What Is Necessary for Healthy Hair?

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/07/26

Dr. Viktoryia Kazlouskaya, MD, PhD, is a dermatologist with 20 years of skincare, cosmetic procedures, and dermatological research expertise. She specializes in evidence-based treatments, including sunscreen, retinol, and antioxidants, while addressing conditions like acne, rosacea, and aging skin. Passionate about patient education, she emphasizes the importance of lifestyle, diet, and personalized care. Dr. Kazlouskaya is also experienced in advanced therapies like exosomes, microneedling, and lasers, making her a trusted authority in modern dermatology. She emphasizes the importance of addressing hair loss early with FDA-approved medications like finasteride and minoxidil. While dietary improvements, such as increased protein and iron intake, support overall hair health, they cannot reverse genetic or inflammatory conditions. Natural remedies like rosemary oil and caffeine provide minimal benefits but do not replace proven treatments. Hair transplants are a last resort, requiring careful planning. Dr. Kazlouskaya also highlights challenges for women experiencing menopause-related hair loss and stresses a holistic approach to hair care and treatment.

Scott Douglas Jacobsen: Today, we’re here again with Dr. Victoryia Kazlouskaya. We’ll be discussing hair. What are the principles of good hair health? I don’t necessarily mean diet yet; I’m referring to indicators. When you examine a person’s hair, what distinguishes healthy hair from unhealthy hair?

Dr. Viktoryia Kazlouskaya: Every person has a genetic predisposition to how much hair they will have and what is considered normal. For example, if a person’s entire family has thin hair, that is likely their normal. Conversely, if someone’s baseline is thick, healthy hair, that is their normal.

Everyone is very different. Normally, when you examine the scalp under a microscope, each hair follicle contains a few growing out of it, and these hairs tend to have the same diameter.

There are also visual characteristics to consider. We assess whether the hair is healthy by its shine and smoothness and whether it appears orderly or unruly. However, many factors come into play—cultural differences, genetic differences, and styling preferences. What is normal for one person may not be normal for another.

Jacobsen: How does nature showcase its variety when looking at hair types? Some people have tightly curled hair, others have loose waves, and some have straight, almost fine hair.

Kazlouskaya: There is truly an incredible variety in both texture and colour, primarily due to genetic differences. Here in New York, we see people of all races and ethnicities.

For example, individuals of African descent often have curly or coiled hair because their follicles are oval or slightly curved. This may have evolved as a protective mechanism against intense sun exposure. Still, it is a characteristic we admire and celebrate.

Asians, on the other hand, almost exclusively have straight, thick hair. Among Caucasians, there is a wide range—from very straight to curly hair. The variety of colours depends on the amount and type of pigment in the hair follicle, which is determined by genetics.

Jacobsen: When it comes to hair colour, we see rare shades like red. Some jokes about redheads going extinct are humorous ideas people bring up in conversations. Why did nature produce the colours we see, such as blonde, brunette, red, and black? Why don’t we see other hair colours?

Kazlouskaya: It’s difficult to say with certainty. Classical genetic studies suggest that pigmentation evolved as a protective feature. For instance, individuals of African descent almost exclusively have dark hair and dark skin, which may have been advantageous in tropical climates with intense sunlight. That explanation aligns with Darwinian theory, but we can’t definitively say it’s the full story.

Determining the exact reasons is challenging. In nature, we see animals with a wide variety of colours, so genetic diversity in pigmentation is something Earth’s organisms share. This diversity gives us various features to observe, admire, and enjoy.

Jacobsen: Given that variety, people have different cultural and aesthetic preferences. How do you find people using techniques and products on their hair to style it in certain ways? Which techniques do not impact the hair’s health, and which are potentially harmful to hair health?

Kazlouskaya: People style their hair in many different ways, and these are often influenced by their cultures and beliefs. For example, Afro-American individuals tend to have unique styling techniques, such as braiding, wearing braids, or straightening.

