Medically reviewed by: Debra Rose Wilson, PhD MSN RN IBCLC AHN-BC CHT
Hair loss can be a very distressing experience at any age. For teenagers, however, it can be especially traumatic. Adolescence is a critical period of psychological development when people develop their self-image, social skills, and confidence.
Teenagers with hair loss can also be bullied or mocked by their peers. This can lead to more psychological stress and further exacerbate hair loss. For all these reasons, treating hair loss in this age group is very important.
Teenage hair loss can be caused by various conditions or factors. Depending on the underlying cause, the treatment can be completely different.
For this reason, the first step is identifying the cause. This will allow you to select the appropriate action to stop and eventually reverse the hair loss. Fortunately, teenager hair loss is treatable in most cases.
Early Signs of Teen Hair Loss
Like most conditions, it is easier to treat hair loss early. The longer the hair loss goes on, and the more extensive it becomes, the more difficult it can be to fully reverse. Knowing how to identify the first signs of hair loss is therefore very important.
A Receding Hairline in Boys
As we age, our hairline changes. There are two types of hairlines to be aware of: a maturing hairline, and a receding one. A maturing hairline is a natural process that takes place during late adolescence. It is normal and will happen in all boys, much like a deeper voice and hairy torso.
On the other hand, a receding hairline is problematic and signals a deeper issue. This is usually male pattern baldness, or androgenetic alopecia (we will look at this in more detail below). Unless treated in time, a receding hairline will keep on getting worse with time.
The main way to discern between a maturing and receding hairline is by looking at the pattern.
An even hairline – one that keeps a consistent line from temple to temple – is the main sign of a maturing hairline. An uneven hairline that is more recessed at the temples is a sign of a receding hairline, unless you have a natural widow’s peak, which further complicates the issue (1).
Diffuse Thinning in Girls
Depending on the cause, males and females can typically lose their hair in very different ways (2). As we saw, boys (and men) often show their first sign of hair loss at the hairline and temples.
While women can also recede in the temples, their hair loss is more often diffuse. In other words, they retain a relatively intact hairline but thin all over the top of the head. The main sign of this is a wide part.
At first, such thinning can go unnoticed. By the time girls realize that their hair is thinner and the part wider, they might have lost most of the hair on their head. Unlike males, however, it is extremely rare for girls and women to go completely bald.
Noticeable Loss on Pillow and in Drain
Regardless of the pattern, one of the first sings of hair loss is increased shedding. We all lose between 50-100 hairs per day. In abnormal hair loss, however, this figure is much higher.
For this reason, boys and girls with hair loss will often notice a high number of strands of hair:
on their pillow when they wake up
in the drain after showering
on their comb when they brush their hair
they might also notice strands of hair coming off when they simply run their hands through their head
As mentioned above, everyone loses hair every day, even if they don’t notice it. The difference is in the extent of the shedding. In instances of teenage hair loss, this will usually be very evident.
Itchy, Flaky Scalp
Not all teenagers with hair loss will experience scalp irritation. Many will, however, and a common symptom is an itchy, flaky scalp.
Itching and flaking are not typically the causes of hair loss. They can be symptoms of an unhealthy scalp environment, however, and be present alongside hair loss. For example, they can be due to sebum buildup or dandruff (3). Treating this scalp irritation can be very helpful in restoring the scalp’s overall health and establishing a healthy micro-environment for hair growth.
The Top 8 Causes of Hair Loss in Teens
Here is a look at the most common cause of hair loss in teens.
1. Hormones
From adolescence to adulthood, significant changes take place in a teen’s body (4).
As hormones naturally surge in the teen years, this is also a time for hormone-related conditions to awaken. Two of the most common hormone-related conditions are polycystic ovary syndrome (PCOS) and abnormal thyroid functioning. (5, 6).
PCOS can be a very unpleasant condition for teenage girls. The main feature is an imbalance of male and female hormones, as well as insulin. Symptoms can include thinning on the scalp, unwanted hair growth on other parts of the body, acne, disrupted menstrual cycle, weight gain and more.
Thyroid problems can result both from excessive (hyperthyroidism) and deficient (hypothyroidism) thyroid activity. Again, these are far more common in girls.
Hair loss will only typically follow severe forms of thyroid dysfunction. In milder cases, the hair will likely be unaffected.
The course of action:
The treatment will vary depending on the exact nature of the hormonal imbalance. Often times this will involve medications. In some instances, lifestyle interventions and dietary changes can also help.
PCOS is a notoriously difficult condition to treat. A cure is not possible, so the girls must learn to manage the symptoms and live with the condition. Doctors will often prescribe medications like minoxidil or spironolactone (discussed below). Supplementation with vitamins and minerals like vitamin D and zinc can also help.
In the case of thyroid problems, your doctor can prescribe medications like levothyroxine or beta-blockers. Depending on how your body reacts to the treatment, your hair might start to grow back after a few months.
