“My hair is falling out” was the complaint of a forty-five-year-old woman. This is always a difficult challenge for us. First, is the loss real or imagined? There are at least 100,000 hairs on the scalp, and with aging we lose them insidiously. And in the case of women with bouffant coiffuring, 80,000 of these can be lost before the thinning is obvious to anyone but the patient. We have no instrumentation to accurately count the hairs. Assessment is therefore crude, unlike the precision we achieve in counting the invisible red cells in a drop of blood. The number of hairs on sample areas of skin can be counted, but is so painstaking a process as to be impractical, except in a research study of the modern hair growth stimulants, Rogaine® (minoxidil) and Propecia® (finasteride). She could and did count the hairs combed out each day. These far exceeded the normal average daily hair loss of 75 to 100.

We concluded that this patient's hair loss was real. Now came the search for why. The hair was not breaking off, nor did it have loose roots. Her root strength was good when we tugged on her hair. Under the microscope her hair appeared normal. Was it simply aging? Every single one of us no longer has the hair count of our youth. However, that hair loss is gradual and inapparent, whereas this woman knew that her hair had been thinning for only the past few months.