Male pattern hair loss has been established as androgen-dependent because it is associated with changes in the androgen receptor and responds to antiandrogen therapy (Ellis et al., 2002). With FPHL, genes that encode aromatase, which converts testosterone to estradiol, are also implicated (Yazdabadi et al., 2008, Yip et al., 2009). The process of androgen biosynthesis is depicted in Figure 1.

Madarosis is the hallmark of lepromatous leprosy. It was reported in 76% of patients with multibacillary leprosy.[76] Bilateral symmetric cicatricial madarosis occurs in lepromatous leprosy due to histiocytic infiltration of hair follicles[77,78] [Figure 4]. It occurs in multibacillary leprosy after at least 5 to 10 years of untreated disease.[79] Loss or atrophy of the eyelashes may follow. Madarosis adds to the cosmetic disfigurement caused by leprosy. Absence of madarosis is a good prognostic sign in long-standing cases.[80] Unilateral madarosis may occur in tuberculoid leprosy due to the facial patch in the eyebrow region. In tuberculoid leprosy, madarosis occurs due to granulomatous infiltration of hair follicles leading to their destruction.
A little farther up the follicle is the mysterious feature called the bulge. That's where follicle stem cells live. When they get the right set of chemical signals, these self-renewing cells divide. They don't divide like normal cells, in which both halves become new cells that keep splitting and developing. Only one half of the follicle stem cell does that. The other half becomes a new stem cell, and stays put for future regeneration.
Around 30 million U.S. women will experience hereditary hair loss, or female pattern baldness (androgenetic alopecia), while others will struggle with situational hair loss, brought on by medical conditions, medications, poor health and nutrition, environmental factors such as smoking and sun damage, or even from adverse reactions to hair care products or treatments.
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This is an autoimmune disorder that is also known as “spot baldness” and can result in hair loss ranging from just one location (alopecia areata monolocularis) to the entire scalp (alopecia totalis), or to every hair on the entire body (Alopecia areata universalis). Although it is thought to be caused by hair follicles becoming dormant, what triggers alopecia areata is not exactly known. In most cases, the condition corrects itself.
Other drugs commonly attributed to causing madarosis are miotics, anticoagulants, anti-cholesterol drugs, antithyroid drugs, propranolol, valproic acid, boric acid, and bromocriptine.[21,99] Anticoagulants in high doses have been found to produce loss of scalp, pubic, axillary, and facial hair with loss of eyebrows after a latent period of a few weeks of treatment with dextran and heparin.[100] Propranolol can cause diffuse alopecia along with loss of eyebrows due to telogen effluvium,[101] usually after three months of therapy.[44] Loss of medial aspect of eyebrows can be seen in fetuses exposed to valproic acid.[102] Diffuse alopecia including that of eyebrows has been described due to chronic ingestion of mouthwashes containing boric acid. There was complete reversal following stopping the practice.[103] Levodopa has been noted to cause severe diffuse alopecia within three months of daily use.[104] Hair loss can occur soon after starting topical minoxidil therapy (due to detachment of club hairs following resting hairs reentering anagen), and after cessation of therapy (due to telogen effluvium).[98]
Also called “chastetree,” Vitex is an herb which is typically prescribed to treat estrogen dominance. It seems to be recommended as a remedy for especially low levels of estrogen as well however, and does seem to have a general balancing effect on the overall ratio of estrogen to progesterone. Vitex’s balancing effect is thought to result from the stimulation of dopamine production. 

The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is seen as hair thinning predominantly over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most commonly seen after menopause, although it may begin as early as puberty. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Genetically, hair loss can come from either parents side of the family.

Eyebrow thinning that manifests in irregular patches, especially accompanied by red and itchy skin, may indicate atopic dermatitis. This condition—commonly called eczema—can occur just about anywhere on the body and is usually hereditary. People with atopic dermatitis may be more sensitive to topical irritants, but eczema just from topical irritants is called allergic contact dermatitis or irritant contact dermatitis. While you wait on the appointment with your dermatologist, you can help ease eczema around the eyebrows by switching to mild soaps or a soap-free facial cleanser, and applying an intensive facial moisturizer within three minutes after bathing.


The study in question, which was first published in the journal PLOS Genetics earlier this year, analyzed the hair growth of 52,000 men between the ages of 40 and 69 in the UK. The numbers: 32% of the men said they did not experience any hair loss at all. 23% said they experienced a little bit. 27% had moderate hair loss, and the last 18% said they were suffering from severe hair loss.
What’s more likely is that telogen effluvium is at play (again). In addition to hormone fluctuations, this type of hair loss happens when there is a drastic dip in protein in the diet or sudden weight loss. For example, if you are sick and can only consume liquids for a month. “If you have protein levels that drop dramatically, your hair follicles go into hibernation, and you can see sudden acute hair loss that shows up three to six months later,” says Dr. Katta.

Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting the use of flat irons (these straighten hair by using high heat) and curling irons.
Your doctor might also suggest the prescription pill finasteride, sold under the brand name Propecia and also in generic versions. Although the drug is not federally approved for use in female patients, some doctors have observed good results in postmenopausal women. But women who are planning to have children should not take this drug because it can cause birth defects.
Scurf refers to the scales and greasy crusts that accumulate along the hair shaft and indicates the presence of seborrhea.[26,27] Collarettes are composed of hard fibrinous scales[25,28] surrounding each individual eyelash. They travel upward along with the growth of the lashes and are indicative of staphylococcal infection. Sleeves or cylindrical dandruff comprise scales that form a cuff around the lash root and are connected with it, in contrast to greasy scales which are not connected to the lash root.[29] Sleeves indicate infestation with Demodex folliculorum.

Management of madarosis primarily depends upon treatment of the predisposing disorder. Inherited disorders can be identified by the associated clinical features. Establishing the diagnosis is an important prerequisite for the management of madarosis. For this, madarosis can be broadly classified as scarring and non-scarring. In non-scarring madarosis, generally regrowth of hair occurs after treatment of the primary disorder. In disorders such as lepromatous leprosy, though the madarosis is non-scarring, hair regrowth does not occur. In such cases, and in cases of scarring madarosis, hair transplant is essential for cosmetic purposes.
The study in question, which was first published in the journal PLOS Genetics earlier this year, analyzed the hair growth of 52,000 men between the ages of 40 and 69 in the UK. The numbers: 32% of the men said they did not experience any hair loss at all. 23% said they experienced a little bit. 27% had moderate hair loss, and the last 18% said they were suffering from severe hair loss.
Low Level Laser Therapy (LLLT) is a non-invasive, non-surgical scientific approach to fighting hair loss. It is effective against multiple levels and types of hair loss including thinning hair, receding hair line, male and female pattern baldness and various scalp issues. LLLT has been rigorously tested for both safety and effectiveness for well over 30 years and has been in use in many countries throughout the world for over 30 years.
Male pattern baldness (MPB) has a distinctive shape. The front hairline recedes, especially at the sides, forming an M shape. This is frontal baldness. The crown of the head, also known as the vertex, becomes bald as well. Eventually the two areas join into a “U” shape. MPB can even extend to chest hair, which can thin as you age. Oddly enough, hair in different locations on the body can react differently to hormonal changes. For instance, facial hair growth can improve while other areas become bald.
Before you start hormone replacement therapy, it's important to talk to your doctor about the possible risks and negative effects versus the benefits of HRT. If you're already at an increased risk for health conditions like heart disease, cancer, and blood clots, HRT may not be the best hair loss treatment for you. If you are prescribed HRT, it important to take the lowest doses that are effective, and to only take the drugs for the shortest amount of time needed to control symptoms.

Try out new hairstyles to disguise your thinning hair whilst you recover your hormonal balance. You may also want to consider a hair piece or clip-in extensions if your hair loss is very bad, but these should be used with care in order to prevent traction alopecia. You may also like to try using rollers or a hair volumizer, to add lift to your locks, or instantly hide thin patches with a good hair loss concealer.
Thank goodness! I am a teacher which requires me to get up about 5:30 during the school year. This summer, I will turn 62 and although I’ve always had problems waking up early in the morning – he it is so severe that I am sleeping 12 to 14 hours a day! This is terrifying as school starts in less than two weeks. I am postmenopausal for close to 20 years now and recently found out that my estrogen level is elevated. Your article is a godsend; I will now be able to have an intelligent discussion with my gynecologist and hopefully become a morning person for the first time in my adult life!

Yes. If you wear pigtails or cornrows or use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia (say: al-oh-pee-sha). If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals used in permanents (also called “perms”) may cause inflammation (swelling) of the hair follicle, which can result in scarring and hair loss.


The real culprit appears to be dihydrotestosterone (DHT), a more potent form of testosterone. DHT is made from testosterone by a specific enzyme in the body, and while both testosterone and DHT are known to have a weakening effect on hair follicles, there appears to be something unique about the conversion process of testosterone to DHT that relates to thinning hair. This is why some drugs that are marketed for hair loss block the conversion of testosterone to DHT. (It’s important to note, however, that these drugs tend to be less effective in women than men, and that one of them—finasteride—is only approved for hormonal hair loss in men, not women. What’s more, the drug has been associated with increased risk of sexual side effects, depression, nausea, hot flashes, and increased estrogen levels—and too much estrogen is its own risk factor for thinning hair; more on that below.) 

