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A Beginners Guide to Hair Loss | Myths, Causes and Treatments

What is hair?

Hair is a filament that grows from a hair follicle in the dermis of the skin.  The overall chemical composition of hair is 45 % carbon, 28 % oxygen, 15 % nitrogen, 7 % hydrogen and 5 % sulphur. It is made up of 95% keratin (protein) in addition to small amounts of melanin (which determines your hair color).  

  • The average hair growth rate is 2 cm per month. 
  • Only the fingers, soles of feet and palms of the human body lack hair.
  • Hair’s role is to control body temperature, lessen friction between hair shafts, protect from sunlight, and defend against environmental factors.

In this post I will examine the biology of hair, why hair growth slows and what causes hair to stop growing and “fall out.”  I will discuss the essential role of stem cells, the environment and how they both directly impact the quality of hair.  I will also identify various approaches to slow hair loss, potentially extending the “warranty” on an aging hair. I will also discuss how age-related hormone changes like testosterone to DHT cause hair loss. My goal is to explain this in easy to understand language so you will be able to follow along whether you have a background in biology or not.

To start, let’s bust some myths

  • You inherit your patterns of balding from your mother’s father.

False. Although it is true that you do inherit certain genes to determine whether or not you have a predisposition to balding.  The composition of your hair comes via your mothers mother.  Complicated genetics. Balding can skip generations.

  • Women have higher levels of estrogen than testosterone.

False. Women have higher levels of testosterone than estrogen. However, on average, women have lower levels of testosterone compared to men but higher levels of estrogen compared to men.  

  • You should brush your hair while it’s wet.

False.  The outer layer of our hair (epicuticle) is a hydrophobic lipid layer that covers the exterior of the hair shaft. As a soft layer, it expands and turns brittle when exposed to water, which explains why wet hair breaks when combed.

  • Fenugreek seeds are used to treat several types of alopecia.

Truth. But they have been seen to frequently cause systemic (whole-body) side effects. Caution is advised.

Hair Loss

Alopecia affects as many as 6.7 million people in the U.S. alone and about 2% of population across the world will experience it once in their life.

Seed and Soil:

Think of your hair as a matter of seed and soil.  Each hair follicle exists within its own ecosystem that is continually communicating to the environment is habitats.  Imagine 10,000 little pockets on your head.  Zooming in inside that pocket or micro-environment you have a seed and soil.  Stem cells are the seed & blood vessels, nerves, fat cells that secrete chemicals to communicate to stem cells (seed), causing the hair to grow and respond based off conditions of the body are the soil. 

Why does my hair grow longer on my head and shorter on my arm?

Let’s take the seed and soil analogy.  We know that there are all different kinds of soil and all different kinds of seeds. For example, In my garden I may have a red bell pepper seed in one pot and a fresno chili pepper in the other.  These seeds are fairly similar, both of them make peppers but they do not bear the same qualities of pepper. Similarly, in different parts of the body there are different compositions of soil and different compositions of seeds.  In one part of the body, the hair might be encoded to produce certain qualities of a hair different from another.  So if you look on your head there are big thick terminal hairs sprouting out from the dermis; in contrast, on your arm you see very small vellus hairs.  Hence, different soils (different parts of the body) produce different kinds of hair. How it’s grown, the quality of it, when it grows is all determined by the soil that it is growing in.

This is foundational in understanding because most of the disease derived from hair is a problem with either the quality of seed (stem cells) or quality of soil (proteins, nerves, fat cells, etc). 

“Seasons” of Hair:

The process of hair growth has three main phases or seasons:

  • Anagen: Active growth stage. The hair fiber in this phase can last from 2- 7 years. At any given moment 80-85% of our hair is in the anagen phase.
  • Catagen: Transitional or Regression stage. The hair fiber begins to “shut down” and stop activity. This stage lasts a few weeks.
  • Telogen: Non-Growing or Resting stage. This occurs when the hair fiber falls out. At any given time, 10-15 % of our hair is in the telogen phase, which generally lasts 2-4 months for scalp hair. After the telogen phase, the hair growth process starts over again to the anagen phase.

Image above: Hair growth phases: anagen (growing phase), catagen (transition phase), telogen (resting phase).

