BAL 101: Introduction to Balding
Balding, by definition, refers to the progressive process of hair loss on the scalp, where the amount of hair falling out exceeds the amount of hair regrowing in the hair growth cycle. The hair growth cycle is composed of three consecutive phases;
- Anagen Phase: Anagen phase denotes the growth phase of the hair on the scalp which lasts for about 2 to 4 years of one’s lifespan. Roughly, 90 percent of one’s hair on the scalp is at this phase.
- Catagen Phase: Also known as the transition phase of the hair on the scalp, catagen phase alludes to the shrinkage of the hair grafts on the scalp over 2 to 3 weeks.
- Telogen Phase: Telogen phase refers to the phase at which hair shedding takes place after 3 to 4 months.
After hair shedding takes place during the telogen phase, up and coming hair starts to grow in. If there is more hair loss than hair regrowth at the end of the telogen phase, balding comes to pass. On the other hand, losing up to 100 hairs per day is considered normal within the natural hair growth cycle.
Balding is commonly used interchangeably with androgenetic alopecia, namely the male/female pattern hair loss. According to the American Hair Loss Council, androgenetic alopecia makes up 95 percent of the cases of permanent hair loss in total.
As a progressive process that happens over time, the typical symptoms of androgenetic alopecia vary between men and women. Androgenetic alopecia manifests as the receding frontal hairline and diffuse thinning at the top of the scalp in men whereas it manifests as the diffuse thinning at the top of the scalp in the form of a ever-widening hair part while the frontal hairline remains intact in women.
Main Cause of Hair Loss and Balding: Androgenetic Alopecia
There is a wide range of causes for balding, with androgenetic alopecia being the most common. The occurrence of androgenetic alopecia is closely related to the genetics, aging and the activity of male hormones called androgens (dihydrotestosterone, testosterone) in the human body.
Genetics and aging plays a significant role in the formation of predisposing factors for androgenetic alopecia, possibly impacting the sensitivity of the hair grafts on the scalp to dihydrotestosterone (DHT) and the activity of key enzymes such as 5-alpha reductase which transforms testosterone into DHT.
The activity of androgens such as DHT and testosterone hormones in the human body underlies the mechanism of the hair loss that ultimately leads to balding. Testosterone refers to the most abundant and active male sex hormone that performs numerous physiological and psychological functions. These include the regulation of sperm production, male sex hormone levels throughout the body, the preservation of bone density and muscle mass as well as the homogenous fat distribution. Dihydrotestosterone (DHT) indicates a more potent derivative of the testosterone, converted by the 5-alpha reductase enzyme. What sets DHT apart from testosterone in terms of the performed physiological and psychological functions is that DHT binds to the androgen receptors (ARs) in the hair grafts. This shortens the anagen phase of hair (growth phase), causing the hair to fall out earlier than normal and leads to the shrinkage of hair grafts which manifests as thinner and more brittle hair on the scalp.
Unveiling the Other Causes of Hair Loss
Although androgenetic alopecia is the leading cause of hair loss, there are a variety of other causes of hair loss. However, other causes of hair loss do not cause hair loss in a predictable progression as opposed to androgenetic alopecia, meaning that the way hair loss occurs is not in a regular pattern seen in androgenetic alopecia-related hair loss. Here are a number of causes of hair loss in a nutshell.
1) Traction Alopecia: Traction Alopecia signifies a particular type of hair loss that emanates from prolonged tension and stress on the hair grafts due to a number of tight hairstyles which are prevalent among the individuals with Afro-textured hair and women such as ponytails, braids, buns, cornrows or hair extension. The hair loss arising from traction alopecia could be reversible if the tension and stress on the hair grafts are relieved at an early stage.
2) Alopecia Areata: Alopecia Areata is an autoimmune disorder where the human body’s immune system attacks the healthy hair grafts on the scalp by mistake. It may also affect other areas of the body where the hair grafts are present including the chest, mustache and beard. It manifests as localized bald patches forming in a circular pattern on the scalp with the potential to evolve into extensive hair loss and even complete balding. In some cases, the hair may grow spontaneously given that it is treated with steroid injections or a medication-based approach under the guidance of a doctor.
3) Anagen Effluvium: Anagen Effluvium occurs when a toxic substance acts on the hair grafts during the anagen phase of the hair growth cycle. It can result from a number of medical treatment such as chemotherapy, radiation therapy. It results in rapid and diffuse hair loss. However, it may be reversible when the toxic substance in question is removed after the treatment, allowing the hair to regrow.
