Baldness & Greying

Why hair falls out

The overwhelmingly common form of permanent hair loss is androgenetic alopecia — male- and female-pattern baldness. It is driven less by "losing" hair than by hair shrinking. In genetically susceptible follicles, the enzyme 5-alpha-reductase converts testosterone into dihydrotestosterone (DHT), a more potent androgen. DHT binds androgen receptors in the dermal papilla — the follicle's control centre — and switches on signals (DKK-1, TGF-β, IL-6) that shorten the growth phase and progressively miniaturise the follicle. Thick pigmented hairs are replaced, cycle after cycle, by finer, shorter, paler ones until the follicle produces almost nothing.

Three quieter forces make it worse. A low-grade micro-inflammation (T-cells, mast cells) settles around balding follicles; scalp blood flow drops — oxygen tension in a balding frontal scalp runs about 60% of a healthy one; and perifollicular fibrosis lays down scar-like collagen that chokes what circulation remains. Genetics set the stage: susceptibility is strongly heritable and polygenic.

Not all shedding is androgenetic, and the distinction dictates the fix. Telogen effluvium is a temporary, diffuse shed triggered 2–3 months after a shock — childbirth, illness, crash diet, high fever, severe stress — and usually reverses on its own. Alopecia areata is autoimmune, producing sudden round bald patches. And nutritional or hormonal loss follows iron/ferritin deficiency, thyroid disease, PCOS, or protein and vitamin-D shortfalls. A dermatologist's first job is telling these apart.

What actually regrows hair

Evidence-based treatment maps onto the biology above: block DHT, wake up circulation, calm inflammation, or replace follicles outright. The two pillars with the strongest data are minoxidil and finasteride, and they work best together.

On the horizon: caffeine and adenosine topicals (non-inferior to minoxidil in some trials), topical melatonin, botulinum toxin to relax the scalp and improve flow, prostaglandin analogues (bimatoprost, latanoprost) and JAK inhibitors (strongest in autoimmune alopecia areata). Nutritional correction — iron, zinc, vitamin D, B-complex — helps only where a genuine deficiency exists; supplements are support, not a cure.

Why hair turns grey

Grey is not a colour the hair adds — it is colour the hair stops making. Each follicle holds melanocytes (pigment cells) fed by a reservoir of melanocyte stem cells. With every hair cycle the stem-cell pool is drawn down, and after roughly ten cycles the supply runs thin. When the pigment factory closes, the shaft grows in unpigmented — silver, then white.

The chemistry underneath is oxidative stress. Follicles naturally make hydrogen peroxide; a young follicle mops it up with the enzyme catalase. As catalase falls with age, peroxide accumulates and bleaches the hair from within while disabling tyrosinase, the enzyme that builds melanin. Genetics set the clock — genes such as IRF4, MC1R and MITF largely decide when you grey, which is why it runs in families and differs by ancestry.

Then there are accelerants. Psychological stress is real here, not folklore: acute stress floods follicles with noradrenaline that depletes the melanocyte stem-cell reserve. Nutritional gaps — vitamin B12, folate, copper, iron, vitamin D — are strongly linked to premature greying (over half of pernicious-anaemia patients greyed before 50). Smoking, thyroid disease and heavy UV exposure each push it earlier.

What slows the fade

There is no reliable pill that turns grey hair dark again — be sceptical of anything that promises it. What the evidence supports is protecting the pigment you still have and fixing reversible triggers.

Khalitya & Palitya

The classical Samhitas — Charaka, Sushruta and Vagbhata — name hair fall khalitya and premature greying palitya (or akala palitya, "untimely greying"). Both are counted among the shiroroga, diseases of the head, and both turn on one dosha above all: Pitta, the principle of heat and transformation.

Baldness Khalitya

The pathogenesis is a sequence of four humours. Aggravated Pitta, carried by Vata, reaches the hair roots (romakupa) and scorches them so the hair falls; then Kapha together with Rakta (blood) blocks the emptied root, sealing it so nothing regrows. Heat that fells the hair, followed by an obstruction that forbids its return — a strikingly apt folk-picture of the miniaturised, fibrosed follicle modern histology describes.

