The truth about hair-loss
Words by Kerry Parnell
Photos: Getty
We lose up to 50 – 100 strands of hair a day, but unless you live in a household with lots of long-haired inhabitants, you’d probably never notice. That is, until you start losing so much hair you can see it’s thinning, or you are developing bald-patches.
When that happens, it’s extremely confronting and a quick search will offer a bewildering array of solutions, supplements and products, promising a quick-fix for your locks-loss. But where do you start and do they really work?
We asked top trichologists what causes hair-thinning and loss and what you can you do about it.
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What causes hair loss?
The good news is, most hair loss is normal, the bad news is, well, your hair may be thinning. Hair loss – or alopecia – can be temporary or permanent and the result of a number of causes. It could be hereditary, due to hormonal changes, ageing, or medical conditions. Male pattern baldness – where men lose their hair as they get older - is the most well-known, but females may also notice hair thinning and loss as they age, or go through menopause.
‘Most people who notice hair-thinning, particularly if it’s on the top of their head, have age-related or genetic hair loss and are otherwise healthy,’ says consultant dermatologist Dr Paul Farrant, who specialises in hair and scalp disorders. Hair loss can be genetic – male and female pattern baldness runs in families – or due to hormonal changes, such as after giving birth, or during menopause.
However, if age is not the reason, according to NHS guidelines, other types of alopecia can be caused by illness, stress, cancer treatment, weight loss or iron-deficiency.
Should you go to the doctor?
If you notice sudden hair loss, more than usual, and/or bald patches, experts advise you should see your GP to make sure there’s no underlying cause, especially if it’s accompanied by other symptoms. Iron-deficiency can cause hair loss as can PCOS, for example. ‘Occasionally female pattern hair loss, which presents as thinning on the top of the head, can be related to polycystic ovarian syndrome and there may be other features like acne or unwanted facial hair,’ explains Dr Farrant. ‘In that situation, blood tests or an ultrasound can be helpful.’
A trichologist can identify what kind of hair loss you have – and why. ‘If you notice thinning or extra hair fall, it’s a good idea to see a specialist to find out what type of hair loss you have and what is causing it, so that they can put you on the correct treatment plan,’ says Anabel Kingsley, consultant trichologist and brand president of Philip Kingsley.
‘There is a difference between ‘thinning’ (female pattern hair loss) where hairs gradually get finer, and ‘hair shedding’ (telogen effluvium), when too many hairs are lost on a daily basis. The former is genetic and progressive, whereas the latter is due to an internal imbalance, like a vitamin or mineral deficiency or thyroid issue,’ she explains.
‘The two hair loss conditions require different treatment, and they can also occur alongside each other.’
Does diet affect hair loss?
A healthy, balanced diet is good for our overall health, which includes our hair, but if that balance is thrown off, through extreme dieting, for example, or conditions such as inflammatory bowel disease, meaning essential minerals and vitamins are not absorbed, then that can manifest in weaker and thinner, hair. Hair is made up of the protein keratin and a lack of protein in the diet can lead to hair becoming more brittle, shedding and thinning.
‘Hair isn’t an essential tissue, so it is the last part of us to receive nutrients we ingest and the first to be withheld from,’ says Kingsley. ‘As hair is a needy but essentially, dispensable tissue, its thickness, strength and growth are easily impacted by even small dietary inadequacies.’ She recommends we eat, ‘three balanced, colourful meals a day incorporating proteins and complex carbohydrates.’
When hormones are driving hair loss, whether that’s postpartum, perimenopause, menopause, PCOS or thyroid-related, it’s important to eat enough protein, explains registered trichologist, Deborah Maguire, to stabilise blood sugar, support liver clearance and reduce inflammation. She recommends eating protein, healthy fats, slow carbs, fibre and zinc-rich foods like red meat, pumpkin seeds and spinach. ‘What you remove matters too, including sugar, alcohol, and ultra-processed foods,’ she says.
Do hair supplements work?
Often the first thing people turn to, when they notice their hair is thinning, is the huge industry of hair supplements promoting products which promise to restore hair health. But do they work?
If you are eating a well-balanced diet, then you probably don’t need supplements, says Dr Farrant. ‘Most supplements are unnecessary for the majority of patients, if they have a good well-balanced diet. As long as there is adequate protein in the diet, most minerals and vitamins can be found in food and therefore supplements are rarely required,’ he says, adding, ‘It’s hard to justify some of the very expensive hair and nail vitamins that are marketed.’
However, if you are vitamin-deficient, through hormonal changes, or illness, then supplements may address your needs. Maguire, who co-founded hair-wellness supplement brand Seed & Soul Nutrition for Hair, says you need to look at your overall health. ‘You can’t out-supplement a stressed or depleted system, you need to support the whole body,’ she says.
Are there medications which help?
