Science Sundays - Hair Loss

Hair is so often seen both publicly and privately as a symbol of our identity. For both men and women, the deeply meaningful relationship between hair and self-esteem and value is evident across history, philosophy, and even religion.

For women, it has been referred to as a “crowning glory” in Biblical text. The image of Lady Godiva riding through the streets on horseback with her body covered only by her long hair was long used as a symbol of civic freedom and beauty. Female communists in 1950s China came up with the name "liberation hairdo” for the short bob they favoured as a symbol of taking over their own lives, and for men, both head and facial hair have been a primary indication of confidence and symbol of healthy biological standing.

My journey with my hair has been tumultuous. I grew up with hair oiling a part of my weekly regime by cultural habit, something I only appreciated later in life when I started to lose chunks of hair at a time with medical illness. I will never forget sitting on the floor of my residence in first-year university while my roommates combed through my hair for me when I was too weak to even do that myself, communicating with each other silently to avoid alarming me, as handfuls of my hair fell out in their hands.

Since we have to first understand how hair grows to understand why it falls, let’s start by breaking down the growth cycle of hair.

The 3 major phases are anagen, catagen, and telogen.

In the anagen or active phase, the cells in the root of the hair strand are dividing rapidly and hair grows at a rate of about half an inch per month, for about 3-5 years. Many people have trouble growing their hair long because they have a short active phase of growth. The hair on our arms, legs, lashes, and brows have a short growth phase, explaining why those hairs are so much shorter than the hair on our head.

Once this phase ends, it enters the catagen phase which is the transitional phase that signals the end of the active growth of hair. This phase lasts for about 2-3 weeks.

Then the strand enters the telogen phase where the follicle is completely at rest, and natural shedding occurs. It is typical to lose anywhere between 50-100 strands of hair/day in this phase, but this number can be affected by a variety of causes, including age, poor nutrition, thyroid disease, hormonal fluctuations, genetics, etc. Telogen phase hairs have a tell-tale characteristic - if one is intentionally pulled out of the scalp, you can tell the strand had been in it's telogen phase by the appearance of hard white material at the root rather than a gel-like covering around the root. The follicle stays inactive in this phase for 3 months before starting the anagen phase again.

Certain traumatic experiences can worsen hair loss beyond what is normal. Events such as drastically losing or gaining weight, emotional stress, surgery, high fever, and medication changes can all cause an early end to the anagen phase, resulting in a lot of hair entering the telogen phase at the same time and causing something called telogen effluvium about 6 weeks later where there is sudden diffuse hair loss. This condition is temporary and hair growth patterns will return to normal within a few months without treatment. If it does not return to normal within 6-9 months, then it is likely to be an underlying medical issue that requires assessment. But don’t worry about permanent balding in telogen effluvium - each hair strand pushed prematurely into telogen phase is replaced by a new hair so it will absolutely return.

Hair loss can be caused by infectious disease, autoimmune disease, eating disorders, nutritional deficiencies, mental health, thyroid disorders, medications, the use of steroids, hormonal fluctuations, etc.

In men, hair loss can be caused by many of the things we’ve mentioned - but most commonly, it is a hereditary trait, in which case the timing of hair loss tends to be similar from one generation to the next. Hormones can also be to blame - a sensitivity to androgens in a condition called androgenic alopecia can cause receding hairline and thinning of the crown in men.

In androgenic alopecia, essentially, there is a derivative of testosterone in our bodies, an androgen called dihydrotestosterone, and it is the enemy of our head hair. When in excess, it progressively shrinks hair follicles until they are thin and frail and fall out easily. The hair does grow back but it takes longer and longer over time until no hair grows at all.

In women, androgenic alopecia tends to affect the crown alone. In women with receding hairlines however it is often a result of traction and over-processing hair but in rare cases can also be diagnosed as Frontal fibrosing alopecia which is characterized by slowly progressive hair loss and scarring of the scalp near the forehead. The cause is not understood, and so there is also no cure as of yet and the best action against this is early action, to prevent loss in the first place, since often the scarring of follicles is a late-stage of disease from which regrowth is not easily possible.

