Hair loss is mainly caused by genetic reasons. But lately lifestyle factors like nutritional deficiencies, stress and disturbed sleep patterns, and environmental factors like pollution are contributing to people losing their hair much earlier in life, says hair transplant expert Dr. Sangay Bhutia.
Hair loss can be a stressful situation for both men and women, seriously impacting their emotional well being. According to a book — Psychosocial Aspects of Hair Loss — a change in appearance caused by factors like hair loss can cause depression, anxiety, anger, fatigue, low self-esteem, embarrassment, discomfort with appearance.
Research says that less than half the women have a full head of hair throughout their life. The most common cause of hair loss in both men and women in androgenetic alopecia or pattern baldness, a kind of genetic hair loss. Studies say that 30-50% men developed male androgenetic alopecia by the time they hit 50.
Hair loss in women can accelerate post menopause, as the production of protective hormones like estrogen and progesterone falls. It is harder for women to deal with losing hair as it is not as socially acceptable for them, as it is for men.
We spoke to Dr. Bhutia, a hair transplant specialist about the causes behind hair loss, and what we can do to prevent it. She is also a member of International Society of Hair Restoration Surgery (ISHRS).
- What is androgenetic alopecia?
- How is hair loss pattern different in women than in men?
- How does your lifestyle impact hair loss?
- Tell us more about the role of nutrition in hair loss.
- Tell me more about the role of selenium and zinc deficiency.
- In terms of age, what are the differences in hair loss in men and women?
- Talk to me about how menopause impacts hair loss in women.
Androgenetic alopecia is the main type of hair loss in men and women. Why does it happen?
Androgenetic alopecia is the commonest form of hair loss. It happens as hair follicles start decreasing in size and eventually fall off leading to hair thinning and baldness over time.
Earlier hair loss used to be an age-related problem in men; it would appear once men hit their 40s or 50s. But now because of factors like the kind of lifestyle people are leading, stress, environmental factors like pollution, disturbed sleep patterns, all of these are contributing to them losing their hair much earlier. Hair loss is becoming common in people as young as in their early twenties especially in men. Although, still the percentage of women who come to us for hair loss treatments is lesser compared to men.
In both men and women, there is progressive thinning of hair. Hair starts becoming finer, thinner, this is what we call vellus hair. In simpler language, think of your hair as a plant, and imagine that the tree is not getting enough water and sunlight, it slowly transforms into a bush with thin wiry branches, from a lush, green plant.
How is hair loss pattern different in women than in men? Why does androgenetic alopecia happen, what age does it set in, and does it impact all women?
In men, hair loss typically happens in an M-shape, it starts from the crown and front and eventually the two converge to become a bald patch on the scalp. But in women, you see a different pattern. There is usually diffused thinning in the mid portion of the scalp, in the crown area. The hairline usually stays intact in women.
In both cases, the blame is to be laid on andgrogens, which are the are sex hormones. They play the main part in miniaturisation of hair follicles and their eventual fall. That is why it is called androgenetic alopecia. Miniaturisation is the hormone-driven process in which the hair follicles shrink in size over time and lead to permanent hair fall eventually.
In the human body, the hormone called testosterone, converts into Dihydrotestosterone (DHT), which is the main causative agent of hair loss. There are enzymes named 5-alpha reductase, which help metabolise testosterone to DHT. 5-alpha reductase is formed in the roots and the outer shell of the hair follicles, in the sebaceous glands. Evidence shows that there is a five-fold increase in 5-alpha reductase in balding men. Studies also show that men with a deficiency of 5-alpha reductase do not develop male pattern hair loss.
There are certain drugs, which are 5-alpha reductase inhibitors like finasteride and dutasteride, that have proven to be useful in treating hair loss.
The influence of the androgen in female hair loss is not as pronounced as in male pattern hair loss, that is why you see a lesser degree of hair loss in women as compared to men.
You mentioned that people’s lifestyle now is a big factor for hair loss, tell us more about that?
