Two people putting hair loss puzzle together
Written by
Zac Hyde M.D.
Medically approved by
Sana Wazir M.B.B.S.; M.D.

Contents

CHAPTER 1. UNDERSTANDING HAIRA woman jogging, happy, good hair, flat style.

 

CHAPTER 2. WHAT IS HAIR LOSS?Two people working on hair loss, flat style.

 

CHAPTER 3. HAIR LOSS SIGNS AND SYMPTOMSWoman losing hair, stressed, flat style

 

CHAPTER 4. HOW TO TREAT HAIR LOSS?Guy showing woman hair, flat style.

 

CHAPTER 5: HOW TO CHOOSE THE RIGHT PRODUCT FOR YOU?

Guy sitting at desk choosing the right hairstyle for the right product, flat style.

CHAPTER 6. HOW TO PREVENT HAIR LOSS?Guy losing hair holding a few strands of hair loss, flat style.

 

 

CHAPTER 7. 200+ DERMATOLOGIST ANSWERS (AMA)

 two men talking to each other about hairstyle, flat style.

 

CHAPTER 1. Understanding Hair

A woman looking in the mirror loving hair hair, pink, flat style.

It might be a weird question to ask, but what is hair? The science behind it is far more complex than it looks on the surface. Hair is not just an asset that enhances a person’s appearance; it also plays an important role in gender identification, sensory transmission, and more.


What Is Hair?

The hair’s structure is composed of 80% keratin, a fibrous structural protein, 10% water, and 5 to 10% pigments and lipids. It grows spontaneously throughout our life, renewing itself according to a natural cycle.

Biologically speaking, the hair we have on our heads is technically dead. The only part of them that is alive is the root embedded in the scalp. Hair has two parts:

Follicles

Also known as hair bulbs, follicles are located between the layers of the dermis and hypodermis. This is where the keratinocytes are produced, along with melanin.

Hair follicle close up, sliced, medical, flat style.

Shaft

This is the visible part of our hair, which comprises dead keratin-filled cells and is made up of three distinct layers: the medulla, cuticle, and cortex.

  • Medulla: The innermost layer of the hair shaft and consists of a soft, oily substance.

  • Cuticle: A thin, protective layer that contains the nutrients essential to hair growth. It has a tightly formed structure, featuring scales that look like overlapping shingles.

  • Cortex: This is the main component of the hair that contains long keratin chains, which give the hair elasticity, resistance, and shine. Both the cortex and the medulla hold the hair’s pigment.

 

Why Does Hair Exist?

At 22 weeks, a developing fetus will start growing hair follicles. There are about 5 million follicles on the body, with 1 million on the head and about 100,000 on the scalp alone.

The function of human hair depends on the body part from which it grows. You may notice that people have different places where they grow hair, and not everybody has the same hair texture or length in a certain area.

One important function of hair is protecting the skin from environmental factors. It translates external input as sensory stimuli and transmits it into the brain.

Additionally, scalp hair is the only part of the body that can be modified to change a person’s appearance. It gives humans a sense of individuality and allows them to socially communicate.

 

What Does Healthy Hair Look and Feel Like?

A woman on Instagram, receiving likes and follows for healthy hair, flat style.
To achieve optimal hair growth, your hair needs to stay in the Anagen phase for as long as possible.

 

This is possible by maintaining a healthy diet, using the right hair care products, and avoiding any processes that can disrupt hair growth, such as chemical treatments like bleaching, coloring, and perming.

But what does healthy hair look like? Here are a few signs:

  • Silky-Smooth and Bouncy: This is the result of a flat-lying cuticle. If you’ve seen a hair commercial before, then you know what we mean by the cuticle being ‘flat’. It protects a sponge-like shaft beneath and works best when its scales are tightly overlapped on top of the cuticle. Light reflects off it, making the hair shiny.

  • Good Elasticity: Elasticity is the measure of your hair’s strength, meaning it’s responsible for keeping your beautiful curls or waves intact all day. Having poor hair elasticity can lead to excess breakages, such as split-ends.

  • Less Hair Fall: We all know by now that shedding is a normal part of the hair’s growth cycle, but losing too many strands daily can be a sign of a more serious health issue.

 

Is There a Difference Between Hairs on Our Body?

To understand the difference between scalp hair, facial hair, body hair, and pubic hair, you need to know about the two major types of hair follicles: terminal (androgenic) and vellus.

 

Terminal Hair Follicle

These hairs are bigger and are extended into the subcutaneous fat tissue during hair growth. Their growth is influenced by hormones and lies within the second layer of the skin. Terminal hairs are at least 0.06mm in diameter and are found on the scalp, face, armpits, and pubic area.

 

Vellus Hair Follicle

At birth, vellus hair is what you have most on your body. It is thin, short, and more translucent compared to terminal hair. Vellus hair may seem unnecessary, but it’s responsible for regulating your body temperature and helping sweat evaporate from your body.

 

How Does Hair Grow?

Stages of Hair Growth, flat style, sliced, close-up.

Hair growth depends on several factors. These include age, weight, metabolism, hormones, medications, sleeping habits, etc. All hair on our body goes through three stages of growth.

At the very beginning, a follicle (hair root) is formed. It looks like a sac and is located under the skin. What we see is a tiny opening in the skin that is a tissue formed from a follicle.

Interestingly, the human body contains more follicles than the body of animals like chimpanzees, gorillas, etc., but it seems to us that we have less hair because most are light.

Therefore, we do not see them. After the formation of follicles, three different phases take place: anagen, catagen, and the last phase called the telogen phase.

1. Anagen phase or active hair growth phase

The first hair growth phase lasts for several years. Precisely, because of this melanin pigment, hair can only be laser-destroyed at this stage.

Many microstructures such as papillae and bulges also occur and are responsible for controlling hair growth.

2. Catagenic or regressive phase

During the second phase, the hair begins to die, but it does not fall out. It only separates from the roots. As a result, the blood supply become completely stopped.

Melanin production is also reduced, and stem cells no longer produce hair. The catagen phase lasts for three weeks.

3. Telogen phase or rest phase

In the last stage, the hair is ready to fall out because it is no longer associated with any microstructure. The process of growing new hair begins. The telogen phase lasts for five or six weeks.

People who experience stress, tension, or illness for an extended period are at this stage for a longer time, resulting in greater hair loss and a lower rate of regrowth.


CHAPTER 2. What Is Hair Loss?

A guy sad, stressed and experiencing bald hair, flat style.

Hair loss refers to excessive loss of hair, which can be triggered by multiple reasons.

Hair loss is one of the most common complaints seen in the field of dermatology.

According to reports, androgenetic alopecia (AA), which is a form of hair loss, affects 50 million men and 30 million women in the United States. To make matters worse, 50% of men over the age of 50 will experience some form of male-pattern baldness.

When people start going through these changes, they are often desperate for any solutions to reverse the process of hair loss. Unfortunately, people tend to believe everything they read online, especially when dealing with a chronic condition.

You see, being desperate is a great opportunity for shady advertisers to promote their ‘magical’ hair loss remedy that grows back your hair in 24 hours! In reality, most of these campaigns only seek financial profit even if it involves scamming people.

minimalistic, long, informative infographic on hair loss.

How does hair fall?

Hair grows in several cycles, which consist of:

  • A long growing phase (anagen)

  • A short growing phase (catagen)

  • A resting phase (exogen)

When the resting phase ends, the hair falls, allowing new hair follicles to grow in the new cycle.

In general, about 40 hairs (up to 78 in men) reach the exogen phase every day. In other words, you can expect up to 78 hairs to fall if you are a man.

If this number exceeds 100 hairs per day, it becomes pathological, and medical care is necessary.

 

The downsides of hair loss

For most people, hair loss is merely an aesthetic issue that doesn’t hold any serious complication to a patient’s health. However, this condition can lead to several mental health problems, including low self-esteem, constantly being self-conscious, and depression.

Eventually, this can negatively impact patients’ quality of life, which is very problematic.

Additionally, hair loss affects a considerable portion of the population from both genders, exacerbating the situation even further.

In some cases, patients may visit the doctor’s office about their hair loss and find out that there is an underlying condition triggering it, including hypothyroidism, autoimmune diseases, and infections.

Overall, hair loss has psychological and organic complications that should get promptly assessed.

 

The causes of androgenetic alopecia

Genes and Family History

THREE WOMAN HAVING CHROMOSOMES ON THEIR HEAD, FLAT STYLE

Having a family history of hair loss is one of the non-modifiable risk factors that significantly increase your risk of developing this condition.

Unfortunately, researchers are yet to pinpoint the exact genetic alteration that triggers hair loss.

 

Testosterone and DHT

High levels of dihydrotestosterone (DHT) in the scalp often leads to androgenetic alopecia.

 

Stress

Researchers identified physical and emotional stress as potential triggers of reversible hair loss (i.e., telogen effluvium).

The triggers of this condition are well-documented and include:

  • Severe emotional stress

  • Complicated surgeries

  • Chronically elevated core temperature

The way this happens is by shifting the person’s hair to the telogen phase. As a result, the hair falls but no follicles replace it, which leads to reversible hair loss.

 

Lack of Blood Supply

As the hair follicle grows, new blood vessels surround it to supply the cells with oxygen and nutrients, eliminate waste products, and ensure the growth of the follicle.

The loss of these blood vessels is linked to certain types of hair loss.

 

Alopecia Areata

Alopecia areata is an autoimmune disease that triggers your immune cells to attack the hair follicles. As a result, your hair falls.

 

Tinea Capitis

Tinea capitis is a fungal infection that may cause bald spots, flakiness, broken hair, and other inflammatory signs in the scalp.

 

Thyroid Conditions and Hair Loss 

Severe thyroid disease (e.g., hypothyroidism, hyperthyroidism) can lead to hair loss. Usually, the baldness is diffuse, including the entire scalp area rather than specific spots. 

Additionally, the hair appears uniformly sparse. The treatment of the underlying thyroid disease is generally sufficient to reverse hair loss; however, it may take months before any results are apparent.

 

Scarring Alopecia

Scarring alopecia is a form of hair loss that presents with scarring in the scalp. 

Common causes of scarring alopecia include rare autoimmune diseases that trigger inflammation and collagen deposition in the scalp, which replaces normal tissues with granulation tissue, preventing the growth of new hair cells.

Unfortunately, this type of hair loss is often irreversible.

 

Non-Scarring Alopecia

Non-scarring alopecia is a form of hair loss that does not present with any scarring. Your doctor may identify inflammation and irritation of the scalp but no significant scarring.

 

Lupus

Lupus is an autoimmune, inflammatory condition that affects several organs. When the inflammation spreads to the scalp, you might develop hair loss.

Note that lupus is significantly more common in women relative to men.

 

Medications

A guy choosing from different hats, flat style.
Cholesterol drugs

Cholesterol drugs belong to a family known as statins, which can lead to hair loss when used for prolonged periods.

Drugs such as atorvastatin and simvastatin are well-documented to cause hair loss. However, the newer generation of statins (e.g., rosuvastatin) does not seem to cause this side effect.

 

Anticoagulants

The most common drug in this category is warfarin, which is used as a prophylactic and therapeutic agent to manage patients with a high risk of clot formation.

Unfortunately, some patients taking warfarin reported hair loss, but we still don’t have a clear understanding of the underlying mechanism.

 

Psoriasis medication

Psoriasis is a chronic medical condition characterized by recurrent shedding of the skin due to inappropriate regeneration.

Treating psoriasis with a drug, such as Acitretin (Soriatane), could cause hair loss.

 

Antihypertensive drugs

There are many classes of drugs used to manage chronic high blood pressure. However, ACE inhibitors are notoriously known to cause hair loss.

Note that the incidence of this side effect is extremely rare, with an incidence of 1%.

 

Steroids

Since androgenetic alopecia is the result of high levels of dihydrotestosterone (DHT) in the bloodstream, it would make sense that taking exogenous steroids (testosterone and progesterone) can trigger this condition.

 

COVID-19 hair shedding

If you are seeing falling hair during the pandemic or after you are recovering from the virus, it can be a result of stress, illness or fever. Don’t worry though, it’s most likely temporary and your hair will return to its glory days. It’s not hair loss, it’s hair shedding.

 

Rare Causes of Hair Loss

Elderly woman in a park, happy, flat style.

These are causes that come at the bottom of your doctor’s differential diagnoses:

  • Surgery

  • General anesthesia

  • A change in medication

  • Childbirth

  • Malnutrition

  • Age

  • Overstyling

  • A high fever

  • Flu

  • Severe anemia

 

CHAPTER 3. Hair Loss Signs and Symptoms

Woman walking in park, losing hair, hair on hand, flat style.

As we mentioned above, hair loss presents with a variety of signs that could arise early or later in the process. Here are the common signs of hair loss:

Receding hairline

The most typical pattern of hair loss in men starts at the hairline. 

Your hair begins to thin at the front and temples of your hairline. Over time, hair loss spreads further until you are left with a horseshoe shape on your forehead.

Read more:

Mature Hairline vs Receding Hairline

Thinning of the crown area

This is another common sign that indicates a type of alopecia. Thinning that occurs in the crown area of your head is typically the first place that makes people notice hair loss.

You see, balding affects the head in a pattern-like structure. For this reason, thinning of the crown area is generally common among all men who experience hair loss.

 

Curly hair

Unlike the two signs listed above, curly hair is not constant among all patients with male pattern baldness. However, when your hair begins to become curly, it might be an early sign that you have a form of alopecia.

Most, curly hair starts at the neck region and over the years. Typically, you will see this sign as the crown area starts to thin.

 

Loss of hair on the top

Losing hair on the top of your head is another classic sign that you are dealing with male pattern baldness.

Unfortunately, several men who deal with this type of baldness end up with significant hair loss on the top portion of their heads. 

Note that some people experience hair loss in specific patches, which could suggest another problem (e.g., infection).

 

Age-related hair thinning

Elderly man looking solutions on phone to fix hair loss, flat style.

As we age, our hair naturally gets thinner.

For this reason, you should take preventive measures to slow down this process and maintain the integrity of your hair.

You also be wary that rapid-paced hair loss is not a sign of age-related hair thinning. This could be an early presentation of alopecia.

 

Wider partings

When your partings start to get wider, it is a sign of hair loss.

This sign is particularly useful for individuals who may not notice that their hair is thinning. 

Therefore, if your hair is thinning out where you part it, you should consider consulting with your doctor for further investigation.

 

Dandruff

While many people believe dandruff formation is a normal process that occurs in everyone, this is not true.

Dandruff is a common sign that something abnormal is going on your scalp. A prevalent condition that causes dandruff is known as seborrheic dermatitis, which is a type of eczema.

Fortunately, this condition does not typically cause male pattern baldness; however, it is better to consult your doctor if you have dandruff, especially when it occurs suddenly.

 

Head Sensitivity

Since hair acts as a heat insulator, you can test for male pattern baldness if you develop unusual sensations in hot or cold weather.

For instance, some people may not feel extreme heat in their heads despite the hot weather. If this is the case for you, your hair might be thinning.

Similarly, if you start dealing with more sunburns than usual, it may indicate significant hair loss, which removes the protective layer from your scalp – your hair.

