Less than half of women go through life with a full head of hair. For men, it’s closer to 20%. For anyone, it’s a worry when you pull that clump of hair out of the plug hole. A Cochrane review of treatments for female-pattern hair loss suggested that women “suffer more than men”, feeling “removed from what is considered a ‘normal’ female appearance”. However, studies show that three-quarters of men with moderate to severe hair loss aren’t thrilled, either. That said, hair loss in small clumps doesn’t usually mean imminent baldness. Its medical name is telogen effluvium and it can be triggered by pregnancy, surgery or serious illness – usually three months after the event – and is due to traumatic disruption of the hair-growth cycle. Hair almost always grows back. Hair loss can also be due to alopecia areata, an autoimmune condition in which hair also usually grows back.

It’s normal to lose up to 100 hairs a day (more than one clump). Hair grows from the base of hair follicles at 1cm a month for about three years. Then the hair just sits there until it is pushed out by a new hair. In the scalp, hairs grow in tufts of three of four. Once male or female pattern baldness kicks in, the tufts lose hairs and the scalp develops bald spots. Men lose hair from the front backwards as well as on the crown, often getting a circle of baldness. Women get thinner hair in the middle of the scalp. So when should you worry about hair loss and what should you do?S

Solution

If you are losing clumps continuously or want advice on hair loss then see your GP, who might ask about what medicines you’re taking or check your thyroid or iron levels. Both male- and female-pattern baldness can be disguised with spray thickeners and shading powders: there are no magic hair potions. Hair extensions and wigs get more realistic all the time but hair transplants are increasingly popular. The Cochrane review found that only minoxidil rubbed into the scalp showed any benefit, and had to be used for at least 12 months and then continuously to prevent further hair loss (it may work by retaining hairs for longer). You have to pay full price for minoxidil, as the NHS doesn’t provide it. Hormone treatments that reduce androgens work for some men, but the Cochrane review found no real effect in women. The author of the review, Dr Esther van Zuuren from Leiden University Medical Centre, says they are currently updating the evidence. LaserComb, which claims to stimulate follicles and has FDA approval, will feature heavily – but don’t hold your breath.