Yes, there are – Minoxidil and Finasteride are both used for hair loss and researchers continue to make breakthroughs in treatments. ‘Both underwent rigorous clinical trials and have a good evidence-base for effectiveness,’ says Dr Farrant. Finasteride’s sister drug Dutasteride, is also proving effective for men, he explains, adding, it’s not technically licensed for hair-loss treatment, so must be prescribed by a doctor.
Meanwhile, biotech companies continue to race to find new solutions for hair loss – last year the first alopecia drug, Ritlecitinib or Litfulo, was licensed by the NHS. And scientists at UCLA recently discovered a molecule which promises to re-awaken dormant hair follicles.
Should you buy special shampoo?
If you’re suffering from hair-thinning, it’s tempting to splash out on expensive shampoos and conditioners which say they will restore your crowning glory. But are they worth it? It depends, says Dr Farrant, who explains they can’t affect hair growth, but they can help your existing hair. ‘Shampoos and conditioners are important for the cleanliness and condition of your hair fibres, but have little impact on hair growth, which is happening much deeper in the skin,’ he says.
‘Additives aimed at promoting hair growth are only on the skin for a short period of time and it’s questionable how much of these get absorbed. Therefore, one has to be fairly sceptical about any ingredients in shampoos and conditioners that are aimed at promoting hair growth.’
However, what good haircare products can do, is help add body and volume to thinning hair. ‘Denser-hair’ products are the new holy hair grail - according to Google Trends, searches for ‘hair density’ have doubled over in the past year. ‘Once a niche category, hair growth is making a strong comeback, with both specialist brands and beauty giants rolling out follicle- stimulating innovations,’ says a spokesperson from global futurists, VML Intelligence.
And what about the scalp?
In recent years, scalp-care has become increasingly popular, too, with social media awash with the new skincare trend for your head. A clean, healthy, scalp does promote healthy hair, particularly if you suffer from a scalp condition which impacts hair growth, explain trichologists.
‘We know a flaky, imbalanced scalp can damage hair as it emerges from its follicle,’ says Kingsley, adding that anti-fungal ingredients found in dandruff shampoos, can help with some hair loss.
‘If you suffer from seborrhoeic dermatitis (red, flaky rashes) or scalp psoriasis (scaly, itchy patches) or any other scalp condition, then it makes sense for this to be addressed medically when dealing with hair loss issues,’ says Dr Farrant. However, the jury is out as to whether we need to add scalp serums into our haircare routine.
‘This is a question that the scientific world has yet to really answer. Whilst it’s logical that we should all aim for a very healthy scalp and a balanced scalp microbiome, what happens on the scalp’s surface may have little impact on what is going on deep in the bulb of a hair follicle where the hair fibre starts its growth cycle,’ he says.
What works for menopausal women?
Changing hormone levels in perimenopause and menopause are one of the biggest causes of age-related hair-thinning in women, say trichologists. ‘Many women will experience hair thinning as they get older and there seems to be a step change around the menopause,’ says Dr Farrant.
‘This is likely due to the decrease in oestrogen, which is generally pro-growth. This can accelerate what is called miniaturisation where individual hair fibres become smaller and thinner because the actual hair follicle has got smaller in the skin.’
You may notice your hair is thinner, when you tie it back, or your parting is getting more visible. A healthy diet is essential, says Dr Farrant and HRT, or Minoxidil can also be beneficial, he says.
What other treatments are available?
For more severe hair loss, there are further options and scientists are making advances all the time, say trichologists – including lots of non-invasive at-home gadgets. ‘Over the last number of years, we’ve seen a real interest in physical therapies to manage hair-thinning,’ says Dr Farrant, explaining these techniques try to stimulate the hair cycle.
Options include low-level laser lights, either in a clinic, or at-home devices. ‘These can encourage hair growth, with evidence that they may work just as well as Minoxidil,’ he says. Another option is injecting platelet-rich plasma into the scalp, plus scalp micro-needling, but he advises those are done in a clinic. While there are home micro-needling gadgets, it’s ‘often painful and best done under specialist care,’ Dr Farrant says.
And there’s a new non-invasive machine called Tricopat, which creates ‘micro-injuries’, using a synthetic growth factor gel and electrical current, ‘which is switching on the mitochondria in the cells to promote hair growth,’ Dr Farrant says. This is available in specialised clinics.
For more information visit: bad.org.uk and nhs.uk
Hair-saving products
Tangle Teezer The Ultimate Detangler Extra Gentle, £14, Boots.com
This brush has flexible, wide-set bristles for fragile hair.
Genesis Bain Hydra-Fortifiant Shampoo, £29.60, kerastase.co.uk
Fortifying shampoo and conditioner for thin hair.
CurrentBody Skin LED Hair Growth Helmet, £649.99, currentbody.com
This red-light therapy helmet promises to promote hair growth.
Paul Mitchell Tea Tree Scalp Defense Serum, £31.53, sallybeauty.co.uk
This serum acts as a shield to environmental pollutants.
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