The Way Hair Grows
To understand hair loss, we need to understand how hair grows. There are four phases that our hair follicles go through:
1. In the active phase, also known as the anagen phase, the
follicle produces new hair, creating new cells at the root. This phase
lasts anywhere from 2 to 8 years.
2. Next, the root stops growing and a bulb is formed. Nutrients and
blood flow are cut off from the bulb as the growth stops. This is
known as the catogen phase and lasts from 4 to 6 weeks.
3. In the dormant stage, also known as the telogen phase,
the hair follicle doesn’t grow hair, but it holds on to the strand in
the follicle. This lasts about 2 to 3 months.
4. Finally, the bulb is released from the scalp and the hair falls out. This is called exogen.
So, now that we understand how hair works, we can more completely understand why and how hair falls out.
The number one process of hair loss is called telogen effulvium.
Telogen effulvium is not a cause or diagnosis itself, but more of a term to explain what’s going on with the hair. Sometimes, due to a number of different factors which we will discuss below, hairs in the anagen phase (growth phase) will prematurely go in to telogen (dormancy.) It is then, 2 to 3 months later, that you notice the increase in hair loss. If you’re going into telogen effulvium, you’ll most likely notice bulbs at the end of your hair strands as they come out. If you gently run your fingers through your hair, it’s normal for one to two strands to come out. But when 10 or more strands come out, you’re likely going through telogen effulvium.
Telogen effulvium is not a cause or diagnosis itself, but more of a term to explain what’s going on with the hair. Sometimes, due to a number of different factors which we will discuss below, hairs in the anagen phase (growth phase) will prematurely go in to telogen (dormancy.) It is then, 2 to 3 months later, that you notice the increase in hair loss. If you’re going into telogen effulvium, you’ll most likely notice bulbs at the end of your hair strands as they come out. If you gently run your fingers through your hair, it’s normal for one to two strands to come out. But when 10 or more strands come out, you’re likely going through telogen effulvium.
Let’s look at a few of the reasons behind telogen effulvium.
Telogen Effulvium Progesterone
One great benefit of being pregnant is that your progesterone is
high. It helps you sleep, it boosts your mood (hopefully!) and supports
your body as the life within you grows. You’ll likely notice during
pregnancy that your hair is growing and is quite full. This is because
increased hormone levels stimulate anagen growth, and fewer follicles
enter dormancy or shedding phases. But then, when you have that dramatic
drop in hormone levels, many of the anagen follicles will enter telogen
phase. Thus, 2 to 3 months later, you’ll notice some substantial hair
loss.
Progesterone-related hair loss can affect women not just after
pregnancy, but after any major drop or fluctuation in hormones. This
means that starting or going off birth control pills, HRT, or
progesterone pills or cream can signal telogen effulvium. If you
struggle with low progesterone and estrogen dominance, drops in hormones
from your natural cycle can also trigger telogen effulvium. Keep in
mind that when you’re losing your hair, it’s not usually from something
that’s going on in your body right now, but something that happened 2 to
3 months ago.
Physical trauma
Any kind of physical trauma or extreme stress that you put on your
body can show up later with hair loss. Surgery, illness, high fever, or
extreme physical conditions may trigger telogen effulvium.
Emotional trauma
Deaths, divorces, traumatic experiences or any extreme emotional
experience can cause telogen hair loss. The relationship between
emotional stresses and hair loss is not fully explored, so before you
write it off as “it’s just stress” consider some of the other causes
mentioned in this section.
Nutritional Deficiencies
Many different nutritional deficiencies can cause telogen hair
loss. Vitamin D, Vitamin B12, zinc, iron and essential fatty acid
deficiencies will cause hair loss. Hair loss can continue if the
deficiencies are not addressed. Vitamin B12, typically only found in
meats, is an important vitamin that as we age, we lose the ability to
absorb from our foods. Sublingual B12 methylcobalmin is the most
absorbable form of B12 and can be helpful if B12 deficiency is to blame
for the hair loss. (Talk to your health care professional for doses and
recommendations.) Vitamin D is also very important, as it supports the
body in creating new cells. When we lack vitamin D, the body will ration
it out, so to speak, to more important bodily functions than hair
growth. Therefore, vitamin D is highly important in continued healthy
hair growth. Crash diets, starvation, severe caloric restriction, and
severe protein or fatty acid restrictions all can lead to telogen
effulvium, which will continue until dietary needs are met.
Medical Conditions
Continued telogen effulvium can be caused by several medical
conditions. Systemic amyloidosis, liver failure, kidney failure, IBS,
HIV, hyper or hypothyroidism, syphilis and lupus. If you suspect your
hair loss could be caused by one of these conditions, visit your doctor
for appropriate testing and treatment.
Skin Conditions
Psoriasis, seborrheic dermatitis, allergic contact dermatitis, and
other inflammatory skin disorders can trigger telogen hair loss.
Side Effects to prescription drugs
As mentioned earlier, starting or stopping birth control pills,
HRT, and progesterone can cause telogen hair loss. Other prescription
pills such as alloppurinol (for the treatment of gout), beta blockers,
retinods, anticonvulsants, antidepressants, blood thinners such
as Heparin and Coumarin, and cholesterol drugs such as Clofibrate
and Gemfibrozil can all trigger telogen hair shedding.
Telogen effulvium can be brief, lasting anywhere from a couple to
several weeks. Typically with this type of hair loss, re-growth will
begin to be visible within 4-6 months. However, if there are underlying
causes that are not treated, the hair loss can continue indefinitely. If
you’re experiencing shedding for more than 6 months, it’s considered
chronic telogen hair loss and you should work with your doctor to
identify the issues causing the hair loss.
