What causes hair loss?

What causes hair loss?

Hair loss, technically called alopecia and also known as baldness, refers to hair loss from the body, specially the head.

Hair loss can be male pattern baldness (androgenic alopecia) or general hair loss.  There are numerous reasons for hair loss and they need to be identified before jumping on to conclusions and trying to reverse the process of hair loss.


What causes hair loss?

Alopecia (hair loss) has variable reasons and causes and isn’t completely understood. Common causes of alopecia include:

 Androgenic alopecia (Male pattern baldness)

Hair loss in 95% of men is due to male pattern baldness due to androgens. This pattern includes receding of hairs from the sides of the forehead along with balding in the center of head at vertex, which meet eventually resulting in a horse shoe shaped hair ring on the back of head.


Nutritional causes

Poor nutrition including reduced intake or deficiency in some of nutrients can result in thinning of hairs.

The nutrient deficiencies include:

  • biotin
  • proteins
  • zinc
  • iron

These deficiencies don’t usually result in total baldness.

Surprisingly the excess of nutrients like vitamin A and animal fats (found in fast foods usually) leads to hair loss too.



There are various infections including skin infections that result in hair loss. These infections include:

  • Fungal infections (including tinea capitis)
  • Folliculitis
  • Dissecting cellulitis
  • Secondary syphilis
  • Demodex folliculorum


Drugs causing hair loss

Various drugs can result in hair loss too that can be temporary or permanent, both. These medications include:

  • Antihypertensive medicines
  • Cardiac diseases medicines
  • Cholesterol lowering drugs
  • Diabetic medications
  • Drugs affecting hormonal balance, including:
    • Hormone replacement therapy medicines
    • Steroids
    • Contraceptive pills
    • Acne medications
  • Mycotic infections treatments include drugs that can cause massive hair loss
  • Chemotherapy drugs


Trauma and injuries

Trauma to the skin of scalp or hair follicles isn’t due to direct injury only, but also due to ponytails and cornrows insult, called traction alopecia. These individuals injure the scalp with rigorous brushing, heat while styling, massaging the scalp roughly – damaging cuticle that is the outer casing of the hair, or by simply pulling the ponytails or hairs with excessive force.

Some individuals have a disorder near puberty and adulthood in which they pull or bend their hairs, resulting in extraction and permanent loss of hairs in them.

Other traumas include major surgery, poisoning, severe stress, etc. resulting in hair loss and are called telogen effluvium.

Radiations as in radiotherapy damage the irradiated area and results in hair loss.


Hair loss management

The first step in managing hair loss is to identify the exact cause of hair loss. If it’s due to some illness, drug or any other controllable factor, it should be managed accordingly.

Non-medical and surgical options include embracing the baldness, using wigs or styling the hairs in a way that the bald area isn’t prominent.


Medical treatment for hair loss

Male pattern hair loss can be managed with limited success using certain medications. However they have their own side effects, which can be very serious in some patients, therefore always consult an expert before using any medicine and keep consulting them regularly for review or if you have any symptoms. These medications include:


  • Minoxidil
  • Finasteride
  • Corticosteroids
  • Immunosuppressant’s
  • Anthralin
  • Hormonal modulators
  • Dietary supplements


Surgical treatment for hair loss

Surgical treatment option for hair loss includes hair transplant. Hair transplant is done under local anesthesia. The hair that’s transplanted falls off within a few weeks, however the follicle remains and the hair regrows permanently within some months.

Options for hair transplant include:

  • follicle transplant
  • scalp flaps

These procedures are effective but also expensive and painful with a risk of scarring or infection.

Another procedure, scalp reduction, is performed in which the hair less patch of scalp is removed. This procedure is usually done in combination with hair transplant specially in patients with extensive hair loss.

Micro needling is a painless procedure and is considered to stimulate hair growth too.


Most effective treatments for hair loss

It’s not possible to define any single best treatment for hair loss in all individuals. Deciding which treatment would be best for specific case depends on the cause of hair loss and various factors specific to each individual and their general health.

For example minoxidil is effective for male pattern baldness and alopecia areata but is not effective for other types of hair loss. Finasteride is good for some patients but in most patients it leads to severe side effects and is thus not recommended without doctor’s prescription, etc.

Hair transplant is considered effective these days but the best one has to be discussed specific to your case with your doctor.


Natural regeneration

After identifying the exact cause of your hair loss and discussing with your doctor, certain natural regeneration tips can be used to regrow your lost hair, including:

  • Head massage with oils like coconut, olive, almond, sesame, etc.
  • Using wide tooth wood comb
  • Eating flax seeds
  • Regular healthy exercise
  • Avoid caps and hair styles that put pressure on the hair roots and scalp
  • Use Amla, eat and use as oil
  • Have fresh vegetables and fruits
  • Manage hormonal imbalances if any
  • Have diet rich in vitamin B complex, biotin and vitamin B6 specially
  • Have foods rich in vitamin E to prevent hair breakage
  • Have foods rich in iron like green leafy vegetables, berries, leeks, cashews, etc.

Before trying any regime, especially the ones including medications, it’s important to consult an expert and see if they suit your specific case and if they’re safe for you. If you feel any symptoms with them stop using them immediately and consult your physician!

N-Acetyl Cysteine to protect your heart?

N-Acetyl Cysteine to protect your heart?

What is N-AcetylCysteine?

N-AcetylCysteine (NAC), also known as N-acetyl-L-Cysteine or simply acetylcysteine, is a cysteine derivative in which a nitrogen atom is attached to the acetyl group.

N-Acetyl Cysteine has its advantages in pharmaceutical overdose (of paracetamol / acetaminophen ), as a nephroprotective and mucolytic agent, microbiological use, use in psychiatry, etc. It’s useful in situations that can improve by sulfate repletion through cysteine or other amino acids related to sulfur.