It’s a bit of a joke that people are never happy with what they naturally have—people with curly hair often straighten it, while people with straight hair try to curl it. In the Afro-American population, we frequently see conditions associated with these styling techniques, such as braiding, dreadlocks, and straightening.

Curly hair follicles are generally more susceptible to damage. When traumatized repeatedly with tight styles, this can lead to a condition called traction alopecia or traction hair loss. Initially, this condition is reversible, but if the pulling and tight styles continue, hair loss may become permanent. Of course, this is devastating for anyone, especially for women.

Styles like dreadlocks and braiding are also popular among Afro-American men, and we often see particular hair conditions associated with these practices in this group. Similarly, in Caucasian and Asian populations, there’s significant damage when individuals overuse curling, colouring or drastically change their hair colour.

For example, Asian individuals trying to achieve blonde or other bright colours common among European or Caucasian populations often experience hair shaft damage, dryness, and breakage. These are common issues.

Jacobsen: There’s one very dramatic type of hair technique. It’s mostly done in salons, but I can’t recall the exact name. It involves using very harsh chemicals and is often a subset of Afro-American culture used to make the hair very straight.

Kazlouskaya: Yes, straightening can be achieved using various techniques and chemicals. When done continuously, these are undoubtedly harmful. Some emerging data suggest that these chemicals may not only damage hair but also have potential systemic consequences, including a possible link to cancers and other health issues.

This is not yet fully proven, but ongoing research is trying to determine whether these techniques are more harmful than just damaging hair. Despite these risks, many patients hesitate to return to their natural hairstyles.

I think natural Afro-American hair is stunning. I often encourage my patients to embrace their natural style. I grew up loving the big, round hairstyles of the disco divas in the 1980s, and I find those look beautiful. However, in Afro-American culture today, wearing natural hair isn’t as common as it could be, which I find unfortunate.

Jacobsen: Regardless of cultural background or ethnic heritage, what are the general principles for maintaining healthy hair?

Kazlouskaya: Hair care routines differ significantly. For example, while Asians and Caucasians typically wash their hair a few times a week, Afro-Americans often wash their hair once a week or even less frequently—sometimes once every two weeks or longer.

This is because Afro-American hair is more difficult to manage due to its tight curls, and the hair follicles are more susceptible to damage. Washing too frequently can harm them. Afro-American hair also requires much moisturizing, and oils are very popular and helpful. Oil treatments protect hair shafts by preventing water damage.

In contrast, oils may not be as beneficial for Asians or Caucasians, as they can make hair greasy and heavy and worsen conditions like dandruff or seborrheic dermatitis. So, there are many differences in how people care for their hair depending on their hair type.

Jacobsen: What about diet? What should people take into account regarding their hair health? In a prior interview, you mentioned having a balanced diet and the importance of protein.

Kazlouskaya: In general, protein is crucial for both skin and hair health. Hair is made of keratin, which is a protein. You cannot directly improve your existing hair shafts—essentially non-living structures. However, you can make them look better by trimming the edges or using treatments to soften them. Hair grows from the scalp, so nourishing your body will lead to healthier hair growth.

For example, if you are experiencing hair loss, focusing only on the strands you already have will not prevent further hair loss. You need to work from within by nourishing the scalp and hair follicles.

A protein-rich diet is essential, especially for individuals over 40, particularly women in premenopause or menopause. Adequate protein intake is one of the first things I discuss with patients experiencing hair loss. I often recommend using free apps to track protein and macronutrient intake, focusing on protein and healthy fats.

Healthy fats—like omega-3 fatty acids, avocados, and olive oil—are also vital. Determining whether a patient is vegan or vegetarian is equally important, as these diets can lead to lower protein intake. I’ve had patients who, despite receiving the best treatments, struggled with hair regrowth until their diets were adjusted. Once their nutrition improved, the treatments became more effective, and their hair health quickly reflected these changes.