4) Telogen Effluvium: Telogen Effluvium refers to a certain type of hair loss that originates from psychological and physical shock like a traumatic event in one’s lifetime (accident, major depression etc.), extreme stress and acute illnesses. To illustrate, the hormonal changes that happens in childbirth, postpartum, menopause and Polycystic Ovary Syndrome (PCOS) and several types of medications such as thyroid medications, anticoagulants, anticonvulsants, oral retinoids and beta-blockers may trigger telogen effluvium. Other potential causes of telogen effluvium include the nutritional deficiencies, initiating or discontinuing hormonal birth control, the effects of anesthesia post surgery, and severe illnesses or infections, including COVID-19. The hair loss characterized by telogen effluvium typically occurs 2-3 months after the date of the psychological or physical shock in question and presents itself as diffuse thinning across the scalp. In most of the cases, hair regrows in 2-6 months time as the body’s recovery sets in.
5) Tinea Capitis: Also known as the ringworm of the scalp, tinea capitis occurs when fungal infection takes hold of the scalp and the hair grafts, resulting in localized scaly and itchy patches on the scalp and brittle hair. This makes the affected hair grafts on the scalp susceptible to falling out. If it is not properly treated with antifungal medication, it could prompt permanent scarring and hair loss across the scalp.
6) Nutritional Deficiencies: In a broad sense, the lack of intake of nutrients essential for the health of hair grafts such as iron, ferritin, protein, vitamin-C, vitamin-D could compromise the healthy growth of hair on the scalp and lead to hair loss. Addressing nutritional deficiencies through a balanced diet, albeit protein rich and supplement support could often revert the hair growth back to normal.
7) Thyroid Conditions: Disorders of the thyroid gland like hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) could impair the healthy hair growth on the scalp, causing the diffuse hair thinning across the scalp.
8) Diabetes: Diabetes, whether due to insufficient insulin production or ineffective use of insulin, leads to elevated blood sugar levels. Excess sugar in the blood can damage various parts of the body, including blood vessels, nerves, and organs such as the eyes and kidneys, which can potentially impair the hair follicles on the scalp. In addition, damaged blood vessels may struggle to deliver adequate oxygen flow to hair grafts on the scalp, which disrupts the normal hair growth cycle by acting on the anagen (growth) phase. Consequently, diabetes results in increased hair loss and slower hair regrowth with the severe disruption of the hair growth cycle. Lastly, individuals with type-1 diabetes could be prone to developing alopecia areata. Thus, diabetes affects hair health both directly, through reduced oxygen supply to hair grafts and the deterioration of the hair grafts’ integrity, and indirectly, by increasing susceptibility to additional hair loss causes.
9) Celiac Disease: Celiac Disease is an autoimmune condition that is triggered by the ingestion of gluten, a protein abundant in wheat, barley and rye. It could cause hair loss as a symptom of gastrointestinal dysfunction. However, hair loss due to celiac disease could typically be reversed with the start of a strict gluten-free diet.
10) Bamboo Hair: Having been often associated with Netherton syndrome, bamboo hair is a genetic disorder that results in excessive scalp tissue shedding and abnormal hair growth. It is characterized by the hair shafts on the scalp appearing brittle, thin, segmented, and knotty rather than smooth.
Treatment Options For Hair Loss and Balding
There are numerous treatment options available for addressing hair loss and baldings, but the choice of treatment for hair loss should be tailored to the specific underlying cause in each individual’s case.
Temporary Treatment Options
Medications
1) Minoxidil: Also known as Rogaine, Minoxidil is a topical over-the-counter prescription medication that can be used by both men and women as a treatment for hair loss that is not related to the DHT activity such as telogen effluvium characterized by an extensive hair loss on the scalp due to physical or psychological shock. It starts to promote hair growth in 6 months.
2) Finasteride: Finasteride is an oral prescription medication exclusively for men that effectively slows down hair loss and balding and may potentially stimulate hair regrowth by blocking the DHT from binding to the androgen receptors (ARs) on the scalp and making the hair grafts at the telogen (resting) phase enter into anagen phase again. It takes 3 up to 4 weeks for the ongoing hair loss to stop whereas it takes around 2 to 3 months for the pre-existing hair to rejuvenate and new hair to grow in. In 2020, topical finasteride became available in Turkey and can now be prescribed to international patients at Vera Clinic, pending approval by our doctors.
3) Spironolactone: Spironolactone is a off-label prescription medication for women solely, which functions as the DHT blocker and reduces the androgen (DHT, testosterone) production in the body.
Hormone Therapy
Estrogen and progesterone therapy may help mitigate hair loss in women caused by profound hormonal changes during menopause.
Laser Therapy
Laser therapy refers to a medical procedure in which low-level laser light is used to regenerate the hair grafts and enhance the blood circulation on the scalp, aiding the regrowth of hair. In addition, it helps soothe irritation on the scalp.
