Hair Loss: Why It Happens and How to Treat It, Part 2

Treatment of hair loss is based on understanding the cause and type of the process. Without this, it is impossible to choose the correct approach. The goal of treatment is not simply to reduce hair loss, but to restore the normal hair growth cycle.

Treatment Strategy

The first stage is stopping active hair loss. As long as the process continues, any attempts to stimulate growth will be ineffective. At this stage, it is important to reduce the impact of factors that shift hairs into the resting phase.

The second stage is eliminating the cause. This is the foundation of treatment. Without correcting deficiencies, hormonal imbalances, inflammation, or other factors, hair loss will continue or recur.

The third stage is stimulating hair growth. This stage is approached after stabilization of the process and only in cases where follicles retain the ability to recover. At this stage, methods are used that enhance follicle activity and promote transition of hairs into the growth phase.

The fourth stage is support and stabilization of the result. Even after restoration of growth, it is important to maintain conditions in which follicles can function normally. These stages may partially overlap, but their sequence remains unchanged: first control of hair loss, then elimination of the cause, and only after that stimulation of growth.

It is important to consider that the approach depends on the type of hair loss. In some cases, the process is reversible; in others, it requires long-term control; and in cases where follicle structure is lost, restoration of growth is impossible and hair transplantation may be required. At the same time, transplantation is considered only when the process is stabilized and there is no active hair loss; otherwise, transplanted hairs may be affected by the same factors and fall out relatively quickly.

It is also necessary to consider time. Hair grows slowly, and even with the correct approach, results develop gradually. The first changes usually appear no earlier than 2–3 months, as this is the time required for hairs to transition into a new growth phase. More noticeable results form within 4–6 months, and a full evaluation of effectiveness is possible no earlier than 9–12 months. Expecting a rapid effect leads to premature changes in approach and reduced treatment effectiveness.

Nutritional Support

Hair growth directly depends on the overall condition of the body and its availability of resources. The hair follicle is an actively dividing structure that requires a constant supply of energy, oxygen, and building components. In conditions of resource deficiency, the body prioritizes limitation of hair growth.

It is also necessary to consider nutrition (diet) as the primary source of these resources. Even in the absence of clear laboratory deficiencies, the diet may not provide sufficient energy and nutrients to support hair growth. Insufficient caloric intake, low protein intake, or a monotonous diet can limit follicle function and contribute to hair loss. At the same time, “normal” nutrition may be insufficient — actively dividing follicle cells require a stable and adequate supply of resources.

Hair consists of more than 90% protein, therefore adequate intake and absorption of protein are critically important for normal growth. The main structural component of hair is keratin — a protein formed from amino acids. With insufficient protein intake, keratin synthesis decreases, follicle cell turnover slows, and hairs prematurely enter the telogen phase.

One of the most significant factors is iron, which is responsible for oxygen transport. With deficiency, the follicle loses its ability to maintain the growth phase and transitions into a resting state, leading to hair loss. It is important to note that this can occur even with normal hemoglobin levels if iron stores (ferritin) are low. In cases of significant deficiency or when faster recovery is needed, intravenous methods (IV therapy) may be used.

Zinc is involved in protein synthesis and tissue regeneration. Its deficiency reduces the follicle’s ability to maintain normal structure and hair growth.

Selenium is essential for normal thyroid function and participates in the regulation of hormones that affect the hair growth cycle. Its deficiency may disrupt hormonal regulation and contribute to hair loss.

Vitamin D participates in regulation of the hair growth cycle and is required for transition into the anagen phase. Its deficiency is associated with slower hair growth and increased hair loss.

Biotin (vitamin B7) is involved in keratin synthesis and cellular metabolism. In clinical practice, it is often used in high doses, but this is not due to correction of deficiency, rather an attempt to enhance metabolic activity of the follicle. Its effect is limited and acts only as support for growth processes without addressing the underlying cause of hair loss. It does not replace proper nutrition and does not correct deficiencies.

Vitamin B12 is necessary for normal hematopoiesis and cell renewal. Its deficiency reduces oxygen delivery to tissues and disrupts hair growth processes.

Folate (vitamin B9) is involved in DNA synthesis and cell division. Its deficiency slows tissue regeneration, including in hair follicles.

Fatty acids are also important, as they support cell membrane structure and scalp condition. Their deficiency may increase inflammation and indirectly worsen conditions for hair growth.

It is important to consider not only intake but also absorption of nutrients, as gastrointestinal disorders may lead to functional deficiencies even with an adequate diet.