 

Alopecia areata

Unlike androgenetic alopecia, this type of hair loss presents with patchy hair loss. Coin-sized patches of hair begin to fall out from the scalp. However, any site of hair growth could be subject to hair loss, including the beard and eyelashes.

Some patients with alopecia areata report itching or a burning sensation in the area before hair loss occurs. Subsequently, the loss of hair could be sudden (i.e., acute), developing in just a few days, or subacute (i.e., a few weeks).

In this condition, the hair follicles do not get destroyed, which allows for their regrowth if the inflammation dampens. Moreover, people who undergo a patchy pattern of hair loss will fully recover without the need for any treatment.

Woman choosing from different combs style.

With that said, 30% of patients with alopecia areata develop an extensive form of hair loss or a continuous cycle of hair loss and recovery. According to reports, 50% of individuals with alopecia areata recover within one year. Finally, 10% of patients will develop a severe form of hair loss known as alopecia totalis or universalis, which translates into complete baldness.

Interestingly, some people with alopecia areata develop signs in their fingernails and toenails before any changes occur in their scalp.

Here are the common signs to be aware of:

  • White spots and lines in the nails

  • Roughness of the nails

  • Nails lose their shine

  • Thinning and splitting of the nails

Other clinical signs of alopecia areata include:

  • Exclamation mark hairs – this is a classic sign of alopecia areata that occurs when a few short hairs grow in and around the edges of the bald spots.

  • Cadaver hairs – when the hair follicle is growing inside the epidermis (i.e., the most superficial layer of the skin), it breaks before reaching the surface.

  • White hair – areas affected by hair loss often undergo depigmentation, where hair appears white.

 

When To See A Doctor?

Woman heat styling, straightening hair, flat style.

Seeing a doctor after noticing that your hair is thinning is crucial to get the appropriate diagnosis and management plan. 

In some cases, the cause of hair loss is reversible with topical or oral drugs, preventing extensive forms of hair loss that can only be treated with hair graft.

Additionally, the Genetics Home Reference linked hair loss to diabetes, obesity, prostate cancer, and high blood pressure. In other words, hair loss might be an early sign that you have a serious health problem.

Visiting your doctor will also identify hair loss that occurs after a major surgical procedure or severe illness, a side effect of certain drugs, fungal infections, and thyroid disease.

If you are concerned about some underlying diseases that are triggering your hair loss, you should see a doctor.

How Much Do You Pay For A Visit?

How Do Doctors Diagnose?

The diagnosis of hair loss depends on the form you have.

For instance, the diagnosis of alopecia areata is fairly easy and mainly focuses on presenting signs. Your doctor will start by assessing the degree of hair loss, then proceed to examine the hair follicles under the microscope (i.e., dermoscopy).

For complicated cases where the diagnosis is still unclear, a skin biopsy might be appropriate. Moreover, blood tests allow for the screening of autoimmune diseases and other systemic ailments.

Fortunately, the highly specific pattern of hair loss seen in alopecia areata makes the diagnosis quick and straightforward.

 

What Happens At Your Appointment?

During a hair loss consultation, your doctor will ask you questions about your medical history and the drugs/supplements you are currently taking. 

After registering your age, weight, and measuring your vitals (e.g., heart rate, blood pressure), you can expect the following questions:

  • General health – expect your doctor to ask you questions about your health and whether you have any concurrent medical conditions (e.g., diabetes, thyroid disease, high blood pressure).

  • The timeline of your hair loss – your doctor will ask you about the progression of your hair loss. Did it occur over a short period of time? Did it take too long? Have you tried anything to resolve the issue?

  • Other concurrent symptoms – besides hair loss, your physician will inquire about other symptoms without explanation (e.g., tiredness, palpitations, tiredness).

  • Recent history of your health – asking you about recent infections, surgeries, acute illnesses will aid in diagnosing the underlying trigger of your hair loss.

  • Medications – listing the medications you are taking or took recently is also important since some drugs cause hair loss. To be prepared, make sure to write all the drugs you are taking on a piece of paper or your phone before visiting the doctor.

  • Supplements – along the line of pharmacological drugs, your doctor will ask about whether you’re taking any supplements (e.g., vitamins, minerals, herbs, pills). You see, taking too much of certain compounds can precipitate hair loss.

  • Diet – the type of food you eat could also be a lead to what is triggering your hair loss.

  • Stress – when your doctor asks you about whether you are stressed, answer honestly. This trigger is often missed by doctors despite being a major trigger of hair loss.

  • Family History – knowing whether any family member had a similar condition is crucial for diagnosing certain autoimmune diseases (e.g., alopecia areata).

The next step to expect is a physical examination, which includes your scalp, hair follicle, nails, and skin. As we mentioned above, dermoscopy may be useful in diagnosing some causes of hair loss.

Finally, your doctor may order a few blood tests to rule out some diagnoses. If you recently had any blood tests, make sure to bring a copy with you, even if there is no abnormality (it will help out in ruling out diagnoses).

In general, this what occurs when you consult a doctor about hair loss.

Note that you should be forthcoming during hair loss consultation to make the diagnosis easier for your doctor and help him/her choose the right therapeutic plan.

Woman checking out the different doctors, flat style.

 

Before visiting a doctor, you need to know which specialties that treat hair loss.

For basic forms of hair loss, you can visit a family physician (i.e., primary care physician) or an internist. If your hair loss is the result of reproductive system abnormalities (e.g., polycystic ovary syndrome), consulting a gynecologist is most appropriate.

For all forms of hair loss, you can visit a dermatologist – a medical specialist in skin, hair, and nails. Dermatologists provide advanced diagnostic tools and management plants for hair thinning and alopecia.

 

CHAPTER 4. How to Treat Hair Loss?

Man walking, searching how to treat hair loss

Your hair loss is a problem that has a multitude of impact on your quality of life. In this chapter, you will find out how exactly do professionals treat it.

Do You Need To Treat It?

Hair loss is a common trigger of psychological problems, especially in susceptible individuals (e.g., young adults, females).

Additionally, some causes of hair loss are reversible and only require the appropriate medical therapy to be resolved. Therefore, it would be a waste not to explore your options to see whether you can reverse hair loss.

In some cases, hair loss might just be a sign that something is not working right. For instance, when you are dealing with thyroid disease, hair loss may be a sign of advanced deterioration. In this scenario, treating hair loss will focus on addressing the hormonal imbalance of your thyroid.

A comprehensive review of your general well-being will allow the doctor to explore any potential diseases you might have, as well as their impact on your integumentary system (e.g., skin, hair, nails).

The next few sections will cover the available treatments for hair loss, which allows you to explore all your options.

 

Cosmetic Treatments

A woman thinking which wig to use, flat style.

In this category of treatment, the goal is to improve your appearance without actually treating the underlying condition.

 

1. Hair-Fiber Powders

Hair fiber powders are made using a small number of keratin fibers charged with electrostatic energy. As a result, these fibers attach to existing hair follicles, which conceals areas of severe hair loss.

Overall, hair fiber powders give your hair a fuller look. If you learn how to apply this product properly, it may even go unnoticed under good lighting conditions.

Note that people who suffer from diffuse hair loss may not benefit from this product since its mechanism of action requires existing hair follicles.

 

2. Synthetic Wigs

Synthetic wigs are a viable solution for individuals with severe hair loss. There are several types of synthetic wigs that suit different individuals.

Make sure to choose the one that matches your hair color and skin complexion.

 

3. Real-hair Wigs

As the name implies, real-hair wigs are made using real human hair to give you a natural look. Be sure to look for reputable brands of real-hair wigs to avoid scammers.

 

Medical Treatments

9 different women hairstyles in flat style.

1. Finasteride

Finasteride is a prescription drug used to treat hair loss.

Mechanism of action

Finasteride works by decreasing the amount of the hormone dihydrotestosterone (DHT), which is responsible for androgenetic alopecia.

Dosage
  • Form: oral tablet

  • Strengths: 1 mg

  • Brand: Propecia

  • Typical dosage: 1 mg per day

 

2. Minoxidil

Minoxidil is another prescription drug that can comes as an oral tablet. Besides treating high blood pressure, minoxidil is approved by the United States Food and Drug Administration (FDA) as a treatment of hair loss.

Mechanism of action

Minoxidil expands the diameter of peripheral blood vessels, which improves the irrigation of hair follicles and promotes their regrowth.

Dosage
  • Generic: Minoxidil

  • Form: oral tablet

  • Strengths: 2.5 mg and 10 mg

 

3. Spironolactone (Carospir, Aldactone)

Spironolactone is a diuretic that treats fluid retention and high blood pressure.

In recent years, doctors started using this drug to treat female pattern hair loss induced by androgenetic alopecia.

This drug is second-line therapy when minoxidil does not work.

Mechanism of action

Spironolactone slows down the production of androgens, which later turn into DHT – the primary hormone that triggers androgenetic alopecia.

In one study, researchers found that 75% of participants with female pattern hair loss reported an improvement in their hair loss after taking this drug.

Dosage

For hair loss, 100–200 milligrams are appropriate. However, your doctor may start you on 25 mg to lower the risk of side effects.

 

4. Oral Dutasteride (Avodart)

Dutasteride is a prescription drug that also treats androgenetic alopecia.

Mechanism of action

Dutasteride inhibits the action of a class of enzymes known as 5 alpha-reductase inhibitors.

As a result, the levels of DHT drop in your blood, which improves the signs of hair loss. This drug also helps people with enlarged prostates.

Dosage
  • Generic: Dutasteride

  • Form: oral capsule

  • Strength: 0.5 mg

  • Brand: Avodart

 

5. Drithocreme (Anthralin)

Drithocreme, also called Anthralin, is a drug that treats psoriasis, hair loss, and several other dermatological conditions.

 

6. Diphencyprone

Diphenylcyclopropenone (DPCP) is a new agent used by some centers of dermatology to treat alopecia areata. It is made up of acetone and has a shelf-life of about 6 months.

Mechanism of action

The application of diphenylcyclopropenone to the skin redirects autoimmune attacks on the hair follicles. Consequently, your hair will be able to regrow more efficiently.

 

7. Janus Kinase Inhibitors

Janus kinase (JAK) inhibitors have a clear effect on alopecia areata.

The mechanisms involved in this process are still unclear. However, several scientific studies confirmed their positive effects on hair loss.

 

8. Corticosteroid Injections and creams

Corticosteroids are a class of drugs that has anti-inflammatory and immune-regulating properties. These drugs may be beneficial for some cases of hair loss, especially the ones that involve active inflammation of autoimmune reactions (e.g., alopecia areata).

 

9. Immunotherapy

Contact immunotherapy is the most effective way to treat alopecia areata. The most common drug used is diphenylcyclopropenone (DPCP), which we detailed above.

 

10. Laser Therapy

Laser therapy (i.e., light therapy) shoots photons into the scalp tissues, which encourage hair cells to grow. It is safe, tolerable, and less invasive than most hair loss treatments.

 

11. Tattooing

Tattooing your scalp might be helpful to add a personal touch to your bald head.

If you are a fan of tattoos, this option may be for you.

 

12. Hair Transplant

Hair transplant is a very effective (and expensive) procedure that focuses on grafting new hair follicles into your scalp.

Depending on your preferences and budget, you can opt for artificial or real hair to graft.

 

13. Scalp Reduction Surgery

Scalp reduction surgery is a procedure that addresses hair loss in men and women. It involves moving the skin with normal hair growth to bald areas on your scalp.

For instance, if the skin on the sides of your head gets pulled up and stitched together, the bald top of your head will be covered with hair.

 

14. Hair Growth Solutions

There are several hair growth solutions on the market, which use vitamins, minerals, and other hair-promoting substances.

Before trying these solutions, you should speak with your dermatologist.

 

15. Styling Products

The following products may be beneficial for people who suffer from hair thinning:

  • Women's Rogaine 5% Minoxidil Foam for Hair Regrowth
  • HairClub EXT Moisturizing Conditioner
  • Kristin Ess Sea Salt Air Dry Mousse
  • Hairmax Ultima 12 Laser Comb

 

16. Shave Your Head (Yes, really!)

A woman using with luscious hair picking different hats, flat style.

Shaving your head might be a good choice, especially if you are dealing with male or female pattern baldness.

Having a shaved head is esthetically much more appealing than having several patches of baldness spread around your head.

 

17. Consult A Board-Certified Dermatologist

Consulting with a board-certified dermatologist is the best approach to treat hair loss. Your doctor will take your medical history, perform a physical examination, and order some tests.

Learn more about hair loss consultation by reading chapter 3.

 

Home Remedies

1. Supplements

Nutritional deficiencies are common causes of hair loss. However, and before you start taking supplements arbitrarily, you may want to speak with your doctor or nutritionist to get some blood tests. This will allow you to make evidence-based decisions and treat your nutritional deficiencies more effectively.

 

2. Exercise!

A woman exercising, jogging in a forest with breezing wind, flat style.

While extreme physical activity may trigger reversible hair loss, experts recommend getting regular exercise to balance your hormones and keep homeostasis checked.

 

3. Essential Oils

Some evidence suggests that applying certain essential oils may help moisturize your scalp and nourish hair follicles.

The research in this field is preliminary and more clinical studies are necessary.

 

4. Garlic

In one study, researchers found that garlic protects skin cells from the damage of ultraviolet light. Another study found that applying garlic gel to bald spots on the scalp may improve alopecia areata. However, the evidence of this study is anecdotal.

More research is warranted.

 

5. Onion Juice

Adding onion juice to the hair and scalp provides them with sulfur, which supports strong and thick hair. Researchers believe that the mechanism of action involves an increase in blood flow to the hair follicles, which promotes their regrowth.

 

6. Saw Palmetto

Studies that inspected the effects of saw palmetto on hair loss are scarce but promising. It appears that saw palmetto blocks the activity of 5-alpha-reductase, which is the enzyme that converts testosterone to DHT. This may help patients with androgenetic alopecia.

 

7. Apple Cider Vinegar

Apple cider vinegar may help with hair loss by warding off bacteria and regulating pH levels. However, these effects may be limited to certain types of hair loss.

 

8. Coconut Oil

Coconut oils work by moisturizing your hair and removing any toxin buildups from the follicles. This oil penetrates underneath the scalp to reaches the shaft of the follicles.

 

9. Evening Primrose Oil

Evening primrose oil may be an effective choice in treating hair loss. It is rich in omega-6 fatty acids, which stimulate hair growth and prevent hormonal imbalances.

 

10. Pumpkin Seed Oil

In 2014, scientists released a large study that examined the effects of pumpkin seed oil on hair loss. The results of the study demonstrated that participants who took the supplements had 30% more hair growth relative to the placebo group.

 

Emotional Help

1. Therapy

As we mentioned at the start of this chapter, hair loss can be a traumatizing event for certain individuals. If you are dealing with a lack of confidence, distorted body image, or just overwhelmed with this issue, you may need to consult with a certified psychologist to get help.

Your therapist will put things into perspective and help you get over the negative thoughts associated with hair loss and physical appearance.

 

2. Support Groups

Three guys using laptop, yellow, flat style, support group.

Similar to other conditions, you will find support groups for people who suffer from hair loss. Sharing experiences and exchanging helpful tips with others will help you get over your own trouble.

The best way to find these groups is by searching online or asking your local doctor.

