Female hair loss
Q) I am a healthy woman in my mid-50s . . . but my hair is falling out. The thinning began almost a decade ago and has continued on slowly but relentlessly, and is now critical. It is worst at the sides and temples, and I dread washing it because
it comes out in 'sheets'.
I have a history of ME, and allergy and digestive troubles, but my energy and quality of life are very good now. I have used Bowen, acupuncture and lots of homeopathy-but my hair is still falling out. I am a sensible weight (possibly a little thin), get lots of exercise, eat 80-90 per cent organic (no dairy) and take a long list of supplements. Menopause began about six months ago.-R.M., via e-mail
A) Thinning hair is relatively common in women, although it rarely reaches full blown baldness. It may start as early as age 20, and accelerates after the menopause. By age 50, as many as 50 per cent of women will suffer from thinning hair. The culprit is the male-hormone testosterone, which all women also have in their system. Hair-thinning happens when hair follicles are sensitive to testosterone, and the hairs are not replaced as they naturally and gradually fall out. A largely inherited condition, it may have little to do with testosterone levels-it's just that some people's hair ismore sensitive than others'.
The pattern of alopecia in women tends to be different from men's, occurring more at the top and sides of the head rather than the crown. If a woman does develop so-called 'male-pattern baldness', it could be a sign of something more serious, such as a tumour causing excess testosterone. Such a condition is rather rare, however.
So, apart from unlucky genes, what else can cause hair loss in women? Not surprisingly, stress can play a part: women with high stress levels are more than 10 times more likely to suffer from the problem (Psychol Rep, 1998; 82: 1044-6). Low levels of hormones can also be a factor, particularly when due to an underactive thyroid. Some gynaecologists recommend checking for heavy-metal poisoning (Ther Umsch, 1990; 47: 985-90), for example, mercury toxicity caused by dental fillings.
Nutrition is important, says alopecia expert Dr Hugh Rushton, of the University of Portsmouth. He's surveyed all the evidence to date, and found that a key nutrient is iron: too little iron can cause hair loss, but only in women. He recommends that women with persistent alopecia undergo a serum ferritin test to confirm whether their blood iron levels are at least 70 mcg/L. Another important nutrient appears to be the amino-acid l-lysine: when combined with iron, one clinical trial showed that "a significant proportion" of women benefited.
However, too much nutrition in general can be counter-productive. "Excessive intakes of nutritional supplements may actually cause hair loss and are not recommended in the absence of a proven deficiency," says Dr Rushton.
Apart from hair-thinning (alopecia androgenetica), women can also suffer from alopecia areata-patchy baldness. This form of balding is frequently seen after the menopause and is believed to be an autoimmune problem, where the body is attacking its own hair follicles. To judge by your symptoms, you may be suffering from areata, too. Again, it's primarily an inherited condition, but may be exacerbated by a thyroid deficiency or coeliac disease.The conventional treatment for both types of alopeciais minoxidil. Originally prescribed as a heart drug, it was discovered to have a weird side-effect: unwanted hair growth. The drug has proved to be a huge moneyspinner for its manufacturer Upjohn, who went onto the market with a minoxidil lotion called Regaine (UK) or Rogaine (US).
Once claimed to be 90-per-cent effective, years of bitter experience have shot holes in that figure. Clinical trials and expert opinion now suggest that only about 15 per centof users achieve "moderate regrowth", 50 per cent enjoy delayed hair loss and 35 per cent experience no benefit whatsoever (BMJ, 1998; 317: 865-9). And, as soon as the treatment is stopped, any new hair soon falls out.
But there's possibly a more effective treatment-in your vegetable basket. The humble onion has been shown to do wonders for areata. In a recent clinical trial, crude onion juice applied to the scalp twice a day showed benefits within a fortnight, with maximum regrowth after six weeks. It worked in about three out of four women, and almost all men. But remember, this was only for bald patches, not generalized hair-thinning (J Dermatol, 2002; 29: 343-6).
Other, more exotic, plant extracts have also proved to be helpful for patchy baldness. In a randomized clinical trial by the Aberdeen Royal Infirmary in Scotland, doctors tested a mixture of aromatherapy oils (thyme, rosemary, lavender and cedarwood) massaged into the scalp once a day, and found a significant improvement in about half the patients (Arch Dermatol, 1998; 134: 1349-52).
For alopecia androgenetica, there's a dearth of sure-fire options. One of the most clinically researched products (but even then, rather inadequately) is ThymuSkin. The active ingredient is synthetic molecular copies of a cow's thymus gland. It is said to show "benefit from treatment" in 100 per cent of women (Ther Umsch, 1990; 47: 985-90). Also available are two herbal preparations, Nisim and Hair Prime, though neither has been clinically researched on women. Nevertheless, both claim good results.
As a last resort, you could try camouflaging the problem. New York hair salon owner Mark Garrison recommends keeping the hair short, using "well-placed highlights and lowlights", and applying hair-thickening products.