Hair loss can result for a number of reasons in both males and females. This may be the result of hormonal changes or medical conditions such as alopecia. Hair loss occurs when new hair doesn't replace the hair that has fallen out.
Hair loss can appear in many different ways, depending on what's causing it. It can come on suddenly or gradually and affect just the scalp or the whole body. Signs and symptoms of hair loss may include gradual thinning, circular or patchy bald spots, and sudden loosening of hair. Circular or patchy bald spots is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair. An increasingly common hair loss pattern in older women is a receding hairline (frontal fibrosing alopecia). Some people lose hair in circular or patchy bald spots on the scalp, beard or eyebrows. The skin may become itchy or painful before the hair falls out. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning.
In females, hormonal changes such as menopause or thyroid problems can lead to hair loss. Specifically, it’s related to a lowered production of estrogen and progesterone. These hormones help hair grow faster and stay on the head for longer periods of time. When the levels of estrogen and progesterone drop, hair grows more slowly and becomes much thinner. A decrease in these hormones also triggers an increase in the production of androgens, or a group of male hormones. In female, excess androgen levels (primarily testosterone) can cause a variety of symptoms such as acne, weight gain, excessive facial and chest hair (hirsutism), irregular menstruation, and excessive loss of hair at the scalp. There are many other factors that can contribute to hair loss during menopause. These include extremely high levels of stress, illness, or a lack of certain nutrients. Diagnostic blood tests that can help rule out other causes of hair loss include thyroid tests, and/or a complete blood count.
In TCM, these hormonal changes are due to a Liver Yin deficiency in combination with a Kidney blood deficiency.
Chronic immune stress from viral infections can also lead to hair loss. This non-scarring hair loss is the result of an abnormal shift in follicular cycling with prolonged telogen phase. During the telogen phase, the hair growth cycle is at rest. This delay in the growth of new hair is what triggers hair loss. Scientists are not certain what causes this condition, although physical and emotional stress is believed to be the most likely culprit, not the virus itself. Hair loss can also be caused by high fever, illness or weight loss of more than 20 pounds – all of which are common viral infection symptoms. This is because a fever or illness can force more hairs into the shedding phase. Dermatologists say that hair loss can occur 2 to 3 months after a patient becomes infected with the coronavirus – even weeks after recovery.
In TCM, this is due to a Qi and Blood deficiency and invasion of Evil Qi from the meridian in combination with liver, and kidney deficiencies.
In males, hair loss can occur from high levels and sensitivity to DHT and reduced kidney function. Hair loss is due to the shrinkage of hair follicles and the resulting impact on the growth cycle. New hairs become finer and finer until there’s no hair left at all and the follicles become dormant. This hair loss is caused by increased DHT levels and certain genes that cause increased DHT receptor sensitivities. Dihydrotestosterone (DHT) is made from testosterone by an enzyme called 5-alpha reductase (5AR). DHT and testosterone are essential in regulating the metabolism of the prostate, skin, and hair follicles. However, DHT is more potent than testosterone. As men age testosterone levels decrease resulting in the activity of 5AR to increase. To compensate, an increase in the conversion of testosterone to DHT occurs. When DHT levels are too high, it can lead to male patterned baldness. DHT can shrink the hair follicles as well as shorten the hair growth cycle by binding to the receptors on the hair follicles. Increased levels of DHT can also make the follicles take longer to grow new hairs.
Hair follicle receptor sensitivity also plays a role in hair loss. The AR gene encodes the receptor on hair follicles that interact with testosterone and DHT. If the receptors are particularly sensitive, they are more easily triggered by even small amounts of DHT, and hair loss occurs more easily as a result. Other genes may also play a part.
Androgens are a group of male hormones that include testosterone as the primary androgen. Higher levels of androgens in males is connected to decreased renal function.2 Androgens have been shown to affect renal hemodynamics and promote glomerular and tubular injury.2 This decline in kidney function can further affect hormone imbalance and results in hair loss. Kidney damage and CKD is tied to hair loss due to excessive protein being lost through urine. Many tissue in the body utilize protein including hair and the hair follicles.
Age, stress, and other factors can influence hair loss. But genes play a significant role, and men who have close male relatives with male patterned baldness have a much higher risk of developing it themselves.
In TCM, this is due this a kidney deficiency in combination with a liver Yin deficiency.
Medical conditions such as alopecia areata (AA), an immune system related disease, can also lead to hair loss. AA is a disease that develops when the immune system attacks its own hair follicles, which can cause hair loss anywhere on the body. The attack to the hair follicle matrix epithelium makes it undergo early cortical differentiation (anagen hair follicles), which are then prematurely induced into the catagen phase.
While hair can be lost from any part of the body, alopecia areata usually affects the head and face. Hair typically falls out in small, round patches about the size of a quarter, but in some cases, hair loss is more extensive. Most people with the disease are healthy and have no other symptoms. The course of alopecia areata varies from person to person. Some have bouts of hair loss throughout their lives, while others only have one episode. It is possible that emotional stress or an illness can bring on alopecia areata in people who are at risk.
In TCM, AA is due to Damp and Heat on the scalp in combination with deficiencies in the kidneys, liver, and blood. The liver is a major organ that determines autoimmunity due to control of the T cell immunity by the suppressor T cells produced from the liver.
