Hair loss is something that can affect both men and women at any age. It can come on suddenly or gradually and can have a dramatic effect on one’s self-esteem. It is a subject that we get a lot of questions about, and to answer them we will be having a regular dialogue with an expert on the subject, Anabel Kingsley, Philip Kingsley Trichological Clinic.
Hair loss is something that affects women as well as men. Could you tell us about what the causes are?
Hair loss can be caused by many things. Additionally, there are also different types of hair loss. One of the most common types of hair loss in both women and men is Androgenic Alopecia, or ‘reduced hair volume’. This is a slow, gradual and progressive reduction in hair density whereby hair follicles become smaller, and hairs become finer with each hair growth cycle. The reason why hair follicles miniaturize is down to genes – it occurs when follicles are genetically predisposed to be sensitive to normal levels of circulating androgens (male hormones).
Another very common hair loss, especially in women, is Telogen Effluvium (TE), or ‘excessive daily hair shedding’. This is not genetic – it can happen to anyone – and it does not change the size of your hair follicles or hair diameter. What TE does result in is a sudden and large number of hairs moving from the growth to the shedding phase of your hair cycle. It is a reactive hair loss caused by an internal imbalance or shift. The reason why TE is so common is that the growth of your strands is very easily thrown off-kilter. Your body views hair as non-essential to survival, so it is the first thing to take a hit when your general health, lifestyle and/or diet is not up to scratch.
At our clinics in London and New York the most common causes for TE we see are:
- Lack of dietary protein
- Crash dieting
- Vitamin D deficiency
- Vitamin B12 and Zinc deficiency
- Ferritin (stored iron) deficiency
- Hypothyroid or hyperthyroid
- Major surgery
- Shifts in hormones, especially a drop in oestrogen
- Certain medications, most notably beta-blockers and anticoagulants
What are the treatments that you find effective for hair loss?
I find a holistic, personalized multi-pronged approach is the most effective way to treat any form of hair loss. There is no ‘one size fits all’ as hair loss is very individual. Your metabolic and genetic profile, as well as your lifestyle and diet, may be very different from a friend who is also experiencing hair loss. However, in all instances, you want to be optimizing all possible factors that can affect the hair growth cycle, such as health, nutrition, stress levels, and scalp health, as well as the condition of your hair itself.
When treating androgenic alopecia, application of stimulating anti-androgenic scalp drops should always form part of your daily hair care routine. As androgenic alopecia is progressive, and it doesn’t just ‘switch off’, it is very important to be consistent with your treatment. From our retail range, I recommend our Tricho 7 Scalp Drops that have been specifically formulated by us for women with fine hair and reduced hair volume. In our New York Clinic, we offer prescription-only anti-androgenic Minoxidil drops, which can be used alongside Tricho 7. Minoxidil is a potassium channel opener and stimulates hair growth by prolonging the anagen (growth) phase of the hair cycle.
For cases of Telogen Effluvium, the underlying cause needs to be identified and then addressed. For instance, if you are losing your hair solely or in part due to a vitamin or mineral deficiency, nutritional supplements will form an integral part of your hair loss treatment plan.
Very often, more than one factor needs to be tackled. I frequently see women with a combination of genetic density changes and chronic extra daily hair fall due to a nutritional-related or thyroid factor.
Do the treatments vary with age?
They can. If you experience androgenic alopecia later in life, treatment tends to be less aggressive. For women who notice reduced hair volume as early as their teens and 20s, there appears to be a clear genetic predisposition. In these cases, stronger topical and/or oral treatments may be needed.
What causes hair shedding does vary with age. For instance, hair loss resulting from Iron and Vitamin B12 deficiency is less common in women who have been through menopause, as you are no longer losing blood each month. However, I see Vitamin D deficiency-related hair loss more frequently in women who are over 40.
What can be done about hair shedding and how is it different from hair loss?
While hair shedding (Telogen Effluvium) is perhaps the most immediately distressing type of hair loss due to how obvious it can be (you may lose up to 3x the amount of hair you normally do on a daily basis), it is actually one of the best types of hair loss to have. As it is a reactive type of hair loss that occurs due to an internal disturbance, once you find the cause and address it, hair will grow back as before. The treatment very much depends on the cause – and finding it may require a deep-dive into your medical history, general health, lifestyle, and diet. Blood tests are almost always a good idea. In our clinics in London and New York, we recommend that specific blood tests be done by a recommended laboratory.
Unlike TE, androgenic alopecia is genetic and does not go away. It is also progressive and so treatment must be ongoing. Because hair diameter changes occur so slowly, it is usually many years before you even notice it – whereas TE is immediately obvious. You may not experience noticeable extra hair shedding alongside reduced hair volume- although it does happen.
Are the treatments for men’s hair loss different from women’s?
Treatments for androgenic alopecia in men and women have similarities as they are both caused by the same thing – a sensitivity of hair follicles on the scalp to normal levels of androgens (male hormones). However, as men naturally have much higher levels of male hormones, you are fighting a harder battle – and treatment for men is less likely to have as much of a positive impact.
There are also different options for oral treatments for hair loss in women and men. Men are able to take Finasteride (Propecia), whereas it is usually not recommended for women. That said, women are able to take certain medications that men are not – most notably oestrogenic medications, such as certain HRTs and oral contraceptives. Both sexes can have hair transplants if there is a good donor site.
For telogen effluvium, treatments are the same for both men and women.
Is menopause a factor in women’s hair loss?
It definitely can be.
When you go through menopause you have two main things occurring that can impact your hair. The first is a drop in progesterone and oestrogen levels – which can affect anyone’s hair. Oestrogen helps to keep strands in their growth phase, and their decline is one reason why many women initially experience diffuse shedding when they go through menopause. The second, because oestrogen levels have dropped, is that your hair has a more androgen heavy environment to contend with. This can be particularly troublesome for women who have a genetic predisposition to follicle sensitivity, as even normal levels of androgens can cause hair follicles to become smaller and hairs to grow back finer. In those with little or no genetic sensitivity, menopausal hair changes can be much more subtle.
The psychological and physical stress of menopause can also impact your hair.
Is stress a factor in hair loss?
Most certainly. Stress can cause a whole host of awful effects. For one, it sends a cascade of cortisol (the ‘stress hormone’) through your body, and this can impact not only your hair growth cycle but your scalp. Many people find their scalp becomes very itchy and flaky during times of stress.
Stress can also impact your eating habits, and how well your body digests foods and absorbs nutrients, which in turn can have repercussions on hair growth.
Do you have any questions around hair and scalp issues you would like us to investigate? Please email us: firstname.lastname@example.org
Anabel has written hundreds of articles for international magazines and websites ranging from Good Housekeeping and The Huffington Post to InStyle and Women’s Health. What she doesn’t know about hair probably isn’t worth knowing! She started her career at Philip Kingsley in 2006, moving to New York to manage the New York Trichological Clinic for 3 years. In 2009 she returned to London to become part of the Philip Kingsley New Product Development Team. Anabel has grown up among trichologists, and is qualified and practices herself. She is an Associate Member of The Institute of Trichologists, graduating with a distinction, as well as receiving ‘The Award of Excellence.’ She has a vast interest and knowledge of the hair and scalp, with a particular interest in nutrition.