Friday, July 12, 2013

Hair Loss in Women

Are you concerned by clumps of hair coming out in the shower, thinning hair or balding spots? We all lose hair every day naturally (50 to 100 strands), but when hair loss seems to be more than usual, or we experience noticeable thinning, what can we do about it? What causes hair loss in women? How can we prevent it, and can we reverse it?

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.

Let's look at a few of the reasons behind telogen effulvium.

Telogen Effulvium

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 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 is a disorder characterized by compulsive pulling of hair from the scalp, eyebrows, eyelashes or other areas of the body. 

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.

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:

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 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.

The Chemical and Physical Behavoir of Human Hair, 5th ed. Clarence R. Robbins, Springer Publishing 2012.

[For educational purposes only.]


Julia Farkas said...

I have a different type of hair loss which was not addressed in this article. I only experience hair loss when my hair gets below my shoulder level. Then I go to the hairdresser, cut it shorter (under my ears, not boy kind of short) and the hair loss stops after about 2 weeks of cutting it short. And for the next 3-4 months I loose very few hairs, almost none. Then as soon as it hits shoulder-length again, it starts falling out again in alarming quantities, to the point where it looks really bad at that length, being so thin, so I have to cut it again. My hairdresser said that my roots are too weak and they can't support the weight of the hair. Could that be true? And what can be done?

Stephanie Greenwood said...

Hm, that's interesting. It may be a case of traction alopecia under the weight of your hair. But I'll have to research that more. Not something that I've run across in any of my research.

Stephanie Greenwood said...

But it may have been started getting some telogen loss for some reason (hormone fluctuation, illness) from an event that occurred 2-3 months ago and your hair started falling out. You got it cut, and then a couple weeks later it subsided. But it may have subsided on its own without the cut because the loss was due to a temporary change in your body that happened months ago. (Like an illness, or a hormone drop). Really difficult to say. If your hairdresser says it's because you have "weak roots" it would be classified as traction alopecia. But only if your hair was really heavy would that be an issue. If you continue to get hair loss, I would suggest visiting with a health care professional.

Ruth said...

Julia, I have the exact same problem. No matter what I cannot grow my hair longer than shoulder length. It's been like this for years and I have seen many doctors about it, nobody could explain it nor could offer treatment that works. Every once in a while I give it another try but my hair just looks really bad hanging down, you can see right through it, it's that thin. I've learned to accept the fact that I'll never be able to grow long hair. Luckily shorter hair suits me, I've been told. Oh, and Bubble and Bee's shampoo is the only one that works for me!

Stephanie Greenwood said...

It may be, Ruth, that the growth phase of your follicles is perhaps limited. Follicles can grow anywhere from 2-8 years, but perhaps your average follicle growth is only 3 years before they turn dormant. That would explain why your hair is thin at the ends when it's longer--because maybe it took 5 years to get the hair that long, and only 20% of your follicles will agree to be active for that long. Does that make sense?

Anonymous said...

I have alopecia areata (the patchy baldness) and iron supplements seem to have helped for me. It's apparently important to get your ferritin levels (iron stores) tested and keep them in the high-normal range for this condition.

Quinn said...


Issac said...

You have shared nice information

bhanu said...

Hi..I face severe hair fall when I apply oil to my scalp head gettin bald..pls somebody help to come out of the prob..

Stephanie Greenwood said...

Bhanu--If you are experiencing severe hair loss, going bald, etc, please visit a doctor, as this can be a symptom of an underlying health condition.