Nine out of ten requests for hair loss treatment now come from women. We spoke to trichologist Anabel Kingsley about why we're losing more hair than ever and what we can do about it

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When you think about hair loss treatment, images of men with hair plugs often spring to mind, so it may surprise you to learn that nearly nine out of ten requests for hair loss treatment come from women, with stress cited as the main reason for the rise, according to Steve O’Brien of the London Centre of Trichology, who says that 85 per cent of his clients are now women, an about-turn from 20 years ago, when 90 per cent of inquiries about hair loss treatment came from men.

On top of stress causing hair fall among women, hair loss was also identified as a long-term symptom of Coronavirus according to Dr Sharon Wong of the British Association of Dermatologists who confirmed that those who suffered with Covid-19 symptoms in March and April 2020 began to notice hair shedding around June and July of the same year.

Here Anabel Kingsley explains what's normal (and what's not) when it comes to hair loss.

Q: Why is my hair falling out?

A: “Look back six to 12 weeks. Identify whether you were ill, experienced a traumatic event, or been through a particularly stressful time.  Due to the nature of the hair growth cycle, it usually takes a few months for hair to fall out after the event that caused it.

“There are many possible triggers of excessive daily hair fall (called telogen effluvium), but the most common are illness, changes to your diet, embarking on a crash diet (it’s very common to notice excessive hair shedding 12 weeks after a juice cleanse, and we have seen this numerous times in our clinics), nutritional inadequacies, a stressful event, giving birth or stopping breastfeeding.

Iron  and ferritin (stored iron) deficiency, as well as thyroid imbalances, can also cause hair loss, but these can take some time to manifest and must be diagnosed via blood work.

“The reason why our hair is so sensitive to internal fluxes is that, physically, we can easily survive without it. Emotionally, we are distraught when we lose our hair, but our body couldn’t care less; the systems regulating our body are more concerned with keeping our essential organs, such as our heart, as well as the nervous system functioning. As such, our hair is usually the first part of us to suffer when anything is amiss. The good news is that telogen effluvium is not permanent, and all hairs should grow back as usual once the underlying cause is found and addressed.”

Q: My hair has suddenly gotten thinner, but I haven’t noticed extra hair loss.

A: “Hair thinning isn’t limited to older women. It commonly occurs in women in their 20s and 30s. Neither does it happen ‘suddenly’. Unfortunately, you have to lose at least 15 per cent of the volume of your hair for it to become noticeable, so by the time you do, the process has probably been going on for at least five years.

“If you think your hair is becoming thinner, but you have had no extra hair loss, you’re most likely experiencing a gradual reduction in the diameter of individual hairs, aka female pattern hair loss.

"Reduced hair volume occurs when you have a genetic predisposition that causes hair follicles on the scalp to be sensitive to normal levels of circulating androgens (male hormones). At our clinics in London and New York, we see many women in their 20s and 30s experiencing hair thinning. It’s much more common than people think.

“If there is a very strong genetic predisposition to follicle sensitivity, reduced volume can begin to occur as soon as someone hits puberty (i.e. when hormone levels change). However, as diameter changes occur so gradually, they won’t be noticed for quite some years.

“In response to this sensitivity, follicles slowly shrink and produce finer and shorter strands. While reduced hair volume can occur alongside excessive daily hair shedding, it often does not."

MORE GLOSS: 6 unexpected reasons you could be losing your hair right now 

Q: Why isn’t my hair growing? It used to be much longer.

A: “It’s not that your hair isn’t growing. It’s most likely falling out prematurely. Hair grows on average half an inch a month and each hair remains in the anagen (growth) phase for, on average, three years. However, certain factors, most commonly iron and ferritin (stored iron) deficiency, can cut the growth phase short.

“To determine whether you are deficient in any vitamin or mineral, you must have a blood test. You can ask your GP, or, alternatively, the trichologists at our London clinic  can arrange it.

"As hair is non-essential tissue, the reference ranges are narrower than for essential systems. For instance, for optimal hair health, ferritin levels should be at least 80 ug/L, while for general health they won’t raise alarms unless they are below 12 ug/L. (Please note: reference ranges can vary slightly from lab-to-lab).

“Deficiencies can mean that hairs are shed before they reach the length they previously did. You should also consider whether your hair is snapping off, as breakage can also make it hard to maintain length. The most likely culprits for hair breakage are over-processing, vigorous heat-styling, using harsh bristle brushes and UV, chlorinated and salt water exposure.”

Annabel Kingsley

Q: What causes menopausal hair thinning?

A: "The perimenopause  (the time leading up to menopause) as well as the years during and after menopause, oestrogen  levels drop and the percentage of androgens (male hormones) rises in relation to them.

