Saturday, March 9, 2024

Hair in Perimenopause and Menopause Part 4: Hair thinning - more than just hormones

The number of hairs on our heads tends to decrease gradually after age 50. It may not be noticeable right away.

This post is about why hair loss happens, a few of the more-common and better studied treatments, how they fit into the picture.


Between ages 50-65, just over 50% of women experience something more noticeable than minor thinning: “Female Pattern Hair Loss” (Androgenetic alopecia). Fifty percent! Ours is a culture that values appearance and losing hair is not popular. But it is common, normal and it’s nothing to be ashamed of. None the less, I’m assuming you might want to try to maintain your hair-density or help it grow back.


We’re going to cover what those issues are, strategies to manage them, and how to weigh costs and benefits.


As always - when you notice hair-thinning, consult with your healthcare provider FIRST! You need to know why you are losing hair, and whether it’s a symptom of an illness, of a medication-change, or a skin-reaction. Hair-loss is an important physical symptom. Don’t risk your health treating hair loss if you don’t know the cause!


[Causes of hair loss a doctor can diagnose that you don’t want to miss include: Medication reaction, thyroid disease, skin disease like psoriasis or alopecia areata, depression, severe stress, nutritional deficiency]. 


Folks - sometimes the first indicator of your skin reacting to a product is hair-loss! 

Image of hair thinning
at the crown, 
used with permission 
of the subject.


Androgenetic alopecia and hair thinning: It’s not just hormones.


But first - let’s talk about hormones!

    • Pattern hair loss in women occurs at the crown/top of the head (around the part), maybe at the hairline. It can be more on one side than the other.
    • Androgenetic alopecia is related to androgen activity (hormones more dominant in men) in the hair follicle. Estrogen and progesterone protect pre-menopausal women from the effects of androgens on the hair follicle somewhat. Androgens can make hairs thicker (like armpit hair and leg hair when you’re a teenager), and they can (in combination with enzymes that break them down) also make thicker hairs narrow and transparent again.
    • Androgenetic alopecia causes hairs to become very thin vellus hairs, like the thin, almost transparent hair on “non-hairy” body parts. And it also shortens the hair’s life cycle from 3-5 years to… less than that!
    • Just having androgens present isn’t the problem. It’s the “newness” of not having as much estrogen and progesterone to offset the effects of androgens. And also…
    • The way growth hormones in the hair follicle present themselves in the face of age and inflammation can interact with androgens to create a toxic environment for hairs. Hormones are never alone, they’re in a stew of other chemicals up there in your hair follicles.
    • Genetics may make your hair follicles more sensitive to these conditions if pattern hair loss runs in your family.
How else do hormones play a role? In Part I, we covered the increased sensitivity-potential of skin due to a less-robust skin-barrier. That means your skin may be more likely to react to things with irritation and inflammation. Inflammation can result in worse hair-thinning!


There is an inflammatory component to hair thinning. This is caused by UV exposure, irritants, or even your own scalp flora (yeasts, bacteria) which, while they’re supposed to be there, and help maintain our skin’s defense system, can also cause some oxidative stress or outright irritation and inflammation. Irritation and inflammation? Me!?


Think of this as cumulative (oxidative) stress on your scalp. UV light from the sun, chronic low-grade inflammation from skin irritants, all come together to create a situation that is more difficult to keep hair follicles productive of full-size hairs that live out their full potential  - a multi-year life span.


There is a Nutritional component to hair thinning.


The short story: Nutrient deficiencies can cause hair thinning, preventing deficiencies is the optimal strategy. Prevent deficiencies by eating a nutritious diet, pay attention to blood tests for iron and vitamin D. If you take daily medications, ask about whether they may make it difficult to absorb nutrients and whether you should supplement. If you have a gastrointestinal disease, ask about whether you need to supplement vitamins and minerals. 


Vitamin and mineral supplements for hair loss have mixed results in people who do not have nutrient deficiencies. Selling you supplements promising hair growth is a lucrative but unregulated market - almost any claim can be made as long as the product does not claim to treat a disease.