Estrogen and combined oral contraceptive (COC) drugs with estrogen or progestogen have been reported as effective, but data are limited (Adenuga et al., 2012, Raudrant and Rabe, 2003, Scheinfeld, 2008). They are thought to function through several mechanisms. Both components of COC drugs increase the levels of sex-hormone-binding globulin (Schindler, 2013). They also send negative feedback signals that suppress the hypothalamic secretion of gonadotropin and releases the hormone and pituitary secretion of the luteinizing and follicle-stimulating hormones, which results in a decreased androgen production (Gilman et al., 1990, Varothai and Bergfeld, 2014). These actions decrease androgen secretion from the ovary and the quantity of free, biologically active androgens, which reduces their effects on the hair follicles (Schindler, 2013). Our practice when prescribing COC drugs is a combination of ethinyl estradiol 20 mcg plus drospirenone 3 mg. Drospirenone is an analogue of spironolactone. This treatment combination is approved by the FDA for the treatment of acne but not alopecia.
When you see more hair in the shower drain, in your hair brush or your ponytail holder goes around an extra time all of a sudden this is typically low thyroid, high stress or low estrogen. It can also be the increased inflammation or oxidative stress or as a result of nutrient deficiencies especially anemias (low iron, B12, etc.). Let’s dig into each of these.
Dozens of other causes of eyebrow loss are also possible including a variety of infectious, autoimmune and inflammatory conditions. Consultation with a dermatologist or hair transplant surgeon is recommended. I strongly advise consulting a dermatologist before proceeding to hair transplantation for women over 40 with new onset eyebrow hair loss after age 40.
The first step in treatment is to identify the cause of the hair loss. Then, treat it appropriately. If an internal cause is the culprit, it should be addressed — for example, thyroid medication for thyroid disease or supplements for a nutritional deficiency. External skin conditions are often treated with topical medications, and, once treated, the hair loss usually recovers. I often recommend Latisse as an adjunctive treatment. Though frequently associated with eyelash lengthening, it is a great option for thickening brows. In fact, people with brows that thin with aging (I typically don't see this in women under 50) may want to opt for Latisse.
At The Hair Wellness Group we cater to those desiring to maintain the health and integrity of their hair.  We offer both General Hair Care services as well as Customized Hair and Scalp Therapy Treatments. We service men and women and all ethnicities…To us hair is hair! We are keenly interested in working with our clients to find the best Hair Care Regimen along with Hair Products and Wellness Products for their needs.
There is also a different in the form of 5AR enzyme (5 alpha reductase) found on the facial hair follicles vs. the scalp hair follicles. This enzyme converts testosterone into that more problematic DHT. Type I DHT is found in sebaceous glands on the face and genital area whereas Type II is found in hair follicles of the scalp. Type II DHT is typically more of a problem in men, but Type II is increased in disorders with high testosterone like PCOS.

The first step in treatment is to identify the cause of the hair loss. Then, treat it appropriately. If an internal cause is the culprit, it should be addressed — for example, thyroid medication for thyroid disease or supplements for a nutritional deficiency. External skin conditions are often treated with topical medications, and, once treated, the hair loss usually recovers. I often recommend Latisse as an adjunctive treatment. Though frequently associated with eyelash lengthening, it is a great option for thickening brows. In fact, people with brows that thin with aging (I typically don't see this in women under 50) may want to opt for Latisse.
Despite the name androgenetic alopecia, the exact role of hormones is uncertain. It is well known that androgens affect the growth of the scalp and body hair and even Hippocrates observed 2,400 years ago that eunuchs did not experience baldness (Yip et al., 2011). However, hyperandrogenism cannot be the only pathophysiologic mechanism for FPHL because the majority of women with FPHL neither have abnormal androgen levels nor do they demonstrate signs or symptoms of androgen excess (Atanaskova Mesinkovska and Bergfeld, 2013, Schmidt and Shinkai, 2015, Yip et al., 2011). Furthermore, cases have been reported in which FPHL developed in patients with complete androgen insensitivity syndrome or hypopituitarism with no detectable androgen levels (Cousen and Messenger, 2010, Orme et al., 1999).
Male pattern hair loss has been established as androgen-dependent because it is associated with changes in the androgen receptor and responds to antiandrogen therapy (Ellis et al., 2002). With FPHL, genes that encode aromatase, which converts testosterone to estradiol, are also implicated (Yazdabadi et al., 2008, Yip et al., 2009). The process of androgen biosynthesis is depicted in Figure 1.
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Cyproterone acetate works in several ways. It not only competitively blocks DHT from binding to its receptors at target tissue (Gilman et al., 1990), but it is also a progestogen that lowers testosterone levels by decreasing the release of luteinizing and follicle-stimulating hormones through pituitary-mediated supression (Gilman et al., 1990, Varothai and Bergfeld, 2014). An open intervention study of 80 women who received treatment with spironolactone (200 mg daily) or cyproterone acetate (50 mg daily or 100 mg for 10 days per month if premenopausal) showed that three of four patients demonstrated an improvement or stabilization of their disease with no difference of effect between the therapies received (Sinclair et al., 2005).
Elizabeth Willett is the Senior Herbalist and Lead Educator at NaturalFertilityInfo.com. She holds a BS in Mass Communications (2000) from Minnesota State University, and a Master of Arts degree (MA, 2010) in Holistic Health Studies with a specialization is herbalism from St. Catherine University in St. Paul, MN. Liz has written over 200 articles on women’s fertility and brings a vast wealth of knowledge and expertise in holistic health and healing to Natural Fertility Info.com
If, however, you aren’t so sure that any of the causes listed above are a problem for you, then a good place to start may be to talk with your healthcare provider about testing. It is important to learn the root cause – especially if dealing with infertility – because that which is causing hair thinning and shedding may also be contributing to your inability to conceive.

