the moisture of
the hair cortex.
The FDA requires that warnings appear on permanent hair color
packaging to alert you to possible damage to your hair if directions
aren’t followed exactly. Read the instructions in the packages
carefully.
easy to apply at home, reasonably inexpensive, and very popular,
but can also be damaging to your hair, especially if they’re not
used properly.
Settling for semi-permanent
Semi-permanent dyes are acidic and are made of small molecules
that can pass through the scales of the cuticle and into the hair
cortex. These dyes are water-soluble and easily washed out. They
may last from one to six weeks, depending on what dyes are used,
but they lose color faster with frequent washings. Semi-permanent
dyes are generally safe and can be used at home. Because they
don’t contain bleach, they can’t lighten hair, but they can darken
graying hair.
If you decide you’re unhappy with your new semi-permanent color,
many home ingredients can help you rinse out the dye. Common
hair rinse ingredients found around the house include tea, beer
(which is also thought to add body to the hair and make it more
manageable), lemon juice, and heavily diluted honey (50 drops in a
pint of water). Rinse with any of these remedies after washing your
hair if you want the dye out faster. The sooner you wash out the
dye, the quicker it will come out.
You may not want to walk around with your hair smelling of
beer, so you can follow up the rinse with a more pleasant smelling
shampoo.
Going platinum
Bleaches oxidize the melanin granules in the cortex of the hair,
causing them to lose their color. This is an irreversible chemical
alteration in the hair itself and can’t be washed out. The most
common bleach for hair is hydrogen peroxide, which can be used
in conjunction with dyes to achieve the desired color.
Bleaches are often alkaline solutions, just like the neutralizing solu-
tions used for perms, which open the scales on the cuticle (for
more on perms, see the later section, “Perming your hair”). When
you bleach dark hair, the small concentrations of phaeomelanin
are resistant to the bleach so it’s not unusual to see a red tinge on
bleached dark hair.
The powerful bleach needed to obtain the platinum blond look will
almost certainly damage the hair cuticle, especially if it takes sev-
eral applications to achieve the desired color, each adding more
damage to the cuticle. The hair loses its silky feel because of the
cuticle damage.
Bleaching also makes hair more porous, which can produce
uneven shading. As new hair grows in its original color at the scalp
level, the entire head of hair often must be bleached again to cover
it, producing more potential damage to the older part of the hair
shaft. Some people just bleach their roots, targeting the hair close
to the scalp but leaving the hair that emerges from the scalp in its
original color.
With repeated bleaching, wet combing is difficult because the hair
cuticle isn’t smooth and has many damaged scales. Back combing
(or teasing) this hair just compounds the problem, producing
mechanical damage and hair breakage as the scales are knocked
off. Bleached hair also swells very easily because it’s so porous,
and hair is much weaker when it’s wet.
Putting on permanent coloring
Permanent hair coloring can be applied to the whole head or just
in select areas for streaks or highlights. Before hair can be perma-
nently dyed, all the existing color has to be removed by a strong
hydrogen peroxide (in a concentration of 30 to 40 percent) that
bleaches out all the melanin granules. This may produce some per-
manent damage to the keratin in the hair cortex, leaving the hair
with a lifeless look.
Ammonia is the alkaline chemical applied to open the cuticle and
allow the hair color to penetrate the cortex of the hair. It also acts
as a catalyst (accelerating the chemical reaction) when the perma-
nent hair color comes together with the peroxide.
Various alcohols and conditioners may also be present in perma-
nent hair color. The conditioners close the scales on the cuticle
after coloring in order to seal the new color to the cortex. Closing
the scales of the cuticle is important to maintain the moisture of
the hair cortex.
The FDA requires that warnings appear on permanent hair color
packaging to alert you to possible damage to your hair if directions
aren’t followed exactly. Read the instructions in the packages
carefully.
How nature colors hair
Two types of pigment (called melanin) in the hair bulb create hair
color, which is produced below the skin, deep in the dermal fat
about
1
⁄4 inch from the surface of the skin. The colors you see are
imprinted on the cortex of the hair fibers; the cuticle that covers
the hair bundles is clear.
These two pigments affect your hair in the following ways:
Eumelanin, the most common pigment, controls black and
brown colors (slightly different dominant genes)
Phaeomelanin has a red color to it; all humans have some
degree of red pigment in their hair, except for people whose
hair is stark white
The amount of eumelanin in the hair determines the darkness of
the color in the following way:
Brown eumelanin in large quantities will make the hair
dark brown.
Brown eumelanin in low quantities will produce a blond color.
Black eumelanin will make the hair black.
Black eumelanin in very low concentrations will create
gray hair.
Most hair colors are a balance between brown, black, and red pig-
ment, based upon the amount of these pigments that blend
together. Northern Europe has more blond-haired people than any-
where else, and Scotland has the highest redheaded population
(up to 10 percent of Scots are redheads). The rest of the human
race has dark pigment granules. If you bleach your hair, you oxi-
dize these pigments and they lose their color.
