Photo of a bald head taken from the back
Treatments for hair loss can be a bit hit and miss

Q&A: Hair loss

18 April, 2013

Q – I used to tease my husband about his hair loss but now I find my own hair is getting thinner and I even have a bit of a bald in the front of my scalp. I eat healthily, don’t smoke, I do like a drink but don’t drink to excess. Is there anything I can do to help restore what used to be my crowning glory?

 

A – There are many causes of hair loss, and it can be an increasingly common and distressing problem as we get older. Many types of hair loss are temporary and the hair growth will often return back to normal in 3-6 months.

For men going bald is typically one of the first signs of physical decay they experience. Hair loss can strike as young as 18, and almost all men will be balding by age 70. It typically starts with a loss of hair in the crown and at the temples. These bare patches gradually spread out, over most of the skull, but leaving a low band of hair above the neck and ears comparatively unaffected. This is classic so-called male pattern baldness, or in medical language “androgenic alopecia” (AGA).

It’s widely believed that one advantage of being female is that girls hang on to their hair. But in fact it’s not that unusual for women to suffer from a number of hair loss problems – general hair thinning, patchy bald spots called alopecia areata (AA), and even AGA. Female AGA strikes predominantly at the top and sides of the head, usually after the menopause. AA is believed to be an autoimmune disorder, where the body attacks the hair follicles.

Because hair loss can also be a symptom of an underlying health problem you should start off by seeing your GP for a general health check and advice. If this turns up nothing you could consider a visit to an alternative practitioner such as a nutritionist or naturopath to discuss your general level health and get further advice.

Getting to the root of the problem

With all the scientific might that we have at our fingertips we are really no closer to understanding hair loss. Some cases may be related to seborrheic dermatitis, to a fungal infection with trichomycosis nodularis, to inflammation of hair follicles with bacteria such as Staphylococcus aureus or Pseudomonas aeruginosa.

Another controversial theory involves a species of tiny mites, Demodex follicularum, present in virtually all hair follicles by the time a person reaches middle age. In most cases they cause no harm. But in some people who experience hair loss the scalp seems to react to the mites, initiating an inflammatory response to reject the mites. This may close down the hair follicles, killing the mites but also killing the hair.

AA and particularly AGA also have a strong hereditary component. In addition to this factors that can promote hair loss include poor circulation, acute illness, surgery, radiation exposure, skin disease, sudden weight loss, high fever, iron deficiency, diabetes, thyroid disease, drugs such as those used in chemotherapy, and a reaction to the hormonal changes of pregnancy and birth.

In women in particular it can also be the result of using hair dyes and other hair preparations that can damage hair follicles.

Poor diet and of course vitamin deficiencies also have a role to play.

The influence of testosterone

Although women can suffer hair loss, it is still predominantly male problem. The culprit is the male hormone testosterone. Paradoxically, while testosterone creates hair on the chest and face, it destroys hair on the scalp. Studies show that AGA is almost invariably associated with dihydrotestosterone (DHT) a potent derivative of the male hormone testosterone – in the scalp.

The biological process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. The upshot is, the higher the DHT levels in the skin, the more hair loss (and in men high DHT is also associated with a higher risk of benign prostatic hyperplasia  and some hair loss treatments such as Finasteride are also used to treat BPH). And while under normal circumstances, women only have a minute fraction of the level of testosterone that men have, even a lower levels can cause hair loss in women.

A stress reaction?

But there’s also a much less well-known factor in hair loss. Numerous clinicians believe that balding may have a psychosomatic component. There’s already evidence that AA can be related to anxiety and depression and some experts believe the same may apply to AGA, though to a lesser extent. 

In contrast a positive attitude may help hair growth. This was discovered almost by accident when doing clinical trials to test potential hair loss products against placebos (i.e. dummy products).  

For example, back in 2001 a company producing a botanical hair loss product based on Mediterranean lily did a full-scale placebo-controlled trial for their product. They mixed the lily extract into an inert cream to be rubbed into the scalp as a treatment for AGA. However, when they tested the cream plus extract against the cream alone (the placebo), the results were astonishing: a staggering 38% of the men improved when using the placebo – more, in fact, than with the real plant extract.

This considerable placebo response turns out to be a feature of alopecia. So, when assessing the claims of any hair loss product, and there are many on the market – it’s worth considering evidence of an effect above a placebo response.

What to do?

Given that losing one’s hair is so traumatic for both sexes, it’s hardly surprising that there are a plethora of hair-restoring products in the market place. Most work only as long as you keep using them and while most also offer a money back guarantee the time invested in using them may be time spent avoiding looking at the root causes of hair loss. In addition some have disturbing adverse effects – from skin rashes and hives, to impotence and a higher risk of invasive prostate cancer.

Remember also that some hair loss just can’t be ‘fixed’.

Amazingly, few treatments have been well evaluated by science; this applies equally to conventional as well as alternative treatments.

Two herbs are traditionally suggested to help hair loss that is not associated with any serious underlying medical cause: horsetail, which is rich in natural silica and nettle root, which can reduce excess DHT.

Herbalists recommend combining the two as an infusion to both drink internally and use as a lotion on the scalp. But equally nettle root commonly added to conventional hair products to stimulate hair growth and inhibit the production of DHT.

Much of the evidence for the effectiveness of nestle root in this regard is extrapolated from its use in lowering DHT levels in cases of prostate enlargement (remember there is a hormonal link between BPH and hair loss) Many studies into hair loss do show small improvements using this herb.

Another common approach for hair loss involved massage with a stimulating oil. Try adding rosemary essential oil (or thyme, lavender or cedarwood, depending on your preference) to coconut oil and massage into the scalp. The combination of massage and the stimulating essential oils will help to stimulate the surface of the scalp, which is beneficial for carrying nutrients to the hair roots. Evidence shows that using essential oils is more beneficial than simply using a carrier oil for scalp massage.

Given the role of stress in hair loss, you should also consider a comprehensive stress relief programme whether that includes a regular massage, yoga, tai chi, regular sessions in the gym or some green exercise outdoors, or simply time out or simply a hobby that truly absorbs you. If you are experiencing underlying emotional issues, time with a counsellor or psychotherapist may be beneficial (though whether it will help your hair grow back is uncertain).

Nourishing the scalp

You should also take a good multivitamin and mineral food supplement as a shortage of certain minerals such as zinc or selenium can also contribute to the problem.

The following nutrients can help nourish the scalp

  • B complex – important for the health and growth of hair. The B vitamins work best when taken together; but try including extra Vitamin B3 (Niacin), Vitamin B5 (Pantothenic Acid), and Vitamin B6.
  • Biotin – deficiencies have been linked to skin disorders and hair loss.
  • Inositol – vital for hair growth.
  •  Methylsulfonylmethane (MSM) – aids in the manufacture of keratin, a protein that is the major component of hair.
  • Vitamin C with bioflavonoids- improves scalp circulation; also assists the antioxidant action in hair follicles.
  • Vitamin E – increases oxygen uptake, thus circulation to the scalp; use natural (d-alpha-tocopherol) form
  • Zinc – stimulates hair growth by enhancing immunity.
  • Coenzyme Q10 – Improves scalp circulation; increases tissue oxygenation.

Essential fatty acids (EFAs) can improve hair texture and to prevent dry, brittle hair.