Alopecia, or abnormal hair loss, is the loss of hair follicles, primarily on the head, although it can also occur in other areas of the body such as the eyebrows, beard, eyelashes, armpits, or pubic area. It can appear as a gradual thinning of the hair, as rounded bald patches, as diffuse hair loss across the scalp, or even as a sudden shedding of clumps of hair after childbirth, illness, or a period of intense stress. It is often the first symptom of what we call baldness, but not all cases progress to complete baldness, nor are all types of alopecia the same.
When we're young, one of the most worrying things can be experiencing early and rapid hair loss that makes us look different in a short time. However, as the years go by, especially if you have bald relatives, it's common to start coming to terms with the possibility that at some point in your life your beloved hair might end the relationship that has bound you together for so many years. Understanding why hair falls out , what's normal and what isn't, and what can be done to slow it down, is key to making calm decisions.
Under normal conditions, our scalp loses around 50 to 100 hair follicles daily , which are replaced by new ones in the same location. (Some sources and classic texts cite around 100 hairs per day as a reference.) This is why it's very common to find a few hairs on your comb, pillow, or in the shower drain. It's quite normal that, when we wash our hair, especially if we have long hair, the shower ends up with a tangled mess of hair that can even obstruct the water flow. This shedding is part of the natural hair cycle and doesn't necessarily indicate a problem.
Furthermore, hair loss is more pronounced at certain times of the year when environmental conditions are not very favorable for keeping our scalp and hair well-hydrated, as can happen in autumn or after intense sun exposure. Therefore, it is very important to use appropriate shampoos and conditioners throughout the year , not only when we notice a significant decrease in the number of hairs.
Hair loss has become a serious problem for some people, as it can significantly affect self-esteem . Many begin to feel inferior to those around them who don't experience this issue, or they perceive that their appearance no longer reflects who they are. This psychological burden means that, although medically it may be considered a cosmetic problem, in practice it has a notable impact on quality of life.
The best mindset to adopt in these situations is to face the problem with information and a realistic attitude , without worrying about what others might think if they see you losing your hair. A common solution in recent years is to shave your head completely, ceasing to fight against something that in many cases is genetic and chronic. This way, you have one less problem to worry about, and for many men, this change in style becomes an attractive way to express your identity . Not everyone is willing to do it, but in many cases, and depending on the type of alopecia, it seems like a very practical alternative.
Currently, the market is flooded with "miracle" products promising rapid hair regrowth in 100% of cases. These claims create unrealistic expectations and often result in significant financial investment without yielding results. It is crucial to thoroughly research the available alternatives and, above all, understand that not all treatments are suitable for all types of alopecia . It is always advisable to select products or therapies backed by scientific evidence and to rely on manufacturers or clinics that offer transparency, clear information, and medical supervision.
In addition to cosmetic products, medical and surgical treatments are now available that can slow hair loss, reverse it in some cases, or camouflage it through hair restoration techniques such as hair transplantation. To choose the right treatment, the most important thing is to have an accurate diagnosis of the type of alopecia.
What exactly is alopecia and how is it diagnosed?
Alopecia, commonly known as baldness, is the abnormal loss of hair . It can affect only the scalp or also other areas where hair grows, such as the eyelashes, eyebrows, beard, armpits, or genital area. It can manifest as:
- Progressive receding of the hairline on the forehead and temples.
- Diffuse loss of density all over the head, without completely bald areas.
- Rounded, hairless plates, well defined, that appear suddenly.
- Sudden and massive fall of hair in the hairstyle or in the shower after childbirth, an illness, a surgical procedure or a great upset.
It's normal to lose between 50 and 100 hairs a day as part of the natural hair shedding process. Seeing hairs on your comb, in the sink, or on your pillow doesn't necessarily indicate any illness. Hair loss should be suspected when you notice a gradual decrease in hair density , when specific areas with less hair or no hair appear, or when you lose significant amounts of hair in a short period.
