Hair Loss - Prevention & Treatments

A sign of health and beauty is a full head of shiny luscious hair.  Many health issues and medications can result in loss of hair or damage to hair. Some folks are also genetically inclined to lose their hair - mostly males - but it can happen to women as well. Statistically women account for 40% of patients with hair loss. Our hair is also highly influenced by hormonal fluctuations and changes. In this post I will write about what you can do to improve your hair, your eye brows and your lashes, and what you can do to treat hair loss.


First off, it is totally normal to "shed" hair.  Hair grows in a cycle and so you are either growing, stagnant, or shedding. Each phase lasts about three months.  Hair is also programmed for a certain length and then will tend to shed (this is why your pubic hair is not down to your knees, see post in my media section on pubic hair!).  It is normal to lose between 50-100 hairs a day, which is why you see hair in your brush or in the shower.  Much more than that can mean you are experiencing hair loss or telogen effluvium There are different types of hair loss, and different causes of hair loss, and many are temporary.


The most common causes of telogen effluvium are stress (there it is again), giving birth, losing weight, undergoing surgery (stress, again), a recent illness with a high fever. These conditions cause increase shedding, which is different from hair "loss" where your hair stops growing altogether. However, when you experience thinning hair, you may feel like you are balding, which is terrifying to women, and not so great for men either.  In most cases, this increased hair shedding is self-limited, and your full head of hair will return without any intervention. But there are things you can do to help, and some definitions.


Anagen Effluvium

Anagen effluvium is when the hair follicle just stops growing, the most common causes are medication such as chemotherapy and also radiation.  This can also affect eyebrows, lashes and body hair.  This usually resolves after the medication has stopped and you see hair growth return to normal after the medication has stopped. It can take months to return to normal though. Rogaine can be used during these times to speed up return growth and during chemo an ice cap can be worn to prevent hair loss on the head.



Male and Female Pattern Baldness

Baldness commonly runs in families, and is a result of the hair follicles being sensitive to the influence of testosterone, or specifically a by-product of testosterone called Dihydortestosterone. In genetically susceptible individuals the hair follicles are exceptionally sensitive to this hormone DHT. Excess DHT leads to thinning and hair falling out. The hair grows for a shorter duration and the length of the hair is also shorter than usual.  At a given time, different areas of the scalp may be affected.  Usually this does not affect ALL the hair on the head, just the top, the sides usually remain unaffected, and it has no effect on the eyebrows or other hair.  Interestingly, trans-men who have been taking testosterone, sometimes experience this type of hair loss as well.


The cause of female-pattern baldness is not very clear. Baldness and thinning of hair is common among women after menopause as the levels of female hormones decline.  Many post menopausal women experience hair thinning.


In addition, in women with polycystic ovarian syndrome and other hormonal disorders with higher levels of male sex hormones, there is a risk of excessive facial hair and thinning of hair over the scalp.


Alopecia Areata

This type of hair loss is commonly seen as an autoimmune disease.  In the case of alopecia areata, the immune system damages the hair follicles instead. The hair follicles however are not permanently damaged and hair may grow back in a few months.  Alopecia areata is seen in persons with other autoimmune conditions such as hyperthyroidism or overactive thyroid disease, diabetes and vitiligo.  This type of alopecia is also seen in persons with Down’s syndrome. Genes also predispose a person to alopecia areata.


Scarring Alopecia

This condition is very rare!!! And is caused by permanent damage to the hair follicles. Some skin conditions like lichen planus, discoid lupus, scleroderma,  and frontal fibrosing alopecia are causative factors that lead to scarring alopecia.  These disorders commonly cause skin changes, scars, rashes, rough patches over skin etc that leads to loss of hair follicles and loss of hair in particular areas.


WHAT TO DO


First off some general advice and then I'll give specific advice for different hair loss issues.


HAIR CARE


Do NOT wash your hair with shampoo and/or conditioner every day.  It strips the hair of its natural oils and will make it dry and brittle. You can get your hair wet every day in the shower, but definitely do not wash it.  If your hair gets greasy and looks yucky try dry shampoo.  And you definitely can train your hair to not "need to be washed" every day. Use shampoos and conditioners with non toxic ingredients (look at GOOP for list of toxins you want to avoid). When you do wash your hair, definitely condition it every time. If your scalp gets greasy then only condition the ends. You can also use oils on the ends to help condition them.  Don't comb long hair when wet - hair is weaker and will break off.  Brush or comb all tangles out before the shower  and then use your fingers to comb through your wet hair afterwards.


Supplements and other Treatments


Does Biotin work? Unfortunately, no - it doesn't.  It does not work unless you have a deficiency. I still take it.  But upon doing research unless you have  a deficiency it doe not help. Collagen DOES work though.  It comes in the form of a powder, there are a lot of decent brands out here, and the reason why it works is that your hair needs collagen to form at the follicle and as we age we produce less collagen , so yes taking this daily supplement is actually beneficial.  It's also good for your nails.