 

CHAPTER 5. How to Choose The Right Product For You

A woman showering, happy, flat style.

After being diagnosed with hair loss, it is time to start looking for products that prevent further thinning of your hair and potentially reverse the process.

However, this task is easier said than done. You need to be aware of several aspects of how hair grows and what it needs to accomplish that. 

The good news is that after reading the chapters above, you are equipped with the necessary knowledge about hair growth and alopecia.

For now, let us explore the ingredients you should be looking for in a product and the ones you need to avoid to promote hair growth.

 

What ingredients to look for in a hair growth product?

Caffeine-infused products

According to a 2014 study, researchers found that caffeine promotes hair growth.

The study concluded that caffeine stimulates hair growth at the molecular and cellular levels in both genders. 

 

Essential oils

Essential oils are not just good-smelling additives. Recent evidence suggests that these oils can promote hair growth.

In one study, participants who received a daily dose of pumpkin seed oil (400 milligrams) led to significant hair growth in men. The study lasted for 24 weeks, with hair growth reaching up to 40% relative to baseline.

Another study inspected the effects of saline, jojoba oil, 3% minoxidil, and 3% peppermint oil on four groups of mice.

The group that received peppermint oil showed a significant increase in dermal thickness, follicle depth, and follicle number.

 

Vitamins and minerals

Since hair grows similar to other tissues, it makes sense that it requires vitamins, minerals, and fatty acids for optimal development.

Hair growth vitamins target all hair on your body, not specifically your hair.

If you are going to buy a hair loss product, you need to look for the following nutrients:

  • Vitamin B2

  • Vitamin C

  • Vitamin D

  • Vitamin E

  • Omega-3 and omega-6

  • Zinc

  • Iron

In one study, scientists showed that the intake of omega-3 and omega-6 fatty acids for 6 months helps protect against hair loss.

 

What ingredients to avoid in a hair growth product?

Just like you need to look for the right ingredients for hair growth, you also need to be wary of the ingredients that exacerbate this condition.

As we discussed in previous chapters, several causes drive hair loss. Therefore, every ingredient we are going to list worsens hair loss in a different mechanism.

For instance, diethanolamine (DEA) triggers inflammation and severe immune reactions in the scalp, which is the last thing you want when you’ve been diagnosed with alopecia areata.

Here are the ingredients you need to avoid when buying a hair loss product:

  • Sodium Lauryl Sulfate

  • Parabens

  • Propylene Glycol

  • Imidazolidinyl Urea

  • Sodium Chloride

  • Diethanolamine (DEA)

  • Fragrance

Choosing the right product for hair loss is a challenging task for laypersons who do not possess the necessary knowledge about hair growth and anti-hair loss products.

Fortunately, you have become an expert in the field of hair loss, which allows you to confidently choose the right products that meet your needs.

 

CHAPTER 6. How to Prevent Hair Loss (Once And For All)

Guy choosing a hair style, a hair care product looking at laptop, flat style.

Throughout this guide, you probably realized how difficult it is to manage hair loss.

Can you prevent hair loss?

The variety of underlying mechanisms and their complex and poorly understood pathophysiology make this task even more challenging.

For this reason, many experts switched their focus to finding effective ways to prevent hair loss.

The collection of preventive measures take into account the most common hair loss etiologies; however, you should keep in mind that some causes characterized by immune dysfunction (e.g., alopecia areata) are very challenging to prevent.

With that being said, here are the most effective ways to prevent hair loss:

 

1. Go natural

A woman walking under the sun, in park, happy, flat style.

Going natural with hair loss is never the wrong answer. Choose the products that contain natural ingredients to prevent your hair from falling.

Learn more about this by reading the previous chapter.

 

2. Watch the chemicals

In the previous chapter, we listed some chemicals that precipitate the hair loss. You need to be very careful before buying hair products that contain shady ingredients.

 

3. Drugs that can cause hair loss

Several pharmacological drugs trigger inflammation in the scalp, which leads to hair loss. However, each drug has a slightly different mechanism.

Here is a list of drugs to keep in mind:

Cholesterol drugs – drugs such as atorvastatin and simvastatin.

Anticoagulants – warfarin.

Psoriasis medication – Acitretin (Soriatane).

Antihypertensive drugs – ACE inhibitors. 

Antacids – histamine receptor blockers (e.g., cimetidine).

Antiarrhythmic drugs – antiarrhythmic drugs entail 5 classes that treat cardiac arrhythmias, such as atrial fibrillation and atrial flutter. One classic drug that causes hair loss is amiodarone, which belongs to the third class of antiarrhythmics. 

Steroids – exogenous steroids (testosterone and progesterone).

 

4. Quit the hot stuff

The overuse of hot styling tools (e.g., hairdryer, curling wand) makes your hair dry. As a result, it will become prone to thinning and falling.

 

5. If you have to, use sponge rollers!

A woman at the hairdresser, barber, using sponge roller, flat style.

 

You have that one date you need to prepare for? Don’t worry, you can still get curls! You should use sponge rollers as it does not create a lot of stress on your hair.

However, using sponge rollers depletes the oil and moisture from your hair. Sponge rollers also lead to traction alopecia, where the hair follicles themselves become damaged. Avoid this by not wrapping your hair too tightly around the rollers. Also, do not use sponge rollers daily.

 

6. Stop dyeing your hair!

A guy dyeing his hair, painting his head of hair red, flat style.

While dyeing does not inhibit hair growth, it can damage color-treated hair. In other words, the hair follicle sitting underneath the scalp cannot be damaged by dyeing your hair since the product does not reach that depth. However, hair shedding increases after dyeing your hair.

Before your dye your hair, you may want to speak with your dermatologist to learn about the best practices.

 

7. No more tight braids

Tight braids lead to traction alopecia, which is the result of repeated hair pulling. Besides braids, a tight ponytail or bun can also lead to this condition.

For this reason, you should avoid anything that severely tightens your hair and causes traction alopecia.

 

8. Pick the right shampoo

Every shampoo has unique characteristics.

Knowing your hair type and the potential deficiencies you are prone to will help you choose the right shampoo for you.

As a general rule of thumb, always opt for shampoos that contain natural ingredients with minimal chemical traces.

To make the best choice, you may need to speak with your dermatologist.

 

9. Brush properly

A woman brushing her hair in the bathroom, flat style.

 Brushing your hair frequently can lead to hair loss. This is exacerbated if you are brushing your hair the wrong way.

In one study, researchers examined the effects of brushing on hair loss for 4 weeks. Participants were divided into several groups, where each group brushes their hair in different frequencies.

After 4 weeks, they found that brushing less frequently reduces hair loss.

You always need to be gentle since the scalp is a sensitive region that is susceptible to developing inflammation and irritation after minor injuries.

Monica Davis, a professional hairstylist with 20 years experience and the founder of MyStraightener wrote:

As a hairstylist, I highly recommend brushing only for detangling and styling purposes. However, in both cases, you shouldn’t start brushing without proper hair preparation. You must finish every hair washing with a hair conditioner that matches your hair type and apply serum or hair oil with a thermal protector before drying and styling your hair. Between the washing, you can apply a spray for brushing simplification to reduce hair damage while detangling.

10. Maintain hair hygiene

A guy washing his hair, bubbly, focused, blue, flat style.

Washing your hair regularly with the right product is indispensable to prevent hair loss. When you wash your hair, you will stimulate the scalp, which boosts the process of hair follicle growth.

However, overusing chemicals on your hair to be extra hygienic can be counterproductive.

 

11. Balanced nutrition intake

Eating a balanced diet is a great way to prevent hair loss.

In one study, researchers found that consuming raw vegetables and fresh herbs (e.g., the Mediterranean diet) reduces the risk of androgenetic alopecia.

Foods such as parsley, basil, and salad greens yielded the best results.

Since the hair follicles are made of a protein known as keratin, it should not come as a surprise that including protein in your diet will prevent hair loss.

Finally, adding a multivitamin to the mix promotes hair growth and prevents follicular thinning. Your multivitamin should contain vitamins A, B, C, D, iron, zinc, and selenium.

"To prevent hair loss, it’s important to be mindful of how your supplements and diet can impact each other. For instance, if you load up your plate with vitamin A-rich foods, like sweet potatoes, kale, or spinach, and are also taking a supplement heavy in vitamin A, you may be doing more damage than good. 

 

While it’s nearly impossible to get too much vitamin A from food alone, it’s much easier to overdo it with supplements, and this can be damaging to your hair. Too much vitamin A over a long period of time can actually cause hair loss. As with all things, finding the right balance is key.” - BeautyMag.com doctor."

 

12. Treat underlying conditions

Guy holding a comb, looking at himself in the mirror, flat style.

If your hair loss is the result of an underlying medical condition, treating the disease will most likely reverse hair loss.

However, you may need to act quickly before hair loss becomes irreversible.

 

1. Thyroid Disease

High or low levels of thyroid hormones in the blood (i.e., hyperthyroidism, hypothyroidism) are notoriously known to alter the normal growth of hair follicles.

Regulating your thyroid hormones by taking drugs (prescribed by your primary care physician or endocrinologist) will allow your hair to grow again.

Note that it may take several months to experience a full recovery.

 

2. Anemia

Anemia presents with several signs that affect the integumentary system (skin, hair, nails). In the beginning, researchers theorized that the iron deficiency that triggers anemia is also responsible for hair loss. However, there is no solid evidence to support this theory.

Treating anemia with iron supplementation (if it’s the result of iron deficiency) is enough to reverse hair loss.

 

3. Hormonal Imbalances

Similar to thyroid disease, other conditions that alter the normal balance of steroid hormones can lead to hair loss. 

Fortunately, hormone replacement therapy and other treatment modalities improved the prognosis (i.e., outcome) of these patients.

 

CHAPTER 7. Ask A Dermatologist Anything

Two woman talking with each other, standing, flat style.

You will find the answers to 200+ community questions in this chapter. Tip: Use Ctrl+F to find your area of interest!



General:

  1. Why do I get acne from having long hair?

The length of the hair does not have a direct role in causing acne. Although, having long hair may make it difficult for some people to wash their hair regularly, causing it to become oily. The sebum may clog your pores and lead to the development of acne.

  1. How often should I cut my hair?

You should get a haircut every 6 to 8 weeks for shorter cuts. However, if you are growing your hair long, you should get a haircut after 10 to 12 weeks to prevent the damage from split ends.

  1. Is it risky to buy medication from a wholesaler for cheaper?

I don’t believe it is legal or possible for an individual to buy directly from manufacturers. Only registered pharmacies can buy medicine from wholesale.

  1. Is there a difference in hair between different ethnicity? If yes, can you explain the difference between them?

Yes, there are differences in hairs from different ethnicities. We divide hair types broadly into Caucasian, Asian and African hair. The Asian hair follicles are round to oval in shape which produces straight or slightly wavy hair.

The Caucasian hair follicles are oval-shaped producing straight to curly hair. The African hair follicles are elliptical in shape producing curly or tightly coiled hair. 

  1. Are there any common hair myths you'd like to bust?

A few of the many myths about hair are:

  1. Stress can turn hair grey.

  2. Having dandruff signifies a dry scalp.

  3. Black hair is stronger than blonde hair.

  4. Natural oils are good for hair.

  5. Split ends can be repaired without a haircut.

6. Is hair color a genetic mutation?

Hair color is due to the amount of a pigment called melanin in the hair. The type and amount of melanin in hair is determined by many genes, but it is not a genetic mutation. Genetic mutation is a permanent alteration in the normal DNA sequence causing a genetic disorder/disease.

  1. Why does gray/white hair tend to appear on the temples first?

There is no scientific explanation to this particular question. However, there are many theories explaining the reasons why one feels that hair at the temples tend to become grey earlier.

Genetics is the most appropriate explanation of why the hair at the temples becomes grey first. The genetics of the hair on top of the head is different to that of the sides and back of the head.

Hair pigment loses its ability after 4 to 5 hair cycles at which point greying sets in. The hair at the temples has rapid hair cycles as compared to the rest of the hair thus rapid greying.

  1. Thinning and graying hair during weight loss - is it ever worth seeing someone over?

Yes, you should make an appointment with a board certified dermatologist who can diagnose the root cause of your weight loss (any underlying disease), prescribe the right kind of supplements and in most cases treat the hair loss.

  1. How are hair thickness and hair density determined? Is it all genetic or are there certain lifestyle factors that influence them?

Hair growth and density in every individual are determined by genetics, hormones, and environmental causes. The rate at which the hair grows in each person is different. Hair is a derivative of the epidermis and consists of two distinct parts: the follicle and the hair shaft.

The follicle is the essential unit for the generation of hair. The hair follicle has a continuous growth and rest sequence called the hair cycle. The duration of growth and rest cycles is coordinated by many endocrines, vascular and neural stimuli and depends not only on the localization of the hair but also on various factors, like age and nutritional habits.

  1. Is there anything a person can do to increase her hair thickness or hair density (at-home care, supplements, any particular hair products)?

Hair growth and density in every individual are determined by genetics, hormones, and environmental causes. The hair follicle has a continuous growth and rest sequence called the hair cycle.

The duration of growth and rest cycles are coordinated by many endocrines, vascular and neural stimuli as well as age, nutrition, and lifestyle. There are a few changes that one can make to their lifestyle to boost hair growth. These are:

  • A balanced diet including fruits, green leafy vegetables, protein and lots of water.

  • Supplements containing biotin, zinc, iron and other vitamins.

  • Sulfate, paraben, and silicone-free hair product.

  • Condition hair after every wash to lock in the moisture and keep hair protected and healthy.

  • Use a good quality leave-in hair serum.

  • Reduced styling that uses heat.

  • Hair cut/trimming after every 10 to 12 weeks to get rid of damage from split ends.

  • Avoid under or over-washing hair. Over-washing and use of excessive hair product strips off the natural oils of the scalp making the hair dry, brittle, and weak. Under washing can cause a build-up of sebum and hair product making the scalp greasy, flaky, and itchy.

  1. What's the best way to use essential oil?

Essential oils are extracted from their plants using steam distillation, water distillation or cold pressing. They are used to ease stress, anxiety, pain and help in sleeping at night. The beneficial compounds in essential oils are delivered in three ways: inhalation, topical application and ingestion.

  • Inhalation is the safest and the best way of using essential oils. These volatile compounds are inhaled by using a drop of oil on a clean cloth or is diffused via a diffuser. When inhaled molecules are believed to reach the bloodstream through the lungs and show its beneficial effects.

  • Topical application: Essential oils can be applied to the skin directly to treat pain. It is also used for its antiseptic and anti-inflammatory properties. Essential oils can cause irritation of the skin, therefore they should be diluted with a carrier oil before use.

  • Ingestion: While some essential oils can be ingested in small doses as medication, others are potentially poisonous and should never be ingested.

 

Hair Loss:

A guy getting haircut at the barbershop, flat style.

 

  1. What are the differences between male and female hair loss?

Androgenic alopecia occurs more commonly in males than in females. The classic male pattern hair loss starts above the temples and at the vertex leaving a characteristic M-shaped hairline.

It rarely progresses to complete baldness and leaves hair at the sides and back of the head. It is due to a combination of genetics and hormones.