Anagen Effulvium
Anagen hair loss is characterized by sudden loss of hair, usually
losing more than 80 percent of the hair from the scalp in a short period
of time. In anagen hair loss, the anagen (growth) phase has been
disrupted due to a severe trauma or toxicity to the body. Anagen hair
loss will occur within days or weeks after the disruption, not 2 to 3
months as with telogen hair loss. Hair strands typically don’t have the
bulbs at the ends, but will have a tapered end. However, it may take a
doctor looking at the hair under a microscope to determine if your hair
loss is anagen or telogen if you are unsure of the reason of your hair
loss. The most common reason for anagen hair loss is chemotherapy. Other
triggers include radiation, heavy metal poisoning and boric acid
poisoning. Radiation can cause both anagen and telogen hair loss, both
of which can be permanent.
An autoimmune disease called alopecia can also cause anagen hair
loss. Alopecia hair loss can range from patchy hair loss or the complete
loss of hair all over the body.
Androgenetic Alopecia–Female Pattern Baldness
With telogen hair loss, hair will usually fall out evenly, from all
over the head, without areas of concentrated baldness. Anagen hair loss
is obvious, with numerous bald spots or complete hair loss. With
androgenetic alopecia, or female pattern baldness, there will be
noticeable thinning around the central line part of the scalp, in
addition to general thinning. Female pattern baldness may start out
seeming like telogen hair loss, and it may be several months before this
distinctive pattern is apparent. It can lead to complete baldness;
however, it is rare.
The precise biological mechanism behind androgenetic alopecia in
women is still somewhat unknown. It is believed dihydrotestosterone
(DHT) shrinks hair follicles, making them unproductive or gone
altogether. An enzyme called 5-alpha reductaste is responsible for
converting testosterone in to DHT. So, minoxidil (Rogaine) and other
hair-loss treatments block the production of 5-alpha-reductase, so less
DHT is produced in the body. However, once the treatment is stopped, DHT
is produced again and hair loss experienced once again.
Genetics
Genetics plays a large key in female pattern baldness, as the
levels of androgens (DHT and testosterone) are set largely by genetic
makeup.
PCOS, Hormone Balance
Women with Poly Cystic Ovarian Syndrome are at a higher risk for
female pattern baldness due to the excess of androgens being produced in
the body.
Other Conditions
Traction Alopecia
Traction alopecia is hair loss caused by the rubbing of the scalp
or consistent tugging on of the hair by different hair stylings, like
cornrows, braids, weaves, ponytails or anything else that could
consistently pull at or irritate the scalp.
Trichotillomania
Trichotillomania is a disorder characterized by compulsive pulling
of hair from the scalp, eyebrows, eyelashes or other areas of the body.
Treatments
Hair loss, no matter the cause, can be a stressful situation. Many
times we look for external methods to treat the hair loss, such as
herbal tinctures or special shampoos. And while there may be shampoos or
rinses or serums that claim that they help prevent hair loss or help
re-grow hair, unless they have an active FDA-approved drug ingredient
such as minoxidil, their claims are baseless (and illegal).
The best way to treat your hair loss is to get a proper diagnosis
by a qualified medical professional. Hair loss, no matter the reason, is
a medical condition. And there’s no single answer for everyone.
The solution is as varied as the cause. Hair loss is an external symptom to an internal problem. Drugs such as minoxidil can temporarily stave off hair loss. It usually takes around 4 months before you start to see results, and there are some side effects to these drugs.
The solution is as varied as the cause. Hair loss is an external symptom to an internal problem. Drugs such as minoxidil can temporarily stave off hair loss. It usually takes around 4 months before you start to see results, and there are some side effects to these drugs.
People sometimes ask me what kind of natural supplements they
should take to reverse or slow hair loss. Of course, the answer is
totally dependent on the particular deficiency one is experiencing. And,
without a blood test, it’s impossible to make a suggestion. In general,
however, the following options may be helpful to consider and to talk
to your doctor about:
Iron
Low iron levels have been implicated in adrogenetic and telogen
hair loss. If you have a history of heavy menstrual flow, are
vegan/vegetarian, or have lost a lot of blood through surgery or
otherwise, you may be low in iron. (Iron supplements must be taken
carefully; refer to your healthcare professional for dosage.)
Zinc
Zinc deficiency can cause telogen hair loss, as zinc supports
healthy skin and hair growth. A zinc supplement or multi-vitamin may be
helpful.
Vitamin B12
As mentioned above, vitamin B12 deficiency can cause telogen hair
loss. Sublingual methylcobalmin is the most absorbable form of vitamin
B12.
Flax Seeds
Flax seeds may be helpful preventing androgentic hair loss, as the
lignans present in the seeds have been found to help inactivate
5-alpha-reductase, the enzyme that turns testosterone in to
follicle-shrinking DHT. (I recommend 2 tablespoons a day.)
Vitamin D
Vitamin D is responsible for cell division, so making sure that
you’re not deficient in vitamin D is key to maintaining healthy hair.
Recommended doses will depend on what your current levels are, so speak
with your doctor, naturopath, or other licensed medical professional
about what will help you the most.
Keep in mind that with telogen hair loss, what you do now affects
your hair shedding 2 to 3 months from now. Keeping a log of food,
supplements, drugs and illnesses may help your doctor figure out your
hair loss triggers. Continued hair loss (lasting more than 6 months) may
be the symptom of a serious medical condition, so monitor your hair
loss and visit your doctor if your hair loss does not subside.
Sources:
The Chemical and Physical Behavoir of Human Hair, 5th ed. Clarence R. Robbins, Springer Publishing 2012.
[For educational purposes only.]