The changes that happen in your hair are controlled by signals/stressors in your body. These communications come from different stimuli like cytokines, hormones, and neurotransmitters as they interact with specific components of your hair cells. There are also special proteins and chemicals that play important roles in this process. All of these factors work together to regulate the natural “season” of a hair.

Picture this: As you enter into the freeway 100 cars get on and 100 cars get off.  The same goes for your hair since each hair is in a different “season” or phase of its cycle. You lose about 100 hairs a day, which is normal. But just as soon as you lose them; 100 new hairs are growing out at the same time.  So it looks like the same number of cars are on the freeway at the same time.  Each hair partakes in approx. 40 seasons (2-5 years make up 1 season).

A single hair on your head will undergo continual growth for as long as 8 years.  This is very different than your eyebrows, which have a growth period of a couple months (& also why you don’t see people with eyebrow hairs down to their shoulders). Different seeds, different soil.

Hair Texture and Length

The composition of the hair protein that comes out is genetically encoded. We know this because of animals like sheep (eg. merino wool).  More specifically, you can look at Merino Wool versus Dorper Hybrid Wool (pictured below) . Merino Wool produces qualities of curl, so when you pack it together it provides a lot of air and is breathable. Dorper Wool is flat, so when you compact it it is dense and warm.

The “Seed Warranty”

What happens to our hair as we get older?

Imagine every seed has a “warranty”.  Some seeds can grow for 40 seasons, some grow for 20 seasons, some grow for 5 seasons. This “warranty” is coded in your hair seeds (stem cells). So as you age, some of the seeds naturally have shorter warranties and hence begin to peeter out (cease growth), causing your hair to thin, lose strength, fray and grow at shorter lengths (see image below).  

Pictured above is a normal hair shaft at age 20 (left) and age 60 (right). As you can see it is thinner having lost it’s outer covering (cuticle) which keeps all the moisture in and actually takes up a lot of the color as well. 

The length of your warranty largely depends on your genetics, and epigenetics.

Male & Female Pattern Baldness

The “Seed Warranty” is largely genetically encoded.  This is why you can see an 18 yr. old with male pattern baldness (a shortened seed warranty) and a centenarian with a full head of hair (extended seed warranty).

How can I get an extended warranty plan for my hair (seeds)?

(longer warranty = longer duration of a single hair on head)

Factors known to slow hair loss:

  • Protect your hair
    • Conditioners
  • Keep the moisture
    • No blow dryer
  • Reduce stress & inflammation
    • High stress can subtract from the warranty causing the lifecycle of a seed to be shorter
  • Clean diet

Factors known to accelerate hair loss:

  • Male Hormone (DHT)
  • Reduced Female Hormone (estrogen)
  • Reduced blood flow to hair follicle
  • Stress
  • Inflammation

Markers to check for Hair:

Iron, Zinc, Biotin & Heavy Metals (inhibit).

Top Medicines that effect Hair Loss:

Antidepressants, Blood Pressure, Anti-coagulants, Anti-gout medicines.

Annies Hair Loss Story:

The year is 2006. I am 9 years old with what initially appeared to be alopecia. I am losing my hair at a rapid rate. Hundreds of hairs being lost with just one swoop of the comb through my hair. After consulting with my dermatologist, Dr. Jasmine, and a lot of testing she was able to determine that it was not alopecia. There was no rash, no itching or irritation on the scalp. The pattern in which I was exhibiting hair loss was scross my entire scalp, rather than the typical patches you see with alopecia patients. Puzzled, my mother asked “Well, then what is it?” to which Dr. Jasmine replied “I don’t know.  Is she stressed? Does she have a new diet?” My mother replied “no”.  She gave us two types of creams to apply topically to my scalp. After using the first crème for several weeks and seeing no results, we moved onto the next crème.  The second crème we saw immediately new growth. After 2 weeks it was evident that my hair was growing.  After 6 weeks we stopped using the crème, as prescribed by Dr. Jasmine and at 6 months (with no apparent routine change) my hair was back to normal.

Alright, now that I have given you a solid framework for what is going on here, I am going to dig into what goes into reversing it.

Soil Factors:

Let’s say you buy a bag of soil at Home Depot, its top of the line with all the nutrients you need to encourage a flourishing environment for your seed.  Similarly, your hair follicle stem cells exist in an environment that contain critical nutrients that also create a supportive, nutritive space. 