Accurate diagnosis of the type of alopecia is crucial, because the prognosis and treatment options vary significantly. Some forms are reversible with appropriate management, others can be stabilized with early treatment, and a few, if left untreated, can lead to permanent hair loss.
In most cases, a detailed medical history and a careful physical examination of the hair and scalp are sufficient to determine the cause of hair loss. The healthcare professional will typically ask about:
- Symptoms of hair loss: when it started falling, if there are specific areas, if it affects other parts of the body.
- Family background of baldness or alopecia in men and women of the family.
- Hair care habits: washing frequency, type of shampoo, use of straighteners, dryers, dyes or very tight hairstyles.
- Level of physical or emotional stress recent, significant life changes, or recent illnesses with high fever.
- Diet and weight changes, possible very restrictive diets or nutritional deficiencies.
- Medication use that may contribute to hair loss.
In some situations, additional tests may be required, although they are rarely necessary in all cases: blood tests to rule out thyroid diseases, iron deficiency, hormonal disorders or other systemic problems; microscopic examination of hair to assess its structure; or even a scalp skin biopsy when scarring or inflammatory alopecias are suspected.
Types of alopecia
Within alopecia we can find various types, although the most common and which represents approximately 95% of cases in men is androgenic, commonly called common baldness and which mainly affects men, although it can also occur in women, although with a different presentation pattern.
Androgenic alopecia
Androgenic alopecia, as we've mentioned, is the most common type of hair loss . Two main factors must be considered in this type of alopecia: hormonal and genetic . Although heredity has always been blamed for this type of hair loss, the complete set of genes involved is still not fully understood, but a clear familial predisposition is known.
Male hormones, better known as androgens , act on hair follicles, causing their progressive miniaturization . Gradually, the follicle produces increasingly finer and shorter hairs until it becomes inactive. Androgens can affect the entire scalp equally or specific areas such as the front (receding hairline), the crown, or the entire top of the head, generally sparing the sides and back of the neck.
In men, the typical pattern is a receding hairline and thinning at the crown, which progress over time to varying degrees. In women, when this type of alopecia occurs, hair loss is not usually concentrated in a specific area, but rather there is a diffuse loss of density , especially on the top of the head, maintaining the hairline but with increasingly thinner hair.
In female pattern baldness , hair gradually miniaturizes until it stops growing in certain areas. It is considered to be present when hair loses density on the top of the head, affecting the frontal area up to the crown and both sides of the part if the hair is combed in the center. Genetic and hormonal factors are the most relevant, and age and periods of hormonal change (such as pregnancy, postpartum, or menopause) greatly influence its progression.
Traumatic alopecia
As the name suggests, this type of alopecia is caused by physical trauma in which the scalp is subjected to constant pressure or traction. It can be caused by continuous friction from external elements such as helmets or very tight caps, but also by certain very tight hairstyles that test the hair's resistance, such as very tight braids, buns, high ponytails, or poorly placed extensions. Over time, this continuous traction can damage the follicle and produce alopecia that, if detected early, can be reversible.
Within the category of traumatic alopecia, we must pay special attention to trichotillomania , which is the compulsive pulling out of hair due to anxiety or emotional problems. This creates irregular bald patches. In these cases, in addition to dermatological treatment, it is crucial to address the psychological component with professional help.
alopecia areata
This type of alopecia is particularly striking because it causes round, hairless patches , like mini bald spots, to appear anywhere on the head. These patches can also appear on other parts of the body and, in some cases, can affect the entire scalp (alopecia totalis) or the entire body (alopecia universalis). In many patients, these areas grow back on their own over time without any intervention, although they usually require medical follow-up.
The cause of this type of alopecia is related to genetic and autoimmune factors . The immune system, for reasons still under investigation, mistakenly identifies hair follicles as a threat and attacks them, halting their function. Although it can be visually striking, in many cases it can be controlled and treated with topical medications, injections, and systemic treatments, depending on the extent of the hair loss.
Diffuse alopecia
Diffuse alopecia causes reversible hair loss that can affect the entire scalp or just a specific area, without resulting in completely bald patches. There are several types of diffuse alopecia, classified according to the cause of the hair loss.