If you have no pigment-producing cells (as happens as some
people age), your hair will be white. Albinos have no pigment gran-
ules and have white hair — even their eyebrows and eyelashes.
Phaeomelanin is a robust pigment with a strong impact on the hair.
It’s hard to get hair with a high percentage of phaeomelanin to
respond to dyes and bleaches. Salon operators know that when
people bleach their hair, their natural red pigment lingers, so it’s
not unusual for bleached hair to show a red or orange tinge (par-
ticularly in blonds) and over time turn orange and various shades
of yellow with exposure to light.
color, which is produced below the skin, deep in the dermal fat
about
1
⁄4 inch from the surface of the skin. The colors you see are
imprinted on the cortex of the hair fibers; the cuticle that covers
the hair bundles is clear.
These two pigments affect your hair in the following ways:
Eumelanin, the most common pigment, controls black and
brown colors (slightly different dominant genes)
Phaeomelanin has a red color to it; all humans have some
degree of red pigment in their hair, except for people whose
hair is stark white
The amount of eumelanin in the hair determines the darkness of
the color in the following way:
Brown eumelanin in large quantities will make the hair
dark brown.
Brown eumelanin in low quantities will produce a blond color.
Black eumelanin will make the hair black.
Black eumelanin in very low concentrations will create
gray hair.
Most hair colors are a balance between brown, black, and red pig-
ment, based upon the amount of these pigments that blend
together. Northern Europe has more blond-haired people than any-
where else, and Scotland has the highest redheaded population
(up to 10 percent of Scots are redheads). The rest of the human
race has dark pigment granules. If you bleach your hair, you oxi-
dize these pigments and they lose their color.
If you have no pigment-producing cells (as happens as some
people age), your hair will be white. Albinos have no pigment gran-
ules and have white hair — even their eyebrows and eyelashes.
Phaeomelanin is a robust pigment with a strong impact on the hair.
It’s hard to get hair with a high percentage of phaeomelanin to
respond to dyes and bleaches. Salon operators know that when
people bleach their hair, their natural red pigment lingers, so it’s
not unusual for bleached hair to show a red or orange tinge (par-
ticularly in blonds) and over time turn orange and various shades
of yellow with exposure to light.
Changing Your Natural Look: Dyeing and Processing
More than half of people over age 50 have gray hair, but you’d
never know it. More people dye their hair to look younger than
do any other age-defying beauty enhancement. But if you want to
keep your hair as long as possible, it pays to be careful with dyes,
because improper use of dyes can do permanent damage to
your hair.
Graying generally starts at the temples and then spreads to other
parts of the scalp. Contrary to urban legend, your hair can’t turn
white overnight, although it may seem like it does when you let too
much time elapse between coloring!
Dyeing your hair can take years off you — but it can also be bad
for your hair. Plant-based dyes such as henna are less likely to
cause irritation, but the color doesn’t last as long as if you use
chemical dyes.
Most commercial hair dyes today contain the chemical para-
Phenylenediamine (PPD) as an active ingredient. It’s not uncom-
mon to develop skin sensitivity to permanent dyes containing PPD,
so be sure to test the product on a small area before covering your
whole head with hair color for the first time. Always check for the
presence of PPD in the dye that you are going to use. Even though
semi permanent dyes are not supposed to have PPD in them, never
assume this for your own safety.
There are two types of patch testing for PPD:
Apply a 20-percent dilution of the dye being tested to a small
area on your neck below the collar; wait a full 72 hours to see
if there’s a reaction, which would mean a sensitivity to PPD. A
reaction produces a reddened, rashy, or inflamed area of skin
in the area covered by the test solution.
Apply a patch containing a 2 percent concentration of PPD in
a petrolatum base to the skin and leave it there for up to three
days. If a rash or reddening occurs, remove the patch.
Sensitivities may arise even if you’ve been using a dye containing
PPD for years, so not being sensitive initially to the PPD doesn’t
mean that you won’t become sensitive to it over time.
never know it. More people dye their hair to look younger than
do any other age-defying beauty enhancement. But if you want to
keep your hair as long as possible, it pays to be careful with dyes,
because improper use of dyes can do permanent damage to
your hair.
Graying generally starts at the temples and then spreads to other
parts of the scalp. Contrary to urban legend, your hair can’t turn
white overnight, although it may seem like it does when you let too
much time elapse between coloring!
Dyeing your hair can take years off you — but it can also be bad
for your hair. Plant-based dyes such as henna are less likely to
cause irritation, but the color doesn’t last as long as if you use
chemical dyes.
Most commercial hair dyes today contain the chemical para-
Phenylenediamine (PPD) as an active ingredient. It’s not uncom-
mon to develop skin sensitivity to permanent dyes containing PPD,
so be sure to test the product on a small area before covering your
whole head with hair color for the first time. Always check for the
presence of PPD in the dye that you are going to use. Even though
semi permanent dyes are not supposed to have PPD in them, never
assume this for your own safety.
