Why Am I Losing My Hair?

 

Google "Why am I losing my hair?" and you'll get 5 million ads for shampoo and a list of medical conditions. But what about those of us who don't have any diagnosable conditions related to hair loss? What about those of us who want to understand our situation without being bombarded with ads??

 WELCOME HOME, MY FRIENDS!

In this article, I’ll focus on the nuances of hormonal and age-related changes that affect hair density and texture, and most importantly, what you can do to help prevent it.

 Hair Thinning vs. Hair Loss: What's the Difference?

Hair thinning is influenced by a mix of factors, including genetics, epigenetics, aging, inflammation, and lifestyle choices. It’s marked by a decrease in hair density and/or a shortened growth cycle. With the exception of post-partum cases, these changes usually creep up over years or even decades. If left untreated, hair thinning can lead to hair loss. The key thing to know is that you can take measures to prevent it if you catch it early enough.

Hair loss, on the other hand, is a medical condition characterized by follicular atrophy, which can lead to complete cessation of hair growth. Hair loss may or may not be preceded by hair thinning and can happen over days or years.

Medical hair-loss conditions have their own set of treatment protocols and should be diagnosed by a physician. If you have been diagnosed with Alopecia Areata, Traction Alopecia, Anagen Effluvium, Telogen Effluvium, Trichotillomania, or Androgenic Alopecia, your first priority is to follow the treatment protocol prescribed to you. You may also want to reach out to a cranial prosthesis specialist near you. If you are in the Atlanta area, reach out to Rebecca Walden for a consultation. 

 

What Contributes to Hair Thinning?

Most of us will see our hair thin out as we age. I can’t tell you how many people sit in my chair and lament upon how much hair they used to have. If they don’t have any diagnosable hair-loss conditions, what’s causing their mane to diminish?

The Effects of Androgens and Other Hormones:

 -DHT (Dihydrotestosterone)

 Dihydrotestosterone (DHT) is a potent derivative of testosterone and is the main culprit for contributing to the conditions that lead to thinning hair in both men and women. In individuals genetically predisposed to hair loss, DHT binds to androgen receptors in hair follicles, leading to the miniaturization of these follicles over time. This process results in thinner, shorter hair and can eventually halt new hair growth, contributing to conditions like male and female pattern baldness. While men are more commonly affected due to higher levels of DHT, women can also experience hair thinning and loss, particularly as hormone levels fluctuate with age and during menopause.

Other Hormones:

-Thyroid Hormones and Hair Loss:

Thyroid hormones regulate cellular metabolism and influence hair health. Both hyperthyroid and hypothyroid conditions can lead to telogen effluvium, which is just a fancy term for excessive shedding.

-Cortisol and Hair Loss:

Cortisol, which is released in response to stress, can also contribute to telogen effluvium, particularly in extreme or chronic cases.

-Melatonin and Hair Loss:

Newer studies have been emerging that are showing melatonin to have a positive effect on hair growth. To be clear, this is not me saying you should take a bunch of melatonin to make your hair grow. Augmenting your endocrine system is the last resort here. Having good sleep hygiene and listening to the circadian rhythms of your body will encourage your body to make healthy amounts of the hormone.

 

Blood Flow, Inflammation, and Hair Thinning:

Many of the capillaries that feed nutrients to our papillae are only wide enough for a single file line of blood cells to pass through. Any change in our body that causes a chronic reduction in blood flow will affect hair growth and tissue regeneration. Conditions that contribute to poor blood circulation and/or vasoconstriction:

Sedentary Lifestyle: It’s no surprise that a lack of exercise results in less blood flow, so I will leave it at that.

Gravity: While some would argue that gravity is not a condition, every time I look into a mirror, I see evidence that it is. Along with everything else, our blood is being pulled down toward the earth at all times. I would like to argue that this is a chronic condition. BAM! I digress.

Habitual Use of Vasoconstrictors: Stimulants like nicotine, caffeine, and other drugs engage our sympathetic nervous system, reducing blood flow to the surface layers of our body and concentrating it in our core and muscles for fight-or-flight responses.

Chronic Stress: Chronic stress and anxiety also trigger the sympathetic nervous system and raise cortisol levels, further reducing blood flow to the scalp.

Inflammation: Inflammation caused by DHT, or other age related, and lifestyle factors reduces blood flow to the scalp, affecting hair growth.

Skin Thickness and Hair Thinning:

Dermal Thickness:

As we age, our skin thins and our skin cycle slows down, meaning it takes longer for our skin to renew itself. We hear a lot about this when it comes to facial skin, but the skin on our heads is just as important since it supports hair growth. When our dermis thins, hair follicles start to shrink, resulting in finer and less dense hair.