One of the most common conditions is telogen effluvium , very frequent in women after childbirth or during periods of intense stress. In telogen effluvium, a high percentage of hairs enter the shedding phase (telogen phase) simultaneously after a trigger such as an illness with a high fever, surgery, a very restrictive diet, or an intense emotional event. A few months after the trigger, noticeable and diffuse hair loss is observed. The good news is that, once the cause is resolved, the hair usually recovers gradually.
In addition, other factors such as cancer treatments (chemotherapy), severe malnutrition, vitamin deficiencies, hypothyroidism, chronic illnesses, or certain medications can cause diffuse alopecia. In many cases, treating the underlying illness or correcting the nutritional deficiency allows the hair to return to its normal density.
Hair life cycle and seasonal hair loss
To understand what is normal and what is not, it is helpful to know the hair life cycle , which is divided into three main phases:
- Anagen phase (growth)This is the stage in which hair actively grows. It can last for several years, and under normal conditions, more than 80% of hairs are in this phase.
- Catagen phase (transition)It lasts between two and three weeks. During this period, the hair stops growing, the follicle shrinks and prepares to enter a resting phase.
- Telogen phase (resting and shedding)It can last up to three months. The hair no longer grows and eventually falls out to make room for a new hair that begins its anagen phase.
The fact that many people experience increased hair loss in autumn is usually due to a higher percentage of hairs in the telogen phase at that time. Losing around 100 hairs a day during this period is normal. Only when hair loss is significantly greater, persists over time, or is accompanied by a noticeable decrease in density should you consult a specialist to rule out any underlying problems.
Symptoms that warn of hair loss
Symptoms related to hair loss can vary between men and women , but they often share common characteristics. While losing between 70 and 100 hairs a day is considered normal, it is considered alopecia when daily hair loss exceeds that amount on a sustained basis.
- Waking up from sleep with a large number of hairs on the pillow repeatedly, observing that there are more and more of them.
- Discomfort, itching, or burning sensation on the scalp, which may be related to dermatitis, fungal infections, or other skin diseasesThese alterations can cause redness, flaking, and are one of the main causes of hair follicle loss if left untreated.
- Al finish showering, observe a large number of hairs in the shower drain, more than usual for our normal situation.
- Also find a large amount of hair on the brush or comb when combing our hair, especially if we notice entire strands.
- El Greasy hairWhen not treated with appropriate shampoos, it can promote dandruff, seborrhea, and inflammation, which also contribute to hair loss.
- In men, notice that the front or crown area begins to show obvious thinning It is a very characteristic symptom of hair loss due to androgenic alopecia.
- In women, note that The hair is becoming less and less voluminous.If the hair part widens or the density decreases on the top of the head, it indicates possible alopecia, which is usually easier to treat in women if detected early.
- The presence of bald spots in the form of rounded patchesWith or without prior itching, it is often related to alopecia areata and requires specialized evaluation.
- Scalp pain or tenderness, especially if accompanied by redness, swelling, or scabsIt may indicate infections, ringworm, dermatitis, or scarring alopecia that should be treated as soon as possible.
When you start noticing these symptoms, it is advisable to see a dermatologist or a hair medicine specialist so they can assess the condition of your hair, rule out associated diseases, and suggest the most appropriate treatment for your individual needs.
Causes of alopecia and risk factors
The causes of alopecia are very diverse and, in many cases, can be deduced from the patient's symptoms and medical history . Generally, they can be divided into several main groups:
- Genetic and hormonal causesThese are responsible for most cases of androgenic alopecia. If you have close relatives (men or women) with baldness or hair loss, your chances of developing it increase.
- Hormonal changesIn women, stages such as pregnancy, postpartum, very heavy or irregular periods, and menopause cause variations in the levels of estrogen, progesterone, and androgens that can result in increased hair loss.