Taking high-dose vitamins and minerals comes with potential risks! For example, high-dose biotin can cause a blood test used to determine whether you’ve had a heart attack, to be inaccurate. Which could delay potentially life-saving testing and treatment. It can also alter Thyroid hormone test results.


Iron, Vitamin D, B vitamins, Zinc 


    • There is good evidence that having low (deficient, insufficient) Ferritin and Vitamin D levels may lead to hair loss. Supplementing these (according to your doctor’s guidance) is important for your health, though it may or may not lead to improvements in hair density. This post has more information, a sufficient level can be quite a bit above the lab-test "deficiency" level.
    • If you have a B vitamin deficiency (biotin, folate, pantothenic acid, B12), hair loss may improve with supplements. Most of us are not deficient in those, but in cases of intestinal disease, limited diets, food allergy, or inhibited absorption due to medication interactions, deficiency can be a problem, and correcting it may improve hair density.
    • Zinc deficiency can also cause hair loss. Correcting that may improve hair density. Studies of zinc supplementation for hair density when there is no deficiency have mixed results.

There is a Vascular component to hair thinning. Hair follicles need a steady supply of blood. Exercise is one way to improve circulation. But the scalp may need a boost. 


Topical Caffeine and Minoxidil both increase circulation to the scalp by opening up blood vessels. Massage can do the same - although creating friction or tugging on roots is not helpful

Massage by moving the skin gently in multiple directions several times may be helpful.


There is a Metabolic component to hair thinning. Atherosclerosis (narrowing of the arteries due to cholesterol plaques), high blood sugar/insulin resistance - “metabolic syndrome.” These are systemic health issues that may worsen any form of hair thinning. They need to be addressed for health reasons - but are a good example of how hair-thinning provides an overall picture of a person’s health. Managing your diet and lifestyle to promote heart-health, prevent strokes and prevent Type 2 diabetes may be a benefit to your hair-density in the long term. 😀


There is a Stress component to hair thinning. Illness, surgery, loss of a loved one, psychosocial stress like divorce or losing a job can all trigger telogen effluvium, when a large number of hairs move into the falling-out phase. This may take months to actually see the hair begin to fall. And it may continue for months. Hair may regrow back to its previous density in time. 


Treatments for Androgenetic alopecia aim at a lot of different targets: Hormonal, circulation, inflammation.


Healthcare providers can prescribe (for menopausal women) drugs that block some androgen activity in the follicle (Finasteride or Spironolactone) topically or pills. You’ll see these online through telemedicine too - but be aware there are potential drug interactions and side effects. Those are hormonal treatments, and it’s best to use hormonal treatments with the assistance of a healthcare provider you trust. If you get them through telemedicine, be sure to mention them to your in-person healthcare providers.


Hair loss treatments with consistent results in clinical testing:



Minoxidil [Vasodilator, may inhibit androgen activity]: This works in just over half the people who use it, and can increase hair counts (number of hairs per square inch or cm/sq) by anywhere from 10% to 30%.

    • Women and men can use the 5% strength.
    • It can be applied once daily, even though twice daily is recommended, that’s unrealistic for a lot of us.
    • It can be applied with a cotton swab for less residue and mess.
    • Minoxidil is not for people on blood pressure medication or with heart disease without asking your doctor first.


Topical caffeine [Vasodilator, may inhibit androgen activity, may reduce effects of UV on follicles when used with other forms of sun protection]

    • In a 2018 study done on men with androgenetic alopecia (in vivo), a 0.2% caffeine solution was used twice per day, increasing the number of hairs in the growing phase (anagen) by almost 11% - similar to the results from the 5% Minoxidil used in the same study. 

    • Caffeine may not produce as robust results as Minoxidil - but it is absorbed through the skin from shampoos or serums - and what could be easier than shampooing in your hair-loss treatment? I don’t have numbers for what % or users it works for. That may be coming as it is more widely available.
    • List of products containing caffeine can be found on this page.