It is also necessary to consider the time delay: deficiencies do not affect hair immediately.

Non-Pharmacological Methods

Non-pharmacological methods are aimed at local stimulation of the hair follicle and are used as an addition to basic therapy. These methods enhance hair growth by affecting local processes in the scalp and follicle.

One of the most commonly used methods is microneedling. This is mechanical stimulation of the skin using micro-needles, which causes controlled damage and triggers a local inflammatory response followed by activation of repair processes. As a result, VEGF expression increases, blood supply improves, and signaling pathways associated with hair growth are activated, including Wnt/β-catenin. This promotes the transition of follicles into the anagen phase and enhances hair growth. The method requires regular repetition, as the effect develops gradually.

PRP (platelet-rich plasma) is also used — the injection of plasma enriched with platelets. Platelets contain growth factors that stimulate hair follicle activity, improve its nourishment, and may prolong the growth phase. The effectiveness of PRP depends on tissue condition. In the absence of active inflammation, the method may enhance regeneration. In the presence of significant inflammation, its use requires prior correction, as the response to therapy may be limited.

Low-level laser therapy (LLLT) is also applied. This method is based on the use of light of a specific wavelength, which activates cellular processes in the follicle, improves microcirculation, and increases cellular metabolic activity. This may promote the transition of hair into the growth phase and increase hair density.

Many local methods exert their effect through enhancement of blood supply and activation of signaling pathways that support follicle nutrition and growth.

Topical agents are also used, including plant extracts, oils, and emu oil. Their action is aimed at modifying the local scalp environment and influencing follicle activity.

Some of these have supporting evidence. For example, rosemary oil has demonstrated the ability to improve hair growth, likely through effects on microcirculation and local signaling pathways.

Agents with an irritating effect, such as capsaicin (pepper), stimulate the follicle through local irritation and an inflammatory response. Their effect is related not only to increased blood flow but also to activation of neural and inflammatory mechanisms.

It is important to note that such agents may cause significant skin irritation, burning, and contact dermatitis. There is a risk of contact with the eyes and mucous membranes, which can cause severe irritation. In sensitive individuals, inhalation of aerosols may provoke respiratory reactions.

The effectiveness of these methods depends on the integrity of the follicle. In cases of destruction or significant miniaturization, the result will be minimal or absent.

It is also important to consider that without correction of systemic factors, the effect of local methods is unstable and temporary. These methods are used after stabilization of hair loss and are intended to enhance growth, not as a first-line stage of treatment.

Pharmacological Approaches

Pharmacological treatment occupies a limited but important place in the management of hair loss. Medications are used as part of a comprehensive approach and do not replace addressing the underlying cause.

The choice of pharmacological therapy and its necessity are determined by the cause of hair loss, the mechanism of the process, and the stage of treatment. These methods are used after stabilization of hair loss and are aimed at stimulating and maintaining hair growth.

The main medications are minoxidil and finasteride, used primarily in androgenetic alopecia.

Minoxidil can be used both in topical forms and as an oral medication. It was originally developed as a systemic antihypertensive agent, but during its use a side effect was identified — increased hair growth — which led to its use in the treatment of alopecia.

Officially, the drug is used primarily for androgenetic alopecia, as this condition has the largest amount of clinical data. At the same time, its mechanism of action is not limited to hormonal effects. Minoxidil acts by altering the hair growth cycle and activating the follicle.

Under its influence, the telogen phase is shortened and the transition of hairs into the anagen phase is accelerated. At the same time, it prolongs the growth phase, increases follicle size, and enhances local blood flow, including through stimulation of VEGF. As a result, the effect may be observed not only in androgenetic alopecia but also in other conditions, provided that the follicles retain the ability to grow. The effect is possible only in the presence of preserved follicles. In cases of pronounced miniaturization or destruction of follicles, the drug is ineffective.

The effect develops gradually: the first changes appear no earlier than 3–4 months, and a more pronounced effect forms over time. Effectiveness is limited and is approximately 20–40%. At the beginning of therapy, a temporary increase in hair shedding is possible — initial shedding, associated with accelerated phase transition and the shift of hairs into the growth phase. After discontinuation, the effect is partially lost: hairs whose growth was supported by the drug transition into the telogen phase and shed.

If the factors that caused hair loss are eliminated, some hairs may be retained due to restoration of the normal growth cycle. If the cause persists, the effect is lost more quickly after discontinuation, and hair loss resumes.

Minoxidil is used as maintenance therapy: in reversible conditions, its use may be temporary, while in chronic processes it may be long-term.

