Ortho Evra and Hair Loss

/by William Rassman, M.D./0 /,

I have been using ortho evra for now about 3 months, and I realized that I have been losing a enormous amount of hair…This has been happening since I started using the patch…If I stop using the patch, how long does it take to leave my system, and will I regain my hair???I have lost so much hair that it is depressing at times for me to see that I have lost so much….
I would appreciate a response from you asap…
Thank You!!!

I’ve answered a similar question before: Severe Hair Loss from Ortho Evra

The use of hormones and birth control medications will produce hair loss in genetically prone females. I do not have an answer to your question on the timeline for any reversal, though. There is no assurance that it will be reversed if the hormones precipitated the expression of the hair loss gene, but I would stop using it and consult with your doctor as early as you can.

Stress Induced Hair Loss

/by William Rassman, M.D./0 /,

I’m 42/F and in the past three months I have lost a good amount of hair and there is no balding in my family. I am on thyroid RX (5 yrs of Levothyroxine). Since then I have had my thyroid checked and it’s is normal. I have noticed my scalp does itch (not intensly) and the hair is falling out from the follicle (white tips are on the ends of each strand) and it comes out worse in the shower. Dr recommend to seek a dermatologist, which is my next step. I also take Estrogen (7 years), Topamax (6 mo), Maxalt (2 mo). I have alot of stress in my life besides.

Scared of going bald.

There many reasons for hair loss, such as hypothyroidism, ezcema, alopecia areata, telogen effluvium, lupus, drugs, stress, crash diet and infections. I recommend that you have extensive blood work done to rule out many of these causes for your hair loss; a good endodrinologist or dermatologist should be able to do this. Alopecia Areata and Telogen Effluvium are causes of hair loss where biopsies may be indicated. You also need an extensive mapping of your head for miniaturization. Female patterned hair loss has very characteristic findings on mapping. You must realize that it is normal to lose up to 100 hairs per day.

Size of Miniaturized Hairs

/by William Rassman, M.D./1 /

Hi there,
I have read your explanation of hair miniaturization, and have a question. I am a 30 year old female and I am experiencing hair loss. My hair loss seems to be diffused, with areas that are worse which are my hairline, as well as the crown (alot of my scalp can be seen at the crown). I have been obsessively reading about it on the internet and have found it helpful but confusing information. Anyways, back to the question. I have alot of miniaturization hairs throughout my hair. By alot I mean alot, they stick up everywhere. Do these hairs every stay at a certain size, or do they always end up being very small and thin? Some of mine are extremely thin, and others are thicker. Thanks in advance

This is a good and insightful question. The general belief is that miniaturized hairs are impacted by hormone and genetic influences. As some hair is impacted and others are not, I would think that the impacted hairs (the miniaturized hairs) remain impacted and thin, unless things change like hormone balance, or the effects of medications such as Rogaine/minoxidil. As no one has ever actually tracked a single hair in a follicular group when cycling occurs (anogen through catogen phases), one really can not tell the actual answer to this question other than make a good guess (like I am doing here).

Follicular units usually contain a number of hairs. Mature healthy hairs are called ‘Terminal Hairs’ while the small hairs in a follicular unit are called ‘Vellus Hairs’. Miniaturizated hairs are thought to be ‘sick’ terminal hairs, not vellus hairs. Does a terminal hair become a vellus hair or visa versa? I doubt that, but do not know for sure. Do the hairs in a follicular unit play musical chairs (opps hairs) and change their appearance over time in a single hair cycle? I can have fun with these types of questions, but that is my intellectual exercising of random thoughts that you stimulated have no particular value to help you with your question.

Female Hair Loss When Hair Gets Long

/by William Rassman, M.D./0 /

I’m female and I like long hair but I have noticed when my hair gets about 2 inches past my shoulders it starts to fall out. But when its short I don’t have any hairloss at all.

Your hair length is determined by your hair cycle. What that means, is that longer hair may not be possible for you, because your hair cycle ends when the hair gets just beyond shoulder length (let’s say 14 inches). Assuming your hair grows at 1/2 inch per month, at 28 months the hair cycle kicks in and the hair falls out, being replaced by a new hair grown from the scalp. We cycle hair all of the time ‘asynchronously’, which means that we do not shed our hair like furry animals at seasons, but replace hair at about 100 hairs per day. This is a normal process for you. If your hair grew out 3 feet, then your hair cycle would be 6 years rather than 28 months.