Anti-inflammatory therapy from anti-dandruff shampoo [Anti-inflammatory, anti-oxidant, hair density maintenance]:


A human trial of 3 anti-dandruff shampoos was published in the International Journal of Cosmetic Science in 2002 in 150 men (age 18-65) with mild to moderate hair loss related to androgenetic alopecia, using anti-dandruff shampoos 2-3 times per week after 6 months. They found that shampoos with 1% Ketoconazole, Zinc pyrithione, or Piroctone olamine reduced shedding by an average of 15%, and increased the number of hairs in the “growth phase” by an average of 7%, and Ketoconazole and Piroctone olamine may help change some vellus hairs back to normal-width.


This is hair density-maintenance that is really easy to use.

I have a list of these products, sorted by active ingredient on this page.


There are a number of other topical treatments and supplements to cover in a future post!


Hair-loss preventative maintenance

    • Protect your scalp from the sun. And also from blasts of cold or dry wind by wearing a hat, scarf or hood.

    • Eat a nutritious, diverse diet with adequate protein. 1.1 grams protein per kg body weight is recommended for menopausal women age 60-90 to maintain muscle mass. That’s about 50 grams protein per 100 pounds of body weight. The body needs enough protein if it’s going to grow hair - otherwise it may prioritize other things.

    • If you have chronic telogen effluvium (you keep shedding a lot, or shedding in cycles - unrelated to a medical issue), and you dye your hair or highlight your hair, consider that you may be experiencing shedding in response to hair color treatments. Consider changing brands (and always patch-test first), or use a different means of color (pure henna, HairPrint, color-depositing conditioners or hair color gloss like this, or this). 

    • Skin may become more sensitive - an increase in hair-shedding can sometimes be the only symptom of a sensitivity to a product. Stop using any new products (or ones you use intermittently) if you notice hair shedding with that product.

    • Get at least 6 hours of sleep each night. Too-little sleep correlates with worse symptoms of pattern hair loss.

Cost-Benefit Analysis:

Anything you use to help with hair thinning has to be continued or you will lose the benefits. And you must give the product 3-6 months to learn whether it is working. Assuming it doesn’t cause irritation or difficult side effects.


We don’t care what a product claims to do, we only care about what it does for you. You are unique, that product is "one size fits all."


If you get a good result (see hair filling in thin patches), and you’re not experiencing side effects, that’s a good result! 


If you see some benefits, but the product makes your scalp uncomfortable - that’s not a good result. You could experience long-term inflammation and worsen the situation in the future.


If you get a good result but the product is cosmetically awful, get creative. Can you keep the benefits but apply the product a few hours before washing your hair? Can you use less by applying it with a cotton swab?


Do consider that you may need more than 1 approach. For example, to manage inflammation + circulation.


Some treatments are free - even if they’re only density-maintenance. Like hat-wearing and scalp massage, getting enough sleep. It all ads up!


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Science-y Hair Blog © 2024 by  Wendy M.S. is licensed under CC BY-NC-ND 4.0 



References:

C. C. Zouboulis, U. Blume-Peytavi, M. Kosmadaki, E. Roó, D. Vexiau-Robert, D. Kerob & S. R. Goldstein (2022) Skin, hair and beyond: the impact of menopause, Climacteric, 25:5, 434-442, DOI: 10.1080/13697137.2022.2050206


Kendall AC, Pilkington SM, Wray JR, Newton VL, Griffiths CEM, Bell M, Watson REB, Nicolaou A. Menopause induces changes to the stratum corneum ceramide profile, which are prevented by hormone replacement therapy. Sci Rep. 2022 Dec 15;12(1):21715. doi: 10.1038/s41598-022-26095-0. PMID: 36522440; PMCID: PMC9755298.


Qingyang Li, Hui Fang, Erle Dang, Gang Wang. 2020. The role of ceramides in skin homeostasis and inflammatory skin diseases. Journal of Dermatological Science, Volume 97, Issue 1,


Grymowicz M, Rudnicka E, Podfigurna A, Napierala P, Smolarczyk R, Smolarczyk K, Meczekalski B. Hormonal Effects on Hair Follicles. Int J Mol Sci. 2020 Jul 28;21(15):5342. doi: 10.3390/ijms21155342. PMID: 32731328; PMCID: PMC7432488.

