By Heidi Toy
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11 Feb, 2024
Balding affects everyone to some degree eventually but despite that it can be extremely distressing especially for women and younger age groups. I personally found myself balding in my early thirties which, man, really did not feel good looking in the mirror, especially as a young woman. Anyways I totally get it, but I’ve found my way back from balding to a healthy head of hair, and hopefully with the information here you can too. I go through the difference between hair loss and hair shed in my recent article on the topic . If you’re having hair loss, you are balding. Hair shed is a different kettle of fish, so it may be worth reading. Above, I went over some factors that can cause your hair to fall out and stay out. Now, I’m going to dive deep into some of the patterns balding takes, how to identify which one you are experiencing, and explain exactly what they tell us about your health in order to give you solutions that will actually help. Whether you see a functional practitioner, your family doctor, or a dermatologist, some of the key factors they use in determining how to help you stop hair loss or shed are already evident. What Causes Most Forms of Balding Most forms of balding are a combination of 4 things. Age, genetics/hereditry factors, hormonal imbalances and autoimmunes. Age As you get older hair follicle rest phases just start to get longer, blood flow worsens and follicles will become dormant. Just like with all age related deterioration, we can obstruct it’s progression, but I’m not selling an immortality pill here ya know. Furthermore age will contribute to other factors such as hormonal imbalance. Hormonal imbalance The primary hormone that impacts hairloss is DHT (which is androgenic and comes from testosterone). The simple explanation is that either your hair follicles are more receptive to DHT (as is genetically predisposed) or your DHT levels are very high. It is not, however, the only factor in play. Estrogen and progesterone keep your hair in it’s growth phase for longer, and with testosterone converting to both DHT and Estrogen it should be a significant point of focus in hair loss investigations. Often hormonal imbalances can be a warning sign of problems with the gonads (ovaries and testes), hence why hair loss or excessive growth can be associated with PCOS. Another major issue that can wreck your hormone balance is stress, and thats the main reason I personally started losing my hair in my 30s. Hereditary factors That means your genetics. Some people have blue eyes, some people have brown eyes, and some people lose their hair faster. It’s just one of those things. But this isn’t just “you will lose your hair” it’s a question of what predispositions we are working with here. Are you male or female, and so predisposed to certain patterns of hairloss? Are you predisposed to an illness that could be efffecting your hair? Are you predisposed to a higher level of DHT than average? Are you predisposed to producing high levels of cortisol (the stress hormone, which by the way is how stress destroys your hormone cascade)? In a lot of these cases we can stand against the power of genetics, and, despite your predispositions, get you your hair back. AutoImmunes Autoimmunes (where the immune system turns on the body and attacks healthy tissue) can cause hair loss through a number of different mechanisms such as attacking the hair follicles or contributing to hormonal imbalances. A couple examples might be Lupus or Hashimoto’s Thyroiditis. “Normal” Hair Loss (Androgenetic Alopecia) I say normal… Is it ever really “normal” to lose your hair? I suppose what I’m trying to say is that everyone will lose their hair eventually, and when they do with will be from Androgenetic Alopecia. That is to say, by the combined effects of genetic predispositions, age and hormone levels. This is the typical cause of balding in healthy adults and is, at a certain point, a normal part of aging. However, nobody want’s to lose their hair, and we can do things to buffer the onset of androgenetic alopecia, especially if it’s caught early. Androgenetic alopecia tends to manifest in two patterns, male and female. They are both quite distinctive though men have more pronounced symptoms. With that all being said, before we continue to a breakdown of these two patterns, it’s important to note that just because you hair loss matches one of these patterns does not mean that it is normal natural hair loss. There may be underlying causes that trigger a hairloss pattern that appears to be natural age related hair loss but is in fact more concerning from a health perspective. Key Signs of Male Pattern Baldness: What is Male Pattern Baldness: Male pattern baldness, while not totally exclusive to men, is generally the pattern in which men will lose their hair through androgenetic alopecia. That’s the sort of hair loss which happens naturally over time as we age, though it may be stimulated for other reasons. It’s characterisd by a receding hairline with recession at the temple as well as balding at the crown of the head. When concerned about, and looking for early signs of a receding hairline, looking at the context is always a great place to start. The most common cause of a receding hairline is androgenic activity (aka testosterone and related structures) combined with the hereditary factor (such as being male). If you are taking any medications, prescribed