Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Hair loss

Three questions about hair loss this week. If you have other queries about baldness, take a look at our recently updated section on Hair loss.

Dear Dr Margaret
Can wearing a baseball cap cause baldness and thinning of hair? I have been told it can. Men who wear a baseball cap all the time end up bald, especially on the top of the forehead.

I don’t think that wearing a baseball cap (or any other type of hat) causes baldness. It may simply be that some men who think they are becoming bald feel ultrasensitive about it, and wear a cap as a cover-up. By the time other people notice their hair loss, they have been wearing the cap for some time, so people might think the cap was the cause.

There is one other possibility. If you are in the habit of ramming your cap on tightly, and then tugging to take it off, you could be breaking the hairs at the front of your hairline. This could give the impression of hair loss. The broken hairs would be easy to see if you look closely.

Dear Dr Margaret
Can hair gels and pomades cause baldness?

No, the normal hair gels and other dressings for hair that you would buy from a pharmacy do not cause baldness. In fact, some essential oils are reported to encourage hair growth in patchy baldness (alopecia areata) – take a look at our new section on Bald patches for more details.

It is certainly true that some chemicals can damage hair, so the hairs become fragile and break. This would make the area look bald. Also, a strong chemical could ‘burn’ the scalp, which would damage the hair follicles and cause baldness. But I think you can be confident that hair gels from a well-known manufacturer will not contain any damaging chemicals.

If you are allergic to one of the ingredients in a hair gel or other dressing, your scalp might become inflamed and there might be some temporary hair loss, but this is a very unlikely scenario.

Dear Dr Margaret
I am a 30-year-old woman. I have been suffering from male pattern baldness for almost 10 years. I have a bald area on top of my head, which I manage to cover with my hair, but I find it hard to cope with. To make things even worse, I have excess body hair on my arms, legs and face and I suffer from acne. I am terrified of relationships with men in case they hurt me for being this way.

From what you say, it is unclear whether or not you have seen a doctor about your problem. I strongly urge you to do so. You need a check-up and some hormone tests to sort the problem out.

The most likely cause is polycystic ovary syndrome (known as PCOS). This is a fairly common condition that affects 5-10% of all women, some only mildly. In PCOS, the hormones have become slightly out of balance. It causes hairiness, acne, weight problems, and scanty or irregular periods. It can also cause loss of hair, but this is usually at the sides of the forehead, rather than on the top of the head. Women with PCOS have a higher risk of diabetes and arterial disease later, so your doctor will do a blood sugar test. There is more information about PCOS in our section on Hairiness in women.

Your doctor will decide whether you do have PCOS, or find out if there is another reason for your hair loss. If you do have PCOS, your doctor will probably prescribe a hormone drug called cyproterone acetate to correct the hormone imbalance. This will reduce hairiness and acne. However, losing any excess weight is also very important.

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