If I could grow my hair through a Space Echo, the world would be a better place.
November 24, 2009 11:19 AM   Subscribe

Help me understand why I am losing hair!

YANMD, of course, but I do wish you were. I'll start from the beginning. For reference, i'm a 25 year old male, moderately active (a lot of walking), social drinker, no smoking, no drug use, maybe 2 americanos a day, tops.

About 8 months ago, I was conditioning in the shower and noticed a whole bunch of hair had come out of my head and was all over my hands, something that had never really happened before. This was at the start of a 6 month transition period without health insurance, so I was more or less on my own... So, I was, for sure under a bit of stress at the time, not much more than before in my life, but around the start of this there were a few things that were particularly stressful.

For the next several months, if I were to run my hands through my hair, I would usually come out with 3 or 4 hairs in my hands at any given point. Showering, the amount of hairs coming out would be higher, as I imagine the water makes the hairs have traction on the hands and they stick much easier.

Because of this, I've been more or less terrified of showers for the past several months, being excessively gentle after a life of vigorous lathering, because seeing so much hair on my hands every time I shower is a sickening thing to deal with.

A month and a half ago, I was able to see a doctor, who ran through the possibilites: normal pattern baldness/hair loss, iron deficiency, dermatological malady, something stress related, or some combination of more than one of those. She ordered a blood test, and things went on as normal. I would say now that my hair is definitely noticeably thinner, but not to the point I would expect given the amount of hairs that have come out.

Yesterday, I returned to the doctor as I hadn't been made aware of the results of the blood test. The first thing the doctor said was "if it's a slight iron deficiency, that might be the easiest thing to fix" and then I found out that, in fact and in his words, the results were "normal, better than normal, really" whatever that might mean. It was at this point that he decided to look at my scalp.

What he found, apparently, was a lot of yellowish scaliness in some regard, not scaly as in hard and scaly, but... I don't know, I didn't see it. He didn't seem too taken aback. I mentioned that it might be that I had been showering so lightly over the past several months that my scalp hadn't been exfoliated, but he more or less dismissed this as a cause. I left with a prescription for Stieprox shampoo, a recommendation to get "Stress Tabs" or an equivalent and a follow-up appointment in a month.

So, I showered this morning with the Stieprox for the first time, and I made sure to be vigorous, which made me incredibly nervous, and sure enough, a bunch of hair came out - much more than normal, which I am sure was not helped by the fact I was so nervous about it...

What are my questions? I'm not sure. Should I keep using the Stieprox? I realize that these hairs in the shower that come out aren't coming out because of the shower - they were already loose enough/out of the roots that they would come out anyway, they just happen to depart all at once at that time. My original thought was that this was telogen effluvium, but I know that this usually resolves within 6 months or so, and the pace at which my hair comes out hasn't really seemed to have changed. At the same time, I've noticed that my hairline has sunken a bit over the temples, something which could otherwise be quite normal, if it weren't for the hair coming out everywhere else...

I don't know, really. What questions should I be asking? My priority, as I see it, is to worry about it little enough that it doesn't make me stressed or bothered, which I can do most of the time, save for when it's time for a shower, or when I hit my head or brush my hear on something and I fear it's all about to fall out like a tree in autumn.

Thanks for all your help.
posted by setanor to Health & Fitness (26 answers total)
FWIW, around 25 was when my male pattern baldness really became evident.
posted by gnutron at 11:27 AM on November 24, 2009

Yeah, I started losing my hair on the front end at about 18 or so, and it became markedly more dramatic in my early 20's. But what's going on with you doesn't sound like normal MPB, given the whole lots of hair falling out in the shower from all over your head.

