Skin as a Mirror: Tyumen Trichologist on Hair Loss and Care

Hair health has become a whole industry. Men want to stop rapid baldness, women want to preserve the silkiness and thickness of their locks. Modern trichology (the branch of medicine dealing with the scalp and hair) strives to solve these problems, and often succeeds, albeit at a high cost.

We asked Tyumen trichologist Natalya Bruenok to answer key questions on how to maintain hair health, so as not to have to fly to Turkey for a transplant later. We explored where dandruff comes from, why we go bald, how often to wash hair, and why folk medicine should not be trusted.

Natalya Bruenok is a top-category trichologist and dermatovenerologist. She has over 20 years of experience, 18 of which she worked in a hair treatment clinic. She now sees patients at NEO-Clinic.

Hair on the pillow — a reason to see a doctor?

— How can you tell if you need a trichologist«s help?

— If you notice hair loss. Literature describes the normal daily hair loss as 80–100 strands. I don«t entirely agree with that, because it»s very individual. Suppose you never paid attention before to hair on the pillow after sleep or during washing, and now there«s more than usual; that»s a reason to be concerned.

The opposite can also happen: you might not notice the fallen hair itself, but the volume on your head decreases, thinning occurs, hair becomes sparse. This is a hidden progression: the patient doesn«t pay attention in time, and the process is already very prolonged.

Most often, people come to me specifically with hair loss, but depending on the season, patients with scalp problems may appear.

— Do more men or women come in?

— Let«s say, 75% are women, the rest are men.

— Can you prepare in any way for a trichologist appointment? Maybe get some tests in advance?

— You can get a complete blood count, a comprehensive biochemical blood test, vitamin D, ferritin, thyroid hormones, and check for parasitic infection, because it«s now often found in patients with alopecia areata.

We need to look at everything. Trichologists, so to speak, read between the lines in tests. For a therapist, for example, protein might be within normal limits, but a trichologist will note that it«s already at the lower boundary. This indicates that some changes are happening, affecting hair condition.

— Do patients often surprise you when they come in? With strange misconceptions, folk methods, and so on?

— It often happens that patients come and discuss with me the opinions of various bloggers, who are often very far from medicine, but for some reason, they trust them more. That surprises me a lot.

Of course, also various methods from television, which older women especially like to watch. Sometimes this leads to tragic cases. Once, a patient came to me who listened to a famous popularizer of folk medicine and made a salt mask for her hair using his recipe. Moreover, the woman decided to leave it on not for 30 minutes, but to sleep in it all night for a better effect. In the morning, she woke up simply without hair.

We couldn«t help her in the end because the hair didn»t just fall out; she had burns on her head, and scar tissue had already formed on the skin.

Where does dandruff come from and how to choose the right shampoo

— We often talk about oily and dry hair. What does this mean from a medical perspective?

— In these cases, we«re talking about hair types: oily, dry, mixed, and normal. When a person»s sebaceous gland works very actively, they will have an oily hair type. We recommend that such patients wash their hair every day. There«s no need to fear this: on the contrary, if you don»t, the hair condition will worsen. In the end, this can lead to hair loss and even baldness.

If you have a dry hair type, then daily washing is contraindicated because you will indeed over-dry the scalp. And accordingly, the hair too. We recommend that such people wash their hair as needed, but not less than once a week.

Mixed type is when the hair itself is dry along the length, but the root system is oily. Normal type is hair that is not prone to oiliness or dryness. Probably, these people are the luckiest, but they are a minority.

— Can water quality affect hair condition?

— Yes, it can. Because reagents for purification are used in water, chlorine for disinfection, soda, and so on. All these components over-dry hair. But it also depends on the city district where you live, on the condition of the pipes through which the water flows.

A dermatologist from our clinic shared a case with me. A patient was treated for seborrheic dermatitis. They tried everything, but nothing helped. And then she simply moved to another district with better water, and the problem went away.

— Many Tyumen residents struggle with dandruff. Where does it come from?

— The simplest reason is an incorrectly chosen shampoo. If it doesn«t suit you, it will over-dry the scalp, and it will flake. This is called dry seborrhea — colloquially, dandruff. But there are deeper reasons that come from within.

The skin, [including on the head] — is a mirror of your internal organs. [If dandruff appears], it can indicate a disruption in the gastrointestinal tract. It«s quite possible that you consume a lot of sugar, and this can provoke flaking on the scalp and various dermatitis.

— By the way, how do you choose a shampoo?

— First of all, we look at the hair type, whether it«s dyed or not. Second — of course, the composition — it should have at least 15 beneficial components. Including sulfates, by the way. Sometimes people come to me and say they only use sulfate-free shampoo. But I»m against such compositions because sulfates are also needed; they wash hair effectively.

If you«re afraid that such a composition will over-dry the skin and hair, use shampoos that also have moisturizing components in the composition — oils, vitamins, plant-based ingredients. And of course, use a good conditioner, hair mask after shampoo.

