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Hair Loss/Shedding and lost hair density


Hair part
Hair part  

Ponytail -before&after
Ponytail -before&after  
Hello Dr. Peter,

I'm 33/female and i'm suffering from thinned hair. My hair has always been fine, but the quantities were very good. I remember it was common for me to shed somewhat heavily at a certain time each year, around the time the weather warmed up, but it wouldn't last long and the thickness of my ponytails was never really affected. Two years ago, the shedding didn't stop as usual... i kept shedding and shedding. I didn't count them, but i lost a LOT while showering, every time i touched my hair, all day i was taking hairs out of my clothes and off my arms and shoulders. There have been short periods in these two years when the shedding seems to slow down and i start feeling a little bit more density to my hair. But now i'm really worried as my ponytail is down to half or even less than what it used to be. Aside from the fact that it seems to be stuck at the same length for more than a year now.

I see my center part looks a little bit less dense in the picture (in real life i thought it was the only thing that still looks as it used to), but the hair part seems to get worse and worse closer to the ears and nape of neck. I'm attaching photos so hopefully you see what i'm talking about.

I went to a dermatologist on 2013 when i noticed the shedding wasn't stopping, but he just pulled on my hair, nothing came off, barely looked at me and told me i would be fine. In 6 years i would see all of my hair back. ...But the shedding hasn't stopped and now it's so much worse!

In my family there's no bald or sparse hair woman, though my dad and both grandfathers are bald.

About the reason, i suspect it may have something to do with a health issue I started having where i lost more blood than usual. I also donated blood mid 2013... then had an episode of even more blood loss, then donated blood again around feb 2014 (then i was told i shouldn't have right after the fact, since they found my red blood cells were down). I felt dizzy and exhausted extremely easily for months after that. I started taking iron supplements a few months ago, had a checkup last month and it showed my hemoglobin is normal again. I had surgery to remove a fibroid that was causing the excessive bleeding. I'm hoping once my body recovers my hair will recover too... Does it sound/look like the hair loss is temporary? I really hope I'm not the first female in my family to have female pattern baldness... or any other type of baldness, for that matter.

I hope you can give me some insight as to what might be wrong with me and provide guidance as to what i should do... any ointment i can rub on my head to make it better? haha... Seriously, anything you can suggest will be greatly appreciated.

Many thanks in advance!

There are several issues to be addressed with your history. Normally I would recommend seeing a dermatologist who would treat you for having Female Pattern Baldness, now known as Androgentic Alopecia. Having been to a Dermatologist two years ago and being told there was nothing wrong you may now be afraid to go back and tell the doctor there is something wrong. If you were losing blood you may well have had a low Serum Ferritin. Many doctors assume normal levels range from 10 to 200 but it has been found that levels below 70 may cause women not to have enough iron to grow their hair normally. Stress from illness could have cause Telogen Effluviums which are periods of shedding of hundreds of hairs per day instead of the normal 50 to 100 hairs lost daily. In your case it seems you may well have had some stressful ailment which led to a TE or several TEs which thinned your hair but will a low serum Ferritin you were unable to grow them back. TEs frequently only last a few months and you may have gone to see the doctor at the end of the TE when your shedding was back to normal.
  General anesthesia or the surgery itself ( for the fibroids ) can cause TEs.  
Lastly you can inherit the balding genes from your mother or your father so there is a good chance you are carrying some bald genes.
  Here is what I think happened
1.You had TEs due to various stressful incidents which thinned your hair. Hopefully that has stopped.
2. Chronic blood loss led you to have low serum ferritin which prevent normal regrowth.
  There is a handout I give to my patients which you will find below.
3.You have inherited Female Pattern Baldness and the treatment for that is an oral contraceptive pill such as YAZ + Spironolactone 50 to 100 mg per day -- you can read about that in Chapter 9 in my book.  Topical 5% Minoxidil lotion once a day in the morning will help you get back some of your recently lost hair.
If you go to my website you will find my book "Hair Loss Answers" on the home page and if you click on it you can read it for free online.
Chapter 4 Other Hair Loss Causes
Chapter 9 Drugs That Grow Hair
         Serum Ferritin Patient Handout:
Note: Most Doctors and Labs list the normal range of Serum Ferritin as 10-230.
If you are below 60, I want you to take Ferrous sulfate 325 MG. daily and Vitamin C 500 daily.

Clinical & Experimental Dermatology
Volume 27 Issue 5 Pages 396 - July2002
Doi: 101046/j.1365-2230.2002.01076.xClinical dermatology*Review article Nutritional factors and hair loss D.H. Rushto
Summary: The literature reveals what little is known about nutritional factors and hair loss. What we do know emanates from studies in protein-energy malnutrition, starvation and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increase hair shedding. Hard, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron-deficient women with hair loss.
Serum ferritin concentration provides a good assessment of an individual's iron status.
What level of serum ferritin to employ in subjects with increase hair shedding is yet to
Be definitively established but 70ug/L, with a normal erythrocyte sedimentation rate
(<10 mm/h), is recommended. The role of the essential amino acid, 1-lysine in hair loss
also appears to be important. Double-blind data confirmed the finding of an open study
in women with increased hair shedding, where a significant proportion responded to
1-lysine and iron therapy. There is no evidence to support the popular view that low serum zinc concentrations cause hair loss. Excessive intakes of nutritional supplements
may actually cause hair loss and are not recommended in the absence of a proven deficiency. While nutritional factors affect the hair directly, one should not forget that
they also affect the skin. In the management of subjects with hair loss, eliminating scaling
problems is important as is good hair care advice and the need to explain fully the hair cycle. Many individuals reduced their shampooing frequency due to fear of losing more hair but this increases the amount seen in subsequent shampoos fueling their fear of going bald and adversely affecting their quality of life.

Hair Loss

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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