As if going bald wasn’t bad enough! Research suggests pattern hair loss is more than just a cosmetic issue. Numerous studies have identified links between androgenetic alopecia and a range of diseases. Perhaps most worryingly, bald men are statistically more likely to suffer from heart disease. The good news is that identifying the common cause could prevent heart problems – and even stop hair loss.
Just a cosmetic issue?
If you ask your doctor, chances are they’ll tell you that pattern hair loss is purely a cosmetic problem. After all, hair doesn’t play a vital function in the body. We can live without it.
And this is true. Whilst it may be psychologically distressing, hair loss is not itself dangerous.
However, some forms of hair loss can indicate something in the body isn’t quite right. Vitamin deficiencies, for example, cause hair to fall out. Extreme stress can cause telogen effluvium – another hair loss disorder.
But androgenetic alopecia – common ‘pattern’ hair loss – is not typically thought of in this way. In fact, around 70% of men and 40% of women suffer from it at some point in their lives – most of whom seem otherwise healthy.
The current explanation of pattern hair loss is that it is caused by a genetic sensitivity of hair follicles to the hormone dihydrotestosterone (DHT). The problem, say most doctors, is specific to the hair follicle itself and thus purely a cosmetic issue.
However, this explanation has a number of obvious flaws. Most notably, DHT is known to cause hair growth everywhere else in the body. Why, then, would the hair follicles on the top of the head react in exactly the opposite way? And in such a specific pattern?
But the biggest clue that there’s more going on under the surface? Androgenetic alopecia is correlated with many health disorders, such as:
Most worryingly, pattern hair loss is strongly linked to cardiovascular problems and heart disease.
Links between hair loss and heart disease
A literature review from 1991 found eight articles that identified links between hair loss and heart disease.
Perhaps the most comprehensive study linking hair loss and heart disease is this 11 year follow up of over 22,000 US male physicians. This highly detailed study, conducted by Harvard Medical School and Brigham and Women’s Hospital, found that:
“[O]ur study provides support for the hypothesis that vertex pattern baldness is a marker for increased risk of [coronary heart disease] events. The observed association was independent of age and was stronger in a subgroup of men with hypertension or high cholesterol.”
The study also controlled for factors such as alcohol consumption, diabetes, and level of physical activity.
Not only did the study find a correlation between androgenetic alopecia and cardiac events (such as heart attack), it also noted that the pattern of hair loss was also important:
- Men with frontal hair loss (receding hair line) were 9% more likely to develop heart disease
- Men with mild thinning at the crown had a 23% greater risk
- Men who were completely bald at the crown were 36% more likely to suffer a cardiac event
36%! And when you consider that heart disease is the leading cause of death worldwide, the risk becomes very real.
Preventing heart disease – and possibly hair loss?
The good news is that 90% of heart disease is preventable.
Obvious health advice – quit smoking, reduce alcohol consumption, get more exercise – will reduce your risk of developing heart problems if you are not following it already.
Diet is another major factor, although public health advice with regards to this is often conflicting.
On the one hand, the FDA, Europe’s Food Safety Authority, and Britain’s NHS all recommend a reduced consumption of saturated fats. On the other hand, numerous studies suggest saturated fat has no effect on heart disease risk1,2,3.
Personally, I am inclined to think sugar/carbohydrates are far more dangerous than saturated fats in this regard.
Risk factors for heart disease include:
- High blood pressure (hypertension)
- High blood sugar (diabetes mellitus)
- High cholesterol (hyperlipidemia)
“Dietary sugars have been suggested as a cause of obesity, several chronic diseases, and a range of cardiometabolic risk factors. […] Dietary sugars influence blood pressure and serum lipids. The relation is independent of effects of sugars on body weight.”
These findings are not a one-off either. Whereas the link between saturated fats and heart disease is at best uncertain, the link between sugar/fast digesting carbohydrates and cardiovascular disease is more firmly established.