There are two types of patch testing for PPD:
Apply a 20-percent dilution of the dye being tested to a small
area on your neck below the collar; wait a full 72 hours to see
if there’s a reaction, which would mean a sensitivity to PPD. A
reaction produces a reddened, rashy, or inflamed area of skin
in the area covered by the test solution.
Apply a patch containing a 2 percent concentration of PPD in
a petrolatum base to the skin and leave it there for up to three
days. If a rash or reddening occurs, remove the patch.
Sensitivities may arise even if you’ve been using a dye containing
PPD for years, so not being sensitive initially to the PPD doesn’t
mean that you won’t become sensitive to it over time.
Reshaping hair
Setting can help you reshape your hair’s natural appearance by
giving it more volume. Blow-drying with a round brush to form the
hair and then using rollers to hold it in position until the drying is
complete is a common setting technique.
Setting wet hair with the help of a foam or gel increases the curva-
ture of the hair shaft. Shampooing helps this process because sur-
factants in the shampoo penetrate the hair shaft, making the dried
hair respond better to what you’re doing to it. (Refer to the earlier
section, “Keeping things slippery with surfactants,” for more on
these compounds in shampoo.)
Teasing hair is a common method of increasing volume, but
repeated teasing will permanently damage the hair because it
breaks the scales off the hair cuticle, and these broken scales can’t
repair themselves. (The section, “Combing the cuticles,” earlier in
this chapter explains the cuticles and scales.)
All the following materials are useful in setting hair because they
create adhesion of the hairs. They form films on the hair shafts
that dry and hold one hair to another (like a weld on the hair),
producing a better lift and therefore a better illusion of volume and
fullness.
Water-based materials such as gels, mousses, and foams:
These wash off easily with a good shampoo.
Hair spray: Hair spray forms a hard film that bonds the hair
into place. Combing sprayed hair that has dried can break the
hair at the bonding point. Therefore, it’s best not to mess with
the hair after you apply hair spray, or if you do attempt to
restyle it, be very careful not to tug on the hair as you comb it
again.
Many people spray on way more hair spray than needed,
leaving the hair overly saturated and making it very difficult
to remove the hair spray completely with one shampoo
application.
Hair waxes and pomades: These are more complex to apply
and much more difficult to remove, but a good strong sham-
poo with a very active surfactant will clean waxes and
pomades off the hair shafts, although it may take more than
one washing.
The advantage of waxes and pomades is that they stay in
place and hold the hair against wind and even rain because
they’re not water-soluble. Waxes act like a plaster cast,
imparting a rigidity to the hair shaft, and they work well in
hair of any length. The spiked hair of many movie and rock
stars is achieved using waxes and pomades.
Unlike hair-sprayed hair, which is difficult to remold, wax-
based products make it easy to rework the shape of the hair
again and again. They’re so durable that you could restyle
your hair as you walked down the street (although you may
prefer to do it in front of a mirror)!
giving it more volume. Blow-drying with a round brush to form the
hair and then using rollers to hold it in position until the drying is
complete is a common setting technique.
Setting wet hair with the help of a foam or gel increases the curva-
ture of the hair shaft. Shampooing helps this process because sur-
factants in the shampoo penetrate the hair shaft, making the dried
hair respond better to what you’re doing to it. (Refer to the earlier
section, “Keeping things slippery with surfactants,” for more on
these compounds in shampoo.)
Teasing hair is a common method of increasing volume, but
repeated teasing will permanently damage the hair because it
breaks the scales off the hair cuticle, and these broken scales can’t
repair themselves. (The section, “Combing the cuticles,” earlier in
this chapter explains the cuticles and scales.)
All the following materials are useful in setting hair because they
create adhesion of the hairs. They form films on the hair shafts
that dry and hold one hair to another (like a weld on the hair),
producing a better lift and therefore a better illusion of volume and
fullness.
Water-based materials such as gels, mousses, and foams:
These wash off easily with a good shampoo.
Hair spray: Hair spray forms a hard film that bonds the hair
into place. Combing sprayed hair that has dried can break the
hair at the bonding point. Therefore, it’s best not to mess with
the hair after you apply hair spray, or if you do attempt to
restyle it, be very careful not to tug on the hair as you comb it
again.
Many people spray on way more hair spray than needed,
leaving the hair overly saturated and making it very difficult
to remove the hair spray completely with one shampoo
application.
Hair waxes and pomades: These are more complex to apply
and much more difficult to remove, but a good strong sham-
poo with a very active surfactant will clean waxes and
pomades off the hair shafts, although it may take more than
one washing.
The advantage of waxes and pomades is that they stay in
place and hold the hair against wind and even rain because
they’re not water-soluble. Waxes act like a plaster cast,
imparting a rigidity to the hair shaft, and they work well in
hair of any length. The spiked hair of many movie and rock
stars is achieved using waxes and pomades.