— Our readers asked, is it necessary for shampoo and conditioner to be from the same brand…

— No, that«s certainly not necessary.

Why you shouldn«t shave infants and whether you can turn gray from fear

— Let«s go through several general questions that are often asked to trichologists. You know, sometimes in movies they show: a person experiences something terrible, and instantly their hair turns white. Is it true that you can turn gray from stress?

— There can be many causes of graying. The very first is heredity and genetics. It happens that a person is 16 years old and already completely gray, and you can«t do anything about it. There are also ethnicities that are more prone to graying, for example.

The second cause is indeed stress. This can happen to both a young person and an older one, because stress can lead to impaired blood flow in the root system. And the third cause is endocrine disorders. We can«t stop graying, but we can advise on how to slow down the process.

— There«s also a myth that if you shave your head bald, hair might not grow back. Can that really happen?

Well, that happens in infants, for example. If they are shaved, new hair might grow weak or not grow at all. But in adulthood, shaving itself doesn«t damage hair because our root system is deep under the skin. So if that happens, it»s only from poor-quality shaving, meaning traumatic alopecia can occur.

— How do trichologists view hair coloring? Does it damage hair?

— Of course, coloring, like any chemical exposure, will damage hair, even if you use the highest-quality dyes. There are no dyes today that wouldn«t worsen hair condition.

But, of course, we can choose a higher-quality composition that causes minimal harm. Specialists can help with this. If necessary, you can even test your dye with a trichologist or at a hair salon.

— Several questions came from women who complain about hair after pregnancy. Why does its quality suffer?

— When a woman carries a child, a certain hormonal background is created for this. After childbirth, the hormonal background changes sharply, and the woman experiences very strong stress. As a consequence, this can lead to changes in hair, particularly to hair loss. It can even happen that hair color changes.

Moreover, if a woman is breastfeeding, most beneficial elements are given to the child with milk. Therefore, even if all her tests are like a healthy person«s, problems can occur because there might be a lack of microelements. In such a case, I recommend consulting a specialist.

— Another common myth concerns men. Supposedly if a man is bald, it means he has high testosterone.

— That«s a myth. The amount of testosterone in this case doesn»t play a role. But the sensitivity of the receptors in the hair is indeed important. A man«s testosterone can be normal, above, or below normal, but the receptors in the hair of one are sensitive, of another — not.

We don«t even prescribe testosterone tests because only in very rare cases is there an influence.

Baldness and hair transplantation

— And why do we go bald in general?

— There are many reasons. This includes hereditary factors, stress, endocrine disorders, and iron deficiency. Parasitic infection can very often lead to hair loss. Accordingly, as many reasons, so many diagnoses for alopecia (the scientific name for baldness. — Ed.).

— There are many methods to combat baldness: mesotherapy, laser therapy, and so on. Which method is the most effective?

— Look, the coolest, most effective thing in fighting alopecia is finding the cause of hair loss. We can treat the patient endlessly with all methods, good methods, but it«s like, for example, pouring water into a bucket with a hole — it won»t fill until you fix the leak.

So first, find the cause and treat comprehensively. This can include oral medications and combined therapy.

— Can you tell more about therapy methods?

There is, for example, mesotherapy. This is when injections are given into the scalp, providing access to the root system of vitamins, amino acids, drugs to improve blood flow — everything necessary for the hair root. There is plasma lifting. Specialists take your blood, place it in a centrifuge, and make a preparation from it that is injected into the skin. This procedure affects enhancing blood supply, enriching with necessary components. Also, we recently got laser therapy.

All these methods in combination will yield results once you deal with the causes of baldness.

— Many people now do transplants. How do you feel about this surgery?

— I feel positive, but when the patient has already undergone treatment. I always first recommend stabilizing the process, because the transplant itself doesn«t get rid of hair loss.

It happens that hair stops falling out, but the receding hairline at the forehead is already very deep, hair definitely won«t grow there. We tell the patient that in these areas, hair will have to be restored with a transplant. So, find the problem, get treated, and then have the surgery. As for which area of the head needs to be grafted, that»s exactly what a doctor can help determine.

This interview is a continuation of our series of talks with Tyumen doctors. Here are the previous interviews:

1. ‘You should have sex until your last breath’: a big talk with a gynecologist about HPV, menopause, and vaginal size.

2. ‘A girl did a kerosene detox’: a Tyumen endocrinologist — on Ozempic, the diabetes epidemic, and crazy diets.

3. ‘It’s unproductive to be insecure about penis size’: a talk with a Tyumen urologist about prostate cancer, sexual intercourse duration, and Viagra.

4. ‘Cells mutate in everyone’: a Tyumen doctor — on one of the most insidious cancers that kills millions;

5. ‘The disease doesn’t choose by gender or status’: a Tyumen venereologist — on ‘shameful’ infections and protection from them;

6. How to protect yourself from cancer and whether piercing nipples is harmful. A big talk about female breasts with a Tyumen doctor.