“Oestrogens help to keep strands in their growth phase. Androgens, on the other hand, have the opposite effect and can shorten the growth cycle. This shift in ratio of ‘friendly’ to ‘unfriendly’ hormones, can exacerbate reduced volume – especially if hair follicles are already sensitive to androgens (see above). However, regardless of genes, there will always be a degree of density change as we get older – just like the rest of our body, our hair ages.”

“our hair is usually the first part of us to suffer when anything is amiss”

Q: What should I be eating to get my hair to grow?

A: “As hair is non-essential tissue, it’s the last part of our body to benefit from what we eat and the first to suffer when our diet is lacking. A balanced diet containing all essential food groups is therefore essential. However, if I had to choose three food groups they would be protein, foods rich in iron, and complex carbohydrates. Here’s why:

  • Protein: Your hair is made of protein, and protein-rich foods help to ensure strands are strong. Great examples are eggs, fish, lean meat, and low-fat cottage cheese. “For vegans/vegetarians, almonds, quinoa and tofu are good options. Add a palm sized portion of any protein to your breakfast and lunch.
  • Complex carbohydrates: Hair cells are the second-fastest growing cells the body produces, meaning they require a steady supply of energy to grow. Complex carbohydrates provide a slow and sustained release of energy. Brown rice, whole-wheat toast and porridge are excellent choices.
  • Iron: ferritin (stored iron) helps to keep hair in the anagen (growth) phase. The best sources of iron are red meats, like steak and liver, so try to eat one of these around twice a week. If you do not eat red meat, or already have low iron levels, take an iron supplement such as in PK Tricho Complex.

“Due to the unique nutritional requirements of hair, it can be useful to take a nutritional supplement. Taken alongside a healthy diet, these give your hair an extra boost from within. We make two supplements, Tricho Complex, a multivitamin and mineral supplement, and PK4, a protein supplement, that we specifically formulated for the high demands of hair cells.

“Breakfast and lunch are the most important meals of the day for your hair as it’s when energy requirements are at their highest.

  • The perfect breakfast: smashed avocado on toast with two poached eggs and a side of fresh berries.
  • The perfect lunch: A mixed salad with salmon and new potatoes and a side of fruit.”

 MORE GLOSS: 10 foods to eat for thicker hair

Q: Why does your hair go grey and thin at the front where it’s most visible?

A: “In those who have a genetic disposition to reduced hair volume, hairs at the front usually have the strongest sensitivity to circulating androgens (male hormones). As such, the front hairline is often the first area to be affected by thinning – and to the greatest degree.

“Also, we tend to scrutinise our frontal area more than any other, simply because it’s immediately visible. This can give the impression that it is finer than other areas.

“In terms of greying, white strands can pop-up anywhere, but again – as we are usually more critical of our front hairline, you may simply be noticing them more in this region. Grey hairs can also give the visual illusion that the scalp is more visible, and that the hair is thinner.”

Q: When you pull your hair, what is a normal amount of hair loss and what indicates shedding (how many hairs approx?)

A: “It’s ‘normal’ to lose from 80-100 hairs a day, provided they are growing back to the same diameter and length that they used to. How many hairs is ‘acceptable’ to come out when you pull, depends on a variety of factors - for instance, when you last shampooed and styled your hair.

“If you’ve done either of these recently, you should see hardly any hairs at all. If you haven't shampooed or styled recently, it would be normal to see a greater amount of hair coming out. It’s usually obvious when you are experiencing excess hair shedding, as it’s not unusual to lose two to three times the amount you usually would. In these instances, you will see more when you brush, style, in your drain and perhaps on your pillow and clothes.

“However, I am against ‘hair counting’ and ‘hair checking’ as this can lead someone to obsess. It may also cause further emotional stress if too much hair is in fact coming out. Constantly pulling on your hair to monitor hair fall can also be damaging as it can cause breakage.”

Q: Is brushing good for your hair – can you over brush?

A: “While brushing your hair can be highly satisfying, it’s best kept to a minimum. Imagine what would happen if you brushed a wool sweater repeatedly – it would become frayed, split and damaged. The same applies to your strands. The myth that brushing is ‘good for your hair’ likely stems from decades ago before shampoos and indoor plumbing existed. At this time, people had to brush their hair vigorously as a means to clean it. Similar to how you would beat the dust out of a carpet! Nowadays, this is not the case and you are much better off limiting brush strokes to removing tangles and to styling.”

Q: If you cut your hair short or shave your head will it grow back thicker?

A: “No – your hair is not like a lawn that is stimulated by cutting. However, trimming your hair can make it appear thicker as it evens out the ends and removes splits and frays.”

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