Hair Growth and Hair Loss: Dr. Faye Bate
Hair Growth Cycle and What Goes Wrong
Hair grows in a continuous cycle with four stages, grouped into growth and rest phases: anagen (growth), catagen (transitional), telogen (rest), exogen (shedding).
Anagen (active growth): hair emerges from the follicle and grows for a long period. Duration: between 2 and 8 years, largely influenced by genetics and other factors.
Catagen (brief transitional phase): a short period lasting a few weeks where growth slows and follicles shrink, marking the end of the active growth phase.
Telogen (resting phase): hair is in the follicle but not growing; lasts about 2 to 3 months.
Exogen (shedding): old hair is released from the follicle and shed; this creates the sensation of hairs coming out in the shower. This phase makes room for new hair to grow, returning to anagen.
Hair loss occurs when there is a disruption to this cycle, either:
Premature transition from growth (anagen) to rest (telogen), i.e., the follicle exits anagen earlier than expected; or
Prolonged telogen phase where hairs remain in resting state and are not replaced quickly enough.
The HEADS Formula for Healthy Hair
H = Hormones: addressing hormonal imbalances that sabotage hair growth and cause thinning (e.g., DHT).
E = EATS: ensuring adequate nutrition (minerals and vitamins) essential for hair health.
A = Active ingredients: research-backed products that directly stimulate follicle growth or increase blood flow to follicles.
D = Daily routine: daily habits that can secretly thin hair.
S = Scalp: scalp health matters; if hair is the flower, the scalp is the soil—don’t neglect it.
Hormonal and Endocrine Considerations
Stress and cortisol: higher cortisol (the stress hormone) can negatively impact hair growth; there is dedicated content addressing cortisol misinformation.
Androgenic alopecia (AGA): the most common type of hair loss in both men and women, linked to Dihydrotestosterone (DHT).
DHT: Testosterone is converted to DHT by the enzyme 5-alpha reductase. Excess testosterone (e.g., in PCOS) can contribute to thinning around temples/parting.
Blocking DHT can reduce hair shedding by preventing premature exit from the growth phase; some products can inhibit this enzyme.
Medications and Treatments (NICE Licensed Options)
Minoxidil (topical): widens blood vessels around the hair follicle, increasing blood flow and delivering nutrients to roots.
Mechanism: stimulates growth, prolongs growth phase, may enlarge follicle size; can shift follicles from resting to growing phase in some cases.
Common facts:
May cause initial shedding as old hairs are pushed out to make way for new growth.
Must be used consistently; stopping can revert effects.
Available as 2% and 5% formulations; 5% generally more effective; 5% is used for both men and women for maximum effectiveness, though 2% is more commonly marketed toward women.
Topical formulation can be toxic to pets.
Finasteride (oral or topical): reduces DHT by blocking 5-alpha reductase, leading to less hair shedding and maintenance of growth phase.
Not licensed or widely recommended for use in women due to potential fetal harm; may be used off-label in women under expert guidance and monitoring.
2022 literature review and randomized controlled trial findings: a trial with 0.5 mg finasteride showed significantly increased hair counts vs placebo in women; topical finasteride tends to have fewer systemic side effects than oral.
Caffeine (in shampoos or topicals): evidence from multiple trials suggests caffeine improves hair strength, reduces alopecia severity, and increases follicle activity; may act by increasing blood flow to the follicle and potentially blocking DHT.
Research: two trials in shampoo formulations and five trials in topical formulations; overall positive with minimal adverse effects (e.g., mild scalp flushing).
Peptides (e.g., copper peptides, multi-peptide serums): newer approach to hair growth; promote blood flow, increase growth phase duration, and reduce rest phase time.
Copper peptides have shown increased hair growth and density in studies.
Multi-peptide serums may combine several peptides; The Ordinary has a multi-peptide serum that also contains caffeine.
Other active ingredients discussed: Micon? (not specified in transcript); emphasis on research-backed options and avoidance of gimmicky high-street products.
Nutritional and Supplement Considerations (EATS)
EATS = Essential nutrients and lifestyle: Iron, Vitamin D, Vitamin B (folate/B9 and B12).
Iron deficiency: the world’s most common nutrient deficiency and a significant contributor to hair shedding.
Vitamin D: important for hair follicle strength; deficiency associated with increased hair loss, especially autoimmune-related hair loss.
Evidence: a study comparing alopecia areata patients to healthy controls showed lower mean vitamin D levels in affected individuals and higher inflammation with lower vitamin D.
Recommendation: in regions with limited sun (e.g., UK), consider vitamin D supplementation from October to April.
Vitamin B9 (folate) and Vitamin B12: essential for DNA repair and growth; deficiencies linked to hair shedding and autoimmune hair loss.
Biotin (Vitamin B7): widely marketed for hair health but deficiencies are rare and supplementation is not shown to reduce hair loss or increase growth in large studies.
Cautions: regular biotin supplementation can interfere with certain blood tests (e.g., heart attack markers, thyroid function tests).
General guidance: obtain nutrients primarily from diet; supplements can help when life is busy or if deficiencies exist, but be mindful of overuse and non-evidence-based claims.
Daily Routine and Habits that Don’t Help (and What to Do Instead)
Daily question: cortisol and stress management—stress can impact hair growth.
Habits identified as damaging:
1) Air drying hair: contrary to common belief, air-drying can cause more damage than using a hair dryer if hair is wet and swelling occurs; a hair dryer used 15 cm away with continuous motion causes less surface damage.