or otherwise, which might replace or increase testosterone, then the increased androgenic activity makes hair loss par for the course unless you take action to stop it. It’s also worth considering if you have had greater recent androgenic activity based on your lived experience. Have you experienced an increase in acne levels? Have you found yourself with a shorter temper? Perhaps, while hair is disappearing in some places, it’s becoming more forthcoming in others? All of these are signs of raised testosterone levels. If you are having these signs, and especially where other factors aren’t really in play, it is wise to discuss with a doctor, as raised testosterone levels can indicate that there is something that requires investigating in the gonads (testes or ovaries). Of course, in line with that, there are functional strategies we can employ to correct hormonal imbalances too. Did you know that Stress (there it is again) can increase testosterone levels? This is just one of a number of ways in which it can contribute to hair loss. This is one area where functional strategies will blow your MD’s take out of the water, but more on that later. Finally for context, on a herediary note, consider close family members. Does your father or mother have a receding hairline? Are your siblings having similar challenges? Don’t hesitate to reach out to them to discuss the topic as it can provide valuable insight on the nature of your condition. Next, it’s time to look at the forehead and scalp. Give your hair a quick brush at the back of the scalp then in the area of concern. Is there a difference in the shed? Remember hair shedding is not hair loss, but if you are experiencing localized shedding, it could help explain your concern and guide your efforts to stop the hair falling out. Do you have sensitivity in the scalp? Hair loss is often associated with increased discomfort, sensitivity and itchiness. Now take a photo. The easiest way to know for sure if you have a receding hairline is to take some photos and compare with photos from a week or two later. Just look for changes in the forehead size and hairline, especially at the temples. Key Signs of Female Pattern Baldness: What is Female Pattern Baldness: Female pattern baldness is less commonly talked about, mostly because it has a lower profile, and occurs much later in life than baldness typical of males. It’s also known as hair thinning (though this term has other applications) because its pattern is distributed accross the scalp. It occurs all over the scalp, with no particular area becoming markedly worse. However, it can appear as though the hairline is threatening to recede, or that the location of your usual parting is losing hair more rapidly, due to the fact that the thinning of the hair will be more noticeable where the hair roots are made visible. When concerned about female pattern baldness, as with male pattern baldness, looking at the context is always a great place to start. Again, hereditry and hormonal effects play a significant role in hair thinning that occurs with female pattern baldness. Unfortunately, we don’t have as much research on the issue as with the male pattern. For women, fluctuations in progesterone and estrogen can correlate with hair loss (yes, it can effect men, but it’s definitely not the first place a man should look). That means events like menopause (especially menopause) or childbirth can trigger hair shed and loss. It also ties into the stress response, as demand on cortisol production (the stress hormone) effects your progesterone levels, and not in a good way. Concerns with testosterone and DHT levels still play a role here though, especially as a reduction in estrogen production can cause an increase in DHT. It’s not clear whether the lower exposure of female hair follicles to DHT is what differentiates the actual pattern of hair loss, or whether women have different adrogen receptor distribution on the scalp (oh look, we are getting a little bit technical). It does seem that women can, get male pattern hairloss from very high levels of DHT but whether DHT is the primary causative factor in female pattern hair loss despite the obvious pattern difference is an open discussion. Regardless, it is definitely related, and so the same questions apply regarding androgen levels, those being: Are you on medications which could impact your hormone cascade? Are you experiencing raised acne levels? Are you experiencing abnormal aggression levels? Are you experiencing hair growth in areas not on the scalp? Would you say your stress levels have been elevated? And again, for the hereditary component, look at close family members and talk to them for information on their experience if they may have or may have had similar issues. It is important to consult a doctor regarding significant hormonal fluctuations. As stated previously these can be cause by conditions of the gonads (testes and ovaries). Nevertheless, there are powerful funtional strategies to combat hormonal imbalance, which may even given some symptomatic relief in spite of an underlying condition. Now, take a photo of yourself. Like with a receding hairline one of the most effective ways to check for female pattern baldness is comparison over time. Make it a habit to take a photo of yourself in the same lighting and angle once a week, female pattern baldness is generally slower onset and takes time to manifest, so regular review will help prove the issue and