Hair loss: what it is, causes and remedies

The Andro Genetic website has always focused on androgenetic alopecia, a fundamental topic but only a part of the vast subject of hair loss. I frequently receive requests regarding topics that go beyond baldness in the strict sense, which is why I decided to write this general guide on the different types of hair loss, their causes and possible remedies, be they pharmacological, natural or purely aesthetic, to try to address this problem.

First of all, it is important to clarify right away that hair loss is a normal physiological process, and therefore you should not be scared of it a priori. In fact, all the hair on our body grows regulated by cyclical phases, and even hair does not escape this rule.

In very simple terms, the functioning of the hair follicle is divided into the following three phases:

1. Active Phase (Anagen) : In this phase, the hair follicle produces and grows hair. This phase can last up to 4 years for men and up to 6 years for women and children.
2. Stasis phase (Catagen) : in this phase, the hair progressively ceases its vital functions. It generally lasts up to 3 weeks .
3. Shedding Phase (Telogen) : In this phase, the hair is effectively dead and ready to fall out, replaced by the new growth that “pushes” it out. This phase lasts from 2 to 4 months .

In a healthy person, therefore, the life cycle of hair can last up to 6 years , and hair is replaced several times during the course of life.

Hair Loss: Causes

If there are no factors (pathological or otherwise) that vary or block the phases of the cycle, there is no problem when you see your hair falling out, since it is normal to have on average 15% of the hair in the telogen phase, ready to fall out. It is not possible to know exactly how many hairs are lost per day; however, a loss of up to 100 hairs per day is considered physiological.

In practice, the hair falls out but then grows back healthy and strong as before, so the problem does not arise.

When abnormal hair loss occurs , it is essential to first understand whether it is a temporary phenomenon or if there are underlying pathologies.

Unfortunately, it is not easy to identify the causes of hair loss on your own; therefore, I always recommend going to a dermatologist specialized in trichology . This will allow you, in most cases, to save time and pinpoint the exact problem. Most of the time, the savings are also in economic terms, since you will avoid wasting money uselessly on do-it-yourself treatments, which often turn out to be wrong.

Below, I will give an overview of the many types of hair loss that exist, dividing them according to whether they are pathological or not:

Pathological Causes

A very basic way to understand if you are a victim of pathological hair loss is the presence of itching on the head and pain on the scalp. These factors, together with an increased production of sebum , are almost always present in the cases that we are going to examine.

Also known as Telogen Defluvium or Androgenetic Defluvium , it manifests itself with a progressive miniaturization of the bulbs, leading to hair thinning that progresses according to a typical path, starting from the classic receding hairline up to the crown .

The yardstick for evaluating the progression is known as the Norwood scale . It is a pathology of genetic origin and, although to a lesser extent, it can also affect women, especially if in menopause. If you want to learn more, I invite you to click on the link at the beginning of the paragraph that will take you to our guide.

Trichotillomania

Although it is not caused by a real “disease” that directly involves the hair, I have included trichotillomania among the pathologies since it is a real obsessive-compulsive disorder . Affected individuals literally tear their hair out of their head. This condition is certainly based on deep and internal motivations, which require treatment with appropriate therapies and psychiatric paths. Fortunately, trichotillomania is reversible , therefore, once the cause that leads to hair pulling is eliminated, the hair will grow back regularly.

Telogen Effluvium

Telogen effluvium is a type of hair loss associated with abnormal hair loss in the telogen phase. It can occur in an acute form, often caused by a traumatic or stressful event, which causes up to 85% of the hair to be in telogen, resulting in abundant hair loss over the following three months, with the possibility of losing hundreds of hairs per day.

There is also a chronic form , where the triggering event is less traumatic and is more linked to states of anxiety or internal discomfort that continue over time. In this form, hair loss is less intense than in the acute form, but tends to last longer. Fortunately, there is no miniaturization of the hair, so, in many cases, it can grow back.

Hair Loss and Stress

Stress -induced hair loss is a complex case to interpret even for experienced doctors. It differs from telogen effluvium because, in addition to hair loss, typical symptoms of androgenetic alopecia are noted , such as thinning and miniaturized hair . However, stress and psychological conditions can worsen the problem. Find more information in our article dedicated to stress-induced alopecia .

It does not cause miniaturization of the bulbs, which means that they can return to producing healthy hair during periods in which the pathology is latent. Therefore, it is a reversible condition .

Cicatricial Alopecia

Cicatricial alopecia is a very rare disease characterized by an inflammatory process that leads to the destruction of the hair follicle , replaced by scar tissue . This type of hair loss is irreversible , as the follicle is completely destroyed.