The female pattern hair loss causes diffuse thinning of hair without a recession of the hairline. 

  1. How do hair implants work? Is it like re-sodding a lawn?

A hair transplant is a surgical technique in which hair follicles are removed from a part that is resistant to balding like the back of the head, and are transplanted to a bald spot. It is mainly used to treat androgenic alopecia, also called male pattern baldness.

  1. How effective is minoxidil in long-term hair-loss prevention? Does a chemical or physical castration forgo the need to still take minoxidil?

Both have different mechanisms of action and a physical or chemical castration does not forgo the need for topical minoxidil. Minoxidil is the only FDA approved topical treatment to prevent hair loss.

If you are in earlier stages of androgenic alopecia/male pattern hair loss, minoxidil can help regrow your hair and prevent further loss as it prolongs the growth phase of the hair cycle by increasing the blood flow to hair follicles with its vasodilator effect.

After castration, testosterone is not produced which reduces the loss of hair if done in the early stages of male pattern baldness.

  1. Would weekly hair masks reduce hair loss as it relates to weight loss?

There is no scientific explanation for hair masks to prevent hair loss. Hair loss after weight loss is called Telogen effluvium. It is a reversible process and the hair will start to regrow if you resume eating the right amount and kind of food.

Make sure your diet includes lean protein, whole grains, fruits, and vegetables. If your weight loss is significant or sudden, please consult your physician.

  1. Will a dry scalp result in hair thinning?

Dry hair is brittle which easily breaks and splits. If you have dandruff, continuous scratching of the scalp will lead to damaged hair follicles that cause the hair to fall eventually. However, it is reversible if the cause is found and treated.

  1. Are they willing to prescribe stuff like 5mg finasteride, dutasteride, or Loniten (minoxidil) if a patient knows what it can lead to but still asks for it?

Yes, finasteride can be used for hair loss. Finasteride works by specifically lowering the levels of DHT (dihydrotestosterone) in the scalp, thus helping to reverse the balding process. It does not affect hair on other parts of the body. Men with mild to moderate, but not complete, hair loss can expect to benefit from the use of finasteride.

In women who were studied, it was not effective in the treatment of hair loss (androgenetic alopecia). Similarly dutasteride also works by same mechanism as finasteride. Minoxidil, applied topically, is widely used for the treatment of hair loss.

It is effective in helping promote hair growth in people with androgenic alopecia regardless of sex. Minoxidil must be used indefinitely for continued support of existing hair follicles and the maintenance of any experienced hair regrowth.

  1. What is the generally the best course of treatment, does it differ based on skin type or stage of hair loss?

The best course of treatment differs from patient to patient depending upon the stage and type of hair loss and patients expectations from the treatment. Usually Finasteride, dutasteride and minoxidil are effective up to stage three of Norwood scale that is loss of frontal hair mostly.

  1. How frequently do you see a patient with hair loss?

Hair loss is very common these days I see a lot of patients of hair loss on daily basis. The increased loss of hair can be attributed to our stress full routines and our diet.

  1. Why is not finasteride working for some people and what should be done about it?

Finasteride works only in androgenic alopecia commonly known as male type baldness. The patient should be evaluated for the type of hair loss and also for the stage of hair loss as Finasteride is not that effective in stage four to six on Norwood scale. In such patients other modalities can be used.          

  1. Why is not minoxidil working for some people and what should be done about it?

Minoxidil is useful in mild to moderate hair loss; if the hair loss is severe minoxidil might not work. Minoxidil topical application can also be combined with other agents like Finasteride for better results.        

  1. I’m only 21 and I feel that the hair in the front of my head is thinning. I can’t really cut bangs because it’s quite thin. The annoying thing is that I have A LOT of hair, so it sucks that it isn’t more evenly distributed. I eat biotin daily and I’m not sure if there’s anything else I can do like spray rice water on the area?

Biotin is a good vitamin for hair thinning but it rarely works when used alone. Topical spray of minoxidil 5 % solution should be used with biotin as it has good results for the thinning of the hair.          

  1. Why is my hair falling out? I’m a young female and more than half my hair has fallen out. No specialist I’ve been to have been able to tell me why.

The main causes of hair loss in young female can be:

Hormonal changes and medical conditions: A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems.

Medications and supplements: Hair loss can be a side effect of certain drugs, such as those used for cancer, arthritis, depression, heart problems, gout and high blood pressure.

Radiation therapy to the head: The hair may not grow back the same as it was before.

A very stressful event: Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.

Hairstyles and treatments: Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot-oil hair treatments and permanents also can cause hair to fall out. If scarring occurs, hair loss could be permanent.          

  1. Is Alopecia Universalis reversible?

Alopecia universalis (AU) is an autoimmune condition that causes hair loss. This type of hair loss is unlike other forms of alopecia. Alopecia Universalis causes complete hair loss on your scalp and body. Hair that has already been lost may or may not grow back. It has been estimated that only about 10% of patients experience full recovery.        

  1. How do you reverse Alopecia Universalis?

 The goal of treatment is to slow or stop hair loss. In some cases, treatment can restore hair to affected areas. Because AU is a severe type of alopecia, success rates vary. This condition is classified as an autoimmune disease, so your doctor may recommend corticosteroids to suppress your immune system.

You may also be given topical treatments. Topical immunotherapies stimulate the immune system. Topical diphencyprone produces an allergic reaction to stimulate an immune system response. This is believed to redirect immune system response away from hair follicles.

Both therapies help activate hair follicles and promote hair growth.

  1. What would you prioritize doing to fix hair loss if there’s a limited budget?

The first step to fix hair loss is to improve diet in general, including green leafy vegetables and fruits into your diet can help to fix hair loss. Apart from that taking a good multivitamin can help too. Use hair products that are sulfate and paraben free. Avoid using heat for styling hair.

  1. How do you stop a receding hairline?

To stop a receding hairline different options are available and these include topical minoxidil spray, Finasteride and dutasteride.

Apart from that a good multivitamin specifically biotin can also be used. Hair styling products like gels and creams should be avoided. Green leafy vegetables and fruits should be included into the diet.           

  1. Can the hair follicles that were destroyed by DHT be recovered with medication if the patient is young?

Yes the hair follicles that were destroyed by DHT can be recovered with medications like Finasteride, dutasteride and minoxidil. These medications work by lowering the levels of DHT in the scalp and thus promoting hair growth.

  1. Are there new effective treatments that will be on the market in the next few years?

Yes stem cell therapy is a very promising new therapy for the hair loss, the research till now has provided very promising results regarding the stem cell therapy.         

  1. What routines are good for preventing hair loss?

  • Having a balanced diet that includes green leafy vegetables, fruits and meat and a lot of water.

  • Having supplements that include biotin, zinc, iron and vitamin B complex

  • Using sulphate free shampoos and conditioner

  • Avoiding styling products like gels, creams and sprays

  • Avoid using heat for styling hair

  1. How do I scientifically prevent myself from going BALD?

Well, certain conditions like androgenic alopecia is genetic and is inherited, you can not do anything to prevent it. As other causes of hair loss are concerned like dandruff, poor diet or stress, you can eliminate those factors to prevent you from getting bald.

  1. My dad is bald. Mom's family has luscious hair. My grandma had thick, dark hair up till her late 80s. What are my chances of becoming bald?

Baldness happens because of the genes people inherit from both their mom and dad. Some studies show that 80% of balding is genetic. A key gene can come from a maternal grandpa. But this gene doesn't explain all baldness.

People are just as likely to be bald if their dad or their maternal grandfather is bald. Two new studies have fingered a small region on chromosome 20 called 20p11 as being associated with balding. This sort of thing could explain people who are bald even though their mom's dad still has a full head of hair.

  1. Can eating disorders result in alopecia?

Eating disorders can cause hair loss through the loss of vital nutrients to the scalp. The growth phase of hair growth can be disrupted by a direct lack of nutrients, organ under-performance, or gastric issues. The healthy hair growth cycle is disrupted and ceases to grow effectively.

It may jump to the end of the follicle lifespan where the hairs shed. In this scenario, the hair is falling out faster than it can grow, causing thinning and bald spots.

  1. Some people have recommended yeast infection medication to treat hair loss and to grow back. What are your thoughts?

Yeast infection medications or anti-fungal medications  are only helpful in Tinea capitis (yeast infection of scalp), which occurs mostly in children. Other than this condition yeast infection medications are not useful at all, they can rather damage your liver if used in large quantities.

  1. With scarring alopecia, is it really somewhat reversible with the use of micro-needling?

No. In scarring alopecia there is permanent loss of hair follicle and micro needling will not reverse the condition.

  1. Will hairs that are grown by Microneedling and Minoxidil fall out if one stops Microneedling and uses only Minoxidil?

If the hair are growing with the use of micro needling and minoxidil, after a few sessions of micro needling only minoxidil alone can be used but it depends upon the quality of your hair growth.    

  1. When follicles [in balding regions of scalp] are reactivated as a result of drug treatments, does the initial vellus hair first seen go through a full growth cycle and shed before being replaced by a terminal hair? Or is it the case that what appears as a vellus hair becomes thicker as it grows out to eventually resemble a normal terminal hair?

This question is asked very frequently, and there is no set and stone answer. The vellus hairs will shed and be replaced with a terminal hair and there is no timescale for how long this takes.

It could take 6 weeks, or 6 months even. But when the hairs begin to shed, this is a good sign that new thicker hairs will soon replace them.

  1. What's the best defence for diffuse thinners?

The first step to fix problem of diffuse is to improve diet in general, including green leafy vegetables and fruits into your diet can help to fix hair loss. Apart from that taking a good multivitamin can help too.       

  1. What are the risks of taking finasteride by women premenopause apart from the teratogenicity of a male fetus?

The common side effects of finasteride are

  • decreased sex drive

  • trouble getting or keeping an erection

  • increase in breast size and tenderness

  • skin rash

  • swelling of your lips, tongue, throat, or face

  • depression

  • lumps or pain in your breasts

  • nipple discharge

  1. How to know if I can have good results from a hair transplant?

The results of hair transplant depend upon the quality of hair from your donor area that is the hair which will be transplanted into the recipient area. To know more about results of hair transplant, you should visit a good transplant surgeon.

After proper examination of your scalp, they will be able to tell about your prospects of hair transplant.

  1. What are the recommended Dermapen needle length and techniques to use on a hypertrophic scar on the left cheek under the eye? Can silicone gel be applied immediately after derma needling?

The needle length and the techniques used for hypertrophic scar vary from patient to patient depending upon the severity of scar and the skin type of the patient. You should visit a dermatologist for detailed review.

  1. How do I search for the right dermatologist to get to the root of the cause of my hair loss? I've been to a doctor and went through with PRP but after that disappointing experience, I'm not confident I'll find a quality doctor who's familiar with all the possible treatments and can give me the pros/cons of each.

Well, before going to any dermatologist look up for his/her reviews online by other patients. Almost all of the dermatologists these days have online presence.

Make sure that your dermatologist is board certified. Discuss your concerns, treatment options and ask questions about your condition freely. A good doctor is one who listens to the patient.   

  1. What should the process be? Straight to finasteride/minoxidil or blood tests first?

Finasteride or Minoxidil should only be started by a qualified doctor after detailed examination and blood tests, if required. The blood tests will include baselines, a hormonal profile and PSA (prostate specific antigen).          

  1. Should I consider alternative treatments like LLLT / PRP / etc.?

Before starting any such treatments you should visit a qualified dermatologist. Only after a detailed examination of your scalp he/she will be able to decide what treatment is best for you.       

  1. How to know if I can have good results from a hair transplant?

The results of hair transplant depend upon the quality of hair from your donor area that is the hair which will be transplanted into the recipient area.

To know more about results of hair transplant you should visit a good transplant surgeon after proper examination of your scalp he will be able to tell you about your prospects of hair transplant.      

  1. Is it normal for the scalp to be tender in the area where hair loss is happening?

No, the area of hair loss is not tender. You should look for other causes of inflammation like infection or trauma that can cause tenderness. I would advise a visit to your dermatologist to rule out causes of scarring alopecia.

  1. If shorter hair falling out is normal or an automatic sign of AGA (Androgenetic alopecia)?

Shorter hair falling is normal, usually a healthy person loses about a hundred hairs on daily basis. Androgenic alopecia is a male pattern hair loss that presents as a receding hair line and loss of hair on the vertex.

It is due to a combination of genetics and circulating hormones. Its progression can be slowed down by early treatment with minoxidil and finasteride.

  1. How come so many 1960's hippies are bald today?

Hippies of 1960s today are 60 years of age or more. Androgenic alopecia is a male pattern hair loss that presents as a receding hair line and loss of hair on the vertex.

It is due to a combination of genetics and circulating hormones and can occur in the hippies too. Its progression can be slowed down by early treatment with minoxidil and finasteride. Finasteride received FDA approval in 1998 and minoxidil in 1988 to be used in androgenic alopecia.

  1. Are women not prescribed Finasteride only because it damages a male fetus? If so, would you prescribe Finasteride to a lesbian who is desperate for hair? If no, why not?

Finesteride is contraindicated in female of childbearing age. Apart from foetal side effects, it also has the following side effects which should be kept in mind.

  • decreased sex drive

  • Trouble getting or keeping an erection

  • Increase in breast size and tenderness

  • Skin rash

  • swelling of your lips, tongue, throat, or face

  • Depression

  • Lumps or pain in your breasts

  • Nipple discharge

  1. Is the usage of Fin/ minoxidil safe for 18-year-olds? If not what is the best age to start it?

Finasteride and minoxidil can be used in adults of age 18 or above. The best time to start them depends upon the severity of hair loss.   

  1. What are the safest, proven ways to prevent hair loss besides taking finasteride?

 The safest proven ways to prevent hair loss are:

  • A balanced diet containing fruits, vegetables, protein and water

  • Supplements containing biotin, zinc and other vitamins

  • Hair care products that are sulfate and paraben free

  • Avoid styling hair using heat

  • Avoid over or under washing hair, wash hair 3 to 4 times in a week

  1. Can I use Nizoral once a week long term without any side effects or loss of effectiveness?

Nizoral contains ketoconazole that is used for dandruff. It can be used once weekly for long term without any substantial side effects, though in some people after a prolonged used it becomes less effective at that point another brand can be used.

  1. How do you explain the patterns of hair loss?

In male-pattern hair loss (MPHL), the hair loss typically presents itself as either a receding front hairline, loss of hair on the crown (vertex) of the scalp, or a combination of both. Female-pattern hair loss (FPHL) typically presents as a diffuse thinning of the hair across the entire scalp.  

  1. How to tell TE from AGA from looking? Does the speed that it happens help?

Telogen effluvium is a form of hair loss characterized by hair thinning or an increase in hair shedding. It occurs more often in women and is usually triggered by a disturbance to the hair cycle while Androgenic alopecia is a genetic condition that can affect both men and women.

Men with this condition, called male pattern baldness, can begin suffering hair loss as early as their teens or early 20s. It's characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp. 

  1. Without going straight to minoxidil or finasteride and microblading, what supplements are a must to take before considering something that will affect the hormones?

Supplements that contain biotin, zinc, iron and vitamin B complex have proved to be beneficial in improving overall hair health. However, the treatment of hair loss depends on the type of hair loss and its severity.