2) Tight hairstyles: frequent tension on the scalp and hair shafts causes breakage and thinning; avoid excessive tension and tight beads or glue from extensions.
3) Limiting heat use: excessive heat with curling irons/flat irons can cause damage; moderation is key; dyson air styling devices can help combine drying and styling.
4) Not coloring hair (to avoid damage): long-term bleaching and color can cause damage; consider bond-repair products (e.g., Olaplex) for maintenance if coloring.
5) Not washing hair: the idea of “hair training” is incorrect; more washing is generally better to reduce buildup and inflammation; aim for a clean scalp to support hair growth.
Scalp Health and Microbiome
Scalp microbiome includes bacteria and fungi; balance is needed for a healthy environment for growth.
Common imbalance: yeast overgrowth leading to dandruff, inflammation, flaking, itching, and impaired hair growth.
Scalp care steps:
Regular washing to reduce buildup and dead skin cells; avoid chronic over-washing or under-washing.
Use ketoconazole-containing shampoo (antifungal with DHT-blocking properties) 2–3 times per week to target scalp microbiome and promote growth.
Ketoconazole is a relevant ingredient for thinning hair and should be used as directed.
Glycolic acid can be applied 15–30 minutes before washing to gently exfoliate dead skin cells on the scalp.
Coconut oil: a 2021 longitudinal study suggested coconut oil supports scalp microbiome health and has antifungal properties due to lauric acid, which may reduce harmful bacteria and fungi.
A weekly coconut oil mask is suggested as part of a reset day routine.
Products and Treatment Pathways Discussed
Hair and Me sponsor segment: bespoke, science-first plan for hair health, based on scalp, medical history, and goals; reviewed by experts.
Offer details: first month for £4.99 with code FAYHARE (saving £30); consultation is quick; options include topical drops and oral capsules depending on assessment.
How it works: drops are shaken well and applied once daily using a pipette; ingredient in the drops is claimed to boost scalp circulation to deliver nutrients to the root.
Overall: marketed as a complete, dermatologist-backed solution delivered to your door, designed for visible improvements in 3–6 months or sooner; sponsor messaging includes a direct link to description and code.
Practical Takeaways and Evidence-Based Notes
Don’t rely solely on high-street serums; focus on evidence-based approaches that address the hair growth cycle and overall scalp health.
If considering medications: understand mechanism, dosing, long-term commitment, and potential side effects; consult a professional for personalized guidance, especially for finasteride use in women.
Nutrition matters: address iron status, vitamin D, folate, and B12; beware of overemphasis on biotin without deficiency evidence; aim to meet nutritional needs primarily through a balanced diet.
Scalp care is foundational: a healthy scalp environment supports follicle function and hair growth; consider ketoconazole for anti-DHT/scalp benefits, caffeine-containing products for potential follicle stimulation, and coconut oil for microbiome support.
Hair training is a myth; aim for regular washing to reduce buildup and irritation; a clean scalp supports hair growth.
Daily routine and lifestyle stressors should be managed; consider strategies for cortisol reduction and sleep hygiene; the video references an additional cortisol-focused video for more detail.
If supplementing, prioritize scientifically supported ingredients and be wary of marketing buzzwords like “biotin for hair growth” when deficiencies are not present or not supported by evidence.
The transcript presents a sponsor-led pathway (Hair and Me) that emphasizes personalized, dermatologist-backed plans with measurable timelines; consider evaluating such services against independent evidence and personal health goals.
Connections to Foundational Principles and Real-World Relevance
Hair growth biology aligns with general physiology of tissue renewal, endocrine regulation, and microenvironment health (scalp milieu and nutrition).
The emphasis on the hair cycle (anagen/catagen/telogen/exogen) connects to standard dermatology concepts about follicle biology and how disruptions lead to shedding and thinning.
Treatments like minoxidil and finasteride reflect classic pharmacologic strategies targeting blood flow and hormonal regulation, respectively, with well-documented mechanisms and clinical considerations.
The discussion of nutritional factors (iron, vitamin D, B vitamins) reflects the broader medical understanding that micronutrient status can influence tissue health and inflammation.
The scalp microbiome portion mirrors an increasing appreciation of the skin ecosystem in dermatology and its role in inflammatory conditions and hair cycling.
Ethical, Philosophical, and Practical Implications
The speaker emphasizes evidence-based approaches over sensational or misinformation-driven content common on social media; highlights the ethical obligation to present balanced information.
There is a tension between accessible consumer products and clinically tested therapies; patients should seek medical advice for conditions like PCOS-related hair loss or autoimmune-related alopecia.
Advertising (sponsorships) is disclosed but requires critical appraisal by viewers to separate claims from evidence; readers/viewers should verify claims with reputable sources and professional guidance.
Quick Reference Formulas and Key Values
Hair growth cycle durations:
Anagen: between 2 and 8 years.
Catagen: a brief period of a few weeks.
Telogen: about 2 to 3 months.
Exogen: shedding of old hair to make way for new growth.
Minoxidil concentrations: 2% and 5%, with 5% generally more effective for both genders.
DHT production pathway: Testosterone → DHT via enzyme 5 alpha reductase; blocking this enzyme can reduce hair shedding.
Vitamin D supplementation window (in northern latitudes): October to April.
Caffeine studies: 2 trials (shampoo) and 5 trials (topical formulations) showing positive effects on hair strength and growth.
Ketoconazole shampoo usage: 2–3 times per week.
Coconut oil: 2021 longitudinal study suggesting scalp microbiome benefits due to lauric acid.