Home Help for Hairloss

One of the things I particularly enjoy about my practice as a Holistic Health Coach is working with clients to create a lifestyle integrated with tools to offset the stress of daily living. 

As a Dermatology Physician Associate of 13 years, I recognize the biological effects of stress on the body, often referring to it as “jet fuel” for anything from aging, inflammatory conditions, poor healing, gut dysbiosis and mental health challenges. 

In recent years, I’ve been noticing stress to be a great accelerant of various forms of hair loss. 

Before we dissect a small corner of this topic, it’s important to recognize that hair loss can be caused by a number of etiologies. The ones I see most frequently in clinic are Telogen Effluvium (a temporary and excessive shedding of hair in the resting phase) and Androgenic Alopecia (male and female pattern hair loss/baldness). While Telogen Effluvium is usually caused by a directly offending agent which causes the body to physically, mentally, or emotionally be exposed to a stressor (such as a surgery, food poisoning, a virus, childbirth, car accident or divorce), Androgenic Alopecia is regulated moreso by hormones and gene expression. 

How Are Genes Expressed?

The blossoming field of science called Epigenetics can explain that. Epigenetics is the influence of environmental factors (ie. chemical, dietary, stress exposures) on gene expression. 

One way you can look at it is, if you don’t manage your stress levels, you can turn on some previously inactive, unwanted genes. 

And when it comes to the Androgenetic Alopecia, which is sparked by an excessive response to androgens and characterized by progressive loss of terminal hair of the scalp, stress can influence epigenetics to indirectly heighten sensitivity to the causal compound of dihydrotestosterone through acetylation of genes encoded in DNA. 

Before we continue further, let’s recap the above.

The most common forms of hair loss Dermatologists see in clinic are Telogen Effluvium and Androgenic Alopecia.

Telogen Effluvium, a common form of isolated balding, is usually caused by an acute stressor.

Meanwhile, Androgenic Alopecia is more hormonally influenced, wherein sex steroids work directly on synaptic receptors as well as indirectly through gene transcription.  For years, we believed that our genes predetermined our abilities, appearance, health and longevity.  However, we now know that our experiences, exposures, food choices, lifestyle, metabolic status, amount of sleep, and outlook can actually alter our genes through epigenetics.  

So when our patients are not quintessential testosterone pumping males, what do they look like?

Hair loss patients come in all shapes, sizes, and age. However, before I even walk into the room, I’m looking at my patient intake (that form you fill out with your medical history and concerns) for clues.  Blood pressure medication, any form of Diabetes or pre-diabetes, history of reproductive cancer, thyroid medication, psychiatric medications and cholesterol controlling medications or herbs are first on my list.  I also look at dates of any recent surgeries or hospitalizations to consider as an event along the timeline of hairloss as physically stressful events can proceed loss by an average of about 2-4 months. In women, I’m also looking for self reported histories of polycystic ovary syndrome (PCOS). 

As soon as I walk into the room and introduce myself, I’m taking into account the patient’s body habitus.  I’m looking at their current hairstyle.  If the hair that is present looks greasy, I gather clues about how often it’s washed or if there’s a component of yeast and seborrhea contributing to the state of scalp health.  If the hair is pulled into tight rows of braids, I become concerned that we are dealing with Traction, or Scarring Alopecia, which has a much poorer prognosis.   I take into account their energy level, complexion, weight to frame (BMI estimate), their build, and observe their eyebrows and patterns of body hair.  

By now, the patient is already sharing their concerns and history of the present illness. At this point, I’ve already begun to develop a picture which will soon become whole after asking my patient specific questions regarding the clues I’ve gathered above, in addition to questions about diet, stress levels, and if female - menstruation or menopause.  

I share this here, because I think it’s important for you to be aware of the pre-calculated thought process and part of the conversation many Dermatologists have had with themselves before asking you questions about your condition.  I think these tell-tale factors are important for patients to bring into their awareness, prior to these appointments which tend to move quickly.  Nobody knows you better than yourself, so if you can hold up a mirror and reveal some underlying factors, it will only help to give your physician more information to benefit you in the end.  

Prescriptive Plans:

There are many causes of hairloss.  Needless to say, pathology determines which treatments will be effective. If the answer is not immediately clear, it’s important to get a punch biopsy of the scalp early on to discern the underlying cause.  In many occasions, blood work may be helpful as well.  Labs ordered might look at thyroid hormone levels, insulin resistance, male and female hormones, metabolic balance, iron stores, Vitamin B12 and folate, Vitamin D, zinc, ANA (to rule out autoimmune causes), RPR (to rule out syphilis), among others.  

Many Dermatologists will offer treatment in clinic in addition to prescriptive topicals and oral pills.  Some offices will also offer injections of steroids if scalp biopsies show inflammation.  This can prove helpful in cases of Telogen Effluvium or Alopecia Areata.  However, Platelet Rich Plasma (PRP) injections tend to be profoundly more effective on hair regrowth in Androgenetic Alopecia within a matter of a couple months.  

Topicals often consist of minoxidil which is effective at a concentration of 5% or above.  Minoxidil can be mixed with other medications such as tretinoin or progesterone to effect penetration and efficacy; however, it can also have an irritating effect on the skin of the scalp.  Dermatologists will often prescribe clobetasol solution or a similar steroid solution to offset irritation and counter antagonizing inflammation around the follicles.

Oral pills include finasteride (known as Propecia) for men, or spironolactone for women, in addition to supplementation with popular products such as Nutrafol or Vivisical.  