- Systemic diseasesIron deficiency anemia, thyroid diseases (hypothyroidism and hyperthyroidism), diabetes, autoimmune diseases, and chronic conditions can cause or worsen hair loss.
- Lifestyle and toxic habitsAbusing tobacco or alcohol, getting little sleep, and having a diet poor in nutrients and rich in ultra-processed foods and unhealthy fats accelerates the aging of the follicles and promotes hair loss.
- Physical and emotional stressIntense stress, prolonged anxiety, sudden work or personal changes, as well as surgical procedures or illnesses with high fever, can trigger telogen effluvium.
- nutritional deficitsA low-protein or excessively low-calorie diet, or deficiencies in iron, zinc, folic acid, or vitamin B12 are associated with a significant increase in hair loss, especially in women.
- Infections, dermatitis and fungiScalp ringworm, seborrheic dermatitis, and other inflammatory processes cause itching, flaking, and, if intense or prolonged, hair loss.
- Medications and medical treatmentsSome drugs, such as certain anticoagulants, immunosuppressant treatments, or those used in chemotherapy, can cause diffuse or generalized alopecia.
- Aggressive hairstyles and cosmeticsFrequent dyeing, repeated bleaching, high-temperature ironing, excessive use of hairspray and fixatives, as well as very tight hairstyles, damage the hair shaft and, in the long run, the follicle.
14 tips to avoid hair loss
We never know when baldness might affect us. Even if our parents and grandparents are bald and we're more likely to be, it doesn't always mean we'll be bald in the future . Even so, following a few tips can reduce the impact of external factors and help you keep your hair in the best possible condition.
- Take care of hygieneIt is very important to keep our scalp clean at all times, without dandruff or excess oil, as these can promote inflammation and cause premature hair loss.
- Avoid eating very sweet and ultra-processed foodsFoods with high sugar content, such as commercially produced pastries, promote increased oiliness in the skin and scalp, especially if we don't wash our hair regularly.
- Wash your hair with shampoos specifically formulated for your hair typeEach shampoo and conditioner is designed to address specific problems: oily hair, dandruff, dry hair, brittle hair, or hair prone to falling out. Investing in quality products is worthwhile to maintain a balanced scalp and reduce risks.
- Drink at least two liters of water a dayUnless your doctor advises otherwise, proper hydration helps maintain both the scalp and hair fibers in better condition.
- Avoid hairstyles that pull the hair too tightly., such as very tight braids, tight buns or high ponytails, as they promote traction alopecia.
- Whenever possible, Avoid prolonged use of very tight caps and helmetsso that the head stays ventilated and sweat and grease do not accumulate.
- El Tobacco weakens the vascularization of the scalp and the strength of the hair follicles, contributing to hair loss. Quitting smoking improves overall health and also hair health.
- When using a hair dryer, try don't bring it too close to your head Nor should you use maximum temperatures for long periods, as excessive heat weakens the hair shaft and dries out the scalp.
- Choosing dyes and coloring products that are as natural as possiblewith the fewest harsh chemicals. Spacing out coloring sessions and caring for your hair afterward helps minimize damage.
- Perform periodically gentle scalp massages Using your fingertips promotes blood microcirculation, which can help the follicle receive more nutrients.
- Eat foods rich in vitamins A, B, C, D and minerals such as iron, zinc, and selenium. A diet that includes fruits, vegetables, legumes, nuts, and quality protein is key for strong hair.
- Do not overuse hairspray, fixatives and foamsUsing them occasionally is not a problem, but daily use and excessive amounts can dry out the scalp and leave residue.
- Si vas a sunbathing for long periodsProtect your head, especially if you already have bald patches. A light hat or breathable cap helps prevent sunburn and damage to the hair follicle.
- Manage StressReducing stress isn't always easy, but physical activity, relaxation techniques, getting enough sleep, and balancing work and personal responsibilities help reduce one of the major triggers of hair loss.
