By Fiorella Valdesolo, WSJ, March 24, 2021

Just like skin, hair shows the impact of stress, lack of sleep and the passage of time. Brands addressing hair aging are taking a holistic approach, one that starts at the root. 

In January of last year the actor Ricki Lake posted a selfie with a buzz cut. In the caption she revealed that she had been suffering from hair loss for nearly 30 years. “Ever since I played Tracy Turnblad in the original Hairspray back in 1988 and they triple-processed and teased my then healthy virgin hair every 2 weeks during filming, my hair was never the same,” Lake wrote. She’d gone “from Hairspray to hairless.” The response to her confession, which reached an even larger audience when she appeared soon after on Good Morning America, revealed just how many women related to her struggle.

It’s a huge issue, says Birmingham, Alabama–based dermatologist Corey L. Hartman. “Up to 40 percent of women experience noticeable hair loss before the age of 40, with as many as 80 percent seeing hair loss by the age of 60,” he says. For women, hair loss can take a particularly harsh toll, as it’s often seen as a sign of impaired physical or mental health. “It’s much more acceptable when a man is thinning,” says Lars Skjøth, founder and head of scientific research at hair clinic Harklinikken who has been studying female hair loss for 29 years. After Lake’s public revelation, Harklinikken, which helped her gain back 75 percent of her lost hair, experienced a surge in consultation requests: There are 40,000 people currently on the waitlist.

The most common causes of women’s hair thinning are hereditary and hormonal. Lake suffers from androgenetic alopecia (better known as female- or male-pattern hair loss), in which lowered production of estrogen and progesterone—the hormones that help hair grow faster and stay on the head for longer periods of time—is accompanied by an increase in androgen hormones. As a result, the hair’s growth phase shortens, hair sheds more quickly and the time between growth phases lengthens, explains Melisse Shaban, founder of the hair-care brand Virtue. “The hair follicle itself also changes, shrinking and producing a shorter, thinner hair fiber that’s finer and more fragile and often doesn’t make it to full maturity,” Shaban says. 

“Up to 40 percent of women experience noticeable hair loss before the age of 40, with as many as 80 percent seeing hair loss by the age of 60.” - Corey L. Hartman

Another form of female hair thinning, known as central centrifugal cicatricial alopecia, impacts Black women specifically, says Hartman. It’s “thought to be genetic and influenced by cultural hairstyling practices,” he adds. It’s important to note that a variety of serious conditions can also cause hair loss, says Sugar Land, Texas–based dermatologist Ryan Riahi. “I will have patients who attributed their hair thinning to age when it was in fact due to a medical condition like lupus,” he says.

Hartman estimates he’s seen a 25 percent increase in hair consultations since the pandemic’s start. What’s been bringing more hair-loss patients into dermatologist offices this past year has been a temporary shedding known as telogen effluvium. One main culprit is extreme stress. The hair cycle is divided into three phases: anagen (growth), catagen (regression) and telogen (resting). And these growth cycles can be disrupted by the stress hormone cortisol, says Bridgette Hill, a Palm Beach–based trichologist (a specialist who studies the hair and scalp). A 2016 study published in the Journal of Drugs in Dermatology found that when cortisol is present at high levels it degrades essential hair-growth substances hyaluronan and proteoglycan, demonstrably affecting the function of the follicle. “Stress ignites cortisol production as part of our fight-or-flight response, and nonessential tissues like our hair are deprioritized and will shift from the growing phase to the resting phase,” says Shaban. This type of allover hair shedding is also common in women in the postpartum and peri- and postmenopausal stages. And while reports of hair shedding after Covid-19 infection remain anecdotal, the connection makes sense. “We know that any physical or emotional stressor to the body can result in telogen effluvium,” explains Hartman. 

In her Instagram post, Lake said her hair loss was exacerbated by many factors: yo-yo dieting, hormonal birth control, radical weight fluctuations, pregnancies, genetics, hair dyes, extensions and stress. The issues that often accompany physical or emotional stress—poor diet, interrupted sleep, little exercise or downtime—can themselves cause hair loss. Skjøth has been conducting his own hair-focused sleep studies for the past six years. “The body undergoes numerous cycles during sleep,” he says, “which promote the stem-cell activity that generates epithelial cells for hair growth.” When sleep is disrupted, so too is our ability to repair and turn over new cells, explains Natanel Bigger, founder and CEO of Monpure London, a scalp and hair health brand. The result can be dryness, irritation and accelerated aging of the scalp, leading to an increased risk of hair loss.

