3.1 Hair Loss and Alopecia Types

Hair loss is a named topic on the Oregon Barbering Examination inside Histology of Hair and Scalp (14 of the 100 theory items). The Health Licensing Office (HLO) bulletin lists hair loss next to structure, growth, color, and scalp disorders, so the exam expects you to name patterns and choose a shop action—not to practice dermatology. The Laws & Rules exam tests the same boundary from the other side. ORS 690.005(2) defines barbering as shampooing, styling, cutting, singeing, conditioning, applying hair tonics, dressings and rinses, massaging the scalp, face, and neck, applying facial and scalp treatments with cosmetic preparations (no galvanic or faradic appliances), and shaving or trimming the beard or mustache, all for cosmetic purposes and not for medical diagnosis or treatment of disease or physical or mental ailments. OAR 817-120-0005 then requires authorization holders to practice in a manner that safeguards the public's health, safety, and welfare, and warns that prohibited, unsafe, dangerous, or harmful services can be incompetence, negligence, or unprofessional conduct under ORS 676.612(2)(j). You recognize, you document what you saw in plain language, you adapt or refuse the service, and you refer. You do not diagnose alopecia, you do not promise regrowth, and you do not prescribe drugs.

Androgenetic alopecia, in barber language

Androgenetic alopecia is the progressive, hereditary pattern loss you will see most often. Follicles that are sensitive to dihydrotestosterone (DHT) miniaturize over successive anagen cycles. Coarse terminal hair becomes finer, shorter, vellus-like hair; eventually the follicle may produce no visible shaft. The process is not contagious. It is not a fungus, not a lice problem, and not a reason by itself to send every client home.

Describe male pattern the way a barber actually sees it, not as a clinic score sheet. Early change is a deeper temple recession and a thinning frontal hairline. Mid-pattern adds a thinning vertex (crown) while a band of hair may still connect the front to the crown. Advanced pattern loses that connecting band. What remains is the classic horseshoe or wreath of denser hair running from one temple, around the parietal ridge and nape, to the opposite temple. That horseshoe is the hair you still have to cut, blend, and fade. A skin fade into remaining density can look deliberate; a disconnected hard part carved through a see-through crown advertises scalp. Female-pattern presentation is usually diffuse thinning on the crown with the frontal hairline better preserved. Do not call it "just aging," and do not sell a clipper cut as a medical reversal.

Barber action on intact-scalp pattern loss is design, not pharmacology. Keep lengths even over thin areas, texture the top so light does not bounce off bare scalp, and fade the sides into the remaining wreath. Skip tight tension. Skip harsh chemicals on a compromised hairline. If the client already uses minoxidil—an over-the-counter topical some people apply at 2% or 5%—you may still cut that hair. You do not prescribe minoxidil, you do not start a client on it, and you do not apply it after the cut as a "scalp treatment." Oregon barbering allows cosmetic scalp preparations; it does not allow you to practice medicine. A minoxidil user may have dryness or irritation. Use gentle products and stop if the skin is broken.

Alopecia areata, totalis, and universalis

Alopecia areata presents as sudden, usually round or oval, smooth patches. Hairs at the border may look like exclamation-point hairs—thicker at the tip and tapered near the scalp. It is an autoimmune process and not contagious. Clients often think they caught something from a shop. Your job is to not confirm that fear and not treat the patch as ringworm. When all scalp hair is gone, textbooks use alopecia totalis. When scalp and body hair (brows, lashes, beard) are gone, they use alopecia universalis. An Oregon barber does not assign those labels as a diagnosis. You recognize the pattern so you do not clip through inflamed skin and so you do not sell a tonic as a cure.

If the scalp is intact, you may cut remaining hair, shave the head at the client's request, or shape a beard around patchy loss. If the skin is red, scaly, pustular, or open, stop and refer. Sudden patchy loss with scale and broken hairs is not automatic areata—that picture can be tinea. When in doubt, do not service the lesion.

Telogen effluvium and postpartum shedding

Telogen effluvium is diffuse shedding that follows a systemic shock two to four months later: high fever, surgery, crash diet, childbirth, new medication, or severe stress. A large cohort of follicles shifts into telogen and then releases. Clients bring you handfuls of hair, often with a small white club bulb. It is not contagious and is often self-limited over subsequent months. Postpartum shedding is a common telogen-effluvium pattern after delivery, typically noticed one to six months after birth as hormone levels change and delayed telogen hairs release. A "detox shampoo" will not reset that cycle. Use gentle shampoo, skip tight styles, and refer if shedding is patchy rather than diffuse, the scalp is inflamed, or loss continues well beyond the expected window.

Traction alopecia and Oregon natural hair care

Traction alopecia is loss from chronic tension: tight ponytails, cornrows, braids, locks, weaves, or elastics pulling the same perimeter day after day. The hairline, part lines, and nape are classic sites. Early traction can reverse if tension stops; long-term scarring traction does not. This is not a "type of hair" problem. It is a tension problem.

Oregon puts this in your certificate. ORS 690.046(3) authorizes a person certified to practice barbering to practice natural hair care—braiding, cornrowing, twisting, locking, weaving, wrapping, and related work with hands or simple devices. The Barbering and Laws & Rules exams can therefore test protective styling, not only a clipper fade. If the requested style would keep damaging the same thinning edge, refuse that style, offer a looser pattern, and explain why. That is OAR 817-120-0005 (safeguard the client), not "being difficult."

Refuse versus adapt

Alopecia itself is not an infection. Refuse or stop when cutting, shaving, or product work would be unsafe: open sores, pus, honey-colored crusts, a spreading ring with broken hairs, undiagnosed weeping lesions, or any condition you reasonably believe is contagious and you are not prepared to isolate under Division 10 rules. Adapt when the scalp is intact and the issue is density, a horseshoe pattern, postpartum shedding, or a calm areata patch. Speak in observations ("I see smooth round patches"), not diagnoses ("you have alopecia areata"). Refer unexplained, sudden, painful, or scarring loss to a physician. If your facility keeps consultation notes, record what you saw, whether you adapted or declined, and that you referred—without writing a medical diagnosis.

Salem shop scenario. A regular wants a zero-crown with a carved hard part through a thinning vertex. The scalp is intact—no scale, no pustules. Adapt: skip the hard part that would stencil the balding, keep the crown a uniform short length, and fade the sides into the remaining horseshoe. A different walk-in shows a new round patch with scaling and broken hairs at the border. That is not androgenetic alopecia. Stop, do not clip through it, wash your hands per OAR 817-010-0008, disinfect anything that touched the area, and refer.