Sebum composition: Age-related Changes in Sebaceous Gland Activity

PETER E. POCHI, M .D., JOHN S. STRAUSS, M.D., AND DONALD T. DOWNING, PH.D. Department of Dermatology, University Hospital, Boston, Mass., U.S.A. THE JOURNAL OF INVESTIGATIVE DERMATOLOGY, 73:108-111,1979 

Pochi PE, Strauss JS, Downing DT. Age-related changes in sebaceous gland activity. J Invest Dermatol. 1979 Jul;73(1):108-11. doi: 10.1111/1523-1747.ep12532792. PMID: 448169.


Picardo M, Ottaviani M, Camera E, Mastrofrancesco A. Sebaceous gland lipids. Dermatoendocrinol. 2009 Mar;1(2):68-71. doi: 10.4161/derm.1.2.8472. PMID: 20224686; PMCID: PMC2835893.


Chaikittisilpa S, Rattanasirisin N, Panchaprateep R, Orprayoon N, Phutrakul P, Suwan A, Jaisamrarn U. Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study. Menopause. 2022 Feb 14;29(4):415-420. doi: 10.1097/GME.0000000000001927. PMID: 35357365.

Loing E, Lachance R, Ollier V, Hocquaux M. A new strategy to modulate alopecia using a combination of two specific and unique ingredients. J Cosmet Sci. 2013 Jan-Feb;64(1):45-58. PMID: 23449130.


Sadgrove, N.; Batra, S.; Barreto, D.; Rapaport, J. An Updated Etiology of Hair Loss and the New Cosmeceutical Paradigm in Therapy: Clearing ‘the Big Eight Strikes’. Cosmetics 2023, 10, 106. https://doi.org/10.3390/cosmetics10040106

Koyama T, Kobayashi K, Hama T, Murakami K, Ogawa R. Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue. Eplasty. 2016 Jan 25;16:e8. PMID: 26904154; PMCID: PMC4740347.



Sunday, February 25, 2024

Hair in Perimenopause and Menopause Part 3: Silver!

Silver, gray, white - whatever you call them - these hairs can be assertive. Getting silver hairs sometimes means getting a whole different head of hair. Even if your hair doesn’t change much, there can be a new set of issues to deal with.

There are some product-links for which I may receive a small commission if clicked, at no cost to you and providing none of your personal information to me.


This post will cover 1) changes you may notice in your hair - like more frizz. 2) Changes in porosity in silver hairs. 3) How to manage silver-hair frizz. 4) Stopping or starting to use hair color. 5) Managing discoloration in light-colored hair.


Silver hairs have a tendency to be wider (greater diameter) than pigmented hairs, especially under age 65. Wider (more coarse) hairs need flexibility to be manageable.


Silver hairs may also be more likely to contain the medulla, which is a semi-hollow core at the center of hair increases rigidity. If your individual silver hairs don’t feel wider than the others (held between the fingers), but they behave in a less-flexible or more “wiry” manner, this is probably the reason.



Silver hairs may have more - or different - kinking than pigmented hairs. You might notice hairs have a different texture or curl pattern than the rest of your hair. Kinking also calls for more care directed at flexibility and lubrication [see Part 2] for easier styling and manageability.


What Does That Mean!? Your hair needs flexibility!!! That’s going to come from:

  • Choosing products that might be designed for hydration, for moisturizing, for color-protection [See Part 2]
  • Using a hair mask or deep conditioning treatment sometimes
  • A little oil before washing (as a treatment, or to help detangle hair that is long, thick, curly or tangly). -OR-
  • Oil pre-wash treatments, especially on the more-wiry places.
  • Deep condition - before washing or after. Before if your hair gets limp or flat with deep conditioners.

How to get hairs to group together (not frizz)

(Hint: Use the power of water.)

