Hair loss is not what typically prompts people to book an appointment at our clinic, but it is a common secondary concern. This has been particularly true over the last few years as some people have experienced, and worried about, post-COVID hair loss.
There are several types of loss, divided into scarring and non-scarring categories. The non-scarring types are much more common and include telogen effluvium, pattern hair loss (formerly known as androgenic hair loss), and alopecia areata.
Before describing these three types, it’s important to know the main phases of hair growth/loss.
- Anagen (3-6 years) – active growth phase
- Catagen (1-2 weeks) – hair follicle change/slowing
- Telogen (2-4 months) – resting state, hair not well attached but not actively falling out (a new hair is coming up behind)
- Exogen – hair is lost, time of active shedding
The human head has approximately 100,000 hair follicles and about 10% of these are in the telogen (resting) phase at any given time.
Main types of hair loss
1. Telogen effluvium (TE)
TE is a common experience of rapid shedding when more than the average number of hair follicles are pushed into the telogen phase due to some sort of “shock”. This leads to an increase in loss over the following 1–3-month period of time.
These shocks or events can include:
- Stress (various)
- Infection (especially if there was a fever)
- Hormone changes (e.g. postpartum, hypothyroidism, loss of estrogen, starting and/or stopping the birth control pill)
- Dieting
TE leads to a diffuse loss from all areas of the scalp and is not specific to just one spot. After the shedding event, follicles re-enter the anagen phase and growth resumes. Keep in mind that it may take many months after the loss before you feel like things are fully recovered.
2. (Female or Male) Pattern Hair Loss (FPHL/MPHL)
The most important thing I want you to know about pattern hair loss is that it is almost completely genetic and affects up to 50% of people. Half of us experience genetically related hair loss (to varying degrees) over our lifetime. Half of us. I’m not saying it isn’t frustrating or upsetting. I am saying that there are tons of people in the same boat, and it isn’t because of something you’re doing (or not doing).
Although related to androgen hormones in some form, the details vary and can be inconsistent from person to person. In contrast to TE, pattern hair loss more specifically affects the crown/vertex area of the scalp and is usually more complete in men.
In pattern loss, a few things happen:
- Hairs prematurely move through the anagen phase and there is an increased delay in onset of next anagen (which means you see less hair present and less growth overall)
- Follicles “miniaturize” so your larger, thicker, and pigmented hairs become shorter, thinner, and less-pigmented
3. Alopecia Areata (AA)
Seen as patchy loss, AA is believed to be autoimmune and is more common in those with other pre-existing autoimmune diseases such as celiac disease, Hashimoto’s thyroiditis, lupus, or vitiligo. It’s also associated with smoking and sleep disturbances.
4. Nutrient Deficiency
Not a specific type of loss, but a potential consequence of insufficient amounts of these hair-growth-necessary nutrients.
- Iron
- Vitamin D
Testing
Testing can be broken down into two main categories, blood and hair.
1. Blood tests:
- a. Ferritin and CBC
- b. Vitamin D
- c. Thyroid
- d. PCOS tests
- e. Autoimmune tests
2. Hair:
- a. Hair-card test (checking for degree of miniaturization)
- b. Hair-pull test (degree of loss and areas of loss)
- c. Hair-collection test (degree of loss)
Treatment
Treatment obviously depends on the type of loss you are experiencing. Correcting an iron deficiency or simply waiting out a TE loss is relatively straightforward. Addressing pattern loss or alopecia areata is a more involved process.
There are several treatments to explore: oral, topical (shampoos and lotions) and physical (laser and microneedling). Results are better when multiple strategies are used together, and combinations can depend on tolerance, cost, and length of use.
Conclusion
Hair thinning/loss is common. It can be caused by many things including nutrient deficiencies, stress, infection, hormones, genetics, and autoimmunity. Treatment is usually long-term and can be costly, with results which may not be as complete as we would like.
There are many supplements out there purporting to help solve your hair loss. Very few (if any) will work. Please save your money and your disappointment. As mentioned above, there are some evidence-based strategies. None of them are magical and improvement likely requires a combination approach.
That doesn’t mean it isn’t worth looking at! All of us at Kura have recently done extra training in hair loss and we look forward to helping you get the information you need.