Unlike hair-sprayed hair, which is difficult to remold, wax-
based products make it easy to rework the shape of the hair
again and again. They’re so durable that you could restyle
your hair as you walked down the street (although you may
prefer to do it in front of a mirror)!
Thickening your hair
Who wants flat, wimpy hair, the kind that lacks body or bounce?
Limp hair is almost always very fine hair, because fine hair shafts
don’t have enough thickness to maintain their stiffness and to
stand away from the scalp. Hair that’s naturally curved takes up
more room and makes hair appear fuller than it actually is. (People
from Mediterranean areas, such as France, Spain, and Italy, are
famous for lush, wavy, full-bodied hair.)
Using styling gels or a mousse that attach to your hair shafts can
give your hair a thicker appearance, even if “flat as a pancake”
describes your normal hair to a T. Gels and mousses increase the
roughness of the hair in addition to giving the appearance of a
thicker hair shaft.
The increased roughness of the hairs makes them bond to each
other, which makes your hair appear fuller. When your hair is fine,
it’s not a good idea to use smoothing products that take away the
rough character of the hair because your hair can end up appear-
ing even thinner than it actually is.
You may have to try several different mousses and gels to find
what works best for your hair because there are so many products
on the market that you need to experiment to find the one that fits
you needs best). Mousses and some gels are particularly good for
fine hair to increase the sense of hair bulk.
Limp hair is almost always very fine hair, because fine hair shafts
don’t have enough thickness to maintain their stiffness and to
stand away from the scalp. Hair that’s naturally curved takes up
more room and makes hair appear fuller than it actually is. (People
from Mediterranean areas, such as France, Spain, and Italy, are
famous for lush, wavy, full-bodied hair.)
Using styling gels or a mousse that attach to your hair shafts can
give your hair a thicker appearance, even if “flat as a pancake”
describes your normal hair to a T. Gels and mousses increase the
roughness of the hair in addition to giving the appearance of a
thicker hair shaft.
The increased roughness of the hairs makes them bond to each
other, which makes your hair appear fuller. When your hair is fine,
it’s not a good idea to use smoothing products that take away the
rough character of the hair because your hair can end up appear-
ing even thinner than it actually is.
You may have to try several different mousses and gels to find
what works best for your hair because there are so many products
on the market that you need to experiment to find the one that fits
you needs best). Mousses and some gels are particularly good for
fine hair to increase the sense of hair bulk.
How Gels, Sprays, and Other Chemicals Impact Hair Shape
Hair sprays, gels, perms, and other chemical products and
processes exist for only one reason: So you can force your hair to
do what you want. It’s part of human nature to want what you
don’t have. People with straight hair want curls and people with
curly hair are constantly trying to tame it into straight submission.
Hair, however, has a mind of its own and has certain built-in char-
acteristics that must be overcome if you want it to do your bid-
ding. Some factors that influence the look of your hair are:
The thickness of the hair shafts
The density of the hair
The natural stiffness of the hair (which keeps it from lying on
the scalp like a wet noodle)
The natural curvature of the hair
The slippery nature of the hair (how it slides over its neigh-
boring hairs)
The cohesiveness of the hair (how it sticks to other hairs)
This section looks at the ways changing your look with chemical
products and processes can also change the composition of your
hair — for better, for worse, and sometimes forever.
processes exist for only one reason: So you can force your hair to
do what you want. It’s part of human nature to want what you
don’t have. People with straight hair want curls and people with
curly hair are constantly trying to tame it into straight submission.
Hair, however, has a mind of its own and has certain built-in char-
acteristics that must be overcome if you want it to do your bid-
ding. Some factors that influence the look of your hair are:
The thickness of the hair shafts
The density of the hair
The natural stiffness of the hair (which keeps it from lying on
the scalp like a wet noodle)
The natural curvature of the hair
The slippery nature of the hair (how it slides over its neigh-
boring hairs)
The cohesiveness of the hair (how it sticks to other hairs)
This section looks at the ways changing your look with chemical
products and processes can also change the composition of your
hair — for better, for worse, and sometimes forever.
Washing and drying your hair correctly
You may not think you need instructions for washing your hair, but
there’s a right way and a wrong way to do everything, including
washing and drying your hair! Follow these instructions and you’ll
end up with less hair damage and healthier, better-looking hair:
1. Wet your hair with plain warm water.
2. Put the shampoo in your hands and rub them together to
get the lather up before applying it to your hair.
3. Work the shampoo into the scalp and massage gently
with your finger tips to get the lather up.
4. Let your hair hang while you rinse it thoroughly.
If you’re in a bath tub, lean your head forward as you rinse
the shampoo out with warm water.
5. If you’re not using a shampoo that contains conditioner,
put a separate conditioner in your hands and apply it to
the scalp first before working it into the hair. Leave it on
for at least a couple of minutes and then rinse thoroughly
with warm water.