This paintbrush (left) spreads out and is inflexible when dry. It will be difficult to contain this "frizz!" When dipped in water (right) the power of surface tension between water and fibers holds them together. When dry, this force is lost. But while drying - hair re-shapes itself in this form. Weak (temporary) bonds in the proteins will hold hair in the shape it was while wet. Frizz management starts with wet hair.



While hair is wet
  • Leave-in conditioners, styling creams - to increase flexibility.
  • Use a brush/comb/finger comb to align hairs and press them together. 
  • Slide sections of hair between your palms, or pinch locks between your fingers - pressing hairs together, sliding from root to ends during conditioning. Often called the "praying hands" technique online, this is like smoothing out a decorative ribbon - or straightening the legs of pants as they go on a hanger to stay un-wrinkled.
Dry in ways that contain loose strands: 
  • Twists, braids, rollers, “no heat” curls - those work for a wide variety of hair-types and pre-smooth hairs for whatever you’re planning next. While you're at it - direct the roots in whatever direction you want them to go when dry too.
  • If you’re a wash-and-go or wash-and-wear ONLY person, use a styling product that has some thickness and density to pull those hairs into a group or into your desired shape. That could be a leave-in conditioner or a styling foam or gel, cream or whatever works for you.
  • See the theme? Catch those silver hairs while they’re wet and give them some directions. When you give hair direction while wet, you are temporarily changing part of it’s support structure - some of the hydrogen bonds in the internal protein structure. That’s the reason hair that’s “set” while wet lasts longer. It works for frizz too. Managing your silver halo frizz starts on wet hair.


Porosity: Silver hairs may be more persistently low-porosity. You might notice groups of silver hairs never seem to get wet - they appear dry and springy right out of the shower. Low-porosity hair tends to make people think, “My hair doesn’t soak anything up - it just sits on top,” and then they avoid richer products. Low porosity hair can work well with conditioners containing a little oil, or styling creams, or oil pre-wash treatments to add flexibility. Hydrolyzed proteins may be helpful for retaining hydration in difficult-to-hydrate hair. The trick can be to apply the products with water and focus on even distribution (water helps with that) do you get your hairs well-treated - bit don't end up using so much product your hair is heavy or coated-feeling.


- Be careful about product residue. If any product makes your hair feel more-dry or frizzy or tangly, it could be leaving a residue that isn’t removed during cleansing. Low porosity hair interacts with oils and hair products differently than more-porous hair (dyed, highlighted, etc.).



Transitioning from coloring or highlighting to your natural color:


  • Porosity tends to decrease as un-dyed hair grows in. During that growth process - focus especially on the formerly-dyed hair with conditioner and treatments. Your hair’s new growth may need less of some products or smaller amounts of conditioner. It may behave differently with products you have used for a long time. Lower porosity hair tends to be more selective about which products is responds well to.
  • Most styling products are designed for somewhat porous hair, given that they are designed for the majority of women - who dye their hair.
  • Hair may behave differently. Dyed (or lightened) hair has a less-smooth surface due to damaged cuticles and loss of the oil-based layer that sits atop un-damaged cuticles. Those two effects create some surface roughness and “grip” that helps hair hold a style and keeps curls from slipping out. If hair grows in with less damage, it loses that built-in “styling grip.” That grip or traction can be replaced (if you wish) with:
  • Texturizing or volumizing shampoos, conditioners, styling creams or foams, sea salt sprays, “air-dry” styling creams. 
  • Products containing starches or natural gums tend to be volumizing as well.
  • Products may leave residue or dryness that they didn’t before. Un-damaged hair interacts with products differently than dyed or highlighted hair. It is less quick to absorb water, less likely to absorb oils, and does not “soak up” or bond with conditioner the same. 
  • This might mean you need to use a “clarifying” shampoo more often. You may need lighter products. If you used oils on your hair, you may need to switch oils or use less (or use them in products instead of alone).



Beginning to color or highlight hair you didn’t color before:


These processes make hair more porous. It will need porous-hair-care to stay hydrated and flexible and avoid breakage. I have posts about porous hair care HERE and HERE. Colored or lightened hair tends to need extra time with conditioner, does better with oils, and needs extra help with hydration. Many of the new-ish bond-building hair products are very appropriate for dyed and highlighted hair.


