Losing your hair because of genetics is one thing. After all, there are all kinds of conditions, like androgenetic alopecia (male pattern hair loss) or alopecia areata (spot baldness). But sometimes alopecia is caused by one’s own hand — or rather, by one’s own tightly worn hairstyles and hats, a condition called traction alopecia. So if you’ve been wondering if wearing a hat causes hair loss, the answer is yes. But don’t panic, because most of us are still totally fine wearing a ball cap or beanie without any alarming side effects.
To learn more about traction alopecia, its causes and its treatments, we spoke with Chicago-based hair transplant surgeon Dr. William Yates, who also has an eponymous line of hair care and retention products, Dr. Yates MD. He’s seen every kind of hair condition under the sun, and knows how to avoid or treat them.
What Causes Traction Alopecia?
Here’s an easy way to understand traction alopecia: When people overpluck their eyebrows, the hairs eventually stop growing back. It’s this same repeated, persistent trauma that hairs atop the head experience during traction alopecia, when the hair is pulled too tight.
“This trauma will cause damage over time,” Yates warns. “And it could even lead to scarring alopecia. With scarring alopecia, the hair follicle is completely ‘killed’ and does not have a chance to grow back.” However, traction alopecia is categorized separately since scarring won’t always occur.
It’s not known whether certain conditions or genetics predispose people to traction alopecia, but Yates says there does seem to be a genetic relation, in that some people seem more likely to get it than others.
Independent of that, Yates notes that people who traditionally wear tight hairstyles and use chemical relaxers are much more likely to experience traction alopecia. He says that, because of this styling correlation, a third of Black women develop some type of traction alopecia.
So does wearing hats cause hair loss in the form of traction alopecia? Typically not. A ballcap — even a tightly worn one — will not cause traction alopecia. If your hair is tightly pulled (with extensions, braids, dreadlocks, ponytails, buns, etc.), then you are much more susceptible.
Does Traction Alopecia Affect Men?
“For the most part, men typically do not experience traction alopecia,” Yates says. “However, they can suffer from traction alopecia if they wear tight braids, ponytails, dreadlocks or tight headdresses.”
That said, some 2% of men will experience traction alopecia in their lifetime, but it’s largely due to the above hairstyles. Compare that to the upwards of 80% of men who will experience male pattern baldness and genetic hair loss, and it’s much less alarming. (Especially since traction alopecia is preventable.)
Does male pattern baldness make it easier to experience traction alopecia? No, says Yates. If you wear a tight ponytail or braids while having vulnerable, thinning hair, then it might be easier for that hair to fall out, but only because it was already predisposed to doing so. It would be chalked up to androgenetic hair loss, not traction hair loss. Or, if the doctor noticed a pattern of hair loss due to traction alopecia, then s/he wouldn’t likely blame androgenetic hair loss. In short, think of them separately, and mitigate them individually.
The Best Way to Avoid Traction Alopecia
Assuming you like your hair as it is and want to keep wearing it in a specific style or with a tight headdress (even if it risks permanent loss), how can you mitigate traction alopecia?
“Provide rest periods,” Dr. Yates says. “For example, take the tight style out at night. You can still wear these hairstyles, just make sure they are not tight! Even extensions and weaves can cause traction alopecia if applied aggressively.” Give your follicles a slight bit of slack — it can make a significant, lasting difference.
If you can manage a more natural, loose hairstyle, then that’s the best remedy. If you notice some light hair loss, it might not be too late to revive those hairs, too. “More natural hairstyles without excessive pulling will help reverse the traction alopecia,” Yates says. “Then future hairstyles need to be considerate of the history to prevent it from recurring. Men experience relief and increased self-confidence if they choose to restore their hair loss from whatever cause.”
Is Traction Alopecia Treatable?
Yes, traction alopecia is reversible in its early stages, when you first notice patchy areas of hair or excessive hair breakage. “The first line of defense is to stop tight hairstyles as well as the use of chemical relaxers to straighten the hair,” Yates says. “The tension on the hair follicle has to be stopped so that the follicle can recover and grow healthy, strong hair again.”
Other treatments he recommends mirror those that many men use to counter androgenetic/ale-pattern hair loss: “Minoxidil 5%, Low-Level Laser Therapy (LLLT), and Platelet Rich Plasma (PRP) can all assist in recreating a healthy environment to stimulate good hair growth again,” he says.
- Minoxidil 5%: Minoxidil (the generic for Rogaine) stimulates circulation and nutrient delivery when applied to the skin (and, in this case, the scalp). By boosting the amount of nourishment received by the hair follicles, minoxidil can fortify hair growth all around the crown of the head. Any hair lost to male-pattern recession, however, is beyond saving. (If you aren’t sure whether the hair lost at the front of your head is due to traction alopecia or androgenetic recession, then get a dermatologist’s opinion.) Minoxidil treatments are now available over the counter. Many women are prescribed 2%, while men are frequently prescribed 5%. Regardless, check with your dermatologist to confirm which one you should use for any given condition.
- Low-Level Laser Therapy: While high-powered lasers can cause tissue damage, low-level lasers soothe the scalp and stimulate cellular growth and function. It is becoming increasingly common to skip the doctor’s office for costly treatments with laser hair devices, and instead invest in at-home laser caps for the same goal. Don’t get a cheap one, though — they’re often unregulated and might very well be nothing more than a simple red light. Sticker shock aside, the best at-home laser caps will still save you money in the long run, while also countering male-pattern loss.
- Platelet-Rich Plasma: The doctor extracts a small amount of blood from the patient and places it in a centrifuge to separate the plasma. Because our plasma has unique growth factors, it is extremely beneficial to hair follicles when injected into the scalp, stimulating fuller, stronger hair growth.
Finasteride (the generic for Propecia) is not a remedy for traction alopecia. This drug is used to block the production of dihydrotestosterone (DHT), a byproduct of testosterone. It is used to prevent and treat androgenetic/male-pattern hair loss.
Can Transplanted Hair Be Lost to Traction Alopecia?
Many men don’t know this, but any hair transplanted from the backs and sides of your head — and onto the top of your head — is not susceptible to hair loss due to androgenetic/male-pattern loss. (Think about where we experience hair loss — it’s all the hairs native to the tops of the head, not those on the sides and back.)
So, are these hairs also immune to traction alopecia? No. They experience the trauma like any crown-native hair. Traction alopecia has everything to do with a continued pressure placed on the follicle, and rarely on the microscopic, genetic factors of those follicles.