Shampoos may be sold in office, with many of them only really possessing the ability to strengthen existing hair shafts, but not the quality of reducing shedding or influencing regrowth.  A prescription antifungal by the name of ketoconazole; however, is often prescribed for it’s ability to reduce yeast which contributes to seborrheic dermatitis and inflammation of the scalp.  Recently, researchers have found that it’s application desensitizes androgen receptors in the scalp, blunting the hair loss response.  This can be prescribed and alternated with a hair strengthening shampoo for broad spectrum support.  

Helpful Tips at Home:

The prescriptive treatment plan your provider decides to follow will be based on their clinical experience and outcomes of their previous patients.  Some providers take a simple approach, while others may throw a battery of tests and treatments at you.  The important thing is not to get overwhelmed.  Hair loss can be a very emotional visit.  You and your provider are assessing this process together as it unfolds. Results will not happen overnight. Go into this knowing that some things are in our control while some factors are not. Below are some tips to give you access to non prescriptive support which can help you to influence those factors within your control.

#1 - Make it a priority to schedule time for mindfulness and decompression and DO NOT compromise that time. Find a feel good activity to do every day which forces you to be in the present moment, doing something you consciously enjoy. (Not scrolling through social media)

#2 - Trade the coffee for green tea which is rich in antioxidants and a compound by the name of L-theanine.  L-theanine has a calming effect on physiologic as well as emotional stress. I recommend this supplement for acne patients who flare when under stress as well.

 #3 - Eating a few handfuls of pumpkin seeds morning and night, can be beneficial as pumpkin seeds contain a compound by the name of cucurbitacin as well as zinc and vitamin C which are important for hair growth.  You can also purchase an oral pumpkin seed Oil supplement to take regularly. A 24 week study administering 400mg of pumpkin seed oil (PSO) to androgenetic hair loss patients showed a positive anabolic effect on hair growth by 30-40% compared to the control group.  While the mechanism of action is poorly understood, researchers hypothesize that this is because a compound in PSO blocks the action of 5-alphareductase which in turn decreases plasma dihydrotestosterone (DHT).  Remember that DHT is what binds to androgen receptors in the scalp causing androgenic pattern baldness.  

Other foods that may block DHT and are not as well studied include edamame, onions, coconut oil and foods rich in a compound called Quercetin.

#4 - Consult your PCP and inquire about adding Saw Palmetto and Silica (which often pairs with horsetail extract which can lower blood pressure & effect kidneys).  Saw Palmetto has a hormonal effect while Silica increases the density and strength of hair shafts; however, both of these natural supplements have a few potential side effects of which you should be aware, especially if you are trying to become pregnant.

#5 - Ensure you’re consuming enough bioavailable sources of the minerals iron, zinc, and magnesium.  These minerals, in addition to B complex and Vitamin D, are known to support hair growth and maintenance.  If a deficiency in one of these nutrients is contributing to hair loss, this is one of the easiest ways to turn your condition around.  

#6 - Have your Thyroid checked through lab work at least once a year.  If you are diagnosed with thyroid dysfunction, you will need to have this checked more frequently to gauge efficacy of treatment.  Both an under- and over-active thyroid can present with hair loss, and this can even effect eyebrows and body hair.  

#7 - A healthy scalp has a healthy blood supply.  Take a moment to stimulate circulation of your scalp.  Ask any surgeon, if you have a good blood supply, the nutrients and growth factors get to where they need to go and you heal much better. To increase circulation of the scalp, massage 2 drops of therapeutic grade essential oil of Rosemary and/or Peppermint directly onto your scalp for a minute at a time, twice daily.  This will also help any topicals such as minoxidil penetrate better.  Surprisingly, some studies have shown these essential oils to produce an equal amount of hair growth in head to head studies with minoxidil.  

#8 - Supplement with N-acetylcysteine (NAC), which is a vasodilator that increases oxygen delivery to tissues and causes mitochondria (the workhorses of the cell) to produce more ATP (cellular energy currency). NAC is also a potent antioxidant that effects glutamate receptors and decreases other causes of hair loss such as hair pulling, or trichoteiromania.

#9 - Keep pumping that oxygen and nutrient rich blood with the addition of Ginseng supplementation. Studies on the effects of ginsenosides on androgen sensitized scalps have shown topical application of red ginseng repeals the effects of testosterone mediated suppression of hair regrowth.

#10 - Previous clinical studies have revealed that hair growth is stimulated by 650-nm red light. Pathology results from biopsies taken from the scalp of androgenetic alopecia patients demonstrate miniaturization in the secondary follicles.  This miniaturization of the follicles leads to reduction in hair density (the thinning which precedes visible baldness). Ex vivo studies demonstrate the  role of red light in promoting hair growth and reversing the miniaturization process, while in vitro studies reproducibly identified that red light delayed the transition of hair cycle from anagen (growth phase) to catagen (transition phase). Look into a red light system which produces this wavelength for home treatment.  Be sure to read reviews and look for third party tested systems for quality assurance.

As always, make sure you are consuming a primarily unprocessed diet rich in fiber and colorful foods.  Reduce or eliminate refined sugars and gluten containing carbohydrates to decrease metabolic dysfunction, glucose dysregulation, and pro-inflammatory factors in the gut.  Make lifestyle choices such as these, in addition to getting an average of 7.5 hours of sleep a night, to support immune health and suppress chronic inflammation which can potentiate autoimmune dysfunction and confound a presentation of hairloss.  

Finally, remember, stressing about hair loss will not help the situation.

If you’ve read this entire article, you’re probably in good shape because you’re seeking knowledge and answers. In my clinical experience, the more a patient knows, the more it grows and shows!