A story of hair loss, and what to do about it.
article and image by Lisa R. Lowry, MD
Published in TYLER TODAY Magazine
The merciless intensity of the August sun was a beat down, it’s waves of hot, compressed air pushing beads of sweat on my skin into a small river running down my back. Not to be dissuaded from my mission to use my camera every day for a year, I slugged forward into humidity with the density of Jell-O.
The recent storms had downed trees, and sections of fence lay hidden under dense brush that appeared to have grown on fast forward. Small swatches of sunlight, escaping the grip of the towering tree cover, played hide-and-seek with the moss-covered rocks asleep in the dark earth.
The airspace, both within the tree cover and outside of it, was a multilevel superhighway. Doing lazy circles at the highest level, the turkey vultures demonstrated flying skills to each other. Below them the cardinals and blue jays did quick sprints across the open sky areas, advising everyone to clear the airway with their characteristic caws and chirps. The hummingbirds had no respect for any of the established pathways and readily did impressive vertical drops and climbs, zig-zags and duels, and spiraling loop-de-loops befitting any Top Gun wannabe.
As I pushed against an iron gate, thick with vines twisting, turning, and wrapping thin yellow-green fingers around the lengthy support segments, I was halted in my tracks by the appearance of something I had never seen before. There, just inches from where I had just placed my hand, was a delicate, lacey, exquisite “something.” Had I been in the ocean, I would have suspected some beautiful marine life form that lured prey in with its exotic appearance, only to make them dinner. Had this been the rainforest, I would have thought this was an insect-ingesting flower. Had I been in outer space, well, it did look alien. But I was in my own backyard, and I had no recollection of ever having planted anything that looked like that. Nevertheless, there it was. On closer inspection, it had a base of annular light pink petals. Sitting on top of this was a very intriguing spaghetti noodle-like ring of purple tendrils that gathered at the center creating a ring of pink and purple. Nestled inside, and extending out from the center were arm-like extensions with bulbous projections at the ends, resembling a docking station for would-be guests. Exploring further, I saw it was part of a vine, with the various life stages of the flowers evident once I simply opened my eyes to all that was there. Perfect representations of pre-bloom, bloom, and the afterthought. There was also a light green, lime colored and shaped pod or fruit that occasionally populated the vine amongst the delicate leaves. This amazing plant, whatever it was, had found its way to my yard and was thriving.
I had gone into my garden with a new camera in hand, hoping to learn something and practice a skill. I am a novice, which translates to having a sense of wonder and humility about even the simplest things. Exploration of the same spaces I inhabit every day reveals new experiences, the lessons of which find their way into the other parts of my life. I thought about this plant, its beauty, its complexity, its life cycle, about how carefully nature has crafted it to its purpose. Every part of us too is complex and carefully crafted, right down to the hairs on our head.
Hair has a prominent place in history, culture, and our daily lives. It reflects our genetics, our heritage, our metabolism, our personal preferences, and our state of health. It reflects youthfulness as well as where we are in our progression across life’s timeline, just like my mystery vine.
Ever clever Mother Nature is surely going to get more out of this energy expenditure of growing hair than simple decoration. It also provides very important functions: it is a physical barrier to sun exposure. It assists with temperature regulation, the detection of external stimuli, insulates when it’s cold and helps in the sweating process when it’s hot. Eyebrows and eyelashes protect those “windows to the soul,” the eyes.
Sometimes acutely, sometimes slowly, hair growth will abandon us. It falls out, stops growing, gets thinner, changes colors, breaks, or in any number of ways stops showing up for us in the manner we wish for it to be present. It can feel as deeply painful and as emotionally disturbing as a betrayal. One look at the financially robust hair care industry unveils the lengths to which people will go to restore or improve their hair.
As Dermatologists, we see a broad spectrum of presentations, severities, emotional comorbidities, and responses to therapeutic interventions. We have seen the armamentarium for battling and defining the causes of this menace change drastically over the decades. The only thing that has remained the same is that “it’s complicated.”
Each patient has a unique story: their genetics, environment, health, hair care practices, stress level, diet, and habits all contribute to the scene unfolding. People demonstrate different levels of willingness to pursue evaluation methods and treatments, as well as expectations and financial commitment. Some favor holistic or integrative approaches; others are full speed ahead with whatever might help. Many go online, answer a few questions, and are prescribed medications; some self-medicate after a visit with Dr. Google. My biased response is buyer beware, both in the online world as well as that of Modern Medicine. When the level of emotional distress is high, our vulnerability increases, and our good decision-making skills may be shoved aside. If we are embarrassed or reluctant to speak openly about our plight, we often will select avenues of treatment that allow for minimal communication, exactly the opposite of what we need to solve this problem. If you are experiencing hair loss that is concerning to you, having someone who is knowledgeable and experienced with this complex problem is advised.
Once upon a time, treating hair loss was as defeating for the physician as it was for the patient. Even when we could pinpoint a cause, few treatments were available. Today, with more scientifically based treatments than ever, it is a much more satisfying interaction for physicians and patients alike.
Treating the root cause is always recommended if there is an underlying metabolic component. Thoughtful evaluation with a complete history and physical exam, including skin, hair, and nails, is invaluable. The problem of hair loss often gets mentioned at the end of a clinic visit as an aside, when in fact it is its own big thing. It deserves its own space and time. Blood work may reveal underlying anemia, thyroid disease, inflammatory, endocrine, or other conditions that distract your body from hair growth activities. It’s fighting other battles. There may be a significant genetic component. A history of recent illness, stress, surgeries, childbirth, starting or stopping medications may be contributing. Covid was and continues to be a major contributor to the hair loss wars. A good evaluation of supplements and over-the-counter medications is important. Sometimes a biopsy may also provide helpful information about what treatment option(s) may be best for you.
Diet, exercise, rest, and stress reduction need to be reviewed. Adequate protein intake and other micronutrients are necessary for hair growth. If you were tired and hungry, would you want to work all day fixing your heart and other muscles and then be expected to produce gorgeous hair? I think not. Give your body something to work with. Reducing sugar and ultra-processed foods reduces inflammation. Exercise encourages good blood flow and distribution of nutrients. Rest gives your body a chance to repair and grow. Stress reduction aids in better metabolism, also reducing inflammation. These are basic, global statements that really apply to anything you want your body to do better, but they are so glaringly important and so often ignored, there is a need to make a special effort to point this out.
What’s available and discussion-worthy with your physician in addition to the above?
Collagen supplements, topical or oral minoxidil, topical or oral finasteride, microneedling with or without Platelet Rich Plasma or radiofrequency, light therapy, scalp treatments with the application of topical nutrient-dense products, and a variety of oral and other topical supplements (this is a vast category requiring a lot of exploration and explanation, given its lack of regulation and standardization) are all topics for discussion as mechanisms for treatment. This is not a “one size fits all” proposition.
As I clicked off image after image, my newfound plant friend my muse, I thought about how perhaps the most important ingredients for success with any endeavor (photography or hair growth) are patience, education, and an open mind to new discoveries. Heading back inside to review my photographs (education) and search for the identity of my visiting vine (new discoveries), I breathe deeply and remind myself that patience too, must be practiced.
