losing on top?!

background.....pulled hair out of top of my head for ~20+ years...hiding results with makeup on scalp, and low side part...after I had a child at age 35, (5 years ago) I eventually noticed nothing is growing back on top anymore!!  I have no idea if this is related to child birth, thats just a time frame I can reasonably associate it with......so I kind of figured, well, its my fault, its just not growing back after so many years of pulling...... - never wanted to see a dr, cause that would mean explaining what I am to you!  But now, I have slowly realized that the frontal hair, which I've always kept as bangs, are really thinning!!  I never pull anymore, and never really did in the front anyway........I do have an appt in august, which I dread....but in the meantime, can you tell me if you think this could be related to the years of pulling, or is it completely separate?  Would the hair stop growing due to so many years of pulling?  Do you think some kind of medicine could start re-growth???  I now count hairs I lost after shampooing, brushing, and it is approx 25 or so from shampooing thru the end of hair styling.  I didn't really think thats bad.....only I suppose if they aren't being regrown.  I dont' notice any shedding throughout the day either, only one or two if I happen to run my hand through it or brush though it.  And I only notice the thinning on my bangs area.....though I supposed it could be happening everywhere, and its just too thick on the rest of my head to tell yet.  I hope you can make me feel better about having this hair come back!!  Thanks so much

[Alan Rockoff, MD]

Hiar pulling can indeed damage the follicles if you keep at it for years.  Another possibility is that at least some of your problem is age-related--hair thins over time.  I think you are doing the right thing by seeing a doctor, so you can get to the bottom of this.  If you are still pulling your hair after all these years, a condition referred to as, "trichotillomania," you may want to cosnult a psychiatrist or psychologist.  Both medications and behavior-modification may help keep the condition from progressing further.

Best.

Dr. Rockoff