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Q: I had a heart attack four years ago and had three bypasses. Since then my hair has been falling out. I don't have cancer. Do you think that one of my nine medications is causing my hair loss?

-- M.D., Weldon, N.C.

A: Since you didn't provide me with your age, it's harder to address the problem of hair loss. And without the names of your nine medications it's difficult to determine if one of them might be the cause. So let me provide you with some background information, which should help you begin to solve the problem.

Hair loss occurs all the time. Just like other skin cells, hairs develop, mature, die and then are shed. For unknown reasons, the rate of loss is often cyclical, so that at times it's much more noticeable. Harsh shampoos and frequent use of hair dryers may contribute to the thinning of your hair by making it more brittle.

Hair loss, also called alopecia, can be due to many factors, some related to scarring and others not. Scarring can be caused by chemical injury, physical injury, radiation injury, severe infections and some diseases. Scarring-caused alopecia is often irreversible and permanent.

Non-scarring causes of alopecia include diseases like lupus, syphilis, thyroid and pituitary problems, and anemia. Non-scarring alopecia can also be caused by a variety of drugs. The only treatment in such cases is treatment of the underlying condition, or to stop taking the offending drug.

Although androgenic baldness (often called male pattern baldness) is more common in men, as many as 40 percent of women will develop it or a similar problem. Female pattern hair loss is characterized by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline.

The name androgenic comes from the effect of the naturally occurring hormone androgen. This does affect women as well as men, but there are other unknown factors at work in female pattern hair loss.

In this type of hair loss, the amount lost is variable and unpredictable, but hair is lost gradually and according to a pattern. Both men and women can now be treated for this disorder with minoxidil. But stopping treatment allows balding to return.

Two drugs, one called finasteride (Propecia) and the other called minoxidil (Rogaine and Loniten) have been shown to be effective. The standard treatment uses a 2 percent solution of minoxidil, but a recent study showed that a 5 percent solution works faster and better.

The drug Avacor contains minoxidil and saw palmetto, which may have some benefit as well. Avacor is typically sold as a system that includes pills, lotions and shampoos that end up costing a lot more than simply using minoxidil by itself.

Alopecia areata is another common hair loss disorder, especially in children and young people. It is characterized by a rapid loss of patches of hair. The cause of alopecia areata is unknown. Psychosocial stress is thought to play a part in its onset or worsening.

Another form of hair loss is known as telogen effluvium, which may happen spontaneously or after pregnancy. It can also be caused by crash dieting, high fever, iron deficiency, stress, malnutrition, and by birth control pills.

Finally, hair loss can occur as the result of the recurrent pulling out of clumps of one's hair. This is called trichotillomania, and is a psychological problem that is more common in adolescent girls.

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