  1. Why isn’t there a definitive test to diagnose hair loss?

A dermatologist can help you diagnose or treat hair loss. The doctor will take a medical history, which will include asking about things like:

What medications and/or supplements you take

What type of food you eat (protein is important for hair growth)

What might be going on in your life in terms of stressful situations?

Which family members might have had hair loss?

What kind of hair styles you tend to have and what hair care products and processes you have used

Whether or not you have a habit of pulling your hair out (trichotillomania)

After reviewing this information, the doctor might do or order certain tests, including:

Gentle hair pulling to determine how many hairs come out

Blood tests to test for vitamin and mineral levels (like vitamin D, vitamin B, zinc, and iron), and hormone levels (including thyroid and sex hormones)

Scalp examination under a microscope

Scalp biopsy to remove and examine a very small piece of tissue  

  1. How do I know if it is too late for my traction alopecia to grow back? If there are tiny baby hairs, can they still grow back?

Yes traction alopecia is reversible, if there are tiny hairs they can grow back to normal hair. The following can help in growing hair faster

  • Balanced diet containing fruits, vegetables, protein and water

  • Using a sulphate free shampoo and conditioner

  • Using supplements rich in biotin, zinc, iron and vitamin B complex

  • Avoid styling hair tightly in a ponytail or bun

  • Avoid using heat for styling

  1. If I started with minoxidil and got some results, and then added fin, will finasteride maintain the result I got with min?

If you have male pattern baldness that is androgenic alopecia, Finasteride can produce good results as it acts by decreasing the levels of dihydrotestosterone that is mainly responsible for casing hair loss in androgenic alopecia.

  1. Finasteride has stopped working after nearly 8 years of working. What are my options now?

If Finasteride is no longer working you can go for minoxidil or you can go for a hair transplant. A good dermatologist or a hair transplant surgeon can help you better to make a decision by taking a detailed history and performing a scalp examination.

  1. Is there is a proper way to titrate up finasteride?

As a general guide, if you are taking Finasteride for male patterned hair loss (which I assume you are), you are looking at a minimal dosing of 3mg per week. Side effects, by definition, are dose dependent and slowly increasing the dose and monitoring yourself closely for such side effects allows one to immediately stop the medication if you encounter any.

Additionally, Finasteride has a better treatment effect in combination with minoxidil and you should consider using both synergistically. Finasteride is also used for female patterned hair loss and can be dosed at 2.5 – 5mg per DAY.

I would suggest starting on 1 mg per day as recommended by the drug manufacturer and FDA. You should notice reduced hair shedding after 1 – 2 months, and increased apparent hair density after 6 – 9 months.3 – 6 months would be a good time frame to decide if you want to continue it long term or not.

Do monitor for sexual side effects, as 3% of patients may experience those. As a general rule of thumb for all medications, I’d suggest starting with a lower dose of the medication, and titrating upwards.

Having said that, more than a few studies have shown that Finasteride has no increased dose response effectiveness. So if a lower dose doesn’t work well, a higher dose is unlikely to work as well. So if I were you, I’d start with 0.5 mg and watch for results and side effects. If it works well already, no need to use 1 mg.

  1. Are there any hair treatments such as Olaplex and the Inkeylist or Revuelle hair ampules that actually work?

All of the mentioned products are cosmeceutical products with no active pharmaceutical ingredient. There is no scientific research based evidence about the efficacy or effectiveness of such products.

  1. Do you have any tips for hirsutism in ladies with PCOS?

Natural treatments can help with unwanted hair growth due to PCOS.

These include:

Diet changes: For women with insulin resistance, reducing their intake of sugars and carbohydrates can help. Some women also try specific PCOS diets, but there is little research on how well these diets work.

Weight management: Losing weight can help control many symptoms of PCOS. For many women, the right combination of diet and exercise may be key.

Mental health support: PCOS is a complex disorder that can change a woman’s appearance, fertility, and health. Many women find that support groups, therapy, and positive self-talk help.

Hair removal methods, such as shaving or using hair removal creams, can be effective. However, these methods will not address the underlying cause of excess hair growth.

Women without a diagnosis or who have a diagnosis of an underlying medical condition should talk to their doctors about medical treatment.        

  1. Have you ever seen an nw5 reverse to nw2 with treatment but no transplant?

No, Norwood scale 5 is a lot of hair loss it’s not possible to lower it to scale two without a transplant. The maximum you can achieve without a hair transplant and with medical treatment is Norwood scale four.

  1. Will the usage of finasteride have any effect on medical tests?

Finasteride may change the levels of testosterone and prostate specific antigen in your blood, apart from that it has no effect on your medical tests.   

  1. Can we take small breaks from finasteride to wash off it for a while?

The most likely reason for Finasteride not to work is quite simple and -you'd love hearing that- easy to correct, that is consistency. If you stop and start or miss days or doses, as with most medications, your treatment will be less effective. It may even stop working altogether

  1. Besides hormone issues, why do I have a random bald spot directly on the top of my head?

There can be many reasons for a random bald spot on head. It can be due to androgenic alopecia or it can be due to alopecia areata or due to other reasons.

To reach to a conclusion about your issue you need to have a proper examination of your scalp, a good dermatologist can help you to reach a conclusion by taking detailed history and performing an examination.

  1. Does micro-needling help restore hair if you don't take minoxidil?

Micro needling can help to restore hair but the results vary from patient to patient and also the type of hair loss you are suffering from. Micro needling involves the use of a skin roller with small needles that cause minor skin injuries.

While used as an anti-aging skin treatment, micro needling may also be a method of treatment for hair loss. There's even evidence that it can help a special type of hair loss known as alopecia areata.

  1. What microneedle device and depth do you recommend?

There are many micro needling devices available but the most economical ones are derma rollers. You can use a derma roller of any brand as long as it is of a good quality.  The depth of micro needling depends from patient to patient but as a general guide you can take the following

0.2-0.25 mm derma roller may be used daily or every other day. This size improves the absorption of applied skin care products.

0.5 mm derma roller may be used once every 3 weeks.

0.75 mm derma roller may be used once every 4 weeks.

1.0 mm derma roller may be used once a month (every 5-6 weeks).,

1.5 mm derma roller may be used once every 6 weeks.

2.0-2.5 mm derma roller may be used once every 8 weeks.

  1. Do you recommend applying anything topically after micro-needling?

You can apply serums that contain either hyaluronic acid or ascorbic acid after micro needling.

  1. What are your thoughts on this recent study on the micro-needling depth where .6mm outperformed 1.2mm?

The depth of micro needling is highly specific to your anatomical site of hair loss and the amount of your hair loss. As a rule of thumb it is always better to start with minimum depth of micro needling and then go for increased depth. The following frequencies should be kept in mind

0.2-0.25 mm derma roller may be used daily or every other day. This size improves the absorption of applied skin care products.

0.5 mm derma roller may be used once every 3 weeks.

0.75 mm derma roller may be used once every 4 weeks.

1.0 mm derma roller may be used once a month (every 5-6 weeks).,

1.5 mm derma roller may be used once every 6 weeks.

2.0-2.5 mm derma roller may be used once every 8 weeks.

  1. Do the at-home laser caps/combs work for alopecia areata?

  You may have heard that laser combs, brushes, hoods, and caps can help halt hair loss. The theory is that when hair follicles absorb laser light at a certain level, it stimulates hair to grow. But there's not enough evidence that any of these devices restore hair or prevent balding.

  1. Is topical (finasteride + minoxidil) a better solution than oral finasteride + topical minoxidil? Or is it the other way around?

Using topical finasteride + minoxidil or oral finasteride + topical minoxidil is highly dependent upon the type of hair loss and the amount of hair loss. After a detailed examination of your scalp a dermatologist will be able to suggest you the best treatment.

As a general rule if you are suffering from androgenic alopecia that is male pattern baldness oral Finasteride would be the better option.  

  1. Does increasing blood flow to your scalp either through a massage or being inverted helps reduce or reverse hair loss?

Increasing the blood flow to your scalp in anyway will not help to reduce or reverse hair loss in any way. The amount of blood flow and hair growth has no proven relationship.

  1. Does taking finasteride in your late teens negatively affect beard development and height growth?

In terms of who can use Finasteride, any person over the age of 18 can use this medication irrespective of height, weight, or age, and will most likely see positive results from their treatment

However, Finasteride isn't suitable for use by children and adolescents younger than 18. After the age of 18 Finasteride have no effects on your beard or height growth.    

  1. Can you comment on derma needling depth? Should we be targeting a specific depth or stop at a certain amount of bleeding i.e. pin-sized blood droplets?

Derma needle depth is highly specific to your skin type and anatomical location where you want to use it. As a general rule you should always use minimum depth and gradually increase it when the desired results are achieved.

Pin point bleeding is common in derma needle use. The frequency of depth of needling should always be kept in mind.

0.2-0.25 mm derma roller may be used daily or every other day. This size improves the absorption of applied skin care products.

0.5 mm derma roller may be used once every 3 weeks.

0.75 mm derma roller may be used once every 4 weeks.

1.0 mm derma roller may be used once a month (every 5-6 weeks).,

1.5 mm derma roller may be used once every 6 weeks.

2.0-2.5 mm derma roller may be used once every 8 weeks.     

  1. Is it possible to get disturbances in vision from finasteride or minoxidil?

The reported side effects include permanent loss of libido, erectile dysfunction, depression, and altered mental status. Finasteride has also been associated with ocular side effects such as blurred vision, conjunctival injection, and meibomian gland dysfunction.

It is very much possible that you can get disturbances in vision such as blurred vision.

  1. How does finasteride affect my eyes? I'm having watery/dry eyes due to it.

The reported side effects include permanent loss of libido, erectile dysfunction, depression, and altered mental status. Finasteride has also been associated with ocular side effects such as blurred vision, conjunctival injection, and meibomian gland dysfunction.

As it affects the meibomian gland it is possible to have watery or dry eyes with finasteride.

  1. How does applying minoxidil once per day compared to twice per day?

Use of minoxidil is suggested from 1-2 times a day. It is fine if you're applying it once a day but even if you apply 2nd time it won't lose any effect and might result in an improvement. That also vary from you skin type. So using minixodil twice a day is considered to be more effective the once a day       

  1. Minoxidil half-life is about 20 hours, right?

The half-life of topical minoxidil averaged 22 hours, compared to 1.49 hours for the oral formulation. Minoxidil and its metabolites are excreted almost entirely in the urine (97%), with a very minor degree of elimination via the faeces (3%)

  1. My hair has thinned during the pandemic (I assume it is stress?) and I am only 34 years old. Is there a way to get growth back using supplements, massage, topical products?

 The phenomenon of losing hair due to stress is called Telogen effluvium. It is a temporary form of hair loss due to excessive shedding of the hair in the resting phase of the hair cycle. New hair will eventually grow. However, there are some healthy life choices that can improve the overall health of the hair:

  1. A balanced diet containing fruits, vegetables, protein and water

  2. Supplements containing biotin, zinc and other vitamins

  3. Hair care products that are sulfate and paraben free

  4. Avoid styling hair using heat

  5. Avoid over or under washing hair, wash hair 3 to 4 times in a week

    70. Is there any reason to choose topical finasteride over oral finasteride?

    Finasteride is more commonly known for its tablet form to treat benign prostatic hyperplasia (BPH),  and male pattern hair loss (alopecia). Topical Finasteride provides localized treatment for hair loss without the systemic adverse experiences.

    Topical Finasteride can be used for hair loss without the worry of its adverse effects. The decision to use either oral or topical form is highly subjective and varies from patient to patient; a qualified dermatologist can help you to make the decision after a detailed examination of your scalp.   

    1. Will the feeling of weakness during hair combing of the hair-affected area of the scalp will go away after starting finasteride?

     Finasteride starts to work on the scalp straight away, but it takes at least 3 months before you will see any noticeable effects. Initially, some men will find that their hair is falling out at a faster rate.

    This is a positive sign that Finasteride is working, as the older hairs are making way for newer and stronger strands of hair. After 6 months, most men will find that their hair is growing back thicker and stronger, and less hair is falling out.

    1. Will the quality of hair follicles (not density/thickness) return to its original quality (pre-hair loss) after using finasteride?

     Finasteride starts to work on the scalp straight away, but it takes at least 3 months before you will see any noticeable effects. Initially, some men will find that their hair is falling out at a faster rate.

    This is a positive sign that Finasteride is working, as the older hairs are making way for newer and stronger strands of hair. After 6 months, most men will find that their hair is growing back thicker and stronger, and less hair is falling out.

    1. Is PRP treatment has any positive effects in cases of androgenetic alopecia?

    Platelet rich plasma is relatively recent modality in the treatment of androgenic alopecia. According to different studies regarding its effects on androgenic alopecia, most of the studies claim that it has positive results in androgenic alopecia. But, the results are highly subjective varying from patient to patient and also on the skills of injector.

    1. What requirements are necessary for the PRP treatment to be effective?

    There are no specific requirements to make PRP more effective but you can follow these to have better results

    • Cardio Exercise.

    • Eat a Diet Rich in Green Leafy Vegetables.

    • Don't Smoke, Drink or do Drugs.

    • Increase B-Vitamins and Hydrate.

    • Avoid Non-Steroidal Anti-Inflammatory Drugs

    • Follow Your Post-Procedure Routine

    1. Will hairs grown by minoxidil+microneedling+finasteride fall out if the user stops everything except for finasteride?

    If you are suffering from androgenic alopecia that is male pattern hair loss then only using Finasteride can help you to improve the growth of your hair as Finasteride starts to work on the scalp straight away, but it takes at least 3 months before you will see any noticeable effects.

    Initially, some men will find that their hair is falling out at a faster rate. This is a positive sign that Finasteride is working, as the older hairs are making way for newer and stronger strands of hair. After 6 months, most men will find that their hair is growing back thicker and stronger, and less hair is falling out

    1. Would you advise Finasteride to a minor? Why or why not?

    In terms of who can use Finasteride, any person over the age of 18 can use this medication irrespective of height, weight, or age, and will most likely see positive results from their treatment. However, Finasteride isn't suitable for use by children and adolescents younger than 18.

    1. What is reflex hyperandrogenic after finasteride use and how do you know are experiencing it? Is it rare?

    Reflex hyperandrogenicity happens in some of the patients taking Finasteride, it is defined as increase in your testosterone sensitivity which results in excessive amounts of hair fall and sometimes can cause pimples or increased sebum production on your face.

    It is a rare phenomenon and occurs during the initial phase of the treatment but as you continue taking Finasteride this side effect goes away on its own and after an initial phase of hair fall you will experience that your hair growth is increasing.

    1. Is there a safe way to use estrogen for hair growth in men?

    Men are not normally prescribed Oestrogen for any reason. Oestrogen is a female hormone that is sometimes used to relieve the symptoms of certain types prostate cancer in men. When applied topically on the scalp it has been shown in studies to cause hair to enter the anagen phase.

    Oestrogen taken orally has been shown to completely reverse male pattern baldness in transgender patients. However oestrogen competes with and shuts down the male hormone Testosterone and causes feminization including breast growth and female pattern fat deposits.

