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Hair, often seen as a representation of youth, beauty, or vitality, holds cultural and religious importance and serves as a ‘crowning glory.’ Practically, it offers protection from sunburn and provides warmth. Therefore, the onset of hair loss can have a significant emotional impact and should not be underestimated.
Statistics from the National Health Service (NHS) indicate that approximately 8 million women and 6.5 million men in the UK experience some form of hair thinning or baldness.
Understanding Hair Loss and its Psychological Impact
Hair loss, medically termed alopecia, can produce considerable psychological distress, according to Dr. Kerry Montgomery, a psychologist and advisor to Alopecia UK. She explains, “It can contribute to diminished self-esteem and a negative self-image, potentially leading to anxiety and depressive feelings.”
Diverse Causes of Alopecia
The reasons behind hair loss are varied. While genetic predisposition can be a factor, autoimmune disorders, where the body’s immune system mistakenly attacks its own tissues, can also be responsible. In this instance, the immune system targets the hair follicles, explains Dr. Sharon Wong, a London-based dermatologist and spokesperson for the British Association of Dermatologists.
Stress is another contributing element. Cortisol, the stress hormone, can disrupt the natural hair growth cycle, causing accelerated shedding and thinning.
However, hormonal imbalances constitute the most prevalent cause of hair loss in both sexes.
Types of Hair Loss and Treatment Options
Dr. Wong notes, “While certain types of hair loss may be temporary, others can be permanent, representing a lasting physical alteration.”
Although some forms of hair loss are irreversible, others can be managed or improved. This essential guide, developed in collaboration with leading experts, explores the latest advice and treatments for various types of hair loss.
Treating Different Types of Hair Loss
Alopecia presents in numerous forms, broadly categorized as scarring and non-scarring, explains Dr. Wong.
“Scarring alopecia results in permanent hair loss due to the complete destruction of hair follicles. Conversely, non-scarring alopecia leaves follicles intact, allowing for potential hair regrowth.”
She further elaborates, “Treatment approaches may overlap, aiming to stabilize hair loss, thicken existing hair, or, in some instances, stimulate new hair growth.”
Dr. Sophie Momen, a consultant dermatologist at Guy’s and St Thomas’ Hospital in London, emphasizes the importance of early intervention in all cases.
The following sections detail common causes of hair loss and corresponding treatment strategies.
Alopecia Areata
APPEARANCE: Characterized by coin-sized bald patches on the scalp, and potentially affecting the beard, body hair, eyebrows, and eyelashes. In some cases, individuals may experience complete hair loss across the entire scalp or body.
Affecting approximately 100,000 individuals in the UK, alopecia areata can manifest at any age. It arises from an autoimmune response where the immune system attacks hair follicles, leading to inflammation and subsequent hair loss.
The specific triggers remain unclear, but Dr. Wong suggests that in about half of cases, the autoimmune reaction can be initiated by stress or illness. Although there is no definitive cure, hair can regrow. However, the extent of initial hair loss may influence the likelihood of full recovery.
Recurrences of hair loss episodes may occur.
Treatments involve corticosteroid creams to reduce inflammation, or stronger oral steroids for more extensive hair loss. Novel treatments include JAK inhibitors, targeting inflammation.
Ritlecitinib, a JAK inhibitor, is the first NHS-approved treatment for severe alopecia areata. It functions by blocking JAK enzymes involved in immune function and inflammation.
Not all patients are suitable, particularly those with heart conditions, and side effects may include headaches, diarrhoea, and acne.
Minoxidil, available over-the-counter (Regaine) or as a prescription oral version, enhances blood circulation around follicles, potentially thickening remaining hair. It extends the growth phase and restarts resting follicles.
For cases exceeding 50% scalp hair loss, DPCP (diphencyprone), from specialist NHS clinics, can be applied to bald patches. It diverts immune cells away from follicles, creating a controlled eczema-like reaction, promoting follicle recovery and hair regrowth.
Androgenetic Alopecia (Male)
APPEARANCE: Characterized by a receding hairline, sometimes accompanied by hair loss at the crown. Thinning may also be noticeable.
Commonly known as male-pattern baldness, this is the most frequent type of hair loss in men, influenced by genetics from both parents, contrary to the myth of maternal inheritance.
Onset typically occurs between 20 and 25, increasing with age. It is driven by androgens, particularly dihydrotestosterone (DHT), the active form of testosterone.
Elevated DHT levels lead to follicle ‘miniaturization’, progressively shortening the hair growth phase, resulting in finer, shorter hair and increased scalp visibility.
Topical minoxidil (liquid or foam) can decelerate hair loss by enhancing follicle blood flow, stimulating growth phase entry and extension, promoting longer, thicker hair.