Greying Palitya

Greying is read as a disorder of Bhrajaka Pitta — the sub-type of Pitta seated in the skin that governs colour and lustre, effectively Ayurveda's melanin. Excess body-heat rises to the head and disturbs pigment at the root. The named causes are as much about mind and conduct as diet: anger (krodha), grief (shoka) and chronic worry (chinta) that inflame Pitta and Vata; staying up at night, excess sun, suppressing natural urges; and a diet heavy in salty, sour, alkaline and incompatible foods. That anger and grief were listed as prime movers of premature greying — centuries before noradrenaline and stem-cell depletion — is one of the tradition's more remarkable observations.

Cooling, feeding, renewing

Because the root cause is read as heat, the whole therapeutic logic is to cool Pitta, nourish the tissue (keshya, hair-friendly herbs), and rejuvenate through rasayana. The single most emphasised route is nasya — medicated oil through the nose, held to be the direct road to the head. Charaka prescribes nasal oils of the prishniparni group for both baldness and greying.

Around the herbs sit the therapies of touch and calm: shiroabhyanga (oiling and massage of the head), shirodhara (a steady stream of oil poured on the forehead) to quiet the nervous system, and a Pitta-pacifying diet of sweet, bitter and astringent tastes with cooling qualities. Treat the anger and the sleeplessness, the texts insist, or the hair will not hold.

The grey hair as messenger

Beyond medicine, the classical literature made the first grey hair a pivot of the human story — the moment mortality announces itself and a life is asked to change direction.

The same thread runs through the Dharma literature. The Mahābhārata lists white hair among the signs that a householder should enter vānaprastha — retirement to the forest, the third stage of life. The Manusmṛti tempers this: grey hair marks age but does not by itself confer greatness or wisdom — character must earn what the years merely announce. And the Yoga Vāsiṣṭha holds both truths at once, calling grey hair "the combination of wisdom and the impending approach of death."

The practical upshot, holding both views honestly: for hair loss, start early and use the proven drugs (minoxidil, finasteride/anti-androgens), rule out iron and thyroid problems, and let scalp massage and a calmer nervous system do their supporting work. For greying, accept that established grey rarely comes back, but protect what remains — fix deficiencies, cut oxidative and emotional load, don't smoke — and treat the plant-dye and oil traditions as good cosmetics and good self-care rather than reversal cures.

And there is the older wisdom the epics offer for free: some greying is simply the body keeping time. Yayāti and the Makhādeva king both learned that the more durable response to a first grey hair is less panic about the hair than attention to the life it is measuring.

Feed the follicle

Hair is built from protein and grown by pigment cells that run on iron, copper, B-vitamins and antioxidants. Aim for these most days rather than chasing any single "superfood."

What to put on your head

The ritual matters as much as the ingredient: warm oil, massage 5–10 minutes to pull blood into the scalp, leave 30–60 minutes (or overnight), then wash out. Twice a week is plenty. Always dilute essential oils in a carrier and patch-test on your forearm first.

Daily habits that hold hair

The texts blamed greying on anger, grief, worry and sleepless nights; modern science blames stress hormones and oxidative load. Same prescription:

• Sleep 7–8 hours, on a steady schedule. Night-waking (ratrijagarana) was singled out in the classics, and poor sleep raises the stress load that thins hair and depletes pigment cells.
• Defuse stress daily. 10–20 minutes of meditation, yoga or pranayama (breathing). This directly targets the anger–grief–worry root and the noradrenaline pathway behind stress-greying.
• Move your body. Regular cardio improves scalp circulation and boosts the antioxidant enzymes that clear the peroxide behind greying.
• Don't smoke; go easy on alcohol. Both accelerate greying and starve follicles of blood flow.
• Handle hair kindly. Skip tight ponytails/buns (traction loss), high heat and daily harsh (sulfate) washing; use a wide-tooth comb and don't rake wet hair.
• Shade your scalp from strong midday sun — UV drives the oxidative damage both traditions describe as "heat."
• Fix the medical drivers. Get thyroid, iron/ferritin, B12, vitamin D and (for women) PCOS checked and treated — these quietly cause both shedding and early greying.

The bloodwork that changes what you do

Before blaming genetics, rule out the treatable drivers — worth checking when shedding or greying is sudden, diffuse or early, because a deficiency is the one cause you can usually reverse. Many labs bundle exactly these markers into a single hair-fall panel (for example Healthians' Hair Fall Assessment Package, roughly ₹1,000 with home collection), which costs less than ordering each test alone.