    1. What challenges do dermatologists face when trying to remedy hair loss?

    When treating a hair loss patient a dermatologist might face the following challenges

    • Proper diagnosis of the type of hair loss

    • Identifying the treatment options available

    • Counselling of the patient regarding their expectations and outcomes

    • Loss of follow up of the patient

    1. Why isn’t there a solution to every type of hair loss?

    In the modern times we have a solution to every type of hair loss starting from medical treatments to hair transplant surgeries. The only problem we are facing these days is that some of the treatment options are very expensive such as hair transplants.

    As the time passes by we are discovering newer therapies which are both effective and on the other hand inexpensive.

    1. What’s the probability that after a child develops alopecia areata that they will also develop Alopecia Totalis?

    In more than 90% of the cases of alopecia areata, the hair grows back and fills the bald spots in about one year. In 7% of the patients, alopecia areata progresses to involve larger areas and eventually the whole scalp to become alopecia totalis.

    1. Why alopecia is considered cosmetic when it has a huge impact on self-worth?

    Alopecia areata is an autoimmune disease and is not considered cosmetic. Androgenic alopecia or male pattern hair loss and its treatment are considered cosmetic, unfortunately.

    The explanation for this is the hereditary/genetic pathophysiology of this condition. It is not considered as a disease but as a genetic pattern of hair loss.

    1. Are there ways to permanently thicken up strands that have thinned in diameter without using minoxidil? What's the ideal regimen to do that?

    The hair growth and volume is a result of different factors including genetics, hormones and environmental factors.

    There is some evidence that minoxidil boosts the growth of hair follicles by its vasodilator affect thus, thickening the hair. Other factors that can improve and promote hair growth are:

    • A balanced diet including fruits, vegetables, protein and water

    • Supplements containing biotin, zinc and other vitamins

    • Sulphate free hair products

    • Reduced styling and heating

    • Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth

    1. Does the inflammation caused by micro-needling do more harm to the scalp than good?

    When rolled across your scalp, the micro-needling creates tons of tiny punctures on the surface of the scalp. During all this a mild inflammation is part of the procedure and actually helps the follicle to grow but if the inflammation is a lot and does not settle in a day or two it may be due to an infection that occurred during the procedure. You should visit your doctor immediately.

    1. Can Scalp Micropigmentation (SMP) be done on scarred tissue? Will ink take?

    Scalp Micro-pigmentation is a process similar to tattooing of skin. It uses micro needles to deposit pigment into the scalp giving the appearance of hair follicles.

    It can also be used over scars to camouflage them and blend with the rest of the scalp. The scar will take ink because the pigment is deposited in the skin of the scalp and not the hair follicle.           

    1. What causes scarring alopecia and how can I slow the progression down?

    Scarring alopecia or cicatricial alopecia are a group of disorders making about 3 % of hair loss patients. These are not very common. In scarring alopecia there is inflammation in the dermis or subcutaneous tissue leading to destruction of hair follicles and irreversible hair loss.

    The most common causes are:

    • Trauma

    • Infections e.g. abscesses, kerion and shinglesFolliculitis decalvans

    • Dissecting cellulitis

    • Lichen planopilaris

    • Alopcia mucinosa

    • Discoid lupus erythmatosus

    There is no cure for scarring alopecia but it can be prevented by treating the cause of scarring as early as possible with the appropriate oral and topical antimicrobial treatments.

    1. I have been experiencing hair loss since I was 16! Is there anything I can do to fix it?

    Hair growth in every individual is determined by genetics, hormones and environmental causes. The rate at which the hair grows in each person is different. However, there are a few changes that you can make to your lifestyle to boost your hair growth. These are:

      • A balanced diet including fruits, vegetables, protein and water

      • Supplements containing biotin, zinc and other vitamins

      • Sulphate free hair products

      • Reduced styling and heating

      • Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth 

      1. My family has no history of hair loss, why do I have it?

      It is unlikely that no other person is bald in the family of someone with male pattern baldness but it can happen. It is due to the reason that the gene causing androgenic alopecia skips a few generations.

      You may not have met the family member who was bald. It could be your great grandfather or a great grand uncle.

      1. I used to dye my hair once a month and now it starts to fall, is there anything I can do?

      Hair dyes contain harmful chemical ingredients like ammonia, p-phenyldiamine, toluene and many others that damage the hair making it dry, brittle and increasing hair fall. Tips to restore overall hair health:

      • Avoid using hair dyes containing harmful chemicals

      • Use a good quality shampoo free of sulfates and paraben

      • Use a good quality conditioner after every wash

      • Use a leave-in hair serum

      • Avoid styling hair using heat

      • A balanced diet containing fruits, vegetables, protein and water can improve overall hair health

      1. My bald spots are sore. Should I be worried? Is there anything I should do?

      Alopecia areata is an autoimmune disorder that is characterised by patchy, non-scarring hair loss. The bald patches small, round and oval patches of hair loss. The skin looks smooth and normal.

      Occasionally there is mild itching, burning or soreness. However, if there are any signs of inflammation or infection I would advise to see your dermatologist to rule out onset of scarring alopecia.  

      1. I lose a lot of hair during the pandemic due to stress, will it regrow naturally?

      The phenomenon of losing hair due to stress is called Telogen effluvium. It is a temporary form of hair loss due to excessive shedding of the hair in the resting phase of the hair cycle. New hair will eventually grow. However, there are some healthy life choices that can improve the overall health of the hair:

      • A balanced diet containing fruits, vegetables, protein and water

      • Supplements containing biotin, zinc and other vitamins

      • Hair care products that are sulfate and paraben free

      • Avoid styling hair using heat

      • Avoid over or under washing hair, wash hair 3 to 4 times in a week

      1. Are there any supplements I can take to stop hair shedding?

      A good hair supplement is the one containing biotin, vitamin B complex and zinc. These nutrients, if deficient, have been associated with hair fall. Other than supplements you can incorporate a balanced diet into your routine that contains fruits, vegetables, protein and water.

      Avoid using heat for styling hair and hair products containing harmful chemicals like sulfates and parabens.

      1. Can birth control pills cause hair loss? Or stop it?

      Oral contraceptive pills cause hair loss. The synthetic hormones in these pills interrupt the normal hair growth cycle. They move hair follicles from the growing phase to their resting phase which results in shedding of hair more than normal.

      However, this kind of hair loss is not permanent and it reverses when you stop taking the pill.

      1. What should I do if I have anemia and I start to see hair loss?

      The best way to treat hair loss due to iron deficiency anaemia is to treat the underlying cause. Iron supplements are used to treat iron deficiency anaemia. It will also reverse hair loss once anaemia is corrected. A balanced diet with green leafy vegetables is a good source of iron.

      It is advised to visit your physician for the diagnosis and treatment of the condition.

      1. What do I do if the medications my dermatologist prescribed are not working!?

      The treatment for each type of hair loss is different and generally takes about 3 to 6 months for visible effects. If you have Telogen effluvium, it is mostly reversible and the hair stops falling naturally after 3 months.

      If you have male pattern baldness/female pattern baldness, you may need long term treatment or hair transplant depending on your gender and the grade of the disease.

      If this still does not answer your question please email at contact@scandinavianbiolabs for further queries and detailed discussion of your case and medication that you are using currently. They will forward your question to a dermatologist for free.

      1. I’m going into chemotherapy, do you have any tips for keeping my hair?

      Chemotherapy works by destroying rapidly dividing cells. Thus, as a side effect, it also destroys hair follicles, which is why hair is the first to shed. Unfortunately, it is not possible to keep the hair from shedding. However, the good news is that when chemotherapy is completed the hair starts growing back.

      When chemotherapy is complete some of the drugs can remain in the body for longer periods of time affecting the re-growing hair follicles. These altered follicles then give rise to curly or coarser hair. Best of luck!

      1. Why do my thinning areas have yellow/brown dots at the hair follicles? Are they affecting my hair and is there anything I can do?

      Yellow or brown dots on the scalp in area of hair loss represent follicular openings filled with keratin or sebum. These are associated commonly with diseases of hair loss e.g. alopecia areata and androgenetic alopecia.

      These spots do not relate to activity of disease however, they can form as a result of enlarged sebaceous glands that point towards regression of hair follicles. I would advise to see a board certified dermatologist to rule out causes of permanent hair loss.

      1. What are your thoughts on oral minoxidil?

      Minoxidil is an antihypertensive drug. One of its side effects is increased hair growth on the body which is why it is used in patients of hair loss. Recent studies prove that when used in low doses it is as effective as topical minoxidil 5% in hair growth with a safe profile and well tolerated side effects.

      It can be used effectively in people who cannot tolerate topical formulations. However, if used in higher doses, it can cause adverse effects like hypertrichosis, limb oedema, low blood pressure and increased heart rate. i would recommend using oral minoxidil in low doses in patients who cannot tolerate the topical formulations.

      1. How common are scalp issues like LPP and scarring alopecia?

      Scarring alopecia or cicatricial alopecia are a group of disorders making about 3 % of hair loss patients. These are not very common. In scarring alopecia there is inflammation in the dermis or subcutaneous tissue leading to destruction of hair follicles and irreversible hair loss.

      The most common causes are:

      • Trauma

      • Infections e.g. abscesses, kerion and shingles

      • Folliculitis decalvans

      • Dissecting cellulitis

      • Lichen planopilaris

      • Alopcia mucinosa

      • Discoid lupus erythmatosus

      1. Can retinol, specifically tretinoin, help hair regrowth when combined with minoxidil and topical finasteride?

      Retinoids especially topical tretinoin, is used as a combination therapy with topical minoxidil or alone for hair growth sometimes. The mechanism of action of retinoids is to alter cell proliferation and differentiation and may promote vascular proliferation.

      These actions may cause the hair follicles to increase hair growth during various growth and regression phases.

      1. How common are finasteride side effects?

      Finasteride is a 5 alpha reductase inhibitor indicated for the treatment of male pattern hair loss. The sexual side effects of finasteride are the most common affecting about 4 to 6% of the patients. These side effects are reversible and go away after the medication is discontinued.

      The side effects of finasteride include:

      • Impotence

      • Loss of libido

      • Difficulty in ejaculation

      • Oedema of hands and feet

      • Swelling or tenderness of the breast

      • Dizziness

      • Lethargy

      • Headache

      • Skin rash

      1. Why do I experience itching on the donor area 6 months after hair transplants?

      Itching after a hair transplant is a common symptom and occurs because of the inflammation and not being able to wash the hair. It is a sign of healing. However, the itching stops after 1 to 2 weeks.

      After 6 months, if you experience itching in the donor site it may be due to dandruff or using the wrong kind of hair products. Please consult your dermatologist/transplant surgeon to advise appropriate treatment after thorough examination.

      1. Since my hair ONLY falls out on my head. (I literally have hair everywhere else). Is it possible to get my hair back?

      If your hair fall is androgenetic alopecia/male pattern alopecia, then the answer is a reluctant no. Testosterone is the male hormone that causes hair loss from the scalp only and increases growth of body hair.

      Various treatment options for androgenetic alopecia are early administration of topical minoxidil, oral Finasteride and hair transplants.

      If your hair fall is diffuse (Telogen effluvium) and due to stress or medication then your hair will grow back in 3 to 4 months. This type of hair loss is reversible and growth can be promoted with a balanced diet and supplements.

      1. What are the odds of hair growing back and staying?

      See question 103 above for answer

      1. Does auto-immune diet help with hair loss?

      A balanced diet is the best diet to maintain or improve overall hair health. It should contain:

      1. Fruits

      2. Green vegetables

      3. Fish

      4. Meat

      5. Lentils

      6. Eggs

      7. Nuts

      8. Water

      1. What diet is best to treat hair loss? Vegan, vegetarian, keto, paleo, or raw food diet?

      A balanced diet is the best diet to maintain or improve overall hair health. It should contain:

      1. Fruits

      2. Green vegetables

      3. Protein

      4. Nuts

      5. Water

      Research shows that the Mediterranean diet has positive impact on hair health.

      1. Where did hair loss come from? I was diagnosed at 21 now 24 (Lichen planus on the scalp) Still losing hair daily. What tests can be run to be 100% sure that it’s not being caused by anything else? What is recommended to stop it? Is birth control or hormones in any relations to this?

      Lichen planopilaris or lichen planus of the scalp causes scarring alopecia that is patchy. This means that the hair fall is from a defined area/patch of the scalp, not diffused and that it is irreversible. Diffuse hair loss is not commonly caused by LPP.

      Oral contraceptive pills cause hair loss. The synthetic hormones in these pills interrupt the normal hair growth cycle. They move hair follicles from the growing phase to their resting phase which results in shedding of hair more than normal. However, this kind of hair loss is not permanent and it reverses when you stop taking the pill.

      The diagnosis of hair loss is clinical. If you are on birth control it can be causing your hair loss as diffused hair loss does not occur in lichen planopilaris. This is reversible and will stop when you stop taking the pill.   

      Some life style modifications to improve overall health of the hair are:

      1. Balanced diet including fruits, vegetables, protein and water

      2. Supplements containing biotin, zinc, iron and vitamin B complex

      3. Use sulfate and paraben free hair care products

      4. Avoid using heat for styling

      1. Does cutting gluten actually help? Why?

      Gluten is a protein present in wheat products, barley and rye. It is also present in a wide variety of other packaged food products.

      People with gluten intolerance, celiac disease, alopecia areata and other autoimmune diseases associated with gluten sensitivity suffer from hair loss if they are consuming gluten containing products. A gluten free diet can help reduce hair loss.

      1. Will total hair loss grow back? What treatment is best for it?

      Alopecia Universalis is an autoimmune condition characterised by complete hair loss on the scalp and body.  There is currently no cure for alopecia universalis and sometimes hair grows on its own, even after several years.

      Some promising treatment options for alopecia universalis are:

      • Steroids

      • Cyclosporine

      • Photodynamic therapy

      • Diphenylcyclopropenone

      • Some cosmetic procedures like micro-pigmentation and micro-blading can be used

       

      Hair Care:

      A woman getting her hair styled, at the hairdresser, flat style.
      1. Does the scalp really stop producing as much sebum when I just leave it on and stop washing my hair with shampoo?

      It is a just a myth. Prolonged periods of not washing the hair causes build up and damage the hair. Sebum is produced from the sebaceous glands of the scalp by a rate that is genetically determined and not washing hair with shampoo is not going to stop it. One should wash their hair with shampoo not more than 3 to 4 times a week.

      1. How often should one condition? Conditioner is thicker than shampoo so I see that it removes more hair when scrubbing it in. Are there any liquidity conditioners?

      One should condition their hair every time after shampooing that is 3 to 4 times per week and not more. Hair fall has nothing to do with the consistency of the conditioner; not using the right technique however can cause the hair to fall.

      Remember, shampoo is for the scalp and conditioner for the hair. While applying conditioner, make sure you leave out the roots of the hair and apply it only to the shafts. Applying conditioner to the roots may weaken the hair and cause it to break. While choosing conditioner, make sure it is paraben and silicon free.        