Although academic research on the association between laser therapy and hair growth are not abundant, some studies have yielded promising results. To illustrate, a 2013-dated study that involved 41 men between the ages of 18 and 48 as subjects found 39 percent increase in hair growth among the subjects who had undergone laser therapy.
PRP Treatment
As an off-label treatment for hair loss and balding, PRP treatment uses protein-rich plasma from one’s blood that includes vitamins and growth factors to inject into bald spots on the scalp. It helps stimulate hair growth by enabling the proper feeding of the hair grafts on the scalp with growth factors and vitamins.
Permanent Treatment Options
Hair Transplant Surgery
As the sole temporary treatment for hair loss and balding, hair transplant surgery is a surgical procedure that involves the transfer of DHT-resistant hair grafts from the donor area to the bald spots on the scalp using a number of techniques like FUT (Follicular Unit Transplantation) Hair Transplant or FUE (Follicular Unit Extraction) Hair Transplant. Hair transplant is performed to facilitate high density and natural appearance in individuals with genetics/DHT activity/aging-induced hair loss as they typically experience hair loss on the top of the head. As androgenetic alopecia is progressive, individuals may need more than one procedure over time.
FUT Hair Transplant Istanbul/Turkey involves taking a strip of tissue from the back of the scalp, where hair is still growing. This strip is then divided into hundreds of small grafts, which are implanted into areas of the scalp where hair loss has occurred.
FUE Hair Transplant Istanbul/Turkey entails extracting individual healthy hair follicles from the scalp. The surgeon then creates tiny openings in the balding areas and places the healthy follicles into these openings.
In recent years, Istanbul/Turkey has emerged as a premier destination for hair transplant surgery, attracting international patients seeking top-quality care at an affordable price from all around the world. Before selecting a clinic in Istanbul/Turkey, it is essential for the international patients to understand that undergoing a hair transplant surgery is a significant turning point in their lives and that a successful hair transplant requires an optimal combination of expertise, experience, and a deep understanding of the unique characteristics of hair loss.
Vera Clinic stands out in this regard, offering a personalized and case-specific approach to hair transplant surgery. With a team of skilled doctors and surgeons who specialize in hair restoration, Vera Clinic has become a preferred choice for international patients from around the world.
Last but not least, Vera Clinic comes on top in pioneering the introduction of various breakthroughs in medical aesthetics such as Sapphire FUE Technique and Oxycure Therapy.
If you are desperately grappling with extensive hair loss and are considering to get a hair transplant surgery done in Istanbul/Turkey as a first step towards building up your confidence and self-esteem, it is the high time you booked a consultation at Vera Clinic to explore the best and novel treatment options tailored to your individual needs and expectations and made your dreams come true. Feel free to visit Vera Clinic’s website at https://www.veraclinic.net/ and complete the online form for a free consultation before your visit. During the consultation, our experienced doctors and medical consultants will guide you through the entire process from start to finish, thoroughly evaluate your case, and create a personalized treatment plan tailored specifically to your needs.
Effective Strategies to Prevent Hair Loss and Baldness For Healthier and Stronger Hair
Although the ways in which hair loss and baldness could be prevented is way too challenging taking into consideration the role of genetics and aging, there are still numerous approaches available to reduce the risk of other types of hair loss which are as follows;
- Avoid tight hairstyles to prevent the graft damage that results from continued tension and stress.
- Limit heat and chemical exposure by using styling tools and products such as blow dryers, heated combs, hair straighteners, coloring products, bleaching agents, perms and relaxers etc. minimally and at lower settings.
- Make gentle and regular massages to the scalp as it may stimulate hair growth.
- Eat a balanced diet that includes essential nutrients, particularly protein, iron, vitamin-C and vitamin-D sufficiently.
- Give up smoking
- Use a cooling cap to minimize the hair loss that results from the exercise of chemotherapy.
- Consult with a doctor to discuss the equivalent medication if the medication that you use causes hair loss.
FAQs
Does Vitamin-D Deficiency Cause Hair Loss?
Research demonstrated that vitamin-D deficiency and particularly low levels of vitamin-D receptors can result in hair loss as one of the functions performed by vitamin-D and vitamin-D receptors is to stimulate new hair growth and regenerate the pre-existing hair. Vitamin-D deficiency has been associated with alopecia which refers to an autoimmune disease, causing bald patches on the scalp and possibly other areas of the human body. Alopecia could occur both in men and women. Another research found that there was correlation between the low levels of vitamin-D and women subjects who are 18 to 45 years old and experience alopecia. Vitamin-D deficiency arises from the lack of sun exposure due to the high indoor time, the use of excessive sunscreen and the lack of intake of vitamin-D rich nutrients or vitamin-D supplements. Given the proper treatment for making up for the vitamin-D deficiency, it would take two months after the treatment for the hair to cease to shed and regenerate.