Dr. Wong suggests oral finasteride and dutasteride for lowering DHT levels. However, long-term use is necessary to maintain effects, and potential side effects like reduced libido, erectile dysfunction, and mood alterations exist.
Androgenetic Alopecia (Female)
APPEARANCE: Thinning hair, particularly noticeable with a widening middle parting.
Over 10% of pre-menopausal women experience androgenetic alopecia, or female-pattern baldness, increasing to 56% in women over 70.
Genetics and hormones play a role. Women produce DHT, and declining estrogen levels during menopause amplify DHT’s impact, shrinking follicles and eventually halting hair production. Progression is usually slow, and there is no cure.
Topical minoxidil can slow progression. Oral minoxidil is an alternative, though not licensed for women, so some doctors may not prescribe it.
Dr. Wong explains oral minoxidil’s consistency advantage, bypassing scalp irritation issues. It also overcomes low scalp sulfotransferase enzyme levels, needed to metabolize topical minoxidil.
Spironolactone, another anti-androgen, blocks DHT’s effects but is only available via private prescription in the UK.
Finasteride or dutasteride, DHT-lowering medications, might also help.
These medications, including topical forms, are generally not recommended for pre-menopausal women due to potential menstrual cycle disruption and male fetus sex organ development interference.
Frontal Fibrosing Alopecia
APPEARANCE: Gradual recession of the frontal hairline in an “Alice-band” pattern, potentially encompassing the entire hairline, including the scalp’s back. Eyebrow hair loss may occur, alongside redness and flaky skin around hairs.
While primarily affecting post-menopausal Caucasian women, it can also affect pre-menopausal women, men, and other ethnicities.
Immune system and hormones are thought to be contributing factors.
Dr. Wong states that as a scarring alopecia, untreated follicles risk destruction and replacement with scar tissue due to immune attacks or inflammation. Treatment cannot cure it but aims to slow or stop further hair loss.
Topical steroids and antibiotics such as doxycycline, and hydroxychloroquine, can reduce inflammation.
Methotrexate, an immunosuppressant, may be used if initial treatments fail to stabilize the condition.
Lichen Planopilaris
APPEARANCE: Patchy hair loss on the scalp (often sides, front, and back); potentially affecting body and facial hair. Red and scaly areas may appear around hair follicle bases.
Another autoimmune condition where the body mistakenly attacks hair follicles, lichen planopilaris is more common in women aged 40-60.
Diagnosis confirmation may require a biopsy for lichen planus skin condition testing. Dr. Momen suggests topical and injectable steroids to soothe inflammation. Hydroxychloroquine, an anti-malarial drug, can also reduce inflammation.
Traction Alopecia
APPEARANCE: Hair loss in areas subjected to tight hairstyles like ponytails or buns – typically front, side, and back of the scalp. Shorter, unaffected hairs might be within patches, with a “fringe sign” of longer hairs at unaffected edges.
As the name implies, traction – constant hair pulling – causes this condition, primarily from tight hairstyles such as ponytails, buns, extensions, weaves, or tight braids.
Chemical treatments like hair relaxers exacerbate the issue.
Cure is often possible depending on the duration of the problem, as follicles can suffer permanent damage.
The immediate and most crucial treatment is ceasing tight hairstyles. Subsequently, topical or injected steroids may address inflammation caused by trauma, and minoxidil may stimulate regrowth.
Telogen Effluvium
APPEARANCE: Sudden, rapid hair loss across the entire scalp, causing individuals to lose significantly more than the usual 100 hairs daily, approximately 30% more.
No genetic link exists, and telogen effluvium can affect anyone, often triggered by stress, major life changes, or bodily changes like sudden weight loss or childbirth.
Dr. Momen explains diagnosis is confirmed via a hair-pull test. Gently pulling about 50 hairs should yield no more than five; excess shedding is abnormal.
In 95% of cases, the condition resolves with hair regrowth.
Primary treatment focuses on resolving triggers, potentially including blood tests to exclude other causes.
Does Daily Shampooing Cause Hair Loss?
Trichologist Anabel Kingsley refutes the idea that daily shampooing leads to hair loss, recommending washes no more than three days apart. “Regular scalp cleansing benefits scalp health, similar to skin care, maintaining hair follicle integrity.”
The notion of hair self-cleansing is incorrect. “No external skin part self-cleanses. Decomposed oils can inflame the scalp, and dead skin cells accumulate,” she adds. “Studies suggest scalp flaking and inflammation contribute to hair loss.”
The myth that shaving facial hair thickens regrowth is also debunked. Trichologist Deborah Maguire clarifies shaving only cuts surface hair, not affecting the follicle controlling growth beneath the skin. However, shorter shaving is advisable to protect hair bulbs from pulling damage.