You can prevent damage during coloring or highlighting with these tips:


  • Use an oil pre-wash treatment with a hair-penetrating oil or use a protein-containing product or both. The reason using hair-penetrating oils or protein before coloring hair are beneficial is that both protein even out porosity in hair temporarily. This prevents the harsh chemicals of hair dye from having too much contact with the more-porous areas in your hair.
  • An oil treatment would be applied to dry hair, 4-8 hours before the last wash prior to highlighting.
  • A protein-containing conditioner or protein treatment would be applied before conditioning (for a protein treatment) or during conditioning (for a protein-containing conditioner) in the last wash prior to highlighting/color.


UV protection decreases as the amount of silver hair on your head increases. That’s both the hair’s ability to protect your scalp as well as the protection that color-pigments provide your hair. Pigments in hair filter out skin-damaging UV light from the sun. 

  • Wear a hat, a scarf, a UV buff if you’re in the sun for extended periods. This protects your scalp and also reduces the chance of hair-discoloration. There are UV protecting shampoos and conditioners, but most are not broad-spectrum protection. They also will tend to become less effective over the day (just like sunscreen on your skin). Those products may protect your hair, but you need a physical barrier for your scalp for the best protection. [UV protection posts HERE and HERE]


Discoloration: Silver hair can take on a yellowish or brassy cast. Here are some causes - and solutions.

  • Hard water/high mineral content (especially iron). Use a hard water shampoo, rinse or demineralizing treatment regularly. Invest in an iron filter for the water if you own a home in a place where iron in water is very high, or allow some water to settle overnight and pour through a coffee filter for hair-washing. Reverse osmosis or distilled water may be an option. Products you might consider can be found in this post. 
  • Dark-colored products: Some oils and additives will deposit color on hair. Tar shampoos are a good example! But also coffee bean extracts, some essential oils and darker-hued plant oils. The solution is (for better or for worse) to avoid those products.
  • Sebum: Depending on your climate and environment - not washing often enough may result in discoloration due to oxidation of sebum. On the up-side - lower porosity silver hair may tolerate more-frequent washing. Hair may need different wash-frequencies in different seasons and under different conditions.
  • Environment: If you smoke, or live and work with smokers, that smoke can discolor hair. Smoky environments of any sort may cause discoloration. Air purifiers with HEPA filters that remove very fine particulate matter may help if you cannot eliminate the sources of smoke (such as wildfire smoke). 

  • Porosity: More-porous hair is more likely to be discolored long-term. Manage porosity by avoiding hair-damaging handling, limiting high-heat styling (use a heat-protectant!). Protect your hair from the sun, which increases porosity. Rinse or cleanse your hair after getting sweaty or swimming to remove salts and - whatever else is in your hair. 



Purple and Blue Shampoos and conditioners: These work by depositing tiny amounts of pigment on the hair, which cancel out their opposite color. 


On the color wheel at right, yellow-orange is opposite purple-blue. So if you can deposit a little purple, it’s meant to trick our eyes and brains into seeing the absence of either (the yellow-orange and also the purple-blue). 


For some people, blue works better than purple. 


Getting this right can take some trial and error. If shampoos don’t work, conditioners or toning masks might.


Some product examples:


Conditioners

  • Overtone toning conditioners (you can choose purple, blue, pink or green "toning"). This link is to their shop - great photos to help you choose the color that's right for you.
Shampoo

  • AG Sterling Silver Toning Shampoo (sulfate-free)
  • By The Way Toning Shampoo - Gentle detergents, enriched with oils
  • Additives for DIY

    • Would it shock you to know that you can also add food coloring to your shampoo or conditioner? As long as you're not allergic to the dyes. Blue + Red = Purple. Adjust the amount of blue to get the result you want.

    Science-y Hair Blog © 2024 by  Wendy M.S. is licensed under CC BY-NC-ND 4.0 




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