What is homocysteine?

Homocysteine is a cysteine homologue and is synthesized inside our body from methionine. It’s a non-protein α-amino acid and can be converted to cysteine through certain vitamin-B or recycled to methionine.

Elevated levels of homocysteine are dangerous and enhance endothelial cell injury leading to atherogenesis in blood vessels via inflammation, resulting in ischemia. When the plague due to atherogenesis blocks the blood vessels of the heart, it results in cardiac ischemia and heart attack.

Usually men have higher levels of homocysteine than women. The homocysteine levels increase with age too. In west, average homocysteine levels are between 10 to 12. Homocysteine levels may reach up to 20 in elderly or in people having low vitamin-B intake.

Homocysteine level above 15 µmol/L is called hyperhomocysteinemia and is a medication condition that may lead to increased risk of developing various diseases including neuropsychiatric disorders, fractures, thrombosis, cardiovascular diseases, renal diseases, etc.

High levels of homocysteine are seen mostly in people with high animal protein intake and less leafy vegetables or fruits. Leafy vegetables and fruits are a source of vitamin-B and folic acid that help our body to fix and get rid of homocysteine, keeping its levels in control.


High levels of Homocysteine and Cardiovascular system

High levels of homocysteine affect cardiovascular system of our body by endothelial cells injury. Endothelial cells are the inner most lining of the blood vessels. When the inner lining of the blood vessel is injured, there is an inflammation as a response. This inflammation leads to the formation of a plaque, which can directly reduce the diameter of the blood vessel at that point, hindering the flow of the blood and thus the supply of oxygen and nutrition along with other constituents of blood to the organs where the vessel leads.

Even worse, if the plaque gets dislodged it starts flowing with the blood and can block any vessel anywhere in the body, resulting in blockage of the blood supply to any organs where that vessel leads. If this happens in the heart, cardiac ischemia and heart attack occurs, if it blocks a vessel in brain then stroke may happen and so on.

High levels of homocysteine are also believed to enhance the blood clotting by acting on platelets, further enhancing the risk of cardiovascular or related diseases.


How does NAC help reduce homocysteine?

Elevated homocysteine levels are associates with cardiovascular diseases and can’t be lowered significantly with vitamin-B supplements only.

Almost 80% of Homocysteine is bound to a protein in blood. The free homocysteine is easily metabolized and cleared from the body whereas the protein bound homocysteine keeps on accumulating in the blood and having negative health affects. N-Acetyl cysteine displaces homocysteine from that protein’s binding site probably due to disulfide interchange reactions. As a result, a mixed low molecular weight cysteine and N-Acetyl cysteine disulfides are formed. These compounds are believed to have more metabolic bioavailability and a high renal clearance, resulting in removal of homocysteine from the plasma. However, the decrease in homocysteine levels through N-Acetyl Cysteine is dose related [1].

A study published in 2006 [2] studying affect of intravenous N-Acetylcysteine on hemocysteine concentration in plasma during haemodialysis in end stage renal disease (ESRD) patients concluded that N-Acetylcysteine normalizes the plasma concentration of hemocysteine during hemodialysis resulting in improved pulse pressure and overall condition of patient with end stage renal failure (ESRD) and can be considered a promising approach to reduce the risk of cardiovascular diseases in vulnerable patients.


Effective dose of N-Acetylcysteine

A study on N-Acetyl Cysteine affect on plasma Homocysteine concentration of patients undergoing hemodialysis published in 2009 [3] concluded that oral NAC was sufficient and safe to lower the hemocysteine levels in blood plasma. However they found that doses below 600 mg per day for a month were not effective while dose above 1800mg per day caused complications for gastrointestinal tract without any further affect than a daily dose of 1200 mg per day.

Another study performed in 2003 on healthy individuals in three groups, given different doses of N-Acetylcysteine also found that the affects were dose related in lowering the plasma homocysteine levels, with more reduction in the group with higher dosage. [4]

Note that the dose is dependent on the requirement of the individual patient and an expert should be consulted before starting taking N-Acetylcysteine regularly.


Is supplementation of zinc and copper recommended with frequent NAC use?

A study published in 1990 [5] on affects of oral N-Acetylcysteine on the excretion of trace metals including zinc, copper, magnesium and iron for short term (2 weeks) concluded that there was no obvious loss of these elements from the body.

However it’s believed that the long term use of N-Acetylcysteine does affect the trace elements excretion from the body and they should be supplemented. Consult your doctor before taking any supplement including N-Acetylcysteine alone or any of the trace elements including zinc and copper. Also, the safety of N-Acetylcysteine is unknown for pregnancy and therefore should be avoided during pregnancy. During pregnancy always use medicine or supplements after consulting your physician.




  1. Plasma homocysteine and thiol compound fractions after oral administration of N-acetylcysteine. (http://www.ncbi.nlm.nih.gov/pubmed/7809573)
  2. Intravenous N-Acetylcysteine During Haemodialysis Reduces the Plasma Concentration of Homocysteine in Patients With End-Stage Renal Disease (http://www.medscape.com/viewarticle/531816)
  3. Does N-Acetyl Cysteine Have a Dose-Dependent Effect on Plasma Homocysteine Concentration in Patients Undergoing Hemodialysis? (http://numonthly.com/?page=article&article_id=892)
  4. Urinary and plasma homocysteine and cysteine levels during prolonged oral N-acetylcysteine therapy. (http://www.ncbi.nlm.nih.gov/pubmed/12711838)
  5. Does N-acetylcysteine increase the excretion of trace metals (calcium, magnesium, iron, zinc and copper) when given orally? (http://link.springer.com/article/10.1007%2FBF02657052)