Factors that control the duration of the anagen (growth phase), catagen phase and telogen phase:

Topically applied products containing herbs and their active constituents affect the hair growth process. It was reported that the mechanisms involving (1) insulin-like growth factor-I (IGF-I), (2) vascular endothelial growth factor (VEGF), (3) epidermal growth factor (EGF), (4) fibroblast growth factor 2 (FGF-2), (5) endothelial nitric oxide synthase (eNOS), (6) Wnt/β-catenin signalling pathway, (7) prostaglandin E (PGE), (8) prostaglandin F (PGF) stimulate hair growth, whereas the mechanisms engaging (1) 5α-reductase and dihydrotestosterone (DHT), (2) transforming growth factor beta (TGF-β), (3) fibroblast growth factor 5 (FGF-5), (4) prostaglandin D2 (PGD2) inhibit hair growth. The knowledge summarized in the paper may be an inspiration to create new preparations for the treatment of hair loss. [11]

Accelerators:

Insulin growth factor or IGF-1 this is produced by the liver but recieved stimulation from the brain and pituitary to be released.  IGF-1 is a strong regulator of hair growth.  It does that by extending the anagen or growth phase for longer. It doesn’t necessarily speed up growth, but it extends it for a longer period of time.

Cyclic AMP, which is part of a second messenger pathway and a key player in stimulating growth of the hair follicle. It acts as a messenger between signals that arrive at the surface of cells and conveying those signals to things that happen deep with the cells (such as the turning on and off of various genes). For example, causing a stem cell to continue to give off daughter cells or causing a hair cell to continue growing for longer.

Essentially IGF-1 and cyclic amp are both know to increase the growth of hair by extending that anagen phase.

Vascular endothelial growth factor (VEGF) is a substance that plays an important role in hair growth. It was discovered in 1983 by Napoleone Ferrara. VEGF is a protein that promotes the growth of blood vessels, which are essential for delivering nutrients and oxygen to the hair follicles. By stimulating blood vessel formation around the hair follicles, VEGF ensures that they receive the necessary nourishment for healthy hair growth. [13]

Epidermal growth factor (EGF) EGF (Epidermal Growth Factor) is a substance that plays an important role in hair growth. It was discovered in 1962 by Stanley Cohen and Graham Carpenter. EGF is a protein that promotes cell growth and division, particularly in the epidermis (outer layer of the skin) and hair follicles.

Hair growth is a complex process that involves the regeneration and proliferation of cells in the hair follicles. EGF interacts with specific receptors on the cells of the hair follicles, stimulating their growth and division. This promotes the development of new hair cells and supports the overall growth of hair. By interacting with hair follicle cells, EGF helps to regulate the hair growth cycle and ensures the continuous production of new hair. It promotes the transition of hair follicles from the resting phase to the growth phase, known as the anagen phase. This leads to the growth of new hair strands and contributes to maintaining a healthy hair cycle. [14]

Wnt/β-catenin signalling pathway

Brakes:

The brakes in terms of hair growth are going to be the triggers that either shorten the anagen phase or extend the catagen phase or extend the telegen phase.

The two major brakes on hair growth are PDE, phosphor diesterase (anytime you hear -ase, it’s likely to be an enzyme) and TGF β (growth factor which shortens growth).

Transforming growth factor beta (TGF-β)

5α-reductase and dihydrotestosterone (DHT)

Fibroblast growth factor 5 (FGF-5)

Prostaglandin D2 (PGD2)

Why do 1/2 of people by the age of 50 start to lose their hair?

Well they start to lose their hair because of something called androgen related alopecia which means testosterone derivative induced hair loss (affects both men and women). Generally speaking, young men have higher levels of testosterone than old men.

Androgens, such as testosterone and its derivatives (such as dihydrotestosterone) INHIBIT IGF-1 and cyclic AMP (accelerators).

Androgenetic alopecia (AGA) and alopecia areata (AA) are common forms of hair loss. AGA is caused by the heightened sensitivity of scalp follicles to dihydrotestosterone (DHT) whereas AA is induced by an autoimmune reaction [1].

Polygenic means it does not necessarily come from your mother or father.  It is a set of genome-wide characteristics of 20-40 genes working together. It is really a complicated mix.  There are some families that it is coded very strongly (genetics).