Shampoos combined with conditioners can be very effec-
tive for most men with short hair and for hair that’s not
damaged.
6. Towel-dry your hair gently by patting it; don’t rub your
scalp and hair briskly with the towel and don’t blow-dry
your hair when soaking wet.
7. Comb or brush your wet hair gently. If you use a condi-
tioner properly, the tangles should be relatively easy to
take out with a wide-toothed plastic comb or brush.
8. If you use a mousse, gel, or setting agent, it’s best applied
after you pat-dry your hair, when the hair is still damp.
So-called wet gels give the hair a glossy appearance.
9. If you blow-dry your hair, don’t do so when the hair is
soaking wet.
If you use a blow-dryer, be sure to keep it moving con-
stantly so that the heat isn’t concentrated in one area of
your hair. It’s always best to use the lowest heat and the
lowest speed you can get away with because high heat
causes hair damage. Also, damage generally occurs at the
end of the blow-drying cycle, so always turn off the drier
before your hair is completely dry.
there’s a right way and a wrong way to do everything, including
washing and drying your hair! Follow these instructions and you’ll
end up with less hair damage and healthier, better-looking hair:
1. Wet your hair with plain warm water.
2. Put the shampoo in your hands and rub them together to
get the lather up before applying it to your hair.
3. Work the shampoo into the scalp and massage gently
with your finger tips to get the lather up.
4. Let your hair hang while you rinse it thoroughly.
If you’re in a bath tub, lean your head forward as you rinse
the shampoo out with warm water.
5. If you’re not using a shampoo that contains conditioner,
put a separate conditioner in your hands and apply it to
the scalp first before working it into the hair. Leave it on
for at least a couple of minutes and then rinse thoroughly
with warm water.
Shampoos combined with conditioners can be very effec-
tive for most men with short hair and for hair that’s not
damaged.
6. Towel-dry your hair gently by patting it; don’t rub your
scalp and hair briskly with the towel and don’t blow-dry
your hair when soaking wet.
7. Comb or brush your wet hair gently. If you use a condi-
tioner properly, the tangles should be relatively easy to
take out with a wide-toothed plastic comb or brush.
8. If you use a mousse, gel, or setting agent, it’s best applied
after you pat-dry your hair, when the hair is still damp.
So-called wet gels give the hair a glossy appearance.
9. If you blow-dry your hair, don’t do so when the hair is
soaking wet.
If you use a blow-dryer, be sure to keep it moving con-
stantly so that the heat isn’t concentrated in one area of
your hair. It’s always best to use the lowest heat and the
lowest speed you can get away with because high heat
causes hair damage. Also, damage generally occurs at the
end of the blow-drying cycle, so always turn off the drier
before your hair is completely dry.
Picking the proper shampoo
You have a myriad of shampoo options, but selecting the right one
for your hair isn’t really that difficult when you understand the cat-
egories. Shampoos are generally geared toward use on normal,
fine, or dry hair; you just have to figure out which one you have.
Here’s a breakdown:
Normal hair
• Is neither greasy nor dry.
• Isn’t permed or color treated.
• Generally holds its style well, without the use of lots of
products.
• Looks good most of the time.
Fine hair
• Tends to be limp.
• Looks flat and lacks volume.
• Is difficult to manage.
• Becomes greasy soon after it’s washed.
Dry hair
• Is dull.
• Is frizzy.
• Feels rough.
• Has been treated with perms or coloring agents.
• Tangles easily.
Excess oils tend to weigh the hair down, making it difficult to
manage, because the oil clings to dirt and particulate matter.
Because sebum is easily spread by passing your fingers through
your hair, don’t run your fingers through your hair after you finish
drying and styling it.
And if your hair is greasy, be sure to use a shampoo designed for
greasy hair. It has more powerful surfactants to get the grease off
of the scalp and hair shafts, but be aware that more powerful
surfactants may be more irritating to the eyes and skin.
Shampoos don’t alter the physical properties of the hair, so hair
will be just as pliable and strong after a shampoo as it was before.
But conditioners in the shampoo can interfere with perming and
coloring. You can offset the impact by using shampoos that con-
tain silicone micro-emulsifiers.
Knowing when to trust the label
Because the FDA is involved in the regulation of claims on the labels and the adver-
tising material on these products, you can generally trust the claims if the company
is well known. On the other hand, many fly-by-night companies will risk making
incredible claims, hoping to fly under the FDA radar, to get you to buy their product.
These products often show up on late night infomercials and feature someone
wearing a white lab coat (who almost assuredly is not a doctor, although you’re
meant to think he is).
Because hair products don’t have to be cleared by the FDA before they go on the
market, there’s no central place to go to find out if a product is safe and their ads are
truthful. If the FDA finds that the product is being falsely advertised, they will first act
by serving the company a “cease and desist” letter. It can take considerable time
before a company removes a product from the market under these circumstances.