And of course, age is also a factor. “In fact, research shows that the scalp ages six times faster than the skin,” says Helen Reavey, founder of the hair-care brand Act + Acre. Just as the metabolism slows down with age, the hair growth cycle becomes more sluggish, too. There’s a breakdown in the production of hair fiber and a loss of melanin that causes graying, says Hill. As hair ages, it often becomes thinner and coarser and changes texture; for example, curly hair will lose some of its curl. 

“In fact, research shows that the scalp ages six times faster than the skin.” - Helen Reavey

The hair-care industry’s approach to hair loss has often consisted of making hair look better without getting to the root of the problem. Bigger says that while the skin-care industry is incredibly sophisticated, hair care has often lagged behind. A number of new independent brands, such as Monpure, Act + Acre, Virtue and MFlorens, signal a shift, directing attention to the scalp as much as to the hair. Monpure London, which champions the scalp as the key to healthy hair, is funding research into not just the hair follicle, but the skin tissue around it, which has largely gone unstudied. Act + Acre, founded in 2019 by Reavey, a longtime stylist who has seen firsthand the negative effects of styling practices, is similarly scalp-focused. Minimalist line MFlorens is the brainchild of Mary Arutyunyan, a former international lawyer whose own bout with alopecia areata inspired her pivot to creating a non-pharmaceutical option to fight hair thinning. After years of research,Virtue is making significant strides in addressing female hair loss; its latest innovation, a drug-free alternative to prescription Minoxidil, has seen promising results in consumer testing, with 90 percent of women reporting new growth. “Regrowing hair isn’t new, but no one has spent time trying to protect and nurture these hairs so they reach maturity,” Shaban explains. And new brand Arey takes on graying with its hair-color supporting supplement, which co-founder Allison Conrad says increases cell turnover and melanin production, defends against oxidative stress and protects the hair’s protein structure. The supplement was developed around evidence that graying is actually 70 percent related to diet and lifestyle and only 30 percent genetic. 

Products are only half the story, though; habits matter just as much. In recent years, the popular directive may have been to shampoo less, but both Skjøth and Reavey recommend the opposite: cleansing regularly with a shampoo that’s gentle, sulfate-free (to protect color) and nourishing. Remember that you’re really washing the scalp, not the hair, says Reavey. “Buildup on the scalp from oil, dead skin and products can result in severe scalp issues and may cause hair loss,” explains Skjøth. Use lukewarm water, massage the scalp and, says Reavey, double-cleanse: “The first cleanse removes product buildup and the second delivers nutrients to the scalp.” Be wary of brushing wet hair, as it’s more prone to breakage. Instead use a wide-tooth comb or wet brush and work in small sections from tips to roots. Also, says Skjøth, air-dry whenever possible, and if not, blow-dry with distance on a medium temperature setting. Make sure hair is completely dry before putting it into a ponytail or bun, and don’t make it too tight. “Traction alopecia means hair loss from pulling, and we see it daily,” says Skjøth.

A diet full of foods rich in nutrients like folate, iron, biotin, zinc and omega-3 fatty acids, can all be beneficial too. Many of us are often also deficient in key vitamins, like D and E, that ensure healthy, youthful hair. The market for hair supplements has grown steadily in response. Brands like Nutrafol and Viviscal, which Hartman often recommends to his patients, are popular options; Moon Juice’s SuperHair focuses both on nutritional deficiencies and stress reduction; and while Lyma’s daily supplement, a favorite of nutritionists like Dana James, isn’t hair specific, the brand says research supports its claim that the supplement strengthens hair and decreases loss. This May, Act+Acre will enter the supplement market with plant-based capsules made with vitamins B12 and C, and amino acids that support the cyclical nature of hair growth. “When you’re lacking nutrients, the first area to be affected is your hair as the body naturally redirects the nutrients to other organs and your hair is put into its most dormant state,” Reavey explains. “Your hair really is a barometer for your overall health.”