Thyroid Problems

Changes in thyroxine levels , whether too high or too low, affect not only hair, but also other skin appendages such as nails and hair . Thyroxine plays a crucial role in the active Anagen phase , which regulates hair growth. People with thyroid problems often experience increased hair loss, which also results in hair that is more brittle and dull in appearance .

Anagen Effluvium

Anagen effluvium occurs mainly after taking chemotherapy drugs , which inhibit cellular metabolism, especially of follicular cells. Other treatments can also have similar effects. Hair loss occurs in patches at first, then spreads to the entire scalp. Hair regrowth resumes once the treatment is finished.

Physiological Causes

We will now examine the main types of hair loss that are not related to diseases, but are mainly due to physiological factors .

There are many theories that attempt to explain seasonal hair loss , involving variations in the light/dark ratio throughout the year and their influence on hormone levels, which in turn help regulate the hair cycle. There are also those who attribute the phenomenon to the stressful life of modern times, poor nutrition, pollution… and so on.

With this I do not mean to belittle the various hypotheses, but I consider the school of thought that leans towards a seasonal change more credible . It would be a legacy of the past, written in our genes, which has to do with the typical moulting of the fur of many animals following the variations in temperature during the changes of season.

In practice, we too “change our fur”, although obviously to a lesser extent 😉.

Traumatic Events

This category includes all those events that we inflict on our hair, whether intentionally or not. I am not talking about psychological trauma, but physical trauma . For example, sunburn due to too much summer sun can damage the scalp, resulting in excessive production of free radicals and hair loss in the following weeks or months.

Traumas that can damage the scalp and lead to hair loss include aggressive treatments such as coloring or the use of poor-quality shampoos , which can literally ruin the hair shaft. Frequent exposure to common substances such as chlorine in swimming pools or sea salt can also damage the hair structure.

Generally, these are minor issues that can make your hair dull, dry , or brittle, but usually it’s just the hair shaft that’s damaged. With regrowth, the problem tends to resolve itself, as long as you eliminate the cause that caused it.

Obviously, intolerances or allergies to substances that can cause irritation and dermatitis to the scalp, thus altering the life cycle of the hair, must be excluded.

Hormonal Fluctuations and Hair Loss

We have already seen that hormones such as DHT or thyroid hormones can be the basis of pathologies that lead to abnormal hair loss. In this section, however, we include changes in hormone levels that are not due to diseases in the strict sense, but to particular physiological states .

This explains why pregnant women often notice fuller, more beautiful hair . During pregnancy, estrogen levels remain high, prolonging the hair growth phase (anagen). However, after giving birth, estrogen levels return to normal, and many hairs enter the telogen , or resting phase, falling out over the next 3 months.

However, it is not a disease, but simply a temporary increase in hair loss, which in most cases resolves spontaneously.

Excess Cortisol and Hair

Cortisol, known as the “stress hormone,” if maintained at high levels for too long, can negatively affect the activity of cyclic AMP . This hormone acts as a messenger, sending signals to the hair follicle matrix to initiate the production of keratocytes (the cells that form hair) and melanocytes (which give hair its color).

When this signal is interrupted, the hair goes into the telogen phase and begins to fall out within 2-3 months.

Unfortunately, excess cortisol is quite common today, as simply facing stressful situations can elevate its levels.

There isn’t much data on humans , but I found a collection of studies examining the effect of melatonin in men and women with androgenetic alopecia .

The first interesting pharmacodynamic study concerns the topical application of a 0.1% melatonin solution on 40 women affected by androgenetic alopecia. After 6 months of testing , the treated group showed an increase in hair in the anagen phase compared to the group using the placebo.

An important aspect is that melatonin levels can be easily altered, since it is only produced between midnight and 3 am. This means that an irregular rhythm of life can affect its production, as well as that of cortisol , and consequently, the hair could suffer.

Please note : I am not saying that skipping a night of sleep or getting angry at work will cause massive hair loss. It is not occasional episodes that create problems, but rather prolonged conditions of stress and irregularity . Although they are not the direct cause of diseases such as androgenetic alopecia or areata , it is a fact that abnormal and prolonged levels of these hormones can affect the life cycle of the hair.

Diet and nutritional deficiencies

Following an incorrect diet or one lacking in certain macronutrients is one of the factors that can, indirectly, cause abnormal hair loss. Not so much for what you eat in a single meal, but for nutritional deficiencies that can result from drastic diets or rapid weight loss.

Among the essential nutrients for healthy hair are iron and B vitamins . It is equally important to monitor vitamin D levels , an aspect that I have covered extensively in other articles on this site.