If young people have higher levels of testosterone compared to older, then why would people lose their hair when they’re older and not when they’re younger?

The answer lies in the conversion of testosterone and dihydrotestosterone (DHT). DHT is made from testosterone through an enzyme called 5 alpha reductase. DHT binds to an androgen receptor at 5x the affinity as testosterone (most powerful androgen in humans). DHT is responsible for mental vigor, physical vigor, strength, healing capacity, drive, libido, etc, etc. DHT itself is not bad.

As we get older there is more 5-alpha reductase activity. This enzyme (5-alpha reductase) is involved in processing androgens specifically converting testrosterone to DHT. There is more activity of 5-alpha reductase as we get older due to the simple fact of aging (I also found loose evidence that points to body mass index (obesity) playing a role in increased 5-alpha reductase.

Prescription:

Minoxidil, a hair growth treatment, works in several ways to promote hair growth:

  1. It reduces the amount of calcium inside hair follicle cells, which prevents epidermal growth factor (EGF) from blocking hair formation.
  2. Minoxidil increases the production of VEGF (accelerator) and its receptors in the dermal papilla, which stimulates the growth of new blood vessels during the active hair growth phase.
  3. Minoxidil activates prostaglandin endoperoxide synthase-1 (accelerator), which protects cells and helps stimulate hair growth.
  4. Minoxidil activates the Wnt/β-catenin pathway (accelerator).
  5. Minoxidil increases the number of cells involved in DNA synthesis in different parts of the hair follicle, leading to a longer growth phase and the transformation of fine hairs into thicker, terminal hairs.

Finasteride – is an inhibitor of type II 5α-reductase. This intracellular enzyme converts testosterone into the biologically more active metabolite dihydrotestosterone (DHT) which binds to androgenic receptors in the hair follicle and then activates the genes responsible for hair follicle regression. By reducing scalp tissue levels of DHT, finasteride treatment suppresses male pattern hair shedding.

Dutasteride is a competitive inhibitor both of type I and II 5α-reductase.

About half of the drug companies that treat hair problems with herbal agents obtain them from nature. (7).

A cortex has an amorphous matrix with a lot of sulfur-containing proteins. When cysteine residues from two neighboring keratin filaments come together, they form strong covalent disulfides. The covalent bond gives the hair its shape, flexibility, and texture. The color of the hair comes from several proteins in the cortex. The cortex gives hair its physical and chemical properties.

Nano-Formulations for Herbal Hair Care

Cubosome – Promising thickening agent. These unique properties make cubosomes excellent delivery systems applicable for oral, mucosal, transdermal and parenteral drug delivery. [10] [11]

Phytosome – With a patented technology called Phytosome, plant extracts or polar phytoconstituents are mixed with phospholipids to make phytosomes. These are molecular complexes that are compatible with lipids and make nutrients more bioavailable and easier to absorb [38]. In contrast to liposomes, phytosomes are made up of a molecular complex made of phosphatidylcholine that is chemically bound to plant parts [39]. The aqueous extracts of Abrus precatorius and Trichosanthes curcumerina were mixed to make polyherbal phytosomes that can be used on the skin [40,41]. These showed that they could help hair grow, and the composition was just as effective as a course of minoxidil treatment. Using nanotechnology, herbal nanomedicine is used to treat alopecia.

Ethosome-  Alcohol is incorporated to the lipid bilayer of ethosomes, which are another type of flexible liposome, to make the structure flexible and better at getting into cells. Ethosomes can hold medicines that are hydrophilic, lipophilic, or amphiphilic, all of which can get through the skin and into the bloodstream [43]. Ethosomes were made with the help of vitamins A, E, and C [44]. Because all the vitamins worked together and were spread to the deep layers of the skin, the formulation had a stronger antioxidant effect than the usual way that drugs are delivered.