The basic cause for hair loss is genetic. At some point in their life, everyone will have hair loss. But now, the external additive factors like lifestyle are becoming important. People are working odd hours, their sleep pattern is disturbed, the body doesn’t get time to rest, and your hormones are going haywire. The hormone levels get altered, which can cause hair loss.
The second important reason is nutrition, people are eating high calorie food, and getting little nutrition.
Thirdly, people are also using more chemicals in their hair in the form of chemical dyes, hair treatments like hair straightening and rebonding etc. With all of these are additive factors, there is a combination effect, which triggers hair loss earlier in life.
Will you tell us more about the role of nutrition in hair loss. If you have to recommend a hair healthy diet, what would it include?
Like I said earlier, hair is like a plant, for the plant to grow properly, everything comes from the soil. What we see on your head is just the shaft, the main part is under the skin. The hair follicles have to be nourished. If we are talking of hair as a plant, it needs fertile soil. Therefore if we don’t eat properly, we won’t have enough protein, iron, zinc and selenium in the diet, it is not going to nourish your hair follicles.
Protein for instance is the main component of hair. Protein and keratin form around 80-85% of hair structure, so if there is a protein deficiency, your hair will not grow properly. A protein deficiency can force a large amount of hair into the shedding phase, and it will fall resulting in more than normal hair loss. If there is an iron deficiency, if we don’t eat green leafy vegetables, lentils, our hair will suffer. These deficiencies can also cause your hair to look dull and lifeless, and become more brittle.
Iron is responsible for the production of haemoglobin in the body, and haemoglobin is important for carrying the vital nutrients and oxygen to all the body parts, including your hair follicles. If there isn’t enough haemoglobin, hair won’t get enough nourishment, like other parts of the body.
Hydration is equally important. There are also minerals like zinc and selenium, fatty acids, vitamin D, vitamin A, folic acid, biotin, which are all necessary for hair growth. If there is a deficiency in any of these, it might cause hair loss. Food like salmon, spinach, yogurt, lean meats, sweet potatoes, broccoli, eggs, oysters, berries, nuts like walnut and seeds like flax and pumpkin are all good for healthy hair.
Tell me more about selenium and zinc deficiency? We don’t necessarily hear about these minerals being talked about when we talk of hair health and hair loss.
Zinc and selenium are key minerals in hair follicle development, zinc deficiency leads to malabsorption syndrome and a rare genetic disease called Acrodermatitis Enteropathica. Studies have shown that zinc deficiency leads to hair loss. Minerals like zinc and selenium are vital for hair follicle growth. Meat, milk, cheese, whole grains, legumes, flax, pumpkin or squash seeds, shellfish, nuts like peanuts, cashews and almonds are good sources of zinc.
In terms of age, what are the differences in hair loss in men and women?
In men now you see that hair fall starts to set in their early twenties or thirties. It’s also more severe in men. Some men even get bald in their mid-twenties and thirties. As they age, the hair loss progresses. But in women you see a less percentage of hair thinning in their twenties or thirties. It is more pronounced in women in their 40s and 50s, as they hit menopause.
Talk to me about how menopause impacts hair loss in women?
During menopause, the body produces less of the female hormones like estrogen and progesterone. One of the things that estrogen does is that it inhibits the production of DHT. When there is less estrogen, the action of 5 alpha reductase is more pronounced. And there is more hair loss during that time.
- Female pattern hair loss: Current treatment concepts. Quan Q Dinh and Rodney Sinclair
- Psychosocial Aspects of Hair Loss. Hilal Gokalp
- Male Androgenetic Alopecia. William Cranwell, MBBS(Hons), BMedSc(Hons), and Rodney Sinclair, MBBS, MD, FACD.
- Classification of Male-pattern Hair Loss. Christopher Toshihiro Wirya, Wenyu Wu, and Kejia Wu
Dr. Sangay Bhutia
Hair Transplant Expert
Dr. Sangay Bhutia has vast experience in the field of hair transplant and has been in this field for more than 12 years.
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