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Cheryl Brewster was the envy of every gym rat, with her hard body and shoulder-length, sun-kissed locks.
So when her hair began falling out two years ago, the personal trainer was devastated.
"My part was getting wider, I could see more of my scalp and it was no coincidence that clumps of hair were falling out in the shower," said Brewster, 40, of Orinda.
A slew of vitamins and thickening shampoos later, Brewster's dermatologist diagnosed her with female-pattern baldness and started her on Rogaine the drug minoxidil which initially caused Brewster to shed more hair. It is only recently, after a year of use, that Brewster is seeing regrowth.
"I was horrified," recalled Brewster, who went on anti-depressants. "I didn't want to be the trainer with the bald head."
It's likely that stress and anemia exacerbated Brewster's genetic condition. In fact, there are endless triggers for the millions of women who suffer from hair loss from medications and crash dieting to thyroid problems and autoimmune disorders, said Alexander Lewis, a Walnut Creek dermatologist. Millions more suffer from traction alopecia, a hair-loss epidemic caused by cornrow braids and other tight hairstyles.
Variety of causes
Unlike male-pattern baldness, which is triggered by a known hormone, women with the condition often find themselves on a frustrating journey with more dead-ends than answers. Often they become depressed, coping with the loss of their crowning glory in a society that favors full, youthful heads of hair. For that reason, many don't seek help. But a growing online community is now spreading the word on what works and where to get help.
"Women have camouflaged their hair loss for a long time," said Alan Bauman, a Florida hair transplant surgeon whose clientele is 40 percent female. "But it is definitely coming out of the closet, thanks to new treatments."
Hair loss is perfectly normal. The average woman sheds 50 to 100 hairs daily, experts say. With age, follicles produce less quality hair, particularly after menopause. Regardless, dermatologists see just as many women in their 30s and 40s as post-menopausal women, said Dr. Lewis, a Stanford University adjunct associate professor of dermatology.
Like most dermatologists, he performs scalp biopsies and blood tests to rule out medical conditions and usually follows with Rogaine, the only medicine known to slow hair loss. Oftentimes, he prescribes the 5 percent intended for men, not the 2 percent for women.
"There was some increased facial hair with the 5 percent, so they took it down to 2," he said, "but I haven't seen a lot of that in my practice."
Many who take it stop too soon because it can cause flaking and some initial shedding. But doctors urge them not to.
"You have to give it at least four months," said Kelly Hood, a Lafayette dermatologist.
Cortisone treatments usually follow or are used in conjunction with Rogaine. All treatments work the same way: strengthening follicles to prevent further loss and stimulate new growth.
But when your immune system rejects your hair, strengthening is irrelevant.
The trauma of hair loss
Miranda Gardner suffers from alopecia areata, an autoimmune disorder that effects 5 million Americans. The body acts like it's allergic to the hair, pushing it out in large, circular patches. Gardner, of Concord, first noticed it two years ago, shortly after giving birth to her son.
"I started a new job and this girl kept asking me what was wrong with my head," Gardner recalled. "She thought I had cancer."
Gardner remembered feeling "cold breezes back there," but she couldn't see anything. That night, she used a hand mirror to look at the back of her head. There, she found a bald spot the size of a golf ball. "I cried for three days," she said.
A local dermatologist recommended cortisone scalp injections, which were painful and yielded little result. Next, Gardner saw Vera Price, a UCSF dermatologist specializing in hair disorders. Dr. Price put Gardner on cortisone pills, which she finished in May. She has yet to see significant growth.
Quality, human-hair wigs cost thousands and, like most remedies, aren't covered by insurance. Despite the debilitating psychological effects of alopecia areata, it is considered a cosmetic issue.
As with any disease, there are varying degrees of alopecia. Marty Monroe lives with the most severe kind.
The South San Francisco mother of three has alopecia universalis, a rare form of alopecia areata that causes hair loss on the entire body. She was diagnosed with alopecia areata at the age of 8, and by 18, it had advanced to universalis.
"This is the whole enchilada," said Monroe, who is now 51 and said that humor is what carries her through. "No nose hairs. No underarm hairs."
When she was little, Monroe's mother told her it fell out because of nerves, she said.
And even though Monroe has traced the autoimmune disorder to her mother's side, she does believe trauma plays a critical role in hair loss.
For 17 years, she has led a Bay Area support group for alopecia areata sufferers. Sure enough, most of the people she's met connect their hair loss to a time of severe stress. The death of a loved one. A major life transition.
She gives them all the same piece of advice: "Fake is fabulous. Get a good hairpiece." Hers is long and brown and wavy.
"I'm really happy with what I have," she said. "I'll never go gray."
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