This study compared the relative effects of saturated fats vs. sugars:
“This paper reviews the evidence linking saturated fats and sugars to CHD, and concludes that the latter is more of a problem than the former. Dietary guidelines should shift focus away from reducing saturated fat, and from replacing saturated fat with carbohydrates, specifically when these carbohydrates are refined. To reduce the burden of CHD, guidelines should focus particularly on reducing intake of concentrated sugars, specifically the fructose-containing sugars like sucrose and high-fructose corn syrup in the form of ultra-processed foods and beverages.”
Of course, both saturated fats and sugars come in various forms. Generally, though, it appears that dietary sugar is far more damaging to the heart than saturated fat.
And interestingly, high sugar/high carbohydrate diets are also linked to hair loss. Coincidence?
Inflammation, hair loss, and heart disease
The fact that hair loss and heart disease are so strongly correlated suggests there is a common cause to both.
And the obvious explanation is that high DHT levels cause both hair loss and heart disease – but this doesn’t quite stack up.
Bald men don’t necessarily have more DHT than non-bald men. Some men have incredibly high DHT levels yet maintain their youthful Norwood 1 hair. Others might have low DHT but still go bald.
The same appears to be true of heart disease. While increasing DHT may increase the risk of heart disease, there is no evidence that men who suffer from heart disease have higher DHT levels in general.
What we do know, however, is that bald mens’ scalps have higher levels of inflammation. This is why pattern hair loss is often accompanied by an itchy scalp and why JAK inhibitors and ketoconazole shampoo help prevent hair loss.
Perhaps the most striking illustration of the importance of inflammation in cardiovascular disease is this letter from heart surgeon Dwight Lundell, in which he states that inflammation is the single most important cause:
“Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes.”
Dr. Lundell’s letter also makes the same point about diet from earlier:
“The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today. The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.”
Another symptom common to both hair loss and heart disease is fibrosis: a buildup of collagen in tissues.
Fibrosis levels in the scalps of bald men are around four times higher than non-bald men. Research also suggests there is a significant fibrotic component to heart disease:
“The importance of fibrosis in organ pathology and dysfunction appears to be increasingly relevant to a variety of distinct diseases. In particular, a number of different cardiac pathologies seem to be caused by a common fibrotic process.”
Again, this is too convenient to be dismissed as coincidence.
Connecting the dots: how to prevent hair loss and heart disease
So far we have seen that hair loss and heart disease are strongly correlated, raising the question of whether there is a common cause to both.
Inflammation is a common factor of both conditions, as is fibrosis. Interestingly, inflammation and fibrosis are also closely linked. What’s more, the studies discussed here suggest inflammation and fibrosis do play a causal role in both heart disease and hair loss. It follows, then, that reducing inflammation and fibrosis will reduce the risk of both hair loss and heart disease.
So where does DHT come into the picture? After all, drugs that reduce DHT also slow hair loss!
Perhaps (although there are no studies that have tested for this) DHT increases inflammation in those who are genetically susceptible. This would explain why finasteride and dutasteride slow the progression of hair loss dramatically.
Of course, this would mean that these drugs should reduce the risk of heart disease as well – and preliminary studies on mice do indeed support this connection.
So, Propecia (finasteride) appears to be one way to reduce the risk of hair loss and heart disease. But to tackle the root cause of these conditions, you need to deal with the inflammation.
One way of doing this is through diet. However, as we’ve seen, mainstream dietary advice may actually have the opposite effect.
Most forms of hair loss are taken to be a sign of an underlying health issue. Yet androgenetic alopecia has mostly been regarded as a purely cosmetic problem.
Perhaps the reason for this is that androgenetic alopecia often takes a long time to progress. During this time, negative health effects may not be immediately obvious.
Another explanation may be that pattern hair loss is so universal. How can it be bad when it’s so common?
But the undeniable links between pattern hair loss and heart disease suggest the condition is more than simply cosmetic. Increased inflammation and fibrosis have been demonstrated to cause negative effects in many parts of the body – not just the hair follicles.
Fortunately, though, it appears the genetic element of pattern hair loss has been overstated.
While genetic predisposition appears to make some individuals more susceptible to inflammation and fibrosis, environmental factors can counteract this. Baldness, and heart disease, is not your genetic destiny.