from Guide to Adulting on Oct 29, 2023

How I'm fighting hair loss

Here's a live document sharing what I've done in my own attempts to fight hair loss — what has worked and what hasn't, as well as what I've learned about the topic. Since I'm not a health authority, I'll link to resources that are themselves authorities in their own right. Where possible, check out those resources to double-check what I'm saying.

Step 0. Get to know your hair

I do have a few meta-tips that are worth considering, regarding your own health. These tips extend to monitoring your physical health more generally.

1. Tip #1: Know the stages of hair growth. At a rough level, you simply need to know there are Four Stages of Hair Growth — growth (3-5 years), transition (10 days), rest (3 months), and shedding (2-5 months). In short, it takes about 5-6 months for hair to die and regrow. As a result of this, my Primary Care Physician (PCP) told me that it takes generally 6 months to tell if treatment is working.

2. Tip #2: Take monthly photos of your hair, hairline, and fallen hairs. In short, it may take an expert to tell how healthy your hair is, based on a single photo. However, photos over time are much more telling. Roughly speaking, use these to make a guess for how much hair is in each phase of growth.

   1. How much hair is growing? Photos of your hairline determine how much new hair is growing. In my particular case, I was looking for "baby hairs," or just hairs that are clearly shorter than my other hair strands, to indicate new growth.
   2. How much hair is dying? Photos of your fallen hair determine how much hair is dying. You could do this in the shower or just from your living room rug. At the very least, changes over time can tell you how your hair care strategy is working.
   3. I personally take photos weekly, to get a more fine-grained log of what's happening with my hair.

3. Tip #3: Observe your hair. Feel it, and see how it behaves.

   1. Is your hair thick? My hair is fairly thick, so on any given day, if my hair is happy and healthy, it's likely standing straight up — giving me an all-day bed head. If my hair is deprived of nutrients, it's fallen flat and stuck to my head like someone drew hair on my scalp with a sharpie.
   2. Is your hair oily? or dry? The American Academy of Dermatology Association recommends the following strategy for caring for your child's hair: Shampoo more often if their scalp and hair is oily; shampoo less if hair feels dry or is dull. I used this same process for my own head of hair, settling on a shampoo schedule that's roughly every other day.

The above gave me a rough idea of how my hair was faring at any moment in time. These were signals that I looked for in my own hair, to determine what was working and what wasn't. Your hair may behave differently, but generally, "healthy hair looks clean, soft to feel, shiny, untangled, has no frizz, and is bouncy when shaking the head"¹.

Step 1. Noticing hair loss

There were a few factors that made me astutely aware of my own thinning hair and receding hairline. These are all possible avenues for you to check if hair loss is occurring.

1. My barber made a savage comment. This barber was your typical no-fluff auntie. She made a comment along the lines of "Your hair is receding. In a few years, it'll look really ugly." Well, dmn*. True to her word, I hadn't realized that my hair had been receding.
2. My family has a history of baldness. This makes it all the more likely that I'm seeing genetics at work, as my growing baldness could be unavoidable. This was coupled with a new sensation: I could feel the breeze on my scalp.

My PCP eventually concluded that due to this medical history and other conditions, my receding hairline was due to androgenic alopecia², a fancy name for balding. At this point, my PCP recommended topical treatment, which I'll link to resources for, later. For now, let's discuss more general hair care tips.

Step 2. Follow basic hair care tips

The American Academy of Dermatology Association (AADA) has a few tips for healthy hair. I'll summarize a few basics below, which I now follow to the t:

1. Shampoo is for the scalp. In an attempt to cleanse the scalp and remove dirt, shampoo additionally strips away natural oils which your hair needs to stay healthy. As a result, the AADA recommends focusing shampoo on the scalp rather than the hair.

   1. Head & Shoulder's page on "How shampoo works" says this outright: Shampoo emulsifies the sebum, "which protects your hair and hair follicles". Then, "when you rinse, the water takes the emulsion with it, along with all the dirt and grease".

2. Conditioner is for the hair. Conditioners moisturize and provide a protective layer for your hair, but at the same time, they may clog hair follicles or pores. As a result, the AADA recommends focusing conditioner on hair ends.

   1. In my particular case, I have dandruff, which conditioner on the scalp theoretically exacerbates, possibly by clogging follicles. I have noticed that applying conditioner to the scalp does in fact exacerbate dandruff, in as little as a week. As a result, I follow this tip out of necessity.

3. Limit styling your hair: This includes pulling your hair tightly, coloring your hair, brushing aggressively possibly when your hair is wet, using a curling iron etc. The AADA likewise has a few tips for what not to do on their list of hair care habits that can damage your hair.

   1. My biggest surprise was seeing blowdrying on the list. With that said, a paper from 2011 suggests that "using a hair dryer at a distance of 15 cm with continuous motion causes less damage [to hair] than drying hair naturally"³. So, for myself personally, I blow-dry my hair at arm's length on a low-heat setting.

4. Eat a balanced diet: Mayo Clinic recommends that your daily calorie intake should come from 20% protein, 20%-30% healthy fats, and 45%-60% carbohydrates. There are more details on their "What you eat promotes radiant hair, skin and nails naturally" post.

   1. I didn't notice appreciable changes in hair health with a changed diet, so I suspect my diet is balanced enough for hair health purposes. Specifically, I didn't notice changes in hair thickness or oiliness.

Tuning the above actually resulted in drastic changes in the appearance of my hair, going from dull and frizzy to much brighter and softer. This didn't help with the receding hairline per se, but it made my existing hair much happier.

Step 3. Get physician-endorsed treatment.

After seeing my PCP, I started to test a few different treatments they had recommended, one by one.

1. Take vitamin D supplements. I started to take vitamin D supplements daily, at a dosage that my PCP said was safe.

   1. Got more sunlight. I also did my best to get at least an hour of sunlight exposure every day — partially for vitamin D and also to help set my circadian rhythm according to Stanford's Huberman Lab "Using Light for Health" post.
   2. According to a paper (Amrein et al., 2020⁴) published in the European Journal of Clinical Nutrition, vitamin D deficiency is prevalent (~40% of Europeans), but simultaneously, it's possible to overdose on vitamin D. The US Institute of Medicine recommended no more than 2000 IU per day, in a 1997 report⁵, which Amrein et al finds is more than enough to avoid vitamin D deficiency.

2. Apply topical creams. My PCP suggested topical treatment using an over-the-counter cream called minodixil; the product is known by the name "rogaine". With that said, my PCP also noted that rogaine is designed to treat the scalp and not a receding hairline, so I didn't end up trying rogaine — reserving it as a last resort.

   1. With that said, minoxidil was shown in a 2004 study to promote hair regrowth successfully in a majority of test subjects, from a pool of 904 subjects⁶.
   2. Anecdotally, I've also heard of a few friends that have successfully stopped balding at the scalp but none that had tried the same for receding hairlines.

I've also heard of collagen supplements, but this wasn't recommended (or recommended against) by my PCP, so I didn't try this.

Takeaways

The basic hair care tips endorsed by the ADAA are a place to get started. For other treatment options, definitely consult your Primary Care Physician (PCP) first. After researching and following the plan above, I finally began to see baby hairs that were growing beyond my receded hairline in just ~3 months, indicating recovery was beginning.

This is not to say that the above treatments or hair care tips will definitely work. However, after plenty of trial and error, I do believe firmly in the methodology. Take photos regularly, and start building a medical log that you can refer back to for experimental results.

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