Added to this is the inflammatory effect of nicotine in the body, which leads to an increase in the release of free radicals and consequent cellular damage. This explains why many smokers’ hair often appears brittle and dull .

In short, quitting smoking will also be good for your hair.

Traction alopecia

Even in this case we are faced with hair loss that is not caused by pathologies or genetic predisposition, but by individual behavior. Traction alopecia is in fact caused by hairstyles that exert continuous traction on the hair. In the initial stages, or in the mildest cases, it can manifest itself with inflammatory phenomena such as folliculitis , itching, and so on.

However, if the traction phenomenon persists, a real hair loss occurs with the formation of bald patches without hair. Fortunately, this is a reversible problem: it is sufficient to eliminate the traction by changing your hairstyle.

Hair loss: remedies

When looking for information on the main remedies against hair loss, you find yourself overwhelmed by a multitude of data and products. As you can imagine, after seeing the structure of this article, I believe it is essential to distinguish between drug therapies and natural remedies .

Pharmacological remedies

The topic is vast and it is not possible to cover everything here. However, below I will illustrate the drugs commonly used to deal with cases of hair loss due to pathologies.

• Minoxidil: a drug approved for the treatment of androgenetic alopecia , it also has hair growth stimulating properties, making it useful for other problems. It works by increasing blood circulation and synchronizing the hair cycle in the anagen phase .
• Finasteride: Also approved for common baldness, it is a mainstay in treatment, as it reduces the conversion of testosterone into DHT , a trigger for predisposed people. Being an anti-androgen drug, it is only useful for treating androgenetic alopecia .
• Dutasteride: Similar to finasteride, it is part of the antiandrogens and has a more powerful action, which can lead to greater side effects. To date, it is not approved in America and Europe for the treatment of androgenetic alopecia, but some dermatologists prescribe it off label .
• Ketoconazole: Due to its antifungal and anti-inflammatory properties , it is used in lotions and shampoos to treat seborrheic dermatitis and scalp irritation.
• Cortisone: used in the form of intramuscular injections to block phases of acute telogen effluvium. They show good results even in less severe cases of alopecia areata . For chronic telogen effluvium or mild forms, topical applications are used. In lotions, hydrocortisone butyrate is widely used to relieve the mild inflammatory state characteristic of many forms of hair loss.
• Immunosuppressants: In the most severe cases of alopecia areata, cyclosporines are used , which reduce the activity of the immune system, blocking the attack against the follicles and allowing them to recover.

It is important to remember that ALL of the above medications should be used only under medical prescription issued by a specialized doctor.

• Low Level Laser (LLLT) : Laser hair therapy does not fit neatly into the categories of identified remedies (drugs, natural and aesthetics). However, I consider it more similar to pharmacological therapies. Low Level Laser therapy is already used successfully in various fields and, for hair, it can be useful in certain cases thanks to its demonstrated ability to improve circulation and accelerate cellular metabolism . It is not curative, but it can be an excellent adjuvant to enhance the effectiveness of drugs.

Hair Loss Natural Remedies

Here a world opens up, since there are so many supplements and foods with supposed beneficial properties for hair. On this site, we have already discussed some of them, with greater interest in those effective against androgenetic alopecia , some other forms of hair loss , and finally those with recognized abilities to maintain a healthy scalp . Below, the main ones.