The serum is made of nanoscale parts and rice, which strengthens the roots of hair and stops hair loss. Herbal nano-formulation was also used to take care of hair. Some of these are the citrus mint shampoo and conditioner, which have nanoclusters that make hair shine. Another ingredient with an herbal mix that could be any of the following: chamomile mixed with citrus and mint oils, black elderberry extract, or nettle leaf extract. These herbal concoctions are used to nourish hair. These shampoos help to strengthen hair follicles, improve circulation on the scalp, reduce inflammation, stop dandruff, add volume to the hair, and make it shine. Fermented medicinal herb extract blends (4HGF) made from the mushrooms Phellinus linteus grown on sprouted brown rice and Cordyceps militaris grown on germinated soybeans, or plants Ficus carica, Cacos nucifera oil, and Polygonum multiflorum have been found to have significant anti-inflammatory properties related to promoting hair growth. However, up until now, their inability to effectively penetrate hair follicles has severely limited their usefulness in treating those who are experiencing hair loss.

Moringa oleifera – Ethosomes – Better skin penetration and Hair growth-enhancing activity

Black tea – Ethosomes – Increases transdermal absorption rates and Hair dye

^^^Need to figure out way to have it penetrate past the Stratum Corneum barrier.

Wnt/β-catenin pathway –  is involved in regulating the transition from the resting phase (telogen) to the growth phase (anagen) of the hair cycle. Activation of the pathway promotes the transition to anagen and stimulates hair follicle stem cells to regenerate and produce new hair. Disruptions or imbalances in the Wnt/β-catenin pathway can lead to hair loss or abnormal hair growth. For example, if the pathway is suppressed, it can result in hair follicle miniaturization and hair thinning. On the other hand, overactivation of the pathway can lead to excessive hair growth, such as seen in certain types of tumors.

4HGF – is an herbal mixture of Phellinus linteus (anti-inflammatory) grown on germinated brown rice, Cordyceps militaris (anti-inflammatory) grown on germinated soybeans, Polygonum multiflorum (hair growth properties), Ficus carica (anti-inflammatory), and Cocos nucifera (promoting skin/hair) oil. In this study, they report the hair promoting activity of 4HGF encapsulated with PGA nanoparticles (PGA-4HGF) and their mechanism, compared to 4HGF alone. The average size of spherical nanoparticles was ~400 nm in diameter. Continuous release of PGA-4HGF was observed in a simulated physiological condition. As expected, PGA-4HGF treatment increased hair length, induced earlier anagen initiation, and elongated the duration of the anagen phase in C57BL/6N mice, compared with free 4HGF treatment. PGA-4HGF significantly increased dermal papilla cell proliferation and induced cell cycle progression. PGA-4HGF also significantly increased the total amount of β-catenin protein expression, a stimulator of the anagen phase, through induction of cyclinD1 and CDK4 protein levels, compared to free 4HGF treatment. [12]

PGA/chitosan nanoparticles are capable of entrapping biomolecules or agents into internal structures or absorbing them on their external surfaces. They can also alter biological activities due to their large surface to volume ratio. In addition, topical application of γ-PGA can promote hair-growth by moving hair follicle (HF) states from the telogen to anagen phase. Therefore, we investigated the hair-growth effect of 4HGF encapsulated in PGA/chitosan nanoparticles (PGA-4HGF) in vitro and in vivo. [12]

Melatonin Nanostructured Lipid Carrier

In a study by Hatem et al., researchers explored the use of melatonin nanoparticles combined with antioxidant oils as a treatment for androgenic alopecia. The results showed that compared to a standard melatonin solution, the melatonin nanoparticles (NLC) had clinically beneficial effects.

The NLCs were found to be easy to store and delivered 6.8 times more melatonin to the dermis (the deeper layer of the skin) and 4.5 times more melatonin to the stratum corneum (the outermost layer of the skin) compared to the melatonin solution. This means that the NLCs effectively deposited higher amounts of melatonin in the skin.

The study demonstrated that the melatonin NLCs were more effective in improving hair density, thickness, and reducing hair loss in individuals with androgenetic alopecia (AGA) compared to the melatonin solution.

The researchers also investigated the use of extracts from the Carthamus tinctorius flower, which contain substances that inhibit the enzyme 5-reductase and promote hair growth.

When the NLCs were applied to the skin of C57BL/6 mice, it was observed that more hair growth occurred compared to using minoxidil, a commonly used hair growth treatment.

Overall, the study showed that using melatonin nanoparticles with antioxidant oils, as well as extracts from Carthamus tinctorius, had promising effects in improving hair growth and reducing hair loss in individuals with androgenic alopecia.