Does Iron Deficiency Cause Hair Loss?
When one does have low levels of iron in one’s body, the protein “hemoglobin” that carries oxygen for the growth and repair of cells, including the cellular structures on the scalp that renovates the pre-existing hair and stimulates hair growth could not be produced. Thus, hair loss could occur due to the low levels of iron in one’s body. Iron deficiency-related hair loss takes place in a similar manner to that of androgenetic alopecia and is reversible with proper treatment. Iron deficiency could be treated by upping iron take with nutrients such as spinach, peas, dried fruit, pork and salmon etc. and using iron supplements which are prescribed upon the consent of a doctor.
Does Radiation Therapy Cause Hair Loss?
Radiation therapy commonly causes hair loss, a side effect that depends on the treatment area and radiation dose. This type of hair loss, known as radiation-induced temporary alopecia, typically occurs in the specific area where radiation therapy is administered. For instance, radiation therapy targeting brain or neck tumors often leads to scalp hair loss. Radiation damages keratinocytes, the cells within hair follicles, weakening their ability to hold and produce hair, which results in hair loss. Unlike chemotherapy, which can cause widespread hair loss, radiation therapy usually affects only the treated area. However, this hair loss is generally temporary, with hair typically starting to regrow within three to six months after the completion of treatment.
What We Know About Hair Loss and Covid-19?
COVID-19 can cause a particular type of hair loss known as telogen effluvium. This type of hair loss typically occurs two to three months after a significant stressor, such as an illness with fever or intense emotional stress—both of which are common during a COVID-19 infection. Research shows that 24.1% of subjects experienced hair loss an average of 58.6 days after symptom onset. The hair loss was temporary for some of the subjects, but others were still experiencing it at the time of the study. Telogen effluvium leads to sudden hair loss, often in clumps, and usually affects less than half of the scalp. While the hair loss is typically temporary, lasting six to nine months, research is still ongoing to understand the full extent of this effect in the larger population.
What is the Connection Between Antidepressants and Hair Loss?
Antidepressants can sometimes cause hair loss, though this side effect is relatively rare. The exact mechanism is not fully understood but may involve hormonal changes or disruptions in hair growth cycles. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are most commonly linked to hair thinning. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may also be associated with hair loss, though less frequently.
Individual responses vary, and not everyone will experience this side effect. If hair loss becomes a concern, consulting a healthcare provider is essential. They may suggest adjusting the dose, switching medications, or exploring other treatments while ensuring mental health needs are adequately addressed.
Does Stress Cause Hair Loss?
Stress is a well-documented factor that can contribute to hair loss. When the body experiences physical or emotional stress, it can disrupt hormonal balance, leading to adverse effects on hair follicles. A common condition linked to stress-induced hair loss is telogen effluvium, where hair prematurely enters the resting phase of its growth cycle, resulting in noticeable shedding a few months later. Additionally, stress can exacerbate underlying health conditions, further contributing to hair loss. While typically temporary, it is essential to manage stress effectively to minimize its impact on hair health.
Does Diet Cause Hair Loss?
Diet plays a significant role in hair health, and deficiencies in essential nutrients can indeed lead to hair loss. A well-balanced diet provides the vitamins and minerals necessary for healthy hair growth. Nutritional deficiencies, particularly in iron, zinc, vitamin D, and protein, can weaken hair follicles and disrupt the hair growth cycle, leading to increased shedding or thinning. Crash diets or restrictive eating patterns can also deprive the body of these crucial nutrients, exacerbating hair loss. Maintaining a balanced diet rich in essential nutrients is key to supporting healthy hair growth and preventing diet-related hair loss.
Does Birth Control Hair Loss?
Birth control can be a contributing factor to hair loss in some individuals. Hormonal contraceptives, such as birth control pills, can alter the natural balance of hormones in the body, potentially leading to hair thinning or shedding. This is particularly true for those who are genetically predisposed to hormonal sensitivity, as changes in estrogen and progesterone levels can affect the hair growth cycle. Some individuals may experience hair loss when starting, stopping, or changing birth control methods. While not everyone will experience this side effect, it is important to consult with a healthcare provider if hair loss occurs after using birth control.
Does Smoking Cause Hair Loss?
Smoking has been linked to hair loss due to its negative impact on overall health and circulation. The harmful chemicals in cigarettes can damage hair follicles, reduce blood flow to the scalp, and impair the delivery of essential nutrients needed for healthy hair growth. Smoking also increases the production of free radicals, which can accelerate the aging process and weaken hair strands, leading to thinning and increased shedding. Additionally, smoking can exacerbate underlying health conditions, further contributing to hair loss. Quitting smoking can help improve hair health and reduce the risk of smoking-related hair loss.