Another type of hair loss often seen is spot balding or alopecia areata which makes your hair fall out in smooth, round patches, but does grow back. This is most often a result of autoimmune disease which means your body is attacking itself, and in this case, you’re follicles.

Other causes like Infection, thyroid conditions, nutritional deficiencies, and medication side effects can also be to blame as we mentioned but these generally cause a diffuse thinning.

To understand the type of hair loss you’re experiencing, you’ll want to see your family doctor or a dermatologist. Your physicians will run several blood tests, examine your hair, and possibly perform a small biopsy to ascertain the root cause of your loss. Once this has been defined, treatment may be targeted to reverse the cause if possible but there are ways for you to help restore your hair and hairline concomitantly:

Temporary Solutions

1. Switch up your part

2. Conceal with hair powder or spray

3. Traction alopecia - Leave your hair untied, let it air dry, sleep on a silk pillowcase or hair wrap to reduce all forms of tension on your hair that might aggravate the loss. Take a break from processing your hair, whether with colours, bleach, relaxers, or keratin straightening treatments. None of these are suitable for fragile hair and while your natural colour or texture may not be what you want or the easiest to work with, it is far easier to nurse your hair to health before resuming these procedures rather than losing and regrowing your hair.

Long Term Solutions

Always consult your doctor on your specific presentation before beginning any new supplement routine.

  1. Saw Palmetto - The theory is, if you can prevent testosterone being converted to DHT you can prevent this potential source of hair loss, and Saw Palmetto does just that. It blocks 5-alpha-reductase, an enzyme that is required for the conversion of testosterone to DHT. It is not advised to use this if you have any bleeding or clotting disorder, liver, or pancreas disease, if you are currently pregnant or breastfeeding, or on the birth control pill as it can make this contraception method less effective.

  2. Pumpkin seed oil - A study from 2014 compared the effects of PSO vs placebo on the treatment of male patients with moderate androgenic alopecia, and saw that after 24 weeks of treatment, the self-rated improvement score and satisfaction score in the PSO group were higher than in the placebo group. The PSO treated group had more hair after treatment than at the baseline compared to placebo and the mean hair count increased 40% in the PSO group vs 10% in the placebo.

  3. Viviscal - Not entirely plant based but 100% drug-free. It is a pill taken twice a day that contains shark cartilage, oyster, acerola cherry, ascorbic acid, and silica extracts from the horsetail plant. You take this pill twice a day, for 6 months, and the results have been phenomenal across the board. Not only does hair fall out less, grow more, and look healthier, but your nails lose their brittleness, stop breaking or tearing. However the hair growth does apply to ALL your body hair and the benefits do not last once the supplementation is stopped, so I would always suggest starting with modest and sustainable interventions first, like getting to the bottom of why the hair is falling in the first place.

  4. Rosemary & Peppermint essential oils - Check out my post on Essential Oils vs. Rogaine for more information!

  5. Minoxidil/Rogaine - Originally used as a blood pressure medication, users discovered improved hair growth over time and inspired the transition of Minoxidil into a topical hair growth remedy. It creates a more active anagen phase of growth, allowing for longer and thicker hair growth before inevitable fall out. Unfortunately, however, the benefits do subside with cessation of use.

While these are generally the most common reasons for hair loss, we will discuss postpartum hair loss, telogen effluvium, etc in future posts, along with the management of oily or dandruff prone hair, and my own hair care routine.

Remember that whatever exists within will eventually appear outwards. Start your healing process with your diet, mental wellness, and inner health for a complete radiance.

Until next time...

Disclaimer: This content is strictly the opinion of Dr. Mashal Khan and is for informational and educational purposes only.The information discussed is not intended to diagnose, treat, cure or prevent any specific disease or medical condition. It should not be used for or in the place of medical advice or treatment from a personal physician. All viewers of this content, especially those taking prescription or over-the-counter medications, are advised to consult their physicians before beginning any nutrition, supplement or lifestyle program and with specific health questions. Neither Dr. Khan nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content.

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