Tips for Maintaining Healthy Hair
Even without hair loss concerns, specific nutrients are vital for healthy hair. Deficiencies prioritize other bodily needs, as hair is considered less essential. Deborah Maguire, a Cotswolds-based trichologist, emphasizes this point.
“Protein is key as hair is protein-based. Amino acids in protein are essential for hair growth and strength.”
The NHS recommends approximately 56g of daily protein for men and 45g for women.
Dietitian Emer Delaney suggests meat and plant-based proteins like tofu or soya. “B vitamins, particularly folic acid (B9) and B12, aid cell metabolism and ensure scalp blood flow.”
Folic acid is found in lentils, citrus fruits, leafy greens, and eggs; B12 in meat, fish, eggs, and dairy.
Iron is also vital. “It is crucial for red blood cell formation, carrying oxygen throughout the body,” adds Delaney. “Insufficient oxygen to hair follicles impairs replication, slowing hair growth.”
Iron sources include red meat, fortified cereals, and leafy greens.
Simple habits for healthy, strong hair:
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Sleep on Silk
Silk’s smoothness is gentler on the hair cuticle, minimizing tangling, says Anabel Kingsley. Less tangling means less breakage and thinning when brushing. Silk bonnets offer similar benefits, resulting in more manageable morning hair.
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Reduce Dry Shampoo Use
While occasional dry shampoo use is acceptable, overuse can lead to scalp buildup, clogging follicles and causing inflammation, contributing to hair loss, cautions Deborah Maguire. Some dry shampoos contain alcohol, which can dry hair, increasing breakage risk.
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Avoid Towel-Wrapping Wet Hair
Wrapping wet hair tightly in a towel encourages tangles and unnecessary strain due to towel size and weight. Microfiber towels are better, suggests Anabel Kingsley, being lighter, softer, and more absorbent, but avoid root traction.
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Consider Caffeine Shampoo
Caffeine shampoos may enhance cell energy and counter testosterone’s negative effects on hair follicles. A 2017 study in Skin Pharmacology and Physiology showed caffeine shampoo yielding results similar to minoxidil after six months.
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Choose Hairbrushes Carefully
Harsh, bristly brushes can cause breakage and thinning. Opt for soft bristles or de-tangling brushes. If a brush scratches your hand, it can damage your hair.
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Brush Wet Hair Gently
Wet hair is 50% weaker and more prone to damage like breakage and split ends when brushed, says Deborah Maguire. Use a wide-toothed comb to reduce resistance and detangle gently.
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Limit Heat Styling
High heat from straighteners or hair dryers damages hair, increasing breakage risk, warns Deborah Maguire. Avoid applying heat to hair if it’s too hot for skin. If using heat, use the lowest setting and minimize contact time. Damage is cumulative, so less frequent use helps.
Underlying Health Issues and Hair Loss
“Hair loss can be a symptom of underlying medical conditions,” states Dr. David Fenton, consultant dermatologist at OneWelbeck clinic. Recognizing other physical changes and seeking prompt GP consultation ensures proper diagnosis and treatment.
Medical Conditions Linked to Hair Loss
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Polycystic Ovaries
Polycystic ovary syndrome (PCOS), caused by hormonal imbalances, can manifest as female-pattern hair loss. Increased DHT levels or heightened sensitivity to normal levels are contributing factors. Other symptoms include irregular periods, weight gain, and excessive body hair.
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Thyroid Conditions
Both overactive and underactive thyroid can trigger hair loss, though more commonly linked to underactive thyroid. Other symptoms include fatigue and weight fluctuations. Thyroid hormones regulate metabolism; imbalances disrupt hair growth. Overactive thyroid may cause shedding due to weight loss and heightened metabolism.
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Rheumatoid Arthritis
As an autoimmune condition, rheumatoid arthritis lists hair loss as a known symptom, along with joint pain and fatigue. Methotrexate and leflunomide, common rheumatoid arthritis drugs, can also induce hair loss by affecting hair follicles similarly to inflammation-causing cells. Switching medications may help.
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Anaemia
If hair loss is accompanied by extreme fatigue, pale skin, and cold extremities, iron deficiency anaemia could be the cause. Iron is vital for haemoglobin production, carrying oxygen to all body cells, including hair growth cells.
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Medications
Hair loss is a known side effect of retinoids (acne treatment), antidepressants, and blood thinners like warfarin, all impacting the hair cycle’s growth phase.
Anecdotal reports link hair loss to weight-loss injections, though not officially listed as a side effect. Calorie restriction-induced nutrient deficiencies are a possible explanation.
NHS vs. Private Hair Loss Treatments
Despite widespread hair loss, NHS treatment options are limited, notes dermatologist Dr. Sharon Wong.
NHS mainstays include steroid creams/injections and newer JAK inhibitors.
Licensed treatments for male/female-pattern baldness – topical minoxidil and finasteride – are not NHS-funded.
Topical minoxidil is available over-the-counter (Regaine). Oral minoxidil exists but is private prescription-only, originally for high blood pressure (higher doses), with hair growth as a side effect.
Oral minoxidil can be more effective than topical application due to bloodstream absorption. Generally well-tolerated at low doses, potential side effects include fluid retention, headaches, increased heart rate, and low blood pressure (especially at higher doses), with initial hair shedding as a common side effect.
Finasteride, initially for prostate issues (higher dose), had hair benefits as a side effect. As a licensed hair loss drug, studies show improved hair count and appearance within 3-6 months. Dr. David Fenton explains it lowers DHT, shrinking follicles, but requires lifelong use. Side effects include sexual dysfunction (low libido, erectile dysfunction) in over 1%, alongside reports of depression, suicidal thoughts, and breast sensitivity. Post-finasteride syndrome, with persistent side effects after cessation, is reported.
Physical treatments are mainly private, says dermatologist Dr. Archana Rao. Platelet-rich plasma (PRP) involves injecting concentrated growth factors from the patient’s blood into the scalp to promote growth. Effective for male/female-pattern baldness and alopecia areata, a 2019 study in the Journal of the American Academy of Dermatology showed significant increases in hair count and density. Costs range from £150-£900 per session.
Laser light therapy to stimulate follicles needs further research, adds Dr. Rao, costing around £45 per session.
Microneedling uses tiny needles to create scalp micro-wounds, promoting natural healing and hair regrowth, enhancing topical minoxidil absorption and microcirculation. Costs around £65 per session.
Tricopat, a newer option, combines low-level electric current, red light, and sound waves to stimulate follicles. A 2021 Dermatology Practical & Conceptual study showed regrowth in all 60 participants. From £300 per session.
Considering Hair Transplant Surgery
Hair transplant surgery, not NHS-covered, costs around £7,000 in the UK, states Dr. Chris D’Souza, president of the British Association of Hair Restoration Surgery. Two main types are strip follicular unit transplantation (FUT) and follicular unit excision (FUE).
Strip FUT is more invasive, removing a scalp skin strip, dissecting it into follicle sections, and transplanting them to hair loss areas. It can transplant many grafts without shaving but leaves a linear scar, limiting short hairstyles.
FUE harvests individual follicles one-by-one for insertion into thinning areas. No linear scar allows for very short haircuts, but requires shaving the back and sides for the procedure.
UK costs drive many to seek treatment in countries like Turkey. Dr. D’Souza notes that while successful abroad, things can go wrong due to varying regulations. UK clinics must register with the Care Quality Commission, and licensed doctors must perform surgical procedure steps.
Abroad, brokers connecting patients to technician-led clinics may prevail, meaning non-medically trained individuals discuss surgery and patient cases. Promised outcomes might be unrealistic. Surgery without stabilizing existing hair loss may yield unnatural results. Some alopecia types, like alopecia areata, may render transplants ineffective as the immune system can attack transplanted hair. Thorough research is crucial even for overseas clinics, advises Dr. D’Souza.
Personal Story: Hair Transplant Success
Last May, Michelle Wise, 55, underwent a hair transplant at the Wimpole Clinic in London
Michelle Wise, 55, appears confident and embraces her grey hair, but in 2020, temple and hairline thinning led the Hampshire marketing manager and mother of two to wear a wig.
The issue started post-childbirth in 1998. “Hair was lovely during pregnancy, but thinned afterward,” Michelle recalls.
“I felt self-conscious, growing hair longer to conceal temple thinning. GP advice was age-related, and chemist-bought minoxidil foam was ineffective.”
In 2018, female-pattern baldness was diagnosed at a London specialist clinic.
Wigs were initially effective. “It looked so real, but I worried about it blowing off. Camping with new friends, I woke up early to ensure it looked natural. I realized I didn’t want wigs forever.”
Last May, she chose FUT hair transplant at Wimpole Clinic, London.
“Post-clinic, I had scalp swelling and blood. I avoided washing or wig use for two weeks to secure follicles, sleeping upright for five nights for swelling reduction.”
Six weeks later, at the hairdresser, she vividly recalls seeing new, fine hair growth and a new hairline. “It’s hard to explain the joy to someone who hasn’t experienced hair loss devastation.”
While hair grew, Michelle continued wigs. Last Christmas, she cut and styled her real hair and discarded wigs permanently.
“After decades, I feel like myself again. My confidence is restored.”