Baldness Is No Laughing Matter?

Will Petty is a remote antecedent, son of a clothier, close friend of Oliver Cromwell, mathematician, inventor of statistics, professor of anatomy, physician, a founder fellow of the Royal Society, eventually finding favour with the newly crowned King Charles II.

Which is why he looks so pleased with himself in his massive peruque of nut-brown human hair.

Imported Frenchified periwigs of such luxuriance were extortionately expensive status symbols, a bizarre outermost reaction to the puritanical ethos of Cromwell’s shaven “Roundheads”, the ultimate manifestation of religious and social repression. The new regime, fresh from penurious exile in France, had good cause to celebrate with extravagant glee.

Beneath the glued-on cap of curlicues, the skin of the scalp did its best to continue on its pre-ordained way in shedding and growing hair, lubricating, radiating and conserving heat, and cushioning the all-important brain box from bangs and knocks. Its blood supply is phenomenal – don’t test it.

Left to its own devices (no wig or extension glue, or sun or dye damage), the female scalp can exhibit one of the most powerful physical attractants. A glossy and abundant head of hair equates to health and fecundity, mental and physical resilience, primordial prescience of a human continuum – i.e., just plain sexy.

Males are not quite as blessed. Baldness is not the fault of testosterone. It is the fault of genes. Genes representing “male pattern baldness”, androgenic alopecia, are expressed in the victim’s hair follicle stem cells (1). It is understood that our natural testosterone, in the specific form of dihydrotestosterone (DHT), switches on this genetic predisposition to baldness. DHT activity can be blocked by a popular prescribed medication, but be well aware that DHT makes significant contribution to male sexual function. Block it at a price.

All adults lose between 50 and 100 head hairs a day from follicles retiring into their resting phase, telogen, whilst an equal number of follicles become active in excreting new hair shafts, anagen.

An ancient myth persists – hair turning white overnight through severe shock, first recorded in the Talmud in 83 AD. Of course, this is impossible as the hair shaft consists of the same dead keratin protein as nails, hooves, claws and feathers. One explanation is the ill-understood auto-immune condition of alopecia areata, when random patches of scalp skin cease to produce sturdy shafts, and are replaced by fine, white whisps.

But, a significant shock can cause dramatic hair loss. This, disconcertingly, occurs two or three months after having suffered physical or psychological trauma. This is “telogen effluvium”. The anagen (growth) phase of the hair follicles prematurely ceases and the telogen (resting) phase dominates. After the apportioned time, the telogenic hair shafts collectively fall out of their follicles – in literal handfuls.

This is likely to induce a degree of panic. The good news is that the hair follicles will infallibly recover: the bad news is that this regrowth might take up to six months to complete.

Any known cause of acute distress, physical or psychological, can precipitate telogen effluvium – from childbirth to death dealing disease, from divorce to widowhood, and from an excessively unhappy happenstance between.

Inevitably, COVID-19 is proving to be one of these hyperacute stresses. Published records predict that around 25% of COVID recovered patients will suffer late-onset acute hair loss (2).

Hairdressers and dermatologists are observing more chronic attenuation of hair growth. It is becoming evident that the on-going stresses of lock downs and attendant anxiety and depression are taking their toll on mainly female follicles – not necessarily the disastrous shedding of telogen effluvium, but enough to be noticed.

This might appear to be a somewhat banal observation in the midst of a worldwide cataclysm, but it is a worrying objective pathological sign indicative of the psychological status, the mental health, of a heretofore compliant population.

The first study of the effect of life-stress exposure on hair growth was published in 2017. It clearly showed a slowing of hair growth associated with immunity cytokine imbalance enhancing neurogenic inflammation: these changes were reassuringly transient, reverting to normality on cessation of the stress (3).

Should you suffer from significant hair loss, do report this to your GP, as there are a number of medications and some endocrine gland disorders which could be implicated.

Physical activity, mindfulness, daily gentle hair washing, vitamin D3, adequate dietary protein and due caution with perms and dyes will all help.

Things will get better as soon as the sun starts to shine. Meanwhile: