causes of hair loss

There are some treatable causes of hair loss that you should evaluate. The best way to fix any problem is to know WHY you have that problem. Common causes:

Vitamin deficiency, particularly Vitamin D, Iron, zinc, B12.
Hypothryoidism
Perimenopause and Menopause hormone changes
Post pregnancy. Due to hormonal changes.
Traction. This is hair loss from people wearing a too tight ponytail. When you do this for a long period of time, it hurts the hair follicle and causes loss.
Autoimmune issues. There is a syndrome called Alopecia Areata, where your body attacks your own hair follicles.
Psoriasis (red scaly plaques) which is inflammatory. It also causes itching, and scratching and picking at the plaques can cause more follicle damage.
Stress– emotional, physical, or illness. Hair loss usually seen 3-6 months after the event.
Covid (NOT the vaccine/boosters but the actual infection). Hair loss usually seen 3 months after Covid, and is not related to severity of Covid infection

Hair cycle

Hair has a cycle of growth and rest. When you have hair loss as a woman, the usual issue is that your hair is in the resting phase for longer.

There are three phases of hair growth:

Anagen= growth phase (lasts 2-8 years)
Catagen= degradation phase (lasts 2-4 weeks)
Telogen= resting phase (2-4 months) Usually about 10% of hair follicles at any given time.

You shed your hair when the new hair shaft starts to grow and the new anagen cycle is beginning. On average you lose 50-100 hairs a day, which you see when showering and combing your hair. This is normal hair loss and accounts for the hair loss seen every day in the shower and with hair combing. These hairs will regrow.

Telogen effluvium is when you have sudden increased hair loss. (Usually from stress or illness). This can increase the number of hairs in the resting telogen phase to 30-50%. When this happens, you may notice “clumps” about 2-3 months after the stressor. If you have shoulder length hair, it may take 9 months to a year to grow your hair back to that level.

Androgens (like testosterone) control factors of human hair growth. Androgens must be present for the growth of beard, armpit, and pubic hair. Scalp hair is not androgen-dependent, but androgens are part of female and male pattern hair loss.

Common hair loss treatments

Vitamins & supplements. Be strategic (&wary) Everything from fish oil, Vitamin A, Biotin, Vitamin B to collagen has been touted to help with hair. “Key nutrients to highlight for hair health include iron, zinc, selenium, protein (amino acids), anti-inflammatory fats like olive oil and avocado, as well as antioxidants”. There are many supplements like Nutrafol.
DHT blockers orally. Dihydrotestosterone, a hormone responsible for hair thinning and loss. See finasteride, Propidren. This is for use in men.
Shampoos. Usually niacin (Nioxin), biotin, collagen, or DHT blocker based. Prescription hair loss shampoo is Ketoconazole, to block testosterone and DHT. Avoid shampoos which may irritate the scalp which have parabens, sulfates, and fragrances.
Minoxidil. This is actually a blood pressure medication, but found to be very effective. Start topically. If refractory, consider oral.
PRP. PRP is thought to have high levels of growth factors and cytokines. I saw one review of 12 studies, which overall showed increasing hair density and diameter. Given the low PRP amount and the diffuse nature of the hair loss, it may be great for you if you have a single area of thinning and good PRP levels. Negatives: $$, painful, not good for diffuse thinning.
Exosomes are another new treatment. Lab studies are encouraging, though there isn’t much clinical data confirmed yet. The goal is to stimulate the hair follicle to get out of the resting telogen phase and back into anagen.

Minoxidil topical or oral?

Minoxidil is a blood pressure drug. Its effect on hair was found as an offshoot. Minoxidil is usually given topically to put on the scalp. For any treatment, it is SLOW. Expect not to see much change for 6 months.

It comes as a topical foam or liquid. It should be applied twice a day.
There is a “women’s strength” and a men’s strength, but as all things with the pink tax (where they charge more for women’s things because they are for women- see the difference in razor pricing when they are pink), most doctors I know recommend to use the men’s strength (5%).

Oral Minoxidil has started to be more popular. It is very effective and cheap. So why doesn’t everyone just do that? Because anytime you take something orally, it affects your WHOLE body, not just your scalp.

15%-24% of patients get hair growth elsewhere. (though some studies say 93% get it) “It can cause increased growth or darkening of fine body hairs.” (Stopping the oral minoxidil is said to return those hairs to normal in 1-6 months)
Blood pressure changes. When you see the insert of side effects, you will see it “may cause serious heart problems or worsen chest pain. Dizziness, lightheadedness, headache, acne.
Swelling of the feet was seen in 2%
Fluid retention and sodium retention
Postural hypotension with heart rate alterations were seen in 1.3% of patients

This is something to discuss when you come into the office. Topical Minoxidil is equal to about 1 mg of oral Minoxidil dosing. Oral dosing varies for women and men, and depending on your other medical issues.

TLC for hair

There are other ways to be kind to your hair. You likely know these, but it is good to repeat:

Don’t wash your hair every day
If hair is thinning, is it from shedding? or is it breaking? Hair dye and processing, using heat to style (flatirons, blowdryers). You can use protectants on the hair to try to minimize damage.
Brush gently to detangle.
Sleep with a silk pillowcase

How can you tell if the hair is breaking vs. in telogen phase? Feel the hair going down to the shaft. At the end of the hair you should see/feel a “bulb.” This means you shed the hair.

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5% Minoxidil Topical Solution-Extra Strength 2 bottles of serum. With the scalp cleansed, cleared and properly conditioned, Minoxidil Topical Solution can go to work on the follicles to promote hair regrowth and help prevent hair loss

Covid hair loss

Covid hair loss is real, but has only been seen after having a Covid infection. IT DOES NOT HAPPEN WITH VACCINES.

What do you see?

Rapid hair loss about 2-3 months after your infection
It does not correlate with severity of infection (ie if you have “bad Covid case” doesn’t mean you will lose hair more than someone who had a mild case.)
It has been reported in 66% of patients
Recommendations vary on if you should treat it or not treat it. Given you can lose a significant amount, and for women who may have longer hair, this thinning (seen in the temples and diffuse hair loss) can last for months and months. My vote is treat

Menopause Hair changes

Menopause hormone changes are a big time for rapid hair thinning. What can you do? See all the other recommendations. But I created a separate section for this because I think it is important to keep this in mind when doing treatments for other menopause symptoms.

Altered hair quality. I love my PubMed searches. I found a study that quantitated this change: “an average reduction of ∼12% in the thickness of the hair cuticle”
Reduced hair growth
Reduced hair density on the scalp (diffuse effluvium because of follicular rarefication and/or androgenetic alopecia of female pattern),
Beware of testosterone: Many women complain of libido, muscle, and other issues, so they start taking testosterone in menopause. Please note this can affect your scalp hair.

Of course, to add insult to injury, menopause also tends to cause hair growth on facial areas (read: lips, and chin).

Hair loss