Tests to Run for 13 Year Old Girl Losing Hair

/by William Rassman, M.D./1 /,

Dr. Rassman, my 13-year-old daughter (caucasian) has been experiencing thinning hair these past few months. Her dark wavy hair in the past had always been pretty thick. Her pediatrician ran anemia and thyroid tests which came back normal. We then saw a dermatologist who ran free testosterone and DHEAS–these too came back normal. The next step we are doing is seeing a endocrinologist (appt. not available until February). Are there some other tests that ought to be run in the interim, or should we see a hair specialist (do you know of any in the Metro Detroit area with a female (teenage) hair loss specialty?)

Her diet is fairly balanced, she has not experienced any stressful episodes, and she feels fine physically. I have recently been giving her Women’s 1-A Day vitamins since this problem has occurred. In the Spring of 2005, she began taking Cephalexin (Keflex) for acne. The dermatologist gradually reduced her intake, and she has recently stopped taking it entirely. Another note is we visit the Islands every February (during the past 7 years) whereby she has her hair braided. She would generally keep the braids in for a week, which looking back must have caused a lot of stress on her hair, but again, that would be 8 monts after the fact that the problem began. Thank you for any insight you may be able to provide.

-Very concerned parent

You daughter can go through periods of shedding hair and then reverse and regrow the hair. It is normal to lose up to 100 hairs per day. Now, if she continues to lose more than 100 hairs and she begins to show bald spots or more scalp, then it is a concern. There are many causes for hair loss in women as you outlined she is or has been evaluated for. The list includes: hypothyroidism, alopecia areata, telogen effluvium, androgenic alopecia, repeatedly over plucking, surgery, trichotillomania, stress, chemotherapy, radiation, cancer, eczema, seborrhea, scleroderma, lupus, hormonal imbalance, psoriasis, parasites, fungal, autoimmnune disorders, poor diet, poor nutrient, burn, trauma, leprosy and drugs. The common medications which may cause hair loss are beta-blocker, coumadin, oral contraceptive pill, antibiotics and chemo-medications. Braiding hair could cause permanent hair loss if it is kept for a long period of time and especially when a person has sensitive/weak hairs. I believe visiting a hair doctor in your area is a got start. A full analysis for miniaturization with a good microscopic evaluation of the scalp hair is critical in understanding the process. Continue with your present course and get the scalp mapped out as well.

Female Scalp and Temple Hair Loss

/by William Rassman, M.D./0 /

I have had a worsening problem for over 2 years now.
I am a woman with have a problem with thinning hair and some recession primarily in the scalp temple and frontal area of my hair line. It appears in a male pattern. I don’t have any balding but do have miniaturized short hairs that no longer grow to their previous length or fullness and they are sparse. The frontal hair strands are fragile and tend to have a fly a way appearance. Some hair strands do fall out with a telogen hair and they do grow back but not to the previous length or fullness and some hairs fall forward and seem to rest on my forehead. This problem started after having a eb virus which I had a rash and took acetate fluocinide ointment for which I noticed seeemed to further aggravate the receding appearance of my hair line. So, I stopped using it long ago. I also have eye brow and leg hair that is sparse and does not grow to its previous fullness and some areas on my legs where hair no longer grows at all. I have tried many medicines and they seem to aggravate and cause my fragile hair in the front to break and have not helped. I notice that the problem is worsen during my menstrual peoriod. I have had a full work up of blood tests etc. and all labs have been returned within normal range. I had a biopsi which did not yield any definitive cause either. I have been to many derm doctors, endocrin, rheum etc. and noone is able to provide a definitive diagnosis or a treatment that will help. Please note I am primary concerned with the scalp hair loss the hair loss in the other areas I can deal with. This is a very odd problem. This has been very frustrating any help or advice would be greatly appreciated. I am ok with out a dx if I can get something that will improve the problem.

It is rare, but women can experience male pattern balding or thinning as you describe. In these women, the miniaturized pattern follows the Norwood Classification, sometimes leaving the very frontal 1/2 inch almost normal. You may be experiencing a Telogen Effluvium which is more common in woman. I am not certain about the association of EB virus causing hair loss unless there is a cross reacting antibody to EB virus which mistakenly attacks your hair follicles at the same time. You have a very interesting problem. I would like to see photos from all angles or if you can, drop by for a free consultation so that I can evaluate in detail using a magnifying video camera of your entire head. Have you tried Rogaine for women?

Itch on Scalp from Rat Mites?

