Are You Really Going Bald? A Dermatologist Explains How to Tell

Dr. Loretta Ciraldo differentiates between what’s normal and what’s worth worrying about.

man worried for alopecia checking hair for loss

Published April 18, 2023

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Updated April 18, 2023

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The future looks grim — at least for your hair. Research suggests roughly 85 percent of men will experience pattern hair loss or balding by the time they’re 50. Yikes! Follow the data back to men aged 18-26 and approximately 16 percent will see hairline recession or spotting. For those aged 40-49, hair loss impacts at a rate of 56 percent. (Not promising, I know.)

However, there’s no sense in worrying about hair loss or balding before it actually happens. It’s hard to do, sure, but rest assured that there isn’t anything you can do to prevent it, despite what fringe chat forums might say. “There is no true preventative to use to prevent hair loss,” dermatologist Dr. Loretta Ciraldo MD FAAD (also the owner of skincare brand Dr. Loretta) confirms.

It can happen faster to some if hair loss is hereditary — meaning a parent started balding in their 20s, 30s or 40s — and onset sort of immediately if you have telogen effluvium (aka hair loss caused by a stressful event), but all of us will slowly lose hair over time. It’s an unfortunate fact of life, but in order to properly diagnose it, and then (hopefully) treat it, it’s important to know which type you’re dealing with.

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What Is Hair Loss?

It’s important to know the difference between male pattern hair loss (aka going bald), alopecia areata and telogen effluvium. Male pattern hair loss is a nearly universal issue where hair thins, falls out or slowly grows apart. (Think: George Costanza from Seinfeld.) Alopecia areata is the medical term for an autoimmune disorder that causes the hair to fall out in quarter-sized clumps, often with no reason or pattern. Telogen effluvium, as mentioned above, is hair loss due to a traumatic, stressful or otherwise significant event.

According to Dr. Ciraldo, dermatologists “define abnormal hair loss as more than 120 hairs a day.” But she says you should not simply assume it’s happening because you’re aging. “Do not take it for granted that hair thinning or increased hair loss is solely due to aging. If you are losing more than 120 hairs in a day please see the dermatologist or your primary care physician to determine the cause of the hair loss. It may be related to a number of causes including but not limited to thyroid issues, anemia, or drugs you are taking.”

Am I Going Bald? How to Tell

While a bald spot or vertex — the name for a bald spot and recession on the Norwood Scale, a graph that tracks and predicts balding patterns — are obvious signs your hair’s on its way out, hair loss never starts that way. Translated: you won’t one day wake up with a bald spot. Hair loss is progressive, and happens over the span of decades — even if it begins in your 20s or 30s.

“The two most obvious ‘early signs’ of hair loss that we notice are shedding more hair especially when we shampoo and on our clothes during the day, and that our part appears wider. But we have to remember that as we age, our hair shafts thin to make it appear as though we’ve lost hair when we may have a healthy amount of hair but each hair is just thinner,” Dr. Ciraldo says.

What’s Normal and What’s not?

As Dr. Ciraldo mentioned, serious hair loss is defined as 120+ strands a day. Sure, counting your hairs lost starting…now — by investigating the area around you, your bed for those you lost while you slept, and collecting those attached to clothing you tossed in the hamper — might seem tedious, but it’s the truest way of knowing whether or not you’ve got a problem. (Comparing pictures of yourself today alongside ones taken two months ago isn’t doctor-approved, but it does offer a clearer look at other patterns, like hair growth.)

“[There’s] no need to freak out about hair loss,” Dr. Ciraldo assures. “The first thing to do is the do the 24 hour hair count where you actually count how many hairs you are losing in one 24 hour timeframe. In my practice, many people who are afraid they are suffering hair loss find on their hair count that they are now losing 70 or 80 hairs a day, which is up from what they had been losing but it will never make them seem like they have less hair. So, it’s important to do the hair count even before you see a doctor. If it is under 120/day do not worry or freak out.”

What Is a Receding Hairline?

A receding hairline is technically different from hair loss. However, it’s the first step toward pattern baldness on the aforementioned Norwood Scale. You should be mindful of where your hairline is now in order to notice a difference, say, a year from now, but it’s not worth inspecting every morning, and you likely see your barber too infrequently for them to tell a difference, too.

“By a certain age (usually noticeable by 50), almost everyone has some recession of their hairline,” Dr. Ciraldo says. “This is no cause for concern if it is only a few millimeters of recession — which is the most common amount. If you suddenly see that you have a significant amount of receding hairline again I recommend going to the dermatologist since there is a chance that you may have a variant of the condition called ‘alopecia areata’ or you may be in the early stages of male pattern hair loss, both of which are often very treatable with early intervention.”

Is Hair Loss Reversible?

According to Dr. Ciraldo, “many forms of hair loss are definitely reversible.” Phew! Which ones, you’re wondering? Is there hope for the hair you have left? You’ll need the expertise of a professional like Dr. Ciraldo in order to truly identify the issue.

First, she says, “try to determine any systemic cause, with thyroid disease probably being the most common. If the bloodwork reveals a cause, from thyroid disease to collagen vascular disease, the hair may grow back when the underlying cause is treated.”

Then, “if the dermatologist diagnoses this as a condition called ‘alopecia areata,’ we use injections of cortisone into the scalp to promote regrowth.” If the doctor determines you’re experiencing telogen effluvium, “which is a diffuse rapid loss of hair several months after a traumatic event, including even something like a fever or some psychological stress,” or Covid-19, Dr. Ciraldo explains, the hair will likely regrow on its own.

For those diagnosed with male pattern hair loss (aka natural balding), “Nioxin haircare products will coat the hair shaft and give you a fuller head of hair, and the oral medication Propecia (generic name finasteride) is often excellent at regrowing hair, especially when started in the early stages of the hair loss.” See, there’s hope!