April 3, 2013— -- Lillian White, a dental hygienist from Mendham, Mass., was only 11 when a genetic condition caused her hair to start falling out.
"I was just getting into puberty and that awkward phase and my hair started falling out," said White, who is now 31. "It was terrible. At slumber parties, we would braid each other's hair with friends and they would ask, 'Why are your braids so tiny?'"
As she matured, White refused to go out with boys.
"Who would want date a girl with thin hair?" she said. "It was totally detrimental to my self-esteem. I never had any confidence."
Later, when she studied vocal performance at college, White abandoned her dream of being a singer and slipped into a deep depression.
"I never felt comfortable going on stage," she said. "I had done plays and worn a wig, but it was terrible and hot."
Though often associated with balding men, hair loss affects women, too.
The American Hair Loss Association calls it a "devastating disease of the spirit," just as serious as any disease and one that can take a toll that has a direct impact on health.
"As a dermatologist, the longest office visit I have is when I have a hair loss patient in the room," said Dr. Valerie Callender, associate professor of dermatology at Howard University in Washington, D.C.
"We think of it as our crown and glory," she said. "In Western civilization being attractive is having healthy, thick, long hair and when you start losing it, it's devastating."
Hair loss can be caused by aging, or heredity, but can also be caused by allergies. Starlet January Jones of AMC's "Mad Men" has recently revealed that she, too, was getting thin on the top after using hair dye.
"As a clinical dermatologist, the first thing I think about with allergies and hair loss is the chemicals in hair grooming procedures or treatments," Callender said. "The number one reason for an allergic reaction to a chemical is hair dyes."
One of the first patients Callender treated in the emergency room was a woman with angioedema, a swelling that happens just below the surface of the skin, most often around the lips and eyes.
"I looked at her hair and she had black dye oozing," Callender said. "It was one of the worst reactions I had ever seen."
The acting ingredient in hair dyes is paraphenylenediamine or PPD. The Food and Drug Administration (FDA) just recently issued a warning about adverse reactions to some temporary skin-staining products, such as decal-type tattoos and henna, which contain PPD.
"If you have already had an allergic reaction to hair dyes and two years later, you have a temporary tattoo, you could develop a severe reaction," Callender said.
Other reasons for hair loss can be contact dermatitis on the scalp and allergy to fragrances from skin care products, soaps and lotions.
"That's why they smell so good," she said.
Oddly, yeasts and molds that live in the scalp can also cause hair loss, especially when a person doesn't wash their hair regularly. Irritation and itching, as well as more scratching, can cause a bacterial infection. Hair breakage can also occur.
An autoimmune response unrelated to irritants, alopecia areata, can also cause hair loss, leading to total baldness. It usually starts with one or more small, round, smooth patches on the scalp and can progress, sometimes to complete body hair loss. Hair can grow back or fall out again at any time.
The most common form of hair loss, androgenetic alopecia, is caused by aging.
"Basically, what men have is pretty easy," said Callender. "In contrast, women are more complicated. We can have so many different causes of hair loss. A work-up in women is really, really important. You need to see a dermatologist to determine the cause."
Hereditary hair loss, the cause of Lillian White's condition, is "rare, but not uncommon," Callender said. But more often, women's hair begins to thin after menopause when they lose their estrogen and progesterone and the male hormones or androgens become "unmasked."
"They lose it not only on their scalp, but on their body and we get hair on our face and chin where we don't like it," she said.
Over-the-counter hair products like Rogaine can help, but it must be used continuously or the hair will fall out again. Results take about two to three months.
Low-light treatment is another option with a laser comb. Hair transplants are also being used on women. When all else fails, women can use camouflage techniques like hair pieces and hair systems.
For Susan Falcone, hair loss ran in the family, and she began losing hers at age 12 and is now a certified personal coach focusing on helping women with hair loss.
"My mom kept reassuring me everything was fine," said Falcone, now 40 and from Lancaster, Pa. "By the time I was 15, I went to an endocrinologist at University of Pennsylvania and he said I just had thin hair. The strange thing was that my hair was poker straight until I was 14, then it grew in curly and frizzy around the bald patch.
"I remember thinking I would never get married," said Falcone, who has an adrenal deficiency and polycystic ovarian syndrome that may have contributed to her condition. "I fantasized about a husband. I would wear my wig and take it off when I would go to bed."
She continued to lose hair through high school and into her 20s.
"A man can still look handsome without hair," she said. "But let's be honest. I looked like a 65-year-old man when I was 20-something years old. It was horrible. There is so much shame involved."
At 27, she had a hair transplant that she described as "a failure" because she had diffuse hair loss.
"Essentially, the surgery worked, but the hair around the transplant fell out," Falcone said.
By 32, she started wearing human hair pieces over the top of her hair.
"That was an epic failure, as well," she said. "It was very painful and expensive. I had to drive hours to the salon -- it wasn't working for me."
Falcone experimented with various cosmetic solutions, such as masking lotions and integrated and clip-on hairpieces. After much "trial and error," she said, she settled on bonded hair replacement systems as the solution.
These systems bond hair directly to the scalp with surgical adhesive and can be worn for 10 days.
"It's not going anywhere," she said. "I sleep in it and swim in it. I have a normal life."
Falcone began to meet other women online with the same struggle and wrote a blog that had 3,000 followers. Eventually, she partnered with hairdirect.com to bring educational materials to a larger audience.
She helped Lillian White restore her hair, and today White has the confidence to date and enjoy a full social life.
"My goal to help women focus on solution rather than problem," Falcone said. "I am trying to bust the stigma around it."