/by William Rassman, M.D./0 /,

For a couple of months now, my head has been extremely itchy, and my hair is falling out much more than it should be. I don’t have any bald spots, the hair just falls out all over the head. The itch is so intense and sometimes it feels 100 times worse than the itch from headlice. I’ve been to the dr’s twice, and hairdresser and many friends have checked, all have confirmed that i don’t have headlice. My 2 teenagers just told me tonight that they have been having the same symptoms. Hair also can just pull out without feeling a thing. I’m making another dr’s appointment, but i think the dr might think it’s all in my head (no pun intended). He says my scalp is in great shape, no flaking or anything. I’m just more concerned now that 2 of my kids are complaining of the same thing. Someone suggested it could be something called rat mites. We do have a lot of mice in our house, as we live in the country, now i’m wondering if rat mites could be the problem. Thanking You in advance for your reply

That certainly is an interesting one. You should look into finding someone that specializes in skin problems, rather than just a general practitioner. I would see a good dermatologist and have your scalp and hair evaluated. There is a hair pull test that the doctor can do for you, which I would recommend having done rather than going to the Orkin or Terminex folks to get your head fumigated. Clearly, fomr my answer, you can see that this is not an area of my expertise.

18 Year Old Female with Thinning Hair

/by William Rassman, M.D./1 /,

I am an 18 year old female college student and I have been noticing for about 3 months that right at my bang area, my hair is thinning and I can see my scalp. It not real bad, I mean you cant look at me and say your going bald.I am the only on that notices it. So yeah its not in horrible condition to where it is noticable. I just see it because of cousre I am a girl and look for things like that. What could it be: stress, diet, dying my hair? How can I help my problem? Please help me it bothers me so much even though its hardly noticable except by me when im staring at it…HELP!!

There is a typical female pattern of hair loss just behind the first 1/3 inch of hairline, in the area of the forelock. Whatever you have, you need to see a doctor who can evaluate you in person for miniaturization and determine if you do have female genetic balding. For your peace of mind, you should know that there are things that can be done for it. Overall testing of women for a variety of conditions are well discussed in this blog (see Female Hair Loss category).

Hair Loss from Crash Dieting

/by William Rassman, M.D./0 /

In response to the blog posting Female Hair Loss After Braids…


Hi Dr. Rassman i just wanted to know about the recent 18 year old girl who is losing her hair because of the braids… I wanted to know if it could be possible that she could be suffering from Telogen Effluvium, because of her taking diet pills causing her to crash diet and her hair falling out as much as it has?

Yes, this is possible. Crash diets are a major cause of hair loss in young women, especially compounded with the braids, if there is substantial pulling on the hair.

Red Dots on a Burning, Itching Scalp

/by William Rassman, M.D./1 /,

i’m female and have been getting red dots on me that get a circle then the hair falls out, it burns and itches. Do you think I will go bald? Or will my hair grow back?

Based on your description, an itchy, red, circular ring lesion with hair loss might be due to a fungal or bacterial infection. If it is a fungus on the head, it is called Tinea Capitis. If the lesion is located on your body, it is called Tinea Corporus. If the infection is due to fungus, then the hair will grow back. You should see your doctor to get the diagnosis and appropriate treatment.

Female Hair Loss at 66 Years Young

/by William Rassman, M.D./0 /

I am 66 / F and have been experiencing a brush or comb full of hair everytime I comb my hair. My mom who is 89 has pretty thin hair. What can I do? I watch the infomercials and hype and don’t want to be one of those gullible people besides I am not rich but don’t want thin hair. Would you also suggest short hair? Mine is pretty long.

Minoxidil / Rogaine for women works to some degree and is the only effective medication for women. Most women with female genetic hair loss use shorter hair and ‘puff’ the hair. Most good salons know how to cater to the elderly women who want their hair to be stronger. Light color (blonde/white) tends to make the hair look fuller (even streaking it), as low contrast between your skin and hair color takes less hair to appear full. Get a good hair doctor to assess your situation; use the physician search on ISHRS.org to find a doctor near you. It may not comfort you, but 50% of women over the age of 60 have hair thinning hair from genetic female hair loss and the generally effectiveness of hiding it from the male population reflects well on the hair stylists out there.

Seborrheic Dermatitis in Women

/by William Rassman, M.D./0 /,

I had curly very thick hair all my 56 years. now out of the blue i got seborrheic and it is in my scalp. my hair is falling out. I’m going to the dr. but not much you could do but creams and hard shampoo. it’s not getting better. what can I do? it has been over five weeks. The dr. said this is something I have to live with. I’m not upset. I’m very blessed then other people. thank you if you can give me some feedback. God Bless

Please read the many entries on this blog for female hair loss. First and foremost, you need to have yourself and your health checked out. There are many diseases that can cause hair loss in women and you have to make sure that you do not have one of them. Women, like many men, can get genetic hair loss. In women, it usually is diffuse and not in one of the typical patterns that men show. Women generally thin out, but do not get bald. Some develop a pattern of thinning that can be treated more successfully with Minoxidil and possibly even hair transplants under certain conditions. First, get your self checked out medically and then find a good dermatologist or hair expert physician.