      1. What factors can make hair get greasy quickly?

      Some of the most common causes of oily scalp or greasy hair are:

      1. Genetics

      2. Hormonal changes e.g. puberty, menstruation, pregnancy

      3. Nutrition e.g. too much sugar

      4. Stress

      5. Using the wrong hair products

      6. Over washing or not washing your hair

      7. Skin conditions like seborrheic dermatitis, psoriasis, eczema

      1. What are good permanent hair removal options that can be done from home?

        There is no hair removal treatment that can get rid of hair permanently. However, there are a variety of procedures that one can get done at a dermatologist’s clinic to remove hair for weeks, months or even longer.

        The most effective of these procedures is the laser hair removal and electrolysis. Both of these procedures are directed at destroying the hair follicles with high energy to stop hair from growing. These procedures require multiple sessions and are heavy on the pocket.

        At home, the best way to remove hair and prevent it from growing back for longer periods is a hand held IPL (intense pulse light) device. It is a one-time investment and easy to use. Remember that it does not remove hair permanently but helps in slowing the growth.

        1. Is baking soda a good option to wash your hair?

        Baking soda or sodium bicarbonate is an alkali with a pH of 9 that is much higher than the pH of the scalp. It is abrasive and damages the hair and scalp. It can leave the hair dry and brittle leading to breakage and hair fall.

        It is recommended to use a good quality shampoo and invest in a good conditioner to keep the hair moisturised and protected.

        1. My head got dry, brittle, and flaky after continuous use of baking soda, what should I apply on the scalp after showering to moisturize it?

        Baking soda or sodium bicarbonate is an alkali with a pH of 9 that is much higher than the pH of the scalp. It is abrasive and damages the hair and scalp. It can leave the hair dry and brittle leading to breakage and hair fall.

        I would advise to invest in a good quality shampoo (sulfates, paraben and silicon free) and conditioner. Use a conditioner after every wash to keep your hair moisturised and protected.

        1. Are there any ways to help keep hair straight after using heat on it?

        After styling hair by using heat on it, you can apply a good quality organic leave in hair serum to keep the hair straight and manageable.

        Just like skin serums, hair serums penetrate deeper in the hair shaft where they control frizzy and unmanageable hair and protect from environmental stress. Thus, it can make the hair shinier and frizz free.

        1. Do you recommend not using shampoo at all? Why?

        No, I would not recommend that because prolonged periods of not washing the hair causes build up and damage the hair. Sebum is produced from the sebaceous glands of the scalp by a rate that is genetically determined and not washing hair with shampoo is not going to stop it.

        One should wash their hair with shampoo 3 to 4 times a week. I would recommend using a shampoo that is free of harmful ingredients like sulfates, paraben and silicon followed by a conditioner. Like any other part of the body, the scalp/hair needs to be clean for a healthy growth.

        1. Do you recommend infrequent shampoo usage (every 5 days)? Why?

        I recommend washing one’s hair with shampoo at least 3 times a week as prolonged periods of not washing the hair causes build up and damages the hair. It can also make the scalp more flaky, itchy and greasy if you have oily scalp.

        However, if you are someone with a dry scalp and thin hair, you can get away with not washing your hair for 3 to 5 days. I would advise choosing a good quality shampoo and conditioner free of harmful chemicals.  

        1. What difference does it make to use high-quality shampoo?

        Good quality organic hair products that do not contain harmful chemicals like sulfates, paraben and silicon are better for the hair. These chemicals make the hair dry and brittle and more prone to damage. It can also affect the growth and colour of the hair.

        Organic hair products are safer to use both for the hair and the environment. It also improves the overall health as some of the body parts are exposed to the product while using them. It restores the natural health of the hair protecting them from environmental pollutants.

        Most of the drug store shampoos and conditioner contain harmful chemicals that damage the hair, even those labelled as all natural. These chemicals dry out the hair excessively and make them brittle.

        As a result, the hair falls out easily and is fragile and weak-looking.  Some of the ingredients to avoid in shampoos and conditioner are:

        • Sodium lauryl sulfate/sodium laureth sulfate

        • Parabens

        • Silicon/dimethicone

        • Synthetic perfumes

        • Polysorbates

        • Polyethylene glycol

        • Retinyl palmitate

        • Quaternium 15

        1. What difference does it make to use a high-quality conditioner?

        Good quality organic hair products that do not contain harmful chemicals like sulfates, paraben and silicon are better for the hair. These chemicals make the hair dry and brittle and more prone to damage. It can also affect the growth and colour of the hair.

        Organic hair products are safer to use both for the hair and the environment. It also improves the overall health as some of the body parts are exposed to the product while using them. It restores the natural health of the hair protecting them from environmental pollutants.

        Most of the drug store shampoos and conditioner contain harmful chemicals that damage the hair, even those labelled as all natural. These chemicals dry out the hair excessively and make them brittle.

        As a result, the hair falls out easily and is fragile and weak-looking.  Some of the ingredients to avoid in shampoos and conditioner are:

        • Sodium lauryl sulfate/sodium laureth sulfate

        • Parabens

        • Silicon/dimethicone

        • Synthetic perfumes

        • Polysorbates

        • Polyethylene glycol

        • Retinyl palmitate

        • Quaternium 15

        1. How to choose a shampoo? How to know which one is high quality?

        See question 10 above for answer.   

        1. How to choose a conditioner? How to know which one is high quality?

        See question 11 above for answer.   

        1. Is there really a difference between hair products for curly hair, straight hair, black hair, silky hair, volumizing? What ingredients do that?

        The main difference between hair types based on ethnicity is in their hair follicles. We divide hair types broadly into Caucasian, Asian and African hair.

        The Asian hair follicles are round to oval in shape which produces straight or slightly wavy hair. The Caucasian hair follicles are oval-shaped producing straight to curly hair. The African hair follicles are elliptical in shape producing curly or tightly coiled hair.

        The main difference between curly hair products and regular hair products is based on the fact that curly hair is drier and needs more hydration than straight or wavy hair. Some of the ingredients to look for in curly hair products are:

        1. Organic argon oil

        2. Glycerine

        3. Coconut oil

        4. Castor oil

        5. Jojoba oil

        6. Shea butter

        Ingredients to avoid in all hair products for all kinds of hair are: Sulfates, paraben and silicone.            

        1. Will the shampooing less allow my scalp to stop producing too much oil? If yes, when will I see its effect?

        It is a just a myth. Prolonged periods of not washing the hair cause build-up of sebum and hair products causing the scalp to become more greasy, flaky and itchy. It also damages the hair.

        Sebum/oil is produced from the sebaceous glands of the scalp by a rate that is genetically determined and not washing hair with shampoo is not going to stop it. One should wash their hair with shampoo 3 to 4 times a week and not more.

        1. How can my hair be oily, frizzy, and with lots of flyaways? How can I tame that?

        Hair with oily scalp and frizzy strands is tricky to handle because when you use shampoo to get rid of the excessive oil, you also strip your hair strands off all the moisture making it frizzy in addition to all the environmental stressors that the hair is exposed to. Here are a few tips that can help manage such hair:

        1. Use a mild shampoo free of sulfates, parabens and silicone 3 to 4 times a week

        2. Use a conditioner after every wash

        3. Use a leave-in hair serum

        4. Avoid overexposure to environmental factors like sunlight, humidity and wind

        1. Is it true that a shiny area on the head means the follicles are damaged?

        Yes, it is true. A shiny area on the head after hair loss shows that the hair follicles have degenerated and become skin cells. There are sebaceous glands present with each hair follicle that produces sebum/oil which gives a shiny appearance to the scalp.

        1. According to this YouTuber and the textbook she bought, "moisturized" actually means "conditioned" because "moisturizing" products don't actually change the water in your hair. Is this correct? If so, what does "conditioning" do to hair?

        A conditioner is in fact a moisturiser for the hair.  It works by closing the cuticles of hair shafts thus locking in moisture and protecting it from environmental insults. This helps smoothen and detangle hair preventing hair damage and thus, hair loss.

        1. Why does hair sometimes drastically change texture after chemotherapy?

        Chemotherapy works by destroying rapidly dividing cells. Thus, as a side effect, it also destroys hair follicles, which is why hair is the first to shed.

        When chemotherapy is complete some of the drugs can remain in the body for longer periods of time affecting the re-growing hair follicles. These altered follicles then give rise to curly or coarser hair.   

        1. We lotion our skin after a shower so why don’t we “lotion” our scalp? I realize that conditioner is kind of like lotion but unless it’s a leave-in, it gets washed out. So why is our scalp different than other parts of the skin and how do you take care of it properly with different types of hair/oil production?

        Conditioner is in fact a moisturiser for the hair (the shafts, not roots). A conditioner works by closing the cuticles of hair shafts thus locking in moisture and protecting it from environmental insults.

        As far as the scalp is concerned, it is the part of the body that has the greatest number of sebaceous glands. The sebaceous glands produce sebum or natural oils that keep the scalp moisturised.

        For dry and brittle hair or thick and curly hair, it is recommended to use moisturising hair care products containing organic oils 2 to 3 times a week. This helps in making the hair more manageable and does not strip off the natural oils from the scalp.

        For greasy or excessively oily hair/scalp or dandruff, it is recommended to use hair products free of harmful chemicals 3 to 4 times a week. You can use a mild clarifying shampoo once a week to prevent build-up and dandruff.

        Avoid the following ingredients while choosing hair products for any type of hair:

        • Parabens

        • Silicon

        • Formaldehyde

        • Sodium lauryl sulfate/sodium laureth sulfate

        • Propylene glycol

        • Synthetic perfumes

        • Polysorbates

        • Polyethylene glycol

        • Retinyl palmitate

        • Quaternium 15

        1. Is glycerine good for moisturizing the hair?

        Glycerine containing hair products are beneficial for people with frizzy, dry and brittle hair. It attracts moisture from the air locking it in the hair keeping it soft and hydrated.

        It should be avoided by people with excessively oily scalp because it can make the hair greasier if used too much. It should also be avoided in very humid climates as it can make hair frizzier by drawing extra moisture from the air.

        1. What is the ideal timeframe to wait between shampoos? In the past, people would only wash their hair once a month.

        One should wash their hair 3 to 4 times every week. Prolonged periods of not washing hair can cause build-up of sebum and hair products causing the scalp to become greasy, flaky and itchy.

        In today’s fast paced life, there are more environmental pollutants, products containing harmful chemicals and unhealthy diet routines than the past.

        1. Is tight scalp actually a thing? My hair looked best using a shampoo for tight scalp but they stopped making it. Was that just marketing? If it is real, please explain and offer advice.

        A tight scalp is not actually a medically described condition. However, it can be a sensation caused by various factors. For example a dry scalp, dandruff and styling the hair in a tight ponytail can cause the scalp to feel tight. The goal is to eliminate the cause of this sensation.

        • Use moisturizing hair products that are free of harmful chemicals like sulfates and parabens.

        • Use an appropriate anti-dandruff treatment, if dandruff is causing tightness in scalp.

        • Avoid styling hair in tight ponytails or buns.

        Guy taking a selfie with clean-shaven facial hair, flat style.
        1. Is it safe to use scalp brushes like this in the shower?

        Scalp brushes/massagers can be used to remove product build-up and dead skin cells of the scalp. Gentle massage can also stimulate blood flow to hair follicles which improves hair health.

        There is no real evidence to show that these brushes increase hair growth. Excessive use or rubbing too harshly can cause inflammation in the hair follicles that can lead to infection or hair loss. Keep in mind the following while using a scalp brush:

        1. Use a brush that has soft and widely spaced bristles to avoid undue damage and tangles

        2. Only use a scalp brush, if you use a lot of hair products and have build-up

        3. Only use a scalp brush, if you have greasy scalp or thick flakes of dandruff

        4. Use a scalp brush once weekly for thick hair that has product build-up or flakes/dandruff

        5. Avoid using a scalp brush, if you have dry or fine hair and no product build up

        1. Do you have any tips on using scalp brushes while minimizing damage?

        Scalp brushes/massagers can be used to remove product build-up and dead skin cells of the scalp. Gentle massage can also stimulate blood flow to hair follicles which improves hair health.

        There is no real evidence to show that these brushes increase hair growth. Excessive use or rubbing too harshly can cause inflammation in the hair follicles that can lead to infection or hair loss. You can read the question above to get a better idea of what to do.

        1. Is coconut oil good for hair? Does it do anything? Do you recommend different oil?

        Coconut oil or any other oil for that matter can be used in individuals with dry and brittle hair to give that extra moisture and tame the hair. There is no scientific evidence to prove increase in hair growth by using coconut oil.        

        1. Are there any recommended foods/supplements/topical treatments to keep hair healthy? How about castor oil?

        There are a few healthy life choices that can improve overall hair health:

        1. A balanced diet including fruits, vegetables, protein and water

        2. Supplements containing biotin, zinc and other vitamins

        3. Sulphate, paraben and silicone free hair products

        4. A good quality hair serum

        5. Reduced styling and heating

        6. Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth and volume

        Castor oil or any other oil for that matter can be used in individuals with dry and brittle hair to give that extra moisture and tame the hair. There is no scientific evidence to prove increase in hair growth by using castor oil.

        1. How to improve hair volume?

        Hair growth and the number of hair follicles present on scalp are genetically determined and is different for each individual. However, there are a few healthy life choices that can improve overall hair health:

        1. A balanced diet including fruits, vegetables, protein and water

        2. Supplements containing biotin, zinc and other vitamins

        3. Sulphate, paraben and silicone free hair products

        4. Reduced styling and heating

        5. Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth and volume

           29. What would be a decently priced hair mask that helps restore/maintain my natural so that it would grow longer and healthier?

          There is no scientific evidence that a hair mask increases the rate of hair growth. Hair growth is genetically determined and is different in different people. However, a good quality hair mask may be able to help restore moisture and make the hair appear shinier and healthier.

          While choosing a hair mask or any hair care product make sure that it is organic and free of harmful ingredients. Always check to avoid the following ingredients:

          • Parabens

          • Dimethicone

          • Alcohol

          • Polyethylene glycol

          • Formaldehyde

          • Phthalates

          • Colour and synthetic fragrance

          1. Do you have any tips for hair that gets matted easily?

          Factors like hair texture, hair health, frequency of brushing and exposure to environmental insults all contribute to matting of hair. Matting is more common in thick and curly hair as well as in long and fine hair. To avoid matting of hair, here are a few tips:

          1. Condition hair after every wash

          2. Use a leave-in hair serum

          3. Use a wide toothed comb

          4. Avoid styling with heat

          5. Use warm water to shower

          6. Tie you hair loosely in a braid or scrunchie before sleeping

          7. Brush your hair 1 to 2 times daily

          8. Choose the right hair care products i.e. sulfate and paraben free

              31. What ingredients to avoid in common shampoo and conditioners?

            The ingredients in hair products one should avoid using for promoting hair growth are:

            • Parabens

            • Silicon

            • Formaldehyde

            • Sodium lauryl sulfate/sodium laureth sulfate

            • Propylene glycol

            • Synthetic perfumes

            • Polysorbates

            • Polyethylene glycol

            • Retinyl palmitate

            • Quaternium 15

            1. Is it true if you shave the hair comes back thicker?

            It is not biologically possible for hair to grow back thicker after shaving.  Shaving hair makes the edges blunt giving them a course and stubbly appearance until the hair grows out completely. During this time the hair might be more noticeable and appear thicker but it is really not.

