Gabor Szendi:
Causes and treatment of hair loss

The quality or even lack of a hair crown can tell a lot about an individual. Hairstyle and hair care are cultural codes, but hair also reveals a lot about the biological state of the body.

 

 

Hair loss, which affects many, is not only an aesthetic problem, but can also be a warning sign of illnesses and deficiencies. Almost everyone, regardless of gender, will begin to lose their hair as they get older. The incidence of baldness in humans varies widely, with approximately 50% of Europeans showing male-pattern baldness, while Asian, Native Americans, and black people are less likely to become bald. Baldness is common not only in humans but also in many animals. We do not know what the evolutionary benefits of this are.

The examination of hair loss

It is important to carefully evaluate changes in the quality and quantity of the hair. Has it started to become thinner or is there less of it ; does it have a typical thinning area; does hair fall out in patches; was there were any emotional or physical trauma in the 3-6 months prior to the process? Slow-appearing hair loss may be age-related, or through some gradually occurring deficiency. Sudden onset hair loss may indicate disease, but can also have genetic causes.

Hair loss due to hairstyle

Perhaps surprisingly, hairstyle itself can cause hair loss. In ballet dancers and athletic women, it is observed that their frequently tied-back hair continuously pulls at the hairs, and the roots wither over time. This is also true for all braids, buns and other hairstyles that constantly strain specific areas of the head (Akingbola and Vyas, 2017).

Age, hormonal changes

The most common cause of hair loss is age, and more specifically age-related changes. Female hair loss, just like male balding, has long been attributed to male sex hormones, but today we know that it is true only for a portion of female hair loss (Birch et al., 2002). Although the mechanism is different, the consequence for both genders is that the growth phase is shortened and the size of the hair follicles gradually decreases, which is first seen in the thinning of the hair.

It was observed from ancient times that males who had been castrated in their youth did not have later hair loss, and modern studies have also shown that those suffering from a lack of, or sensitivity to, 5-alpha-reductase type 2 do not become bald. This enzyme converts testosterone to dihydrotestosterone (DHT) and plays a crucial role in male baldness, as this hormone variant inhibits the activity of hair follicles on the top of the head (Birch et al., 2002).

One possible cause of head hair loss in women is also the increased effect of DHT. However, since the hairline on the forehead is retained, it is believed that female hormones somewhat counteract this effect. In addition, in many women who suffer from female-type hair loss, high levels of male sex hormones cannot be found, so there is some confusion amongst hair experts about the causes of female-type hair loss (Mesinkovska and Bergfeld,2013).

Because DHT plays a role in prostate hyperplasia and prostate cancer, drugs that inhibit 5-alpha-reductase have long been present (finasteride, dutasteride), which are also used in a low dose - 1 mg - to inhibit male baldness (Mella et al., 2010). The disadvantage of these drugs is that they can cause sexual dysfunction in some men - some 3% in the studies (Traish et al., 2015). These agents are less effective in women for some reason, and women are advised to take special care when using them at a fertile age, because they may feminize the fetus during pregnancy. On the other hand in post-menopause, 2.5 and 5 mg doses were more successful (Brough and Torgerson, 2017). There are many other hormone treatments, but they are not harmless, and these drugs can only be prescribed by a doctor. Before considering them, it is worth excluding the other possible causes discussed below.

Many long-standing plant-derived hair growth agents also inhibit the enzyme 5-alpha-reductase, for example nettle root extract (Ghorbanibirgani et al., 2013), saw (or dwarf) palm extract (Prager et al., 2002), pumpkin seed oil (Cho et al., 2014), extract of African cherry bark (Levin and Das, 2000), green tea (Kwon et al., 2007), and extract of artocarpus leaf (Shimizu et al., 2000). It is advisable to refrain from using them in pregnancy.

Minoxidil (Regaine, Rogaine) is also a proven agent for both male and female alopecia, although significant hair growth can only be achieved in some subjects (Gupta and Charrette, 2015). The main effect is in improving the blood supply. Depending on the concentration of minoxidil, it may cause skin irritation (taking a break or choosing a lower concentration is advised in these cases), and hair growth stops or even reverses upon stopping treatment. But this is also true for treatments based on the inhibition of DHT.

Pregnancy and hair loss

General experience, as evidenced by exact measurements, is that the proportion of hair in the growth phase increases during pregnancy. Then 3 to 6 months after the birth, the proportion of hair bulbs in the telogen phase increases, thus increasing hair loss, before the ratio of normal growing and resting hair bulbs finally normalizes. Breastfeeding provides a form of protection against hair loss after pregnancy (Gizlenti et al., 2014). This phenomenon is due to major hormonal changes during and after pregnancy.

Patchy hair loss

In its most common form, one or more oval bald patches appear on the head. This is usually caused by an autoimmune process in which the immune system starts attacking the hair follicles (McElwee et al., 2013). In rare cases, this can lead to the complete loss of head hair and body hair. More often autoimmune diseases lead to patchy hair loss. These include vitiligo, type 1 diabetes, lupus erythematosus, autoimmune thyroiditis, myasthenia gravis, celiac disease, scleroderma, rheumatoid arthritis, and ulcerative colitis. Many things can trigger the process, and often it is the result of an immune response to a simple infection or pregnancy. The solution can be a more serious medical treatment, but in mild cases it is worth trying minoxidil, and even onion extract has been found to be successful (Sharquie, 2002). Given that autoimmune disease is the result of western nutrition, it is worth switching to the paleo diet, or at least eliminating gluten and milk from the diet (Le Vere, 2017).