The safety and effectiveness of these products may not have been rigorously tested
and you don’t want to become a victim of some possibly unsafe product while wait-
ing for the FDA to answer a complaint and then put them out of business; the best
thing to do is to buy products from companies that are well known rather than those
that advertise on late night TV.
for your hair isn’t really that difficult when you understand the cat-
egories. Shampoos are generally geared toward use on normal,
fine, or dry hair; you just have to figure out which one you have.
Here’s a breakdown:
Normal hair
• Is neither greasy nor dry.
• Isn’t permed or color treated.
• Generally holds its style well, without the use of lots of
products.
• Looks good most of the time.
Fine hair
• Tends to be limp.
• Looks flat and lacks volume.
• Is difficult to manage.
• Becomes greasy soon after it’s washed.
Dry hair
• Is dull.
• Is frizzy.
• Feels rough.
• Has been treated with perms or coloring agents.
• Tangles easily.
Excess oils tend to weigh the hair down, making it difficult to
manage, because the oil clings to dirt and particulate matter.
Because sebum is easily spread by passing your fingers through
your hair, don’t run your fingers through your hair after you finish
drying and styling it.
And if your hair is greasy, be sure to use a shampoo designed for
greasy hair. It has more powerful surfactants to get the grease off
of the scalp and hair shafts, but be aware that more powerful
surfactants may be more irritating to the eyes and skin.
Shampoos don’t alter the physical properties of the hair, so hair
will be just as pliable and strong after a shampoo as it was before.
But conditioners in the shampoo can interfere with perming and
coloring. You can offset the impact by using shampoos that con-
tain silicone micro-emulsifiers.
Knowing when to trust the label
Because the FDA is involved in the regulation of claims on the labels and the adver-
tising material on these products, you can generally trust the claims if the company
is well known. On the other hand, many fly-by-night companies will risk making
incredible claims, hoping to fly under the FDA radar, to get you to buy their product.
These products often show up on late night infomercials and feature someone
wearing a white lab coat (who almost assuredly is not a doctor, although you’re
meant to think he is).
Because hair products don’t have to be cleared by the FDA before they go on the
market, there’s no central place to go to find out if a product is safe and their ads are
truthful. If the FDA finds that the product is being falsely advertised, they will first act
by serving the company a “cease and desist” letter. It can take considerable time
before a company removes a product from the market under these circumstances.
The safety and effectiveness of these products may not have been rigorously tested
and you don’t want to become a victim of some possibly unsafe product while wait-
ing for the FDA to answer a complaint and then put them out of business; the best
thing to do is to buy products from companies that are well known rather than those
that advertise on late night TV.
Remembering the “no wash” years
For centuries, hair care was a time consuming, uncomfortable process that often did
more harm than good. Before shampoo was invented, harsh soaps, often made of
animal fats, were used to scrub the hair in much the same way as you scrub your
hands today to clean them. The washing process left scummy soap deposits stick-
ing to the hair, which made it look dull. Scrubbing got the dirt out, but with varying
degrees of damage in the process.
Because hair washing in the old days was a major ordeal for many people,
particularly women with long hair, it wasn’t unusual to avoid the process until such
a time as it became impossible to ignore. The unwashed hair built up sebum
(grease), which stuck to the 100 to 150 hairs shed daily and flakes of shed skin.
This all resulted in the hair becoming matted overnight. Tossing and turning in one’s
sleep resulted in a semi-permanent “bed head” as mats of hair became cemented
to each other.
The result not only looked bad, but it also smelled pretty ghastly. People tried to
manage the problem with powders to hide the visuals and perfumes to mask the
odors. These powders added more particulate matter to the mats of hair and sebum,
making the problem much worse in the long run. So if you’ve ever lamented the fact
that you need to wash your hair regularly, be thankful that you can do just that!
more harm than good. Before shampoo was invented, harsh soaps, often made of
animal fats, were used to scrub the hair in much the same way as you scrub your
hands today to clean them. The washing process left scummy soap deposits stick-
ing to the hair, which made it look dull. Scrubbing got the dirt out, but with varying
degrees of damage in the process.
Because hair washing in the old days was a major ordeal for many people,
particularly women with long hair, it wasn’t unusual to avoid the process until such
a time as it became impossible to ignore. The unwashed hair built up sebum
(grease), which stuck to the 100 to 150 hairs shed daily and flakes of shed skin.
This all resulted in the hair becoming matted overnight. Tossing and turning in one’s
sleep resulted in a semi-permanent “bed head” as mats of hair became cemented
to each other.
The result not only looked bad, but it also smelled pretty ghastly. People tried to
manage the problem with powders to hide the visuals and perfumes to mask the
odors. These powders added more particulate matter to the mats of hair and sebum,
making the problem much worse in the long run. So if you’ve ever lamented the fact
that you need to wash your hair regularly, be thankful that you can do just that!
