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!
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| 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.
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:
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