Common conditions that cause hair loss

Thyroid disease

Because the skin contains receptors for thyroid hormones, it is logical that these hormones affect the quality and growth of hair. Hypothyroidism causes hair to be dry, fractured, and coarse, while in hyperthyroidism it softens and loses its hold. Diffuse or localized types of hair loss occurs in both under- and over-functioning cases. Often weight gain, or a thinning of the outer third of the eyebrows, can draw attention to under-functioning. Candida infection of hair follicles occurs in patients with the dysfunction, leading to inflammatory hair loss (Safer, 2011). Since a significant part of thyroid diseases are autoimmune, hair loss is due not only to an excess, or deficiency, of thyroid hormone, but to the autoimmune process itself. When examining patients with total and partial hair loss, high levels of anti-thyroid antibodies were found in 40% of patients in the former group, and 14% in the latter (Bin Saif, 2016). Unfortunately, in many patients with the most common autoimmune thyroid dysfunction (Hashimoto's disease), T4 hormone replacement is ineffective because in many people it does not convert to T3, and the symptoms of under-functioning remain even with normal TSH levels (Gustafson and Bianco, 2014). Vitamin A or selenium deficiency is also a common problem as these are required for the normal thyroid function (Szendi, 2017).

Disorders of carbohydrate metabolism

In developed countries, carbohydrate-metabolism disorders are a common consequence of hyperinsulinism, insulin resistance, obesity, and high levels of inflammation. Hyperinsulinism results in increased testosterone production in the ovaries, and in decreased levels of Sex Hormone Binding Protein (SHBP) in women. In those women with male-type hair loss, the levels of male sex hormones are not necessarily higher, but as their SHBP level is lower, more free testosterone is circulating in the blood (Piacquadio et al., 2014). All carbohydrate metabolism characteristics in both men and women are associated with the tendency to male pattern baldness (Piacquadio et al., 2014; Yang et al., 2014). Because high blood sugar and insulin levels are part of the metabolic syndrome, it is not surprising that metabolic syndrome is ten times more common in women and men with male pattern baldness (Arias-Santiago et al., 2010).

In polycystic ovary syndrome, hyperinsulinism usually causes the ovaries to produce a large amount of testosterone, resulting in hirsutism (deep voice, hair growth) and in at least 20% of the cases of male-type hair loss (Quinn et al., 2014). Conversely, 67% of patients with male-type hair loss have PCO syndrome (Cela et al., 2003). Because female hair loss is often caused by PCOS, with or without hyperinsulinism, it is worth looking first in this direction. Generally, a carbohydrate reduced diet and weight loss will solve the problem.

Deficiencies

Emily Guo and Rajani Katta review the main micronutrients in their summary, which should be considered if the quality of hair worsens, or there is increased hair loss. However the authors consider it important that before taking any vitamin or mineral it is worth proving the hypothesis of deficiency, as overdose often only worsens the situation. For example, deficiency of selenium or vitamin A can cause hair loss. But hair loss is also a typical symptom of overdosing on these.

Iron deficiency can also cause hair problems. The vulnerable groups are those who suffer greater amounts of menstrual blood loss, vegetarians who do not consume animal heme iron, celiac patients with malabsorption, and those who suffer from intestinal inflammation. However, iron supplementation should be continued under continuous monitoring to avoid overdose.

Zinc deficiency also results in hair loss. Zinc deficiency is easily developed through malabsorption, or when taking various antihypertensive or antiepileptic drugs. Lack of Vitamin B3, Vitamin E and Vitamin D can also cause hair problems (Guo and Katta, 2017).

Hair problems caused by drugs and toxicants

It is hard to even list how many types of drugs can cause hair loss through known or unknown mechanisms. Therefore, we only mention the more commonly used groups of medicines, but in the case of hair problems, we always have to consider the side effects of medicines that are believed to be innocent.

Heparin and warfarin-type blood thinners, cholesterol lowering agents, antihypertensive agents, analgesics (paracetamol, non-steroidal anti-inflammatory drugs), antipsychotics and antidepressants, anti-epileptics, and antacids (H2) may cause diffuse hair loss. (Trüeb, 2008).

A rare cause of hair loss can be the accumulation of certain metals such as thallium, arsenic, copper, lead, mercury, cadmium, and bismuth. Arsenic and copper can originate from drinking water, and mercury from amalgam fillings (Trüeb, 2008). Certain occupations can also be associated with the accumulation of these rare metals in the body.

Another psychiatric disorder related to hair is trichotillomania, that is, the picking of hair. It usually starts at the age of 10-13. The most common form is the regular tearing of the hair, which often leads to complete hair loss. Patients often pull their hair unconsciously or if they are aware, feel compelled, are unable to stop, or give bizarre explanations for the tearing - such as that the hair is not good, or is not in its right place (Grant, 2016). Success in treating both conditions is doubtful.

Summary

The amount and quality of hair can depend on a thousand things. If we are lucky, it is simply stress, prolonged illness, certain treatments (for example chemotherapy) that have caused our temporary hair loss. If all of these can be ruled out, then the next step is to look at our diet. The metabolic syndrome is not limited to overweight people. If we have high blood pressure and our fasting blood glucose level is above 5 mmol/l, the suspicion of metabolic syndrome can arise. If we do not take vitamins and minerals, we are very likely to suffer from some deficiency. If all this does not help, we should think carefully about which "hair expert" we turn to, so that we do not waste our time, money, and hair.

 

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