2. Stress
The physical and emotional changes teens experience can cause substantial stress. Among other things, this can lead to shedding.
In rare cases, the stress might be so severe that teenagers pluck their own hair. This is called trichotillomania, or compulsive hair pulling. It is rare that teenagers will pull out their own hair, however. Far more often, the stress will cause the hair to fall out on its own.
Psychological stress can be an important contributor to hair loss, but stress can also come from other things. The following is a list of stressful life events that can lead to hair loss:
major illness
surgery
pregnancy
traumatic event or accident
rapid weight loss or extreme dieting
These events typically precede the hair loss by around 3 months.
Scientists call the hair loss that results from these stressful events telogen effluvium. As the name suggests, the characteristic of this condition is that the hair follicles simultaneously transition in massive numbers to the telogen (or resting) phase of the hair cycle (7).
After around 3 months, the telogen hairs fall out to make way for the new hairs. This is why hair loss appears sometimes after a stressful event.
The course of action:
Your doctor will look at your medical history, ask you questions and identify if stress is the key factor in your hair loss.
Removing the stressful event that triggered the hair loss is the first step. You can also take steps to lower your overall anxiety and stress levels.
Fortunately, most cases of telogen effluvium can reverse relatively easily. They often do this on their own, even without any intervention.
3. Medicine
Teenagers can take medications for a variety of reasons. These can range from Premenstrual Dysphoric Disorder (PMDD) to severe acne or depression, to name only a few examples.
While these medications can help the condition they are prescribed for, they can also cause unpleasant side effects. One of these is increased shedding.
Some of the types of medications more likely to cause hair loss in teenagers are (8):
psychiatric medications like antidepressants and mood stabilizers
oral contraceptives
chemotherapy for the treatment of cancers
thyroid medications
steroids
medications to lower cholesterol
immunosuppressants
hormone replacement therapy
drugs to treat Parkinson’s disease
anticoagulants
The course of action:
Because hair loss will typically follow soon after you start or modify the medication, it will often be possible for you to identify it as the possible cause. Your doctor will then be able to confirm this.
Sometimes your doctor will be able to tell just by asking you questions and examining your scalp as part of a routine clinical examination. Other times they may order blood panels or other laboratory tests.
Whatever you do, do not cease or modify a medication without consulting your doctor first.
4. Nutrient Deficiencies
For many teenagers, eating a healthy, well-balanced diet is not at the top of their priorities. While the majority will make it through their teen years unscathed and with no long-lasting effects, some will experience adverse health effects. These can sometimes include hair loss.
Common nutritional deficiencies in people from 10 to 20 years of age include iron, vitamin D, vitamin B12, zinc, and magnesium. All of these can trigger poor health effects, including loss of hair (9).
The course of action:
One of the best things you can possibly do for your body – including your hair and scalp – is to improve your daily diet. This means incorporating nutrient-rich foods and eating well-balanced meals.
The typical diet for Westerners can be damaging, both to the body and the hair.
An on-the-go culture means many people resort to quick and low-nutrition meals. These fill up the stomach but don’t provide much in the way of vitamin and mineral support.
If the thought of making significant changes to your diet intimidates you, you can start off gradually. For example, replace your sugary breakfast cereal with fruit and protein (eggs). Or, cut your serving of carbs by half for each meal, replacing them instead with green, leafy vegetables.
Another option is to take a supplement. For girls, this will often be iron tablets, as iron deficiency is the most common cause of hair loss with a dietary component. For both boys and girls, there are also supplements made specifically for hair loss.
(You can find more information on the role of nutrition in hair loss here.)
5. Traction Alopecia
Traction alopecia is defined as hair loss caused by ongoing or repetitive tension of the hair. It is a completely preventable condition, brought about by a person’s lifestyle (10).
The most common cause of traction alopecia is a person’s hairstyle. A hairstyle that applies substantial pressure on the hair follicle, like braids or dreadlocks, can, after some years, lead to traction alopecia. Applying strong chemicals to the hair can also contribute to traction alopecia.
Here are the most common hairstyles and lifestyles that can contribute to traction alopecia:
Braids: these are small or large sections of hair that are interwoven.
Dreadlocks: similar in appearance to braids, these are sections of hair that are matted together.
Ponytails/pigtails: These are sections of hair pulled together and tied with an elastic band.
Cornrows: A distinctive style of braiding where the hair sits close to the scalp.
Weaves: Weaves are artificial or natural strips of hair sewn together like a curtain with a seam at the top. The weaves are sewn, glued, clipped or otherwise attached to the hair.
Extensions: Strips of natural or artificial hair attached to the hair
Curlers: Wearing hair curlers for too long can damage the hair.
Headgear such as helmets, headphones, and masks can also cause traction alopecia.