Choosing and Using the Right Products
The right shampoo and conditioner can work wonders on your
hair, helping it stay not only shiny and attractive but also healthy.
With shelves and shelves of products available in stores, how do
you know which ones to choose? Should you go for the one with
the most four-syllable ingredients on the label, or maybe the one
with the label that coordinates with your bathroom colors? Or are
they all the same, and the cheapest will do?
In this section, we help you pick out products that will benefit your
hair, as well as describe the improvements that science has
brought to the world of hair care products and how they affect you
and your locks.
Looking at today’s hair
care products
Things have definitely changed for the better in the industrialized
world. Today, it’s not unusual to wash your hair frequently, some-
times more than once a day. Although this is a good move from
both a visual and an odor perspective, it means that modern
shampoos must be designed to prevent damage incurred by
frequent use.
Shampooing your hair removes environmental particles that may
build up during your daily activities. People who work in dirty
environments (such as shoveling coal in a coal mine) or even just
outside all day will clearly build up more particulate matter than
those people who work indoors. Cleaning your hair removes any
particulate matter as well as the sebum that builds up throughout
the day.
Attracting positive products to your hair
You probably never knew this, but hair has a small negative electric
charge. Thinking back to high school chemistry, you may remember
that opposite charges attract. That means that you can use chemi-
cals and products that have a positive charge to them in an effort to
treat mild damage to your hair. These products are attracted to the
negatively charged hair and coat the hair cuticle, restoring the
shine to dull, dry hair and making it more manageable.
One product that can help your hair through electricity is condi-
tioner, which carries a weak positive charge. The positive mole-
cules in the conditioner, which contains silicone, stick to the
negatively charged hair shafts, and the conditioner molecules pen-
etrate the scales of the cuticle, allowing moisture to reach the
matrix of the hair shaft. This moisture increases the hair’s shine
and luster and the depth of the hair color.
Add this to the conditioning properties that help detangle the hair
when combing it, and you get conditioners that make hair softer
and easier to manage — wet or dry.
Getting the tangles out
Most modern shampoos also contain some conditioning agents
mixed in with the cleansers for easy combing of wet hair. You also
have the option of using a separate conditioner for even better
detangling.
If you’re having difficulty detangling your hair, applying more and
more conditioner won’t help. Rather, dry your hair and then use a
detangling agent.
Dreadlocks or long kinky hair can be a detangling nightmare. It
may help to separate your hair into sections and go through each
section using a long knitting needle. Detangle it from the scalp out-
ward if possible; you may run into a knot that you need to detangle
against the direction of the scales on the cuticle.
Damage to the hair structure during the detangling process is a
real risk, so this process should never be rushed. In other words,
attempting to yank your comb through a tangle is a hair care no-no.
Adding chemicals
Shampoos and conditioners are more than cleaning agents:
They’re also an alphabet soup of chemicals. Various chemicals are
added to
Control the viscosity (thickness of the solution).
Control the pH (the degree of acidity present).
Act as preservation agents to ensure that bacteria doesn’t
grow in the shampoos and conditioners.
Make the products attractive. Coloring agents are used in con-
junction with perfumes to make the product please both your
eyes and your nose.
Hair care products often include chemicals such as dimethicone
and panthenol (a vitamin B derivative), which are absorbed into
he hair shaft and provide moisture to dry areas when the new hair
grows. These compounds are more easily absorbed by the hair
when surfactants are also added to the mix (see the section
Keeping things slippery with surfactants” in this chapter for
more); surfactants help overcome the body’s sebum, which can
prevent full absorption of moisture in the hair.
Certain shampoos contain compounds like zinc pyrithione to treat
laky scalps (otherwise known as dandruff). These shampoos gen-
erally state on the packaging whether they’re recommended for
people with dandruff. All shampoos that claim to treat dandruff
must meet FDA over-the-counter drug requirements.
Volumizing shampoos and conditioners that add moisture to the
hair shaft, thereby increasing the bulk of the hair, contain such
unpronounceable products as polyquarternium and stearami-
daproply dimethylamine, which alter the electric charge on the
hair shaft. These tongue twisters are particularly important in
winter months when the air is dry, especially in heated buildings.
Keeping things slippery with surfactants
Today’s commercial shampoos contain compounds called surfac-
ants, compounds that accomplish a number of things when added
o shampoo. Surfactants
Help shampoo lather up in hard or soft water.
Help hair rinse easily and thoroughly.
Eliminate the need for hard scrubbing, which can damage
your hair.
Facilitate removal of grease and any dirt from the scalp and
hair, because the surfactant can penetrate physical barriers,
such as flakes of skin and dirt, embedded in the skin or hair.
Facilitate the foaming properties of a shampoo, which helps
lift the particulate materials (dirt) into the foam. A thicker
shampoo with surfactants in it will easily spread through
the hair.
Maintain a balance between the penetrating power of the
shampoo and the sensitivity of the scalp skin, which benefits
people with sensitive skin.
hair, helping it stay not only shiny and attractive but also healthy.
