It’s All Downhill From Here: Hair Loss and Aging

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Although more common in males, age-related hair loss can happen to anyone. While primarily cosmetic, hair loss is often distressing and can have a significant impact on a person’s quality of life.

What Changes With Age-Related Hair Loss?

Age-related hair loss usually appears as a gradual thinning. In men this usually begins on the forehead, causing the hairline to recede, while in women it is more common for hair loss to be diffuse, and is usually first noticed as a broadening of the central parting of the hair. Some people can also lose hair in circular or patchy bald spots.

What Causes These Changes?

Individual hair follicles have a ‘life cycle’ which ends with the hair falling out, following which a new hair will begin to grow after a short delay. With age, the growth phase of this cycle becomes shorter and the delay becomes longer, meaning that fewer follicles have hair at any one time. Hair follicles also grow smaller (resulting in new hairs being thinner), and follicular cells begin to die, meaning that new hairs cannot be grown. These changes are accompanied by a reduced blood supply.

We still don’t have a full understanding of what causes these changes. While many forms of hair loss exist with varying causes, hormones called androgens seem to play a central role in driving age-related hair loss. Of particular importance is the hormone dihydrotestosterone (DHT), which is formed from testosterone in the hair follicle by the action of an enzyme called 5 alpha reductase. DHT appears to be more important in male hair loss, as efforts to block its production in females show inconsistent results. In females, hair loss may also be caused by a loss of aromatase, an enzyme produced by hair follicles and that can convert androgens to oestrogens (which increase the time spent in the growing phase).

Those with a family history of hair loss are more likely to experience hair loss themselves. Stress can also disrupt the hair cycle and accelerate age-related hair loss.

How Can We Prevent Or Reverse Age-Related Hair Loss?

While genetic factors play a significant role in the likelihood of experiencing hair loss, lifestyle factors are also likely to contribute. Studies have found a link between hair loss and metabolic factors including insulin resistance, high blood pressure, high total cholesterol, high triglyceride and decreased insulin sensitivity.

Pharmacological treatments for hair loss are mostly aimed at suppressing androgen production and lengthening the growth phase of the follicular cycle. Finasteride suppresses DHT production by inhibiting 5 alpha reductase, while minoxidil probably works by increasing blood flow to hair follicles. There is also evidence that some supplements like vitamin E can regrow lost hair. However, these treatments don’t restore lost hair follicles. One approach that could be used to restore hair follicles is stem cell therapy: that is to say, harvesting folliclular stem cells from the scalp, cloning them, and re implanting them to regenerate lost hair.

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