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Trichotillomania is a hair pulling disorder associated with anxiety, stress, depression, boredom and frustration. It is where a person manually removes hairs with their finger, either a few strands throughout the day or sometimes many strands at one time during an emotional outburst. This behavior is usually a means of coping with stress or emotional turmoil. However, it can sometimes become a habit that is difficult to break. The eyebrows is a commonly targeted area as is the scalp.
Contact dermatitis causes skin inflammation and when severe it can affect the hair follicles as well. It can either be due to some irritant making contact with the skin of the eyebrows or due to a substance to which a person has an allergy. This gives rise to the two types of contact dermatitis – irritant contact dermatitis or allergic contact dermatitis. Substances that could cause contact dermatitis at the eyebrow includes eye makeup including eyebrow pencils, hair removal creams and waxes, other cosmetics, hair dyes and scalp hair styling products.
It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.
Complete Belgravia's online consultation if you are unable to visit one of our London clinics. The questionnaire should take no more than 10 minutes to complete and will provide our hair loss specialists with all the information required to recommend an effective course of home-use treatment. For those who live in or around London, we always recommend a clinical consultation.
The leading cause of hair loss in men is male pattern baldness, also known as androgenetic alopecia. This occurs in men whose hair follicles are sensitive to the hormone dihydrotestosterone, or DHT. Over time, DHT-sensitive hair (usually found on the top and front of the head) becomes weaker and finer and eventually stops growing. Most men have DHT-resistant, healthy hair follicles around the sides and back of their head. This is why so many men have a horseshoe pattern on their head.
Hair loss can occur either in acute or chronic hypervitaminosis A. Loss of eyebrows and eyelashes can occur in chronic hypervitaminosis A which can occur in a number of conditions, either due to enthusiastic overdosing or due to intentional prescription of high doses for diseases such as acne, retinal disorders with night blindness, and others.[116] The cutaneous manifestations include dry, rough, and scaly skin. Chronic hypervitaminosis A is also becoming increasingly common with use of retinoids for various skin disorders. Acitretin has been noted to cause a high incidence of diffuse hair loss.[117] Premature teloptosis may be a prime factor in hair loss induced by retinoids.[98]
Most of us look at the eyebrows as a patch of hair that has an aesthetic purpose and it is often shaped for cosmetic purposes. Although the exact purpose of the eyebrows is not conclusively understood, it is believed to be prevent water or sweat from falling on to the eyes itself. For most people its function is of little concern compared to its cosmetic purpose. As with hair anywhere on the body, eyebrow hair and the follicles from where it arises can be prone to the same diseases and disorders which may lead to hair loss..

Low iron and low B12 can arise from a variety of causes including autoimmunity, poor intake, depletion due to medications (i.e. antacids) or bad digestion and are common causes of hair loss. But other common nutrient deficiencies can arise as part of a less than stellar diet low in zinc, protein (especially the amino acid lysine) or a deficiency of vitamin B6 (a very common issue with women taking hormones like the birth control pill). Low vitamin D has also been linked to excessive hair loss as has excessive vitamin A intake (less common.)
“…a beauty editor told me she had been using Viviscal... Since beauty editors see truckloads of products every week, I was immediately convinced when she said it worked – so I bought it myself. I started taking it twice a day for the first six months and saw dramatic results within three to four months. My hair was less thinned out …and it was also less brittle. I’ve gone to the same hairdresser since I was 19, and he was the first to comment on how full and strong my hair looked…”

Madarosis is a clinical sign that has become pathognomonic of leprosy in countries like India. However, this apparently benign clinical sign has wider ramifications in many systemic and dermatological disorders. Hence, establishing a proper diagnosis and appropriate management is mandatory. Though management of the primary disease results in regrowth of eyebrows and eyelashes, many require surgical management. Thus, the management of a patient with madarosis requires a coordinated effort from the dermatologist, ophthalmologist, internist, and reconstructive surgeon.
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