Side effects of minoxidil depend on the form of use. With topical application, skin irritation, erythema, itching, and dermatitis may occur.

With oral use, the drug acts systemically, so increased hair growth in different areas of the body (hypertrichosis) may occur, not only on the scalp. Decreased blood pressure, tachycardia, edema, and dizziness may also occur.

Finasteride acts through a different mechanism. It inhibits the enzyme 5-alpha-reductase, reducing the level of dihydrotestosterone (DHT) — a key factor in androgenetic alopecia.

As a result, follicle miniaturization and progression of the process are slowed, meaning the effect targets one of the key mechanisms of the condition. The effect of finasteride develops gradually and requires long-term use. After discontinuation, its effect gradually decreases, and the process may resume.

The use of finasteride is limited due to possible side effects, including decreased libido, erectile dysfunction, mood changes, and in rare cases persistent symptoms after discontinuation. In women, its use is limited and requires separate evaluation of indications.

Both minoxidil and finasteride are contraindicated when planning pregnancy, during pregnancy, and while breastfeeding.

Recovery

After stopping active hair loss, the recovery phase begins. This stage develops gradually and requires time. Stopping hair loss and restoring growth are different stages.

Even after eliminating the cause, hairs that have already transitioned into the telogen phase continue to shed until their cycle is complete. This is a normal phase transition process, not a sign of treatment failure. As this phase resolves, follicles gradually return to the anagen phase, and new hair growth begins.

The average rate of hair growth is about 1 cm per month, so changes do not appear immediately. In the early stages of recovery, new hairs may be thin and weak, as the follicle requires time to fully restore its function. Visually, this appears as short “new” hairs and a gradual increase in density.

The first signs of improvement are a reduction in shedding intensity and the appearance of new growing hairs.

As recovery progresses, hair density increases, but the process is uneven: after initial improvement, it may slow down. This is related to the characteristics of the hair growth cycle, not deterioration of the condition. Full restoration of hair volume takes significant time and depends on hair length. For example, reaching shoulder length may take about 1–2 years.

The degree of recovery depends on the cause of hair loss and the preservation of follicles. In reversible conditions, near-complete recovery is possible. In chronic processes, recovery may be partial and require maintenance therapy. If follicle structure is lost, hair growth is not possible.

Recovery occurs alongside ongoing therapy and requires its continuation for the time needed to complete a full hair growth cycle.

Errors in the Treatment of Hair Loss

Hair loss often becomes a prolonged problem not only because of the cause, but also due to an incorrect approach to treatment.

Errors in management can sustain the process, reduce treatment effectiveness, and lead to a lack of results even when appropriate methods are used.

One of the most common mistakes is expecting rapid results. Hair growth is a slow process, and the absence of visible changes in the first weeks is perceived as inefficiency. This leads to premature changes in therapy and does not allow proper evaluation of its effect.

A key mistake is starting growth stimulation without stopping active hair loss. In this case, follicles continue to transition into the telogen phase, and any stimulation methods do not produce a meaningful result.

A common mistake is ignoring the cause of hair loss. Using only growth stimulators without correcting deficiencies, hormonal imbalances, or inflammation leads to a temporary effect or no effect at all.

It is also common to rely on a single method as the main solution. Hair loss is a multifactorial process, and isolated intervention rarely produces a stable result.

Another issue is incorrect interpretation of laboratory tests. Evaluating only “reference ranges” without considering the clinical context may lead to missing significant deficiencies, for example normal hemoglobin with low ferritin levels.

Another important mistake is irregular use of therapy or early discontinuation. This interrupts the effect on follicles and leads to loss of achieved results.

An additional factor may be stress associated with hair loss. It can amplify the process and sustain it through the same mechanisms that originally triggered it.

Errors in the treatment approach can themselves become a factor that sustains hair loss and slows recovery.

Conclusion

Hair loss is not an independent disease, but a reflection of changes in the function of the hair follicle and the entire organism.

It is based on disruption of the hair growth cycle, which may be caused by different factors — from temporary stressors to chronic processes. In most cases, multiple mechanisms act simultaneously, making hair loss persistent and prone to recurrence. The key step is determining the type of hair loss and the factors that caused it. Without this, any treatment methods will provide limited or temporary results.

Recovery is possible only if the follicle structure is preserved and requires sequential correction of the factors affecting its function. Hair growth is a slow process, so results develop gradually and require time. Thus, an effective approach to treating hair loss is based not on stimulating growth, but on understanding the mechanism and eliminating the factors that disrupt it.