The course of action:
An experienced doctor will usually be able to distinguish traction alopecia from other forms of patchy hair loss, like alopecia areata.
If you catch the condition early on when the hair follicle is still intact, then doing away with the hairstyle will usually be enough to reverse the condition. There are no medications or other treatments that can be used to aid recovery, so you must give the hair time and allow it to grow back on its own.
If traction alopecia is left to go on for many years, it will be irreversible. The remaining options at that point would be a hair transplant procedure or hairpieces to conceal the damage.
6. Androgenetic Alopecia
In Teenage Boys
Androgenetic Alopecia (AGA), also known as Male-Pattern Baldness (MPB), is more likely to occur in men over the age of 35. Having said that, about 25% of men who suffer from MPB will begin to see signs by the age of 21 (11).
AGA follows a predictable pattern. First, the temples recede, followed by the entire frontal hairline. The crown then starts to thin, and eventually the entire top of the head. In the worst cases, only the back and side of the head remain intact.
This is a condition with many factors, though genetics plays a large role in the development and early-age expression. If your male relatives (father, grandfathers, uncles) suffer from male pattern baldness, you are more likely to also develop it.
(Learn more about the genetics of hair loss here.)
In Teenage Girls
While androgenetic alopecia is somewhat common in teenage boys, it is rarer in teenage girls.
As we discussed above, it has a very distinct appearance compared to male AGA. While girls can also thin at the temples, more often they will thin all over the top of the head. The part will widen, and the underlying scalp might be visible. Unlike men, however, women almost never go completely bald (12).
The course of action:
For males, the FDA has approved two medications against pattern baldness:
Minoxidil is an over-the-counter topical medication that stimulates hair growth wherever you apply it, including the balding scalp. You apply it twice daily.
Finasteride is a prescription pill that you take once a day. It targets male AGA specifically, by inhibiting the synthesis of the hormone DHT. This is the hormone that scientists believe causes pattern hair loss in susceptible individuals
For females, the FDA has only approved topical minoxidil. However, doctors often prescribe various off-label medications. One of the most common is spironolactone.
7. Alopecia Areata
Alopecia Areata (AA) is an autoimmune disorder that causes patchy (typically circular) bald spots on the scalp and other parts of the body (13).
This form of hair loss can affect males and females of any age. It especially affects younger people though, as two-thirds of sufferers are under 30 years of age. People with this condition are more likely to also have autoimmune disorders such as lupus, vitiligo, and autoimmune thyroid disease. There is also a genetic component to this condition, meaning that you are more likely to have it if another family member already has it.
Scientists are not clear about what causes alopecia areata but believe it is an autoimmune condition.
For reasons that are not clear, the body’s immune cells attack the hair follicles, particularly those in the growth phase of the hair cycle. This process leaves most follicles in the affected areas in the resting phases of their cycle, leading to increased shedding and ultimately baldness.
The course of action:
There is currently no cure for alopecia areata (14). For this reason, many doctors will advise you to wait it out, and if necessary use a hairpiece in the meantime.
When a doctor does prescribe treatment, it will usually be an immune suppressant you apply topically on the bald spots. The purpose of these medications is to turn off the immune system cells and stop them from attacking the hair follicles. The most commonly used immune suppressants are triamcinolone or a class of steroids known as glucocorticoids.
These treatments can benefit between one-fourth and two-thirds of patients, but they come with a high risk of side effects. The most common side effect is inflammation of the hair follicles (folliculitis).
8. Undiagnosed Medical Condition
While this is not the most likely cause of teenage hair fall, you may want to consider it if you have ruled out everything else.
A variety of medical conditions can trigger shedding and balding.
These can be:
organic, including lupus and anemia
psychological/psychiatric, such as anorexia and anxiety
hormonal, such as polycystic ovaries and thyroid dysfunction (we discussed them above).
The course of action:
First, make a list of your symptoms. Have you noticed an increase in mood swings or fatigue? The cause may be hormonal. Or perhaps you have noticed dizziness, fatigue, and general feelings of ill – these can indicate a physical problem such as anemia.
Next, make an appointment with your doctor. You can discuss your symptoms and observations with your doctor. Your doctor might then run diagnostic tests to rule out common conditions. You may need to undergo blood testing or a full physical exam.
If the problem is still undiagnosed, your doctor may recommend you seek out a specialist.
An endocrinologist is your best bet if the problem is likely hormonal. A psychologist or psychiatrist can help to diagnose and treat any mental health disorders that may be triggering your hair loss, among other symptoms.
Conclusion
While hair loss at any age is a very unpleasant experience, it can be devastating on teens and young adults. Fortunately, you can often treat teenage hair loss with success, and depending on the cause even completely reverse it.
Because the causes of teenage hair loss are so varied, identifying the cause is critical. This will allow you to select the appropriate treatment option. Your doctor will also be able to help you with this.
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