With shelves and shelves of products available in stores, how do
you know which ones to choose? Should you go for the one with
the most four-syllable ingredients on the label, or maybe the one
with the label that coordinates with your bathroom colors? Or are
they all the same, and the cheapest will do?
In this section, we help you pick out products that will benefit your
hair, as well as describe the improvements that science has
brought to the world of hair care products and how they affect you
and your locks.
Looking at today’s hair
care products
Things have definitely changed for the better in the industrialized
world. Today, it’s not unusual to wash your hair frequently, some-
times more than once a day. Although this is a good move from
both a visual and an odor perspective, it means that modern
shampoos must be designed to prevent damage incurred by
frequent use.
Shampooing your hair removes environmental particles that may
build up during your daily activities. People who work in dirty
environments (such as shoveling coal in a coal mine) or even just
outside all day will clearly build up more particulate matter than
those people who work indoors. Cleaning your hair removes any
particulate matter as well as the sebum that builds up throughout
the day.
Attracting positive products to your hair
You probably never knew this, but hair has a small negative electric
charge. Thinking back to high school chemistry, you may remember
that opposite charges attract. That means that you can use chemi-
cals and products that have a positive charge to them in an effort to
treat mild damage to your hair. These products are attracted to the
negatively charged hair and coat the hair cuticle, restoring the
shine to dull, dry hair and making it more manageable.
One product that can help your hair through electricity is condi-
tioner, which carries a weak positive charge. The positive mole-
cules in the conditioner, which contains silicone, stick to the
negatively charged hair shafts, and the conditioner molecules pen-
etrate the scales of the cuticle, allowing moisture to reach the
matrix of the hair shaft. This moisture increases the hair’s shine
and luster and the depth of the hair color.
Add this to the conditioning properties that help detangle the hair
when combing it, and you get conditioners that make hair softer
and easier to manage — wet or dry.
Getting the tangles out
Most modern shampoos also contain some conditioning agents
mixed in with the cleansers for easy combing of wet hair. You also
have the option of using a separate conditioner for even better
detangling.
If you’re having difficulty detangling your hair, applying more and
more conditioner won’t help. Rather, dry your hair and then use a
detangling agent.
Dreadlocks or long kinky hair can be a detangling nightmare. It
may help to separate your hair into sections and go through each
section using a long knitting needle. Detangle it from the scalp out-
ward if possible; you may run into a knot that you need to detangle
against the direction of the scales on the cuticle.
Damage to the hair structure during the detangling process is a
real risk, so this process should never be rushed. In other words,
attempting to yank your comb through a tangle is a hair care no-no.
Adding chemicals
Shampoos and conditioners are more than cleaning agents:
They’re also an alphabet soup of chemicals. Various chemicals are
added to
Control the viscosity (thickness of the solution).
Control the pH (the degree of acidity present).
Act as preservation agents to ensure that bacteria doesn’t
grow in the shampoos and conditioners.
Make the products attractive. Coloring agents are used in con-
junction with perfumes to make the product please both your
eyes and your nose.
Hair care products often include chemicals such as dimethicone
and panthenol (a vitamin B derivative), which are absorbed into
he hair shaft and provide moisture to dry areas when the new hair
grows. These compounds are more easily absorbed by the hair
when surfactants are also added to the mix (see the section
Keeping things slippery with surfactants” in this chapter for
more); surfactants help overcome the body’s sebum, which can
prevent full absorption of moisture in the hair.
Certain shampoos contain compounds like zinc pyrithione to treat
laky scalps (otherwise known as dandruff). These shampoos gen-
erally state on the packaging whether they’re recommended for
people with dandruff. All shampoos that claim to treat dandruff
must meet FDA over-the-counter drug requirements.
Volumizing shampoos and conditioners that add moisture to the
hair shaft, thereby increasing the bulk of the hair, contain such
unpronounceable products as polyquarternium and stearami-
daproply dimethylamine, which alter the electric charge on the
hair shaft. These tongue twisters are particularly important in
winter months when the air is dry, especially in heated buildings.
Keeping things slippery with surfactants
Today’s commercial shampoos contain compounds called surfac-
ants, compounds that accomplish a number of things when added
o shampoo. Surfactants
Help shampoo lather up in hard or soft water.
Help hair rinse easily and thoroughly.
Eliminate the need for hard scrubbing, which can damage
your hair.
Facilitate removal of grease and any dirt from the scalp and
hair, because the surfactant can penetrate physical barriers,
such as flakes of skin and dirt, embedded in the skin or hair.
Facilitate the foaming properties of a shampoo, which helps
lift the particulate materials (dirt) into the foam. A thicker
shampoo with surfactants in it will easily spread through
the hair.
Maintain a balance between the penetrating power of the
shampoo and the sensitivity of the scalp skin, which benefits
people with sensitive skin.
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