document progression to show whoever you go to for help. “Abnormal” Hair Loss Besides your typical baldness patterns (male and female androgenetic alopecia) there are other manners that hair loss can present that suggest less natural origins. Most of them can link in with each other, and it is possible to have them alongside your natural hair loss, which can be a bit confusing. The three most significant would be Cicatricial (Scarring) Alopecia, Alopecia Areata, and Traction Alopecia. What is Traction Alopecia? Traction alopecia is very simple, really. It’s hair loss because the hair follicles are being pulled on over time (acute ripping out of the hair is another matter and not one we’ll handle here). It will be localised to the area that has had traction applied. This could be a cause for losing your hair on one side of your head if you have had traction applied there. What causes Traction Alopecia? Maybe you are tying your ponytail too high and tight. Maybe you are fidgeting with your hair more vigorously due to stress. Really anything which pulls on the hair over an extended period could cause traction alopecia. Deserving of a specific mention might be mental health conditions which involve you pulling your hair, whether as the condition itself (tricotillomania) or as a coping mechanism. Key Take Aways for Traction Alopecia Most of the time, hair lost to traction alopecia can be reclaimed. Only in very pronounced cases where permanent damage to the hair follicle occurs, will the hair be unable to regrow. Traction alopecia won’t happen in a single moment. If you wear your hair down and you’ve brushed your it and have pulled out a clump of hair, unless you were really (and I mean really) going at it, then it wasn’t traction alopecia, and you have to look at other potential causes for hair shed. What is Cicatricial (Scarring) Alopecia As the name (scarring, not cicatricial) suggests, this form of hair loss is said to have occurred when the lack off hair growth is caused by scarring of the hair follicles. It can be very uneven, so if you are finding less hair on one side of your head (you’re losing hair on one side of your head) or you are noticing a patchy asymmetrical hair loss then you are very possibly dealing with scarring alopecia. What Causes Cicatricial (Scarring) Alopecia There are a wide array of potential causes for scarring alopecia and considering your own recent circumstances will help guide you to the cause of yours. One cause would be autoimmune conditions, most notably Lupus. Conditions such as Lupus can cause rashes and scarring, when these occur on the scalp hair loss occurs which can, unfortunately, be permanent (due to damage to the hair follicles). Physical traumas can cause scarring alopecia, so if you are having uneven or onesided hair loss, consider if you have had any major traumas to the area, even if they were a long time ago. Non-autoimmune rashes and skin conditions also play a role, one key example would be eczema which is well known for causing quite pronounce hairloss if allowed to persist. Key Take Aways for Cicatricial (Scarring) Alopecia It refers to damage of the hair follicles and for the most part is permanent. It can be caused by health conditions, such as autoimmunes, but also acute trauma. What is Alopecia Areata This is non-scarring hair loss outwith the usual patterns of hair loss (androgenetic alopecia). Most commonly this will involve a patchy appearance. You may find one patch on a side of your head or you may find many smaller patches. Rarely will there be any symmetry. Alopecia Areata is really a catch-all term, but with so many factors pinned down remaining causes are actually quite limited. What Causes Alopecia Areata Autoimmunes, most prominently Hashimoto’s thyroiditis (which caused my hair loss), are the most common cause of alopecia areata. In the case of Hashimoto’s, there is a reduction in thyroid activity (hypothyroidism) which has been shown to correlate with hair loss. This is thought to be because it low thyroid hormone affects skin cell regeneration, which results in stalling of the hair growth phase cycles. Another cause of alopecia areata would be a reduction in blood flow to a given area, but this is a very rare cause due to the nature of the blood vessels in the scalp. You can also find that poor sleep will cause this kind of hair loss as it weakens the hair follicles (when it is a habitual deficiency). Key Take Aways for Alopecia Areata Most of the time, especially with proper care and treatment Alopecia Areata hair loss is temporary. It’s involves no permanent damage to the hair follicle (non-scarring) but instead turns the follicle off so to speak. From a functional standpoint… There are a lot of actionable steps we can implement to reduce risk of balding and hair loss. These generally encompass reduction of 3 types of stressors on the body. Those would be: Emotional Stress Dietary Stress Pain/Hidden Inflammatory Stress This can help reduce balding and hair loss by: Providing sufficient nutrients to ensure follicles don't fall dormant. Holding autoimmune conditions, like Hashimoto’s Thyroiditis, in remission. Reducing the need for hair related fidget habits and ensuring you have the energy necessary to practice proper hair care. I personally reversed my hair loss using functional medicine, so I know it works and I've helped hundreds of other women do the same. If you want to put a stop to hair loss, get on a free discovery call with me .