• Vitamins : As already mentioned, all the B vitamins are very important , useful for skin health and hair shine. Then come those with strong antioxidant properties such as A , C and E. An excellent remedy against seborrheic dermatitis is represented by vitamin H , better known as biotin . If you want to learn more, I invite you to read our guide on the most important vitamins for hair . A special case is represented by vitamin D3 , which, due to its characteristics and functions performed, not only for the hair but for the entire organism, can almost be assimilated to a hormone. Given its importance, I invite you to read our in-depth article on vitamin D , where its influence on hair loss is also discussed. ATTENTION : Vitamin supplementation should be carried out after the deficiency has been ascertained with specific tests and prescribed by the doctor. Of course, they are not drugs, but taking them without it is useless and, in some cases, harmful.
• Serenoa Repens : It has antiandrogenic properties , since it is able to reduce the conversion of testosterone into dihydrotestosterone . It is useful in prostate and urinary tract disorders, while for hair it is a valid aid in cases of mild androgenetic alopecia . In my opinion, and also according to the numerous studies carried out that you can see in the specific guide, Serenoa repens is currently the only valid natural alternative to finasteride and dutasteride , although with obviously inferior results compared to drugs.
• Horsetail : In general, horsetail is known for its diuretic and purifying properties , but in the trichological field it is used for its high mineral content including potassium and especially silicon , very useful for remineralizing and strengthening the skin appendages, i.e. hair and nails , when they appear dull and weakened.
• Zinc : This mineral is very important for the functions it performs in the body, especially in men. In fact, it optimizes testosterone levels , but at the same time has a slight anti-aromatase function, therefore it keeps estrogen levels (female hormones) under control. It regulates cell regeneration , promoting protein synthesis and therefore also keratocytes , which make up hair and nails. Its effects are enhanced by combined use with vitamin A. A deficiency can lead to hair loss and in fact it is one of the values ​​that trichologists ask to monitor in the analyses for check-ups.
• Magnesium : Magnesium is also an important mineral for the general health of the body, which carries out fundamental functions at a muscular and skeletal level . At a trichological level it is useful because it maintains cellular metabolic activity at optimal levels and allows the absorption of vitamins C , E and group B , which, as we have seen, are very important for hair. Furthermore, it seems to intervene positively in avoiding the appearance of gray hair . This is also one of the values ​​that dermatologists monitor with analyses for their trichological patients.
• Mela Annurca : In chronological order, it is probably the most recently released family of hair supplements . The first product was Applemets Hair , which we have discussed extensively on our site. In short, I can say that this type of product was developed in Italy based on university studies that have demonstrated an effective acceleration of hair and nail growth.
• Neem Oil : A very interesting product for its antibacterial and antifungal properties , it manages to keep the scalp healthy and hydrated and is a good natural alternative to keep itchy scalp and seborrheic dermatitis at bay . There will be an in-depth analysis soon.

Antioxidants

This type of substance has a protective action on a general level, reducing damage from cellular oxidation throughout the body. However, they are also very important for hair health and below we will see some of the most used ones for this purpose:

• NAC (n-acetyl cysteine) : It is known above all for its liver- protecting and detoxifying properties for the entire organism. In practice, it is able to counteract oxidative processes and cellular aging and therefore it is also useful for hair health.
• Green tea : Thanks to the antioxidant action of the polyphenols and the anticancer action of the catechins it contains, it counteracts the action of harmful free radicals . Furthermore, its intake has been associated with an increase in the SHBG protein , which binds a part of the testosterone. Therefore, its use could have a rationale in the context of a therapy against androgenetic alopecia .
• MSM (methylsulfonylmethane) : It is a compound that can be found in nature and derives from sulfur. The sulfur amino acids , which it is rich in, are very important for maintaining strong protein structures and therefore, since hair is made up of proteins , it increases the growth speed and quality.

Hair Loss Remedies Only Aesthetic

In this category I will include what I believe to be the main remedies against hair loss today that do not act to cure or reduce the loss, but “bypass” the problem by trying to artificially recreate the coverage of the scalp.

Among the ADVANTAGES are:

• In the most suitable situations, it is possible to obtain a clear change of image in a few seconds with remarkable results.
• Extremely reversible : if you don’t like the effect, just shampoo and everything goes back to how it was before.

There are also spray or foundation formats that address the issue of water resistance; however, in my opinion, they offer inferior aesthetic results.

Hair Prosthesis

Hair prostheses are the evolution of the classic wig and consist of a custom-made system , applied with specific glues to cover bald or thinning areas. It is essential that the scalp is prepared with a shave, and weekly maintenance phases are planned . Of course, it requires a certain amount of commitment, but the results achievable with the latest generation hair prostheses can be truly extraordinary , even for the most expert eyes.

In short, I can say that this is a good solution for those who like to wear shaved hair and require not very frequent maintenance (usually once a year).

Hair Transplant

This is the most extreme remedy to combat hair loss and is generally used by those who suffer from androgenetic alopecia . It is not a topic covered in depth on this site, but it is correct to provide at least some information. In practice, hair transplantation consists of a real surgical procedure, during which hair follicles are taken from areas not subject to androgenetic alopecia (usually from the nape of the neck) and then replanted in the bald or thinning areas.

The results obtained can be really good; however, the following limitations must be taken into account:

• Starting situation of the subject : if the thinning area is very large, many follicular units will be necessary.
• Limited quantity of available bulbs (follicular units): unfortunately, they are taken from one side and implanted from the other…
• It is still a surgical procedure , and as such it can lead to problems and complications.

Baldness is just one of the many ways in which we can lose our hair. Certainly, it is among the most serious, as, if not addressed in time, it can have irreversible effects. However, as you can see, the topic of hair loss is extremely broad and has many facets. It can affect both men and women and, in some cases, even children.