5 Hair loss myths you should know

Physician Lim Jing Yang From the modern medical perspective, alopecia refers to a gradual loss of hair, partial or complete, occurring anywhere on the head or on the body. It can be broadly classified into scarring alopecia as well as non-scarring alopecia. While scarring alopecia is best evaluated by a dermatologist, non-scarring alopecia can be treated in an outpatient setting. Common non-scarring alopecia conditions include [1]: Condition Presentation Pattern hair loss Also known as Androgenetic alopecia (AGA), it is a non-scarring hair loss condition that primarily affects the top and front of the scalp Tinea capitis A fungal infection of the scalp that causes patches of hair loss that may be red and scaly. Diagnosis is done with a dermascope and it must be treated systemically. Telogen effluvium A non-scarring, non-inflammatory alopecia caused by physiologic or emotional stress. Once the precipitating cause is removed, the hair typically will regrow. Trichotillomania A disorder where a person has a strong urge to pull their hair out. Treatment is aimed at controlling the underlying psychiatric condition. Trichorrhexis nodosa When defects in the hair shaft break secondary to trauma and is often a result of hair styling or overuse of hair products. Anagen effluvium An abnormal diffuse loss of hair during the growth phase caused by an event that impairs the mitotic activity of the hair follicle, most commonly chemotherapy. Pattern hair loss, also known as androgenetic alopecia (AGA) is a hair condition that primarily affects the top and front of the scalp. It manifests itself as both Male-Pattern Hair Loss (MPHL) as well as female-pattern hair loss (FPHL). In MPHL, the hair loss presents as a receding front hairline or loss of hair on the top of the scalp or a combination of both. In FPHL, this usually appears as gradual thinning at the part line, followed by increasing non-localised hair loss spreading from the top of the head. Myth 1: Only older people suffer from baldness While most men experience male pattern baldness from middle age onwards, about 25% of them will begin before 21[2]. As for women, even though more than half of women would have Female Pattern Hair Loss (FPHL) by 79 years of age, 12% first develop clinically detectable symptoms by age 29[3]. Hence, developing hair loss in your twenties is possible especially if you have a strong family history. Myth 2: Bald men have more testosterone Elevated testosterone levels do not cause hair loss. Male pattern baldness is due to how sensitive your hair follicles are to Dihydrotestosterone (DHT) – a kind of androgen hormone that is up to 3 times more potent than testosterone. DHT also binds to Androgen receptors (AR) and about 10% of testosterone is converted to DHT on a daily basis. Variations in the androgen receptor gene can increase androgen receptivity in your scalp follicles, making you more likely to experience male pattern hair loss[4]. High DHT levels shrink your hair follicles as well as shorten the hair cycle. This causes hair to fall out faster, grow out thinner and be more susceptible to breakage. DHT also increases the time for your follicles to grow new hairs once old hairs fall out[5]. Myth 3: Washing and shampooing your hair too much can cause hair loss Hair seen collecting on the shower drain inlet might appear as if more hair is lost when washing or shampooing. However, this is hair that would have fallen out regardless whether you washed with shampoo or not. Our hair goes through different phases of growth and it is during the dormant phase where it stops growing and eventually drops out of the hair follicle. A new strand of hair would then replace the same spot. Hair follicle cycle Myth 4: Vitamins can stop hair loss Vitamins (C and D) and minerals (iron, zinc, selenium) play an important role in the growth of hair and development of a normal hair follicle. However, hair loss cannot be averted if it is not caused by micronutrient deficiencies, Furthermore, it is best not to consume too many vitamins as overdosing on certain vitamins like A and E might even speed up hair loss[6] Myth 5: Stress causes permanent hair loss Stress is very much a part of life while living in an urban environment. We get stress from work, family and sudden events that happen when least expected. This stress can cause a spike in adrenaline levels that damage the melanocytes, which are the hair cells that produce melanin, the pigment that gives our hair colour[7]. Telogen effluvium is another condition caused by stress resulting in non-scarring and non-inflammatory temporary hair loss. Hair will usually regrow once the stress factor is removed[8]. What is hair loss from a TCM perspective? TCM believes that pathological hair loss is a warning sign from our body telling us that some changes to our lifestyle are needed to maintain healthy hair growth. Just as we need to water, plough the soil and spread fertiliser to ensure healthy crop growth, the same is needed to nourish our hair follicles and stimulate healthy growth of hair. Traditional modalities such as acupuncture, massage and herbal medication can help one achieve that. There is a saying in TCM that mentions that health of the hair lies in the Blood, hence the saying “发为血之余” Fa Wei Xue Zhi Yu. The health of the Blood then depends on the quality of function of the Organs like the Kidney, Liver, Spleen, Heart and Lung. The Kidney stores essence of which quality shows in the hair. The Liver stores Blood while the Heart is in charge of the blood vessels, the activity of these two Organs ensure healthy blood flow to the scalp for hair growth. The Spleen is in charge of transforming the food we eat into nutrients for hair growth and sustenance while the Lung is associated with the exterior part of our body thus ensuring that nutrients are brought to the top of the head. Thus, from the TCM perspective, the