I’m Seeing Hair Loss — Am I Overreacting?

Dear Dr,

I’m 24 and have had very thick hair all my life, though my father is bald and started losing his hair in his late teens. (My mother’s father was not bald, and everyone on her side of the family has thick hair). I’m spending this summer doing research in Egypt, and shortly after I’d arrived I noticed hair falling out while shampooing and drying my hair. I think the worst was about 10-14 strands in one shower. I’m wondering whether I’m starting to go bald, or whether I’m losing hair because of the climate (maybe it’s not falling out so much as drying and breaking?). I had been taking extra vitamin A (25,000 IU) for acne, but have stopped that because I read on the internet that large doses of vitamin A can cause hair loss. I have also started using “anti-hair fall conditioner” which they sell here, but not, so far as I’m aware, in the States. Over the two weeks after those first few days, I didn’t notice much hair falling out at all. Yesterday however about 10 hairs or so came out while shampooing and drying, and today maybe 5 or 6. Out of curiosity, I took a picture of the back of my head, and was surprised to notice what looks like a bald spot. Now, I don’t know many people here in Cairo, so I’ve got a bit of extra time on my hands to worry. Am I overreacting? Is this just climate related “hair fall”? In the pictures I’ve included, does it look like I’m starting to bald? Is that just what the back of my head is supposed to look like? (I hadn’t, before this concern arose, taken many pictures of the back of my head). One of the photos is of my frontal hair line. I’ve always had a pronounced widow’s peak, but maybe it’s been receding without my noticing? This worry has become a major distraction from my work. Please help me figure out if I am going bald or not. I’ll be here until August, and have no way of seeing a trichologist until I’m back in the states. Should I start Rogaine now (supposing I can get it here)? If I wait two months to start it, will I have missed the opportunity to halt the onset of baldness?

You can use my photos, but please conceal my face and don’t use my name. I realize it’s difficult to give a prognosis at a distance, but I really would appreciate your best guess on my condition. Not sure this is relevant, but I thought I should mention that when hair does come out while I’m washing, drying, or combing my hair, it often makes a kind of a pop or snap, which might be the hair breaking. Also, most of the hair that comes out is white at the scalp-side tip.

Thanks so much for your help

First, thank you for granting me permission to use your photos.

I don’t think anything severe is going to happen to your hair for the next few months. Don’t stress yourself out about it. When you return to the United States, come visit me if you can (I’m in California) and I will map out your hair for miniaturization and that will let you know if you are truly balding or not. Not much else I can offer via the internet without examining you. The best FDA approved medication for treating hair loss is Propecia (finasteride 1mg). We lose 100 hairs/day and that is standard in everyone. You can hear your hair popping and snapping? That’s an interesting one, for sure.