Stratum Corneum Thickness:

A less common condition that negatively affects hair growth and density is hyper keratinization of the stratum corneum. When the stratum corneum builds up too thickly, it begins to hyper keratinize (Keratin hardens when exposed to oxygen) like a fingernail and subsequently the dermal layer underneath, where our hair originates, will thin out. Women who completely abandon lather have experienced hair-loss due to hyper keratinization. Brands like Wen have sulfate-shamed consumers into thinking that lather is bad but sometimes we need our little bubble friends to help lift away the top layer of our skin and clear the way for new. Now I want to be clear; I am not poo-pooing no-poo’s. They have a place in our routine as well but should not be the only thing we use to cleanse our scalps, mkay? Want more on what to and what not to do with your hair? Check out the hair 101 blog

A client asked me the other day "What did we do before shampoo?"  I replied, "We died at the age of 35".

 

What Can Be Done About Thinning Hair? The Prioritized approach

Start addressing your thinning hair the moment you notice it. Once a follicle stops producing hair, it’s nearly impossible to get it going again. I have listed hair-thinning interventions by priority for your convenience. 

Priority 1: start your hair-loss routine and get your hormones checked 

I told a gentleman client the other day “Rogaine has a half life of about 8 hours, so you’ll need to use it twice a day indefinitely to continue receiving the benefits” to which he indignantly replied “WHAT? I HAVE TO USE IT TWICE A DAY FOREVER?!!”   I simply said “Yep, just like keeping your teeth requires you to brush them 2 times per day forever, except putting Rogaine on your head takes about one twentieth the amount of time.”

 

On a list of things that people don’t want to do, adding another step to their routine is usually near the top.  You just have to ask yourself how much you want to keep your hair.  Over the course of decades, a hair loss prevention routine will cost thousands, maybe tens of thousands of dollars and many hours of time. The best way to make up your mind about it is to shave your head bald.  I mean like shaving cream and razor bald.  I did that many years ago to see how I would look as a bald man and what I saw looking back at me in that mirror…..   Let’s just say, I will do LITTERALLY anything to keep my hair.

Hairloss routine:

Minoxidil (Rogaine):

Minoxidil is widely accepted as the first line of defense when it comes to preventing or reducing hair thinning. Begin your minoxidil regimen sooner rather than later.  It’s available over the counter in 2% for women and 5% for men.  It is important that you maintain a consistent routine.  Keep it by your toothbrush!

See your Dermatologist:

Oral Minoxidil 

Minoxidil is also prescribed off-label as an oral medication at low doses to encourage hair growth. Be aware of potential side effects, especially if you’re a woman, as it can cause increased body hair growth.

Compounded Topicals:

As a prescription, minoxidil comes in strengths up to 12% and is often compounded with tretinoin to enhance absorption, and sometimes with 5a-reductase inhibitors like Finasteride and Dutasteride. For women, you might see drugs like spironolactone in place of Finasteride and Dutasteride.

Oral and/or Topical Finasteride/Dutasteride: These are drugs that intervene in the formation of the enzyme 5a reductase and therefore reduce levels of DHT in the blood stream. Due to concerns over potential side effects, these drugs have been incorporated into topically applied products though the efficacy of this delivery method does not yet match up with that of the oral medication.

Though it is less common, Finasteride may be prescribed to women who are experiencing androgenic alopecia during menopause, but hormone levels need to be monitored regularly. Dutasteride is the more potent of the two and not likely to be prescribed to women.

Note:  Lower levels of DHT may have detrimental effects on mood, sex drive, and the ability to build or maintain muscle. I know, it’s like having to choose between giving an angry porcupine a hug or lay naked face down on a fire ant hill but life is full of choices like that now isn’t it? Keep in mind that for most, these symptoms dissipate over time and things return to normal for most people.

 Disclaimer: While 5a-reductase inhibitors are not exclusively for men, women who are pregnant, might become pregnant, or are capable of getting pregnant should not handle these drugs, nor should their significant others use topical versions. Anyone in a household with women who are, capable of, or might get pregnant, and are taking Finasteride or Dutasteride orally should thoroughly wash their hands after handling the drug

See your endocrinologist

For men in their late 40’s and up and for women experiencing the symptoms of menopause an endocrinologist will need to look over your bloodwork to make sure that there aren’t other underlying hormonal imbalances that are leading to your hair thinning/loss.

Androgen Receptor Inhibitors:

A newcomer to the scene, the drug Clascoterone which was created to treat acne vulgaris, belongs to a class of medications that have the ability to block androgen receptors in the skin.  It’s efficacy for hair-loss prevention is still being tested but if it proves to be effective, this drug has the potential to be the holy grail for androgenic skin conditions.
 

"They say that wisdom comes with age. I wonder if I could trade in just a little wisdom for some more hair..."

 

Priority 2 : Address Inflammation and Get Your Blood Flowing

Exercise: Daily exercise doesn’t just build muscle; it circulates fresh blood throughout the body. Try inverted stretches and yoga poses like Downward Dog to really encourage blood flow to your scalp. Ever notice how yoga instructors have such great hair?

Regulate Stimulants: Modern life makes it nearly impossible to get by without some stimulants. Try to be selective about how much and when. Set a cutoff time and stick to it—no coffee after lunch, no Adderall in the evening, etc. This will give your sympathetic nervous system a break while you sleep, allowing blood flow to increase to your extremities.