Stress has been, controversially, attributed to hair loss - and the sort of hair loss you're talking about honestly sounds like it's trauma induced. You don't mention anything of the sort, but you never know. More info on that here.
posted by Lutoslawski at 11:36 AM on November 24, 2009

I should add that, while hair does come out everywhere in the shower where it didn't before, the amount is markedly less on the back of my head, though not insignificant.
posted by setanor at 11:44 AM on November 24, 2009

My mother in law had problems with hair loss when she "went vegetarian" (i.e., ate only refined carbs and dessert for months at a time). How is your protein intake?
posted by something something at 11:46 AM on November 24, 2009

You're at the age when hair generally starts falling out due to male pattern baldness. The only two medications which have been demonstrated to be effective in treating male pattern baldness are minoxidil and finasteride (generic names -- they're sold as Rogaine and Propecia, respectively, in the United States). Don't freak out, this is very treatable if you want to treat it, and harmless (though annoying) if you don't.
posted by killdevil at 11:46 AM on November 24, 2009

If this is MPB, which does seem likely, would that suggest my scalp problems are more from my lack of proper scalp cleaning in the shower over the past 8 months? Would Propecia be a better route than the Stieprox for the next month? I don't want to lose so much more hair before I try to keep what I do have...
posted by setanor at 11:48 AM on November 24, 2009

You may have a scalp condition. See a dermatologist, who will be able to give you something more concrete than a bottle of shampoo and some nebulous advice.

If, perhaps, you've been scratching the scaly areas, stop doing so. Even moderate scratching can damage, break, and uproot a surprising amount of hair.
posted by Iridic at 11:50 AM on November 24, 2009 [1 favorite]

Do you have longer hair? 2 to 4 hairs coming out at a time, and maybe 4-6 in the shower, does not sound like that much to me. The average person loses about 50-100 hairs per day from their head (source), but different physical conditions can affect this. It also makes sense that you will see more hairs "fall out" with a vigorous washing, especially after a long period of time - all that dead hair was there already, and a vigorous shake/washing just knocked them loose from the other follicles.

Your doctor doesn't seem that concerned with your hair loss, and I'm wondering if perhaps the stressed period you went through made you notice the hair shedding more than you usually do? And maybe once you started noticing it you "saw it everywhere", like when I learn a new word? Did this, perhaps, coincide with a period where your hair was growing longer (and therefore each hair was more noticeable and overall required more vigorous washing?)

What questions should I be asking?

It seems like the post you just wrote should be exactly what you tell your doctor. He/she needs to know that this is something you are worrying about.
posted by muddgirl at 11:52 AM on November 24, 2009

I lost a LOT of hair from stress and illness a few years ago, and regrew it quickly.
posted by Inspector.Gadget at 11:54 AM on November 24, 2009

Welll, your doctor seems to think you may have a fungal scalp infection -- that's what the shampoo you have is for. It may be that you've got something going on that is more acute than simple male pattern baldness. It may be worthwhile to see a dermatologist; this is what they're for.

And no, Propecia won't do you much good over a period of a week or two. It's really for long-term use, and you won't notice it doing anything much for at least a couple of months after you start taking it.
posted by killdevil at 11:56 AM on November 24, 2009

So, how does this sound:

I'll keep using the Stieprox for a month, but I won't scratch or irritate my scalp unduly, as a lot of hair seemed to come out when I started digging into my scalp whilst lathering. Meanwhile, I'll try to get a referral to a dermatologist? That should be an adventure with UHIP...

I'd love to know either way if this is the sort of thing that might regrow or not. I suppose the dermatologist could help me sort that out.
posted by setanor at 11:59 AM on November 24, 2009

I lost tons of hair when I was hyperthyroid.
posted by barnone at 12:00 PM on November 24, 2009

I lost tons of hair when I was hyperthyroid.

Would that show up on a blood test or might it not?
posted by setanor at 12:00 PM on November 24, 2009

Are you spending a lot of time indoors and not getting a lot of sunlight? I believe this was my problem. I started taking 10,000 IU of Vitamin D-3 supplements daily, and all the scalp and skin problems I had gradually went away, including hair loss. (I believe there's a correlation, but I can't prove anything.)

-24 y/o male, IANAD, YMMV.
posted by Theloupgarou at 12:24 PM on November 24, 2009

Could you have Alopecia?
Is the hair lost pretty random. Like random splotches where you have almost no hair left and all over your body?

My boyfriend has alpecia and that's how his started. He now has no eyebrows and barely any chest hair. He has big splotches all over his head.

posted by ChloeMills at 12:46 PM on November 24, 2009

Sorry man. Welcome to your mid-20s. Propecia is the only thing that's going to stop your hair from falling out if you have the typical receding hairline, but you have to consider whether taking prostate medicine long term is worth the risk.
posted by electroboy at 1:06 PM on November 24, 2009

On review I really do think you should let the anti-fungal medicine do its trick before you move on to try other options. Getting a second opinion from a dermatologist is a good idea, too.
posted by muddgirl at 1:16 PM on November 24, 2009

How long is your hair? When my hair was longish, I noticed it was falling out all the time.