Prevention and when to see a specialist
Leading a healthy lifestyle, avoiding excessive alcohol and tobacco use , managing stress, and maintaining proper hair hygiene can help prevent hair loss or, at least, slow its progression when there is a genetic predisposition. However, when the causes are primarily hereditary, these measures, while beneficial, are not always enough to completely stop hair loss.
Therefore, it's important that at the first signs of excessive hair loss , you consult a dermatologist or a clinic specializing in hair treatments. A surgeon or doctor specializing in trichology can examine your case, assess for any associated medical conditions, perform tests if necessary, and recommend the appropriate treatment.
Specialized centers use tools such as digital trichoscopy , which allows for immediate analysis of the cause of hair loss and the determination of the percentage of hairs in the shedding phase, as well as follicle miniaturization. This type of analysis helps to design a personalized treatment plan and assess its evolution over time.
Treatments for hair loss
Currently, the market offers a wide range of products that claim to quickly stop hair loss and that hair follicles will regrow over time. However, only a few compounds have demonstrated solid efficacy in rigorous scientific studies.
According to various studies, minoxidil and finasteride act on follicles and androgens in different ways, helping to slow hair loss and, in some cases, improve density.
- MinoxidilIt is applied directly to the scalp as a solution or foam. It improves microcirculation in the follicle and prolongs the hair growth phase. In the first phase of treatment, the first thing that usually happens is a slightly more intense shedding, as it pushes hairs into the telogen phase, but this is temporary. Afterward, stabilization is observed and, in some cases, an increase in density.
- Finasteride and other 5-alpha reductase inhibitorsThese medications are taken orally (primarily by men) and work by blocking the conversion of testosterone to dihydrotestosterone (DHT), the hormone that most contributes to follicle miniaturization in androgenic alopecia. In this way, the progression of baldness slows downIts use should be supervised by a doctor to assess benefits and possible side effects.
It's important to add that, although these drugs stop or slow the progression of hair loss and can improve appearance by reactivating follicles that are still alive, they don't usually generate new follicles from scratch . In many cases, their effect is to stabilize hair loss and improve the quality and thickness of the remaining hair, but if the follicle is completely destroyed, its recovery is limited. That's why early diagnosis and a combined treatment strategy usually offer better results.
Although these treatments are very useful for androgenic alopecia, they don't work in all cases or for all types of hair loss. For alopecia of inflammatory, autoimmune, traction, or nutritional deficiency origin, the medications and strategies are different and include topical or injected corticosteroids, vitamin supplements, dietary changes, antifungals, immunomodulators, and so on.
In addition to these classic drugs, other complementary techniques are used today:
- Hair mesotherapy: micro-injections into the scalp of a combination of vitamins, amino acids and drugs that act directly on the hair bulb, prolonging the growth phase and strengthening the hair.
- Platelet Rich Plasma (PRP)Blood is drawn from the patient, processed to concentrate the platelets, and then injected into the scalp. PRP contains Growth Factors: Stimulating Hair Growth that stimulate hair regeneration and improve the follicle environment.
- Oral supplementationWhen there is a deficiency in vitamins, iron, zinc, or other nutrients, the doctor may recommend specific supplements to correct them and support hair health.
- Personalized topical treatments: magistral formulas that combine different active ingredients adapted to the specific case (topical antiandrogens, minoxidil in different concentrations, anti-inflammatories, etc.).
In cases where the hair follicle is already destroyed or baldness is very advanced, the options include hair restoration techniques such as hair transplantation or grafting. These procedures involve extracting follicular units from donor areas (usually the nape of the neck and sides) and placing them in the balding areas. Current results, achieved by specialized teams, can be very natural.
Before starting any treatment or undergoing any procedure, it is essential that a specialist physician review your case , explain the realistic options, expected response times, and limitations of each technique. A correct diagnosis and an individualized plan make all the difference between investing your effort and resources wisely and wasting them on unrealistic promises.
While this information helps you better understand what's happening when hair starts to fall out, if you have persistent doubts or notice rapid changes in your hair, it's wise to consult with professionals who can assess your situation in detail, prioritize your health, and guide you toward the most suitable treatment.