De-stress: Well DUH! Easier said than done right? I get irritated with people who say this to me and here I am saying it to you, but it is so true. I am not going to leave it at that, however. If it tickles your pickle, take a little diversion over to my “De-stressercises” blog for some practical tips on how to do so.

Red Light Caps: If you have the time, work from home, or just don’t care what people think, wearing a low-level-laser red-light LED cap can help with blood flow and tissue regeneration. But remember, for it to work, you actually have to use it. You’d be surprised how many people let home devices collect dust. Also, if you’re short on time, look for caps with more LEDs and higher energy output, as they have shorter wear durations. In this case, you get what you pay for, so save up!

Scalp Massage: As a stylist, I can’t tell you how many times I’ve seen clients afraid to touch their scalp or brush their hair for fear of causing it to fall out. While aggressive brushing may not be recommended, treating our scalps too gently can actually be harmful to hair growth. The hair that comes out when we brush or wash it is ready to come out—it’s finished its growth cycle and is   a resting phase before new hair sprouts. Honor your fallen friends and take care of their little replacements by brushing/massaging your scalp!

High-Frequency Devices: These wands aren’t just good for zapping the occasional pimple; they can also increase blood flow to the scalp. Look for one with a comb attachment.

Vasodilators:  In addition to having a hormonal effect on hair, Minoxidil also has a vasodilative effect. This is why it is so important to begin a minoxidil regimen early on and stick to it religiously. Keep it next to your toothbrush so you remember!

Ketoconazole: There’s growing evidence that an overpopulation of normally occurring bacteria and fungi might partly be to blame for the inflammation that leads to thinning hair. Ketoconazole, the active ingredient in Nizoral, is an anti-fungal that reduces dandruff-causing fungi and may also positively impact hair growth by reducing inflammation around the follicle and clearing DHT.

Azelaic Acid: A newcomer to the scene, azelaic acid seems to have potent antimicrobial and anti-inflammatory properties. It’s also being used to treat acne, rosacea, and thinning hair.

 

Priority 3: Address Thinning Skin and Scalp Health

Surfactants: Not all sulfates are created equal.   Use a shampoo with gentle surfactants to provide some lather and give yourself a nice scrub with your fingertips or a silicone palm brush.

Exfoliants: Once every 2 weeks, use a scalp exfoliating product for at least 5 minutes. Choose something with enzymes for those of you with colored hair. Try to avoid physical scrubs ESPECIALLY if it contains microplastic beads! If your hair isn’t colored, you can even use a light alpha hydroxy acid peel or cleanser. (Acids can affect artificial hair dye), and don’t let it get in your eyes! I’ve had firsthand experience with that one. If you have a lot of buildup bring in a pro. Look for your nearest HydraFacial spa and ask them if they do the Keravive scalp treatment.   

Retinoids: In addition to facilitating the absorption of other topicals, using Retin-A on your scalp will also help to turn over new cells and will thicken your dermal layer. Learn more about retinoids here

Derma-Rollers: Derma rollers create micro-punctures in the scalp, which do two things: they facilitate the absorption of topical growth treatments and trigger a healing response that revitalizes the dermis. Look for .25-.5mm needle length, and when it comes to quality, derma rollers, like wine, show the biggest improvement between the cheap ones ($4-$15) and the middle-priced ones ($15-$30). The more expensive ones are only incrementally better than the middle-priced ones. Usage: 2-3 times per week, 10-15 uses per roller. Works best in conjunction with topical treatments.

Peptides: Topically applied peptides like Biotinoyl Tripeptide-1, Myristoyl Pentapeptide-17, Myristoyl Hexapeptide-16, and GHK Cu-3 are very effective at not only encouraging hair growth but also increasing the diameter of the hair and regenerating the skin. Some studies even show that GHK Cu-1 (Biotinoyl GHK Tripeptide-1) can delay or prevent hair from turning gray! The downside to peptides? They’re expensive and have a short shelf life.

Micro-Needling: Micro-needling is the next step up from derma-rolling and should be performed by a professional. Like on our face, micro-needling treatments have been shown to thicken the dermal layer and trigger tissue regeneration.

Fractional CO2 and YAG Laser: Promising results are emerging from studies using laser therapies on the scalp, notably in increasing hair diameter.

Microneedling with RF and Exosomes: The next level up from microneedling, these treatments also involve radiofrequency and topical application of exosomes, which speed up tissue regeneration.

PRF (Plasma-Rich Fibrin): PRF comes from your own blood plasma and contains growth factors that encourage tissue regeneration. PRF injections into the scalp every few months have shown magnificent hair-regenerating results. PRP may also help some, but most have moved away from this as PRF works longer and with better results. The downside is that these treatments are very expensive.

Conclusion:

I really wanted to keep this article short and sweet. Now that I am almost 3000 words in, I guess that’s out the window. I didn’t go over medical hair loss conditions like Like I said before, a quick Google search will tell you everything you need to know about those conditions, so I’ve covered what I needed to cover.

Now that you have a better understanding of what causes your hair to thin, you’re set up for success in preventing the loss of it!

Now I would like for you to please go and have a quality day!

 

MBM