Thing is, I'm not bald or balding. Hair just falls out. It's supposed to. When it's longer, the end of a hair's life cycle is more noticeable. Also: Longer hair means more breakage, more tangles, etc.

But, yeah... I'm just a couple years older than you, and I have a couple of friends my age with the pate of George Costanza. It happens.
posted by Sys Rq at 1:36 PM on November 24, 2009

I should add that, while hair does come out everywhere in the shower where it didn't before, the amount is markedly less on the back of my head, though not insignificant.

That's classic male pattern baldness. See the aforementioned George Costanza. You'll have thick hair on the back of your head long after the rest is gone thin or just gone.
posted by 6550 at 2:05 PM on November 24, 2009

Thyroid: It would show up on a thryoid blood test. If you go back and they're running tests, ask if it makes sense to get a T4/TSH panel.
posted by barnone at 2:17 PM on November 24, 2009

Keep in mind that you may not go full on Costanza. My dad's receded sort of like Dr. Drew, then stopped in his mid-30s and has been more or less stable ever since (he's 65). That's the way mine appears to be going as well (I'm 33). I was pretty freaked out by it when it first started happening in college, but honestly, most people really don't care and it's not going to stop you from getting a date with anyone worth dating.

I considered trying propecia, but the side effects

(Recognized side effects of finasteride include impotence (1.1% to 18.5%), abnormal ejaculation (7.2%), decreased ejaculatory volume (0.9% to 2.8%), abnormal sexual function (2.5%), gynecomastia (2.2%), erectile dysfunction (1.3%), ejaculation disorder (1.2%) and testicular pain.)

sort of negates the goal of improving your appearance. I mean, why cultivate a full head of hair if your junk doesn't work, your balls hurt and you have ladyboobs?
posted by electroboy at 2:41 PM on November 24, 2009 [1 favorite]

It sounds to me like it could be alopecia. Do some googling as there are different kinds i.e. diffuse thinning over the entire head, coin sized patches of hair loss in certain areas, etc.

There are treatments for alopecia that work for some people (such as steroid injections) but for the most part, you really just have to wait it out and see how it progresses. I was a sufferer a few years ago and lost about a quarter of my hair. It took about a year to grow back and I haven't had any problems since but once you have it, it can come back at any time.

See a dermatologist as recommended as you might simply have a scalp inflammation that is treatable. But in my experience, once they ruled out internal and external causes, the diagnosis they were left with was alopecia.

Mefi mail me if you'd like any further info.
posted by gfrobe at 2:45 PM on November 24, 2009

Have you radically changed your diet, or lost a significant amount of weight? That often brings about hair loss.
posted by tzikeh at 3:28 PM on November 24, 2009

If you had a thyroid problem, you would have other symptoms in addition to the hair loss, most notably fatigue and significant weight gain despite not changing your diet recently. You might also have really dry skin , but it wouldn't just be on your scalp (chapped lips all year round, cracked heels, etc.). Much more common if you have a family history and generally more common in women. You are a little younger than average as well for this to show up, but if you have the other symptoms, T4/TSH panel.
posted by misha at 4:10 PM on November 24, 2009

Please note that hyperthyroid certainly won't cause the weight gain/fatigue of hypothyroid--it's essentially the opposite. My mother claims that hyperthyroid is a great post-pregnancy weight loss method! (Obviously not actually recommended, but it's about when her thyroid issues flared up)

I had a noticeable amount of extra hair loss when I moved to Japan. It has mostly calmed down now after about 6 or so months, but it definitely was a cause of stress for me, and I think stress doesn't actually help these things improve any.

What do your other male relatives have in terms of hair loss? Grandparents count too!
posted by that girl at 6:05 PM on November 24, 2009

The yellow scaly stuff sounds like the same thing as cradle-cap that babies get. You cover the scalp in olive oil overnight, comb it through.. and shampoo off in the morning. One or two nights should get rid of it.
posted by taff at 11:55 PM on November 24, 2009

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