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Excessive hair loss is an alarming condition. Especially if you don’t understand what is normal versus what needs medical attention. Hair loss can be triggered by many things including recent illness, stress, even a poor diet. Pinpointing the cause is the first step to stopping the loss.
Hair growth cycles
It helps to understand how hair grows in a cycle. In each cycle there is an initial long growing phase (anagen) lasting 2-6 years, a very short transition phase (catagen) lasting about 2 weeks, and then a resting phase (telogen) of 1-4 months. After this, the hair falls out (exogen) of the follicle. So it is normal that 50 to 100 hairs of your head will fall out each day as they reach the end of their individual telogen phase.
What about losing far more than 100 hairs/day? This very common condition represents a prolonged telogen phase called telogen effluvium. When the growing phase is disrupted it is called anagen effluvium.
When a worried patient comes complaining of persistent gradual hair loss but with almost no areas of baldness, I diagnose it as telogen effluvium. This is always due to some physical, mental or emotional stressors which I explore with the patient. I ask about recent pregnancy, surgery, febrile illness, new medication, X-rays, major emotional stress, heavy smoking or drinking.
I also look for poor diet in combination with insomnia or anxiety. This is the picture of eating disorders. Nutrition is important here because hair follicles will die prematurely due to lack of protein (lean poultry, lean beef, fish, beans, nuts, cheese, egg whites, etc.) and omega-3 oils. You also need plenty of fruits and vegetables to provide vitamin C, the B vitamins, and the minerals iron, zinc, calcium and magnesium.
To explore hormonal causes of telogen effluvium we may do blood tests looking for excess androgen hormones (in women), low thyroid function, or abnormal cortisol levels (from prolonged emotional stress). Hair loss usually doesn’t even begin until 1-2 months after the stress began. Even the use of birth control pills, menopause, or dramatic weight loss can be considered as the cause.
What can you do about telogen effluvium? The first thing to do is to identify and stop the cause if possible. Additionally, consider the following:
- Be careful with brushing your hair and use of high heat hair dryer, flat iron, hair color chemicals, and hair spray/gels.
- Gentle massage with oil to stimulate blood circulation and hair growth: add 2-3 drops of lavender or rosemary essential oil to olive, coconut, or almond oil and massage into your scalp. Leave it on for an hour, and then shampoo your hair. Do this weekly.
- Assure you are eating protein, healthy oils, fruits and vegetables as mentioned.
- Take a careful look at stress in your life and either reduce it or master it.
- Natural shampoos (below).
Anagen is different than telogen effluvium. It is an abrupt dramatic shedding of almost all of your scalp hair plus other body areas including eyebrows, eyelashes and body. Causes of anagen effluvium are toxic drugs chemotherapy (heaven forbid you use this), radiation, autoimmune disease, but may also be from severe blood loss or iron deficiency anemia, systemic lupus, autoimmune thyroiditis, or infections such as syphilis, or even fungi. What to do for this? In addition to eliminating the causes, treatment could include topical minoxidil and organic permanent make-up.
The term alopecia simply means “baldness” and there are a few types to consider. The most common is male pattern-baldness, also called androgenic alopecia. It can begin even in a man’s early 20’s. I believe that is why young men are completely shaving their heads more often now. It also affects about 80% of men age 70 and older. It also accounts for half of baldness in women.
What is the treatment for androgenic alopecia? Here are the well-known products:
- Topical Minoxidil: (2% for women, 2% or 5% for men) turns very tiny and thin hairs into mature hairs. Only 30-40% of patients experience significant hair growth. Minoxidil may also be effective for alopecia areata (discussed below). Minoxidil can take 8-12 months to work and you can’t stop treatment or your hair will likely fall out again. Common adverse effects of Minoxidil include mild scalp irritation, allergic skin rash, or increased facial hair.
- Topical Anthralin: apply 0.5 to 1% for 10 to 20 min then wash off. Expect new hair growth not for 2-3 months. It is irritating to the skin and can cause temporary, brownish discoloration, so apply it using gloves.
- Finasteride (for men only) blocks conversion of testosterone to dihydrotestosterone. The dose of 1 mg by mouth once a day usually stops hair loss and stimulates hair growth, but it takes 6-8 months of treatment to get a significant result. Adverse effects can be decreased libido, erectile or ejaculatory dysfunction. It has been known to also stimulate gynecomastia (boobs) in men. Again, once treatment is stopped, expect hair loss again.
- Oral contraceptives can work to improve female pattern baldness.
- Spironolactone blocks androgen receptors and decreases testosterone production. I can be useful for female-pattern hair loss and lower facial hair growth (hirsutism). It is a mild diuretic and lowers blood pressure.
- Surgical treatments using follicle or plug transplant grafts from thick hair areas to balding areas work quite well.
Alopecia areata is different. It starts more abruptly as discrete circular bald patches. It can occur in children, young adults or in middle age and can even continue to complete baldness. It is not easy to determine the cause in most cases. A combination of genetic predisposition, a virus or an autoimmune effect is suspected. Fungal infection, trichotillomania (hair eating), lupus, are known to cause this balding pattern. This condition is best taken to your physician to help with the diagnosis and treatment.
In my next article I’ll discuss natural products found in shampoos and conditioners for strengthening and restoring hair.
To healing and feeling good,
Michael Cutler, M.D.
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