            Other methods of hair removal like waxing or laser does not give this particular appearance because it removes hair from the hair follicle and not from the surface as in shaving.           

            1. What are your thoughts on the Head & Shoulders shampoo?

            The head and shoulders shampoo contains selenium sulphide which can target the toughest dandruff. However, it is not recommended to use it regularly unless needed because selenium sulphide causes hair loss and greying of hair.

            It is a known carcinogenic and regular use should be avoided. Other harmful chemicals are sulfates, parabens and dimethicone.

            1. What do you think about drugstore shampoos and conditioners?

            Most of the drug store shampoos and conditioner contain harmful chemicals that damage the hair, even those labelled as all natural. These chemicals dry out the hair excessively and make them brittle.

            As a result, the hair falls out easily and is fragile and weak-looking.  Some of the ingredients to avoid in shampoos and conditioner are:

            • Sodium lauryl sulfate/sodium laureth sulfate

            • Parabens

            • Silicon/dimethicone

            • Synthetic perfumes

            • Polysorbates

            • Polyethylene glycol

            • Retinyl palmitate

            • Quaternium 15

            1. Are organic, natural products better for my hair?

            Yes, organic hair products that do not contain harmful chemicals like sulfates, paraben and silicon are better for the hair. These chemicals make the hair dry and brittle and more prone to damage. It can also affect the growth and colour of the hair.

            Organic hair products are safer to use both for the hair and the environment. It also improves the overall health as some of the body parts are exposed to the product while using them. It restores the natural health of the hair protecting them from environmental pollutants.

            Some of the ingredients to avoid in shampoos and conditioner are:

            • Sodium lauryl sulfate/sodium laureth sulfate

            • Parabens

            • Silicon/dimethicone

            • Synthetic perfumes

            • Polysorbates

            • Polyethylene glycol

            • Retinyl palmitate

            • Quaternium 15

            1. What’s superior, bar soap or liquid shampoo? Why?

            Shampoo bars that are organic and free of harmful chemicals like sulfates and paraben can be used as a replacement of the traditional liquid shampoos. They are travel friendly, eco-friendly (no plastic) and cost less than liquid shampoos.

            One bar can last for a long time. However, shampoo bars may not be able to clean the scalp as effectively as liquid shampoos which make the scalp feel flaky, greasy and itchy.

            I personally prefer liquid shampoos followed by a conditioner which are free of the harmful chemicals like sulfates and paraben.

            1. I've done laser hair removal on my face for several years. Why has the hair yet ceased to grow?

            There is no treatment that can remove hair permanently. Laser hair removal is one of the most effective procedures to remove hair. It is targeted at destroying hair follicles and preventing the growth of hair.

            Unfortunately, the results obtained are about 80% and not permanent. Hair tends to grow back even after laser hair removal.             

            1. My hairdressers told me it’s bad to wash my hair, is it true? Does it depend on hair types?

            I would not recommend that because prolonged periods of not washing the hair causes build up and damage the hair. One should wash their hair with shampoo 3 to 4 times a week.

            I would recommend using a shampoo that is free of harmful ingredients like sulfates, paraben and silicon followed by a conditioner. Like any other part of the body, the scalp/hair needs to be clean for a healthy growth.

            1. What are your thoughts about baking soda and apple cider vinegar instead of shampoo/ conditioner?

            Baking soda or sodium bicarbonate is an alkali with a pH of 9 that is much higher than the pH of the scalp. It is abrasive and damages the hair and scalp. It can leave the hair dry and brittle leading to breakage and hair fall.

            It is recommended to use a good quality shampoo and invest in a good conditioner to keep the hair moisturised and protected.

             Apple cider vinegar is acidic in nature with a pH much lower than the scalp. It can damage the hair causing it to become dry and brittle. It can also cause the hair to lose pigment.

            1. Does using a dry shampoo once/twice a week really cause buildup? Does this inhibit growth?

            A dry shampoo does not clean your hair; it only absorbs oil for the time being to make it less visible. Over using dry shampoo or leaving it in your hair for prolonged periods of time can lead to its build up on the scalp. This can cause itchy and flaky scalp and lead to hair breakage.

            It can also cause the hair follicles to clog leading to folliculitis.  Simply using it once or twice a week should not cause any problem given that the hair is washed and conditioned properly.

            1. Why does my hair stop growing after reaching a certain length?

            Hair growth in every individual is determined by genetics, hormones and environmental causes. The rate at which the hair grows in each person is different. However, there are a few changes that you can make to your lifestyle to boost your hair growth. These are:

            1. A balanced diet including fruits, vegetables, protein and water

            2. Supplements containing biotin, zinc and other vitamins

            3. Sulphate free hair products

            4. Reduced styling and heating

            5. Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth

            6. Trim/haircut every 10 to 12 weeks to reduce damage from split ends

                42. What is the best way to maintain curly hair when you have a red, itchy, flakey scalp?

              People with curly hair tend to wash their hair less frequently as they should because curly hair lacks moisture and dry out easily. This causes build-up of sebum and hair products causing the scalp to become flaky, itchy and greasy. If your hair is curly and flaky at the same time follow these steps to maintain your curls:

              • Use an anti-dandruff/antifungal shampoo like ketoconazole to get rid of the dandruff or use your regular shampoo (sulfate free) more frequently

              • Use a shampoo and conditioner that are right for curly hair and free of harmful chemicals like sulfate, paraben and silicon.

              • You can use a stronger clarifying shampoo once every week to get rid of the excessive sebum and greasiness effectively

              • Do not over-shampoo your hair

              • Avoid very hot water, it can strip moisture from the hair

              • Use wide toothed combs to detangle hair easily

              • Avoid using heat styling tools frequently

              • Use a leave in hair serum for retaining moisture and reducing frizz

              1. How do you stop hair from growing?

              There is no hair removal treatment that can get rid of hair permanently. However, there are a variety of procedures that one can get done at a dermatologist’s clinic to remove hair for weeks, months or even longer. The most effective of these procedures is the laser hair removal and electrolysis.

              Both of these procedures are directed at destroying the hair follicles with high energy to stop hair from growing. These procedures require multiple sessions. At home, the best way to remove hair and prevent it from growing back for longer periods is a hand held IPL (intense pulse light) device.

              It is a one-time investment and easy to use. Remember that it does not remove hair permanently but helps in slowing the growth. Other methods used for hair removal are: shaving, waxing, and depilatory creams.

              1. When the scalp is tender and painful does that mean lichen planopilaris (LPP) is active? Or is it just a symptom of this disease that I must live with?

              Lichen planopilaris is an inflammatory condition that causes patchy scarring alopecia. The common symptoms of the disease are itching, pain and burning in the area involved.The cause of this disease is unknown.

              I would advise you to visit your dermatologist for examination as LPP is a slowly progressing disease and it can be active if the scalp is tender and painful.

              1. If I suffer from hair loss, how often should I shampoo and condition myself?

              Hair should be shampooed and conditioned 3 to 4 times a week and no more. Excessive washing of the hair can strip off the natural oils leaving the hair dry and damaged.

              To prevent damage to hair and hair loss, it is recommended to use a good quality shampoo and conditioner that are free of harmful chemicals like sulfates, paraben and silicon.

              (Question 46 is a duplicate)

              1. Are there vitamins/nutrients that make apricot oil beneficial for use on our scalp and hair?

              Apricot oil is obtained from dried apricot kernels by cold pressing. It is rich in nutrients like proteins, sugars and fatty acids like oleic and linoleic acid. It also contains vitamin A, D, E, copper, magnesium, phosphorus and potassium.

              Oleic acid is an omega-9 fatty acid. There are various studies that prove the beneficial effects of omega-9 fatty acids for hair. They are believed to increase the density of hair.  It moisturises the hair and scalp and reduces dryness.

              Linoleic acid is also a fatty acid which helps by stimulating hair growth and locks the moisture in the hair.

              Apricot oil also has anti-inflammatory properties which might help in some scalp conditions. It should be noted that hair growth is genetically determined with some effects from hormones and environmental conditions.

              1. Is it best for specific hair types or can anyone soak up the benefits?

              Like any other oil, apricot oil is the most suitable for dry scalp or for African hair types which tend to be drier than the hair of other ethnicities. Apricot oil contains oleic and linoleic acids that help lock in moisture in the hair and keeps them moisturised.

              This in turn prevents breakage of the hair. There are a few studies that prove the beneficial effects of omega-9 fatty acids (oleic acid) in maintaining healthy hair. It is best for dry hair but anyone can use it to prevent their hair from environmental damage and dryness.

              Individuals with excessively greasy or oily scalp should use oils less frequently.

              1. Can apricot oil penetrate the hair shaft like avocado oil?

              Apricot oil does not penetrate the hair shaft; it only prevents moisture from evaporating from the strands. The apricot oil lightly coats the hair shafts and locks the moisture in the hair by sealing the cuticles.

              It contains fatty acids like oleic and linoleic acids that help to moisturise the hair and scalp and reduce dryness. The factors that affect the penetration of oil in the hair shafts are:

              • Amount of triglyceride

              • Size of triglyceride

              • Length of fatty acid chains

              Oils with large triglyceride molecules and short chains of fatty acids do not penetrate the hair shaft.

              1. Is it ok to use apricot oil on the scalp causing build up?

              Apricot oil is one of the lightest oil to use on the hair. It comprises of fatty acids like oleic and linoleic acid, vitamins A, E, D, zinc and copper. All these components help the hair to retain moisture making them soft and less prone to environmental damage.

              Due to its light chemical composition, this oil does not make the hair greasy or causes build-up. In fact, its application to the hair is helpful in removing excessive build-up of sebum and hair care products that may linger on your scalp due to continuous use of these harmful chemicals.

              1. How would you recommend adding apricot oil to our routines?

              Apricot oil can be used alone or in combination with any other carrier oil in a hot oil treatment. Put some oil in your hands and massage it into your scalp in circular motions. Wrap your head with a plastic cap or a towel for about an hour. Then, simply rinse your hair with a shampoo followed by a conditioner.

              This process can be repeated 2 to 3 times a week for best results.

              Remember, while using hot oil treatment the oil should be warm but not burn your scalp.

              1. Can CBD use on our hair and scalp have benefits because of its omega fatty acids and antioxidants?

              Hair follicles contain cannabinoid-responsive receptors and there is evidence of cannabinoid deposition within the fibre followed by cannabis consumption and topical application of CBD. It is believed that there may be potential to use CBD to treat certain hair problems.

              However, given the complexity of hair growth more research is needed to prove the effects of CBD in hair loss. In short, there is no concrete evidence to support the claims that topical cannabinoids are beneficial in hair growth.

              CBD oil is made by extracting the compound called CBD from a hemp plant and it does not contain omega fatty acids. It is the hemp oil that contains omega fatty acids, not CBD oil.

              1. Hemp seed oil is becoming a popular ingredient in hair and body care because it is rich in polyunsaturated fatty acids. What can they do for our hair and scalp?

              Hemp oil is obtained by cold pressing hemp seeds. This oil is rich in polyunsaturated omega fatty acids and has more omega fatty acids than olive oil. It has no trans fats.

              The omega 3, 6, and 9 all help in maintaining healthy hair, skin and nails. It helps in strengthening the hair, moisturising the hair, and preventing water loss to protect the hair. Some studies also suggest that hemp oil can help relieve the symptoms of dry and itchy scalp.

              1. I’ve also read that hemp seed and CBD can promote hair growth and help with hair loss. I know these are big claims because hair loss can be attributed to genetics and other factors. Can either of these ingredients potentially help with hair loss?

              The main difference between hemp seed oil and CBD oil is that hemp oil is made by cold pressing hemp seeds, while CBD oil is made by extracting the compound CBD from the leaves, flowers and stalk of the hemp plant. Both hemp and CBD oil have their own health benefits.

              Hemp oil is rich in omega fatty acids which promote healthy skin, hair and nails. It does not contain any trans fats or CBD.

              The topical application of CBD oil is helpful in relieving pain, but there is less scientific evidence to prove its effects in increasing hair growth and helping with hair loss.

              Hair Growth:

              A guy receiving likes and follows on Instagram for great hair, great picture, flat style.

              1. Why does my hair grow so slow?

              Hair growth in every individual is determined by genetics, hormones and environmental causes. The rate at which the hair grows in each person is different. However, there are a few changes that you can make to your lifestyle to boost your hair growth. These are:

              1. A balanced diet including fruits, vegetables, protein and water

              2. Supplements containing biotin, zinc and other vitamins

              3. Sulphate free hair products

              4. Reduced styling and heating

              5. Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth

                 2. Is nail growth correlated with hair growth?

                Skin, hair and nails are made up of a protein called keratin mainly. The nail growth is not correlated to hair growth. Nails grow from the nail matrix at a rate of approximately 3 mm per month.

                Hair grows from hair follicles in three cycles: the growth phase, transition phase and shedding phase. Hair grows at a rate of ½ inch per month.

                1. Are there any scientifically proven ways to increase hair growth as my hair usually stops growing just below my shoulder-length?

                Hair growth in every individual is determined by genetics, hormones and environmental causes. The rate at which the hair grows in each person is different. However, there are a few changes that you can make to your lifestyle to boost your hair growth. These are:

                • A balanced diet including fruits, vegetables, protein and water

                • Supplements containing biotin, zinc and other vitamins

                • Sulphate free hair products

                • Reduced styling and heating

                • Cosmetic procedures like Platelet-rich plasma (PRP) can increase hair growth

                • Hair cut/trimming after every 10 to 12 weeks to get rid of damage from split ends

                1. What ingredients to avoid when it comes to promoting hair growth?

                The ingredients in hair products one should avoid using for promoting hair growth are:

                • Parabens

                • Silicon

                • Formaldehyde

                • Sodium lauryl sulfate/sodium laureth sulfate

                • Ammonia

                • Propylene glycol

                I personally prefer to use hair products that are free of sulfate, paraben and silicon.

                1. What foods to avoid when it comes to promoting hair growth?

                The food products that should be avoided to promote hair growth are:

                • Excessive sugar

                • Alcohol

                • Refined grains

                • Fast food

                • Fish are generally considered source of proteins for healthy hair but some fish like swordfish and mackerel are high in mercury and should be avoided.

                A balanced diet is the key to healthy hair. It should include fruits, vegetables, beans, pulses and water.

                1. What habits to avoid when it comes to promoting hair growth?

                A few of the many habits to avoid for promoting hair growth are:

                • Avoid using hair products containing sulfates, Parabens and silicon

                • Avoid using excessive heat while styling your hair

                • Avoid eating foods with high sugar content, fast food and alcohol

                • Avoid over washing the hair. Shampoo your hair no more than 3 or 4 times a week.

                • Avoid pulling your hair back into a tight ponytail/bun.

                1. Do hair serums work to promote hair growth?

                Good quality hair serums that are free of harmful ingredients may provide some benefits to hair growth. Just like skin serums, hair serums penetrate deeper in the hair shaft where they control frizzy and unmanageable hair and protect from environmental stress. Thus, it can make the hair shinier and thicker.

                Conclusion

                A rockstar playing guitar with long hair, flat style.

                Now that you know everything there is about hair loss. What did we miss? What do you want to know about hair loss?

                Comment below and we’ll have a dermatologist answer your burning questions!

                 

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