Polycystic Ovary Syndrome and Hair Loss

/by William Rassman, M.D./0 /,

My daughter is 21 and has had thinning hair for the past 3-4 years. She was diagnosed 18 months ago with Polycystic Ovary Syndrome and was placed on a daily dose of Actos to help control her insulin levels. Her hair loss seems to have accelerated since being on the medication. This is very alarming for her. Is her POS causing this or her Actos? Is there anything she can do to reverse it, slow it down or stop it?

PCOS (Polycystic Ovary Syndrome) is a well known cause of hair loss. It reflects some extra male hormone production (all women make testosterone and androgens) which tends to grow hair on the face and take it off of the head in those with the gene that produces genetic hair loss, like male patterned balding. Your daughter needs to be evaluated by a good doctor in the hair loss field (like me or a good dermatologist) who can evaluate the type of hair loss she is experiencing. First, her scalp needs to be diagnosed with the form of hair loss (for miniaturization) and then her endocrinologist should get involved. There may be a role for 5 alpha reductase blockers, but I would want her doctor to work with the hair expert on this management process. I’ve posted previously about PCOS on this blog; see Polycystic Ovary Syndrome.

Female Hair Loss After Braids

/by William Rassman, M.D./1 /

HI, Dr. Rassman, I am an 18 years old female and I used to wear braids on and off for long periods during my life. This past June I decided to take them out to grow out my own hair. I started going to a hair dresser faithfully every 2 or 3 weeks and saw much improvement. Also during that time I started taking OTC diet pills and after a couple of visits to the hair dresser i noticed in August that i was losing hair below my crown. My hair dresser told me it might have been the stress of the braids that made the hair in that area stop growing and it was now regaining its strength. Since then, the area has grown and spread to the left side of my head. I am not sure if i should call these areas bald spots because there is still hair there, they are just very short compared to all the other areas. The temples, the back portion of my head, the top crown, and right side of my head still have all of its hair and i have not noticed any thinning. I am not sure why this is happening and need some advice on what steps I can take to grow back the hair in these areas.

Let the hair grow out for another 6 months and then make a proper assessment with a good doctor who understands hair. A good baseline also is a good idea just to have a measurement for the progress that you would expect to see and to rule out other problems. The differential diagnosis includes traction alopecia, female hair loss, and the huge variety of medical and scalp conditions that are discussed in previous blog posts (see Female Hair Loss category). A baseline assessment would include a full mapping of your head for miniaturization, which would then be remapped at about 6-8 months from now.

Female Hair Loss

/by William Rassman, M.D./0 /

Hiya, I am a 35 year old female and heartbroken. January of this year my hair changed from healthy, quite greasy really, to dry as a bone and unmanageable. Getting worse at every wash, dryer and dryer. Had all the tests done by my gp. Hormone, thyroid, everything was ok. Now my hair pulls out with the gentlest of brushing, snaps in my hands, and my scalp is showing on my part. My fringe has shriveled to nothing and my hair looks like it has been burnt mainly at the front. I have developed a receding hair line in a classic M shape, and have thick black hairs that seem to just grow everywere all over my head. The texture is that of pubic hair. My hair no longer feels like hair, it is so dry when i touch my scalp it crunches. I have conditioner on it, but nothing seems to help. I have started taking vitamins and my hair feels like it is coated with a sticky dry residue now. Seems to be able to help. I am not a vain person, I am nothing special, but to see myself like this is breaking my heart. Please can you offer some idea as to what the problem is? I am spending hours just sitting in front of the mirror in tears. I no longer recognise the person looking back any more. My marriage is suffering and i am finding it difficult to go out. I feel like everyone is looking at me. My self image is on the floor. Please please can you give any ideas as to what the problem is? My hair seems to be shrinking, not growing, apart from the back which seems to be unaffected. So far you are my last hope. Please please can you help?

This is not something that I can manage over the phone or through an email. You need to be managed by a competent doctor and possibly a good/great hair stylist for the topical management of the fragile hair. Please, find the appropriate people to look after you. Do not become your own doctor or hair specialist. I would suggest using the ISHRS site as a good place to search for a local doctor.