Nutrafol - WORKS! (before and after photo above provided by Nutrafol).  It is a relatively new formulation and this supplement targets two specific causes of hair loss: inflammation and elevated stress hormones.


By targeting these causes, in addition to the usual nutritional culprits, Nutrafol claims to be better than other hair loss supplements. It is a combination of many vitamins and minerals and targets inflammation and stress hormones. It comes in a pill form and four pills a day are recommended.


Massage - yes, it is good for your scalp and hair.  Increasing the circulation helps reduce inflammation and also brings the natural and good nutrients to your scalp.  Can it help with hair loss? Maybe. One of my best friend's father claimed to be growing hair on his head by performing massage on his scalp.  He was a doctor and a scientist and it worked for him!


Laser? Not sure. I would not waste my money. I think at some point the technology will develop but I don't think we are there yet.


PRP -  platelet-rich plasma, a.k.a. PRP. Our blood is made of two main components, red blood cells, and plasma.  The plasma contains white blood cells and platelets, which are rich in growth factors.  It can be an effective medical treatment for hair loss. There is a simple process whereby your own blood is withdrawn and centrifuged and then injected back into your scalp.


Rogaine (topical Minoxidil)

Rogaine works really well for some people but it doesn’t work for everybody. There are two non-prescription strengths 2% and %5.  5% is only "approved" for men, but I recommend women use it as well, as it is much more effective than 2%.  About half of the people who use it do well and see new hair growth,  but another 40% or so hold steady, not growing new hair but not losing more either. And about 10% find that it doesn’t help at all.  Regrowth can take a while. It may be 12 weeks or longer before new hair starts growing, I suggest using Minoxidil for 6 months and seeing what happens -it is topical and can be applied to the thinning areas twice daily.  It does have some side effects, the most common side effect is scalp irritation. Some women may have unwanted hair growth on their forehead or face. The other downside: you have to keep using it or your hair will start thinning again.


Finasteride (Propecia). This prescription drug is available only to men. It is taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits.


FOR WOMEN - Among the most popular medication is spironolactone, an androgen receptor-blocking drug that claims to help treat female pattern hair loss, among others conditions.


SURGERY 

For male pattern baldness and female permanent hair loss often a surgical solution is very effective.  Hair transplant is not like the old days where it looked horrendous, like a dolls head.


What is now generally performed surgically is called follicular unit transfer.  This literally takes a hair follicle from the back of the head where the hair is thick and abundant and transfers it to the front where it is thinning.  It is an option for most people who have hair loss but still have normal hair on some part of their head.  The downside is that it is very expensive, but it yields natural results, and the transplanted hair will not fallout due to influence of hormones. One such brand is called  NEOGRAFT  (I have this machine and do this procedure).  It is definitely an investment but it a great procedure that can be done in a day, while you are awake, and the results are permanent.


Eyelashes


Long eyelashes are the biggest craze right now next to eyebrows.  Lash extensions with either mink or plastic lashes has a great effect but over time will definitely weaken and harm your natural lashes, so unless you plan on doing it all the time, I recommend it only for special occasions.



Latisse is a prescription medication that was used for glaucoma and found as a side effect to grow hair!  (see before and after above)


It works slowly, meaning you wont see results for at least a month, but it enhances your own natural lashes, and wont harm them at all.  Down side - it can temporarily cause some redness of the eyelid, and if you get a lot in your eye itself over time it can change the color of your eye! (You would have to mis-use the medication and stick it in your eye rather than on the lash line). Good news is that results are long-lasting and you don't have to continuously use Latisse to maintain thick, full lashes.


If you have thin or thinning eyelashes, come to my office for a consultation and I can prescribe Latisse if it's a good match for you!


Revitalash - is like a conditioner for eyelashes and does seem to enhance them, condition them and make them stronger. It can be used daily, and has no down side!


Castor Oil! Yeah, old school. It strengthens and makes them look amazing, probably acts like a conditioner.


Magnetic Lashes - they look great and wont harm your lashes, but I personally cannot get them on. I don't think it should be that hard and I am good with my hands (I am a surgeon), but I literally could not do it!!


EYE BROWS


There is a ton of specialized make up that is amazing for painting in brows, and most is incredibly effective.  One very cool treatment that is more permanent is called microblading, where tiny little cuts are made and specialized ink is used to tattoo the appearance of hairs. This is not the old school tattooing that looked absurd, and didn't wear well with time.


Of course there is threading which is a technique to reduce and shape the eyebrows!


As you can see, "hair loss" and "hair growth" is a big topic to cover in one blog. It does seem a bit ridiculous that we spend so much time trying to enhance hair on certain parts of our bodies, and the rest of our time trying to rid ourselves of hair elsewhere! Maybe next blog will be on hair removal? Hair loss can cause of a lot of insecurity and I just want you to know that there are a lot of viable options out there! I hope this blog has given you hope for possible treatments for you if you do suffer from any of the conditions listed above.


Until next time,


Dr. Alexes Hazen