Ensure sufficient iron intake for women, as iron deficiency and anemia are common issues. Women lose iron through menstruation and childbirth and often eat less meat. Iron deficiency is one of the first conditions we check for in female patients with hair loss.

While addressing iron deficiency with diet is important, iron from supplements is not always well-absorbed. Therefore, improving dietary sources of iron can be more effective.

Vitamins also play a significant role in hair health. For example, data suggests that vitamin D deficiency can worsen hair loss. There are many vitamin D receptors in the hair follicles, so even though the relationship may not be entirely direct, we notice that patients with very low vitamin D levels often struggle more with improving their hair health.

Supplementation can help, but vitamin D is also present in many foods, such as meat and eggs. Maintaining a diverse diet that includes fresh foods, vegetables, antioxidants, and vitamins is important for overall hair health.

Jacobsen: What rare hair conditions might require medication or treatments where a good diet or a youthful lifestyle alone may not be sufficient?

Kazlouskaya: Hair diseases encompass a very broad topic. I could probably name at least 30 different conditions quickly, and not all hair loss is the same.

There are different types of alopecia, and some are caused by genetic conditions affecting the hair shaft. For example, the hair shaft might have abnormalities like twisting, bubbles inside, or irregularities. There are at least 10 to 15 classifications of how hair shafts can be abnormal, and many of these conditions are due to genetic issues.

In addition to hair shaft abnormalities, genetic conditions that affect the overall structure and health of the hair are also highly complex. Dermatologists undergo years of residency to learn about hair diseases. Still, not all dermatologists specialize in treating hair-related issues because it requires focused expertise. It’s a specialized topic within dermatology.

While diet is beneficial for overall health and can support the ideal genetic potential of your hair, it is not enough to overcome genetic diseases or certain inflammatory conditions. For example, male pattern baldness, or androgenetic alopecia, is primarily driven by the DHT (dihydrotestosterone) mechanism. Although diet plays a minor role, it cannot fully address the problem.

Inflammatory conditions and other types of hair loss cannot be resolved solely through diet. Even for common male baldness, while diet can contribute to overall hair health, it does not significantly impact the primary causes of hair thinning in men.

Jacobsen: What should men do to mitigate early-onset balding, particularly in the crown or the front of the head?

Kazlouskaya: Men experiencing early-onset balding should start treatment as early as possible. If you have already noticed hair thinning, it likely means the process has been ongoing for several years. The best action is to consult a professional to confirm the diagnosis.

Using a dermatoscope or trichoscopy, we examine the hair follicles and scalp with a magnifying device, either handheld or digital. If we observe miniaturization—the hair shafts are thinning—that’s often an early sign of androgenetic hair loss. By the time it becomes visible in the mirror, approximately 20% of the hair may already be affected.

The earlier you begin treatment, the better. For men, two FDA-approved medications work well: finasteride and minoxidil. Starting these medications as soon as possible slows the progression of hair loss. While these treatments are essential, other factors, such as diet, lifestyle, and overall health, also play an important role.

We underestimated the significance of these factors in the past. Still, during the COVID-19 pandemic, we noticed that individuals with worse COVID outcomes—often linked to comorbidities such as diabetes, obesity, and heart conditions—also experienced more severe alopecia and pattern hair loss.

Recent studies suggest potential connections between hair loss, cholesterol levels, lipid metabolism, and general health. For instance, I’ve seen patients with stable hair loss for years suddenly experience worsening after developing metabolic issues like high cholesterol. Everything in the body is interconnected, so addressing these systemic issues is critical.

Nevertheless, science strongly supports the use of FDA-approved medications as a first-line treatment. Additionally, for those considering hair transplants, a good hair surgeon will not perform a transplant without the patient also using medication. Doing so is considered bad practice.

Jacobsen: What about women who are perimenopausal, menopausal, or postmenopausal? What are your recommendations for them?

Kazlouskaya: Women face greater challenges in treating hair loss because we don’t have specific medications that target female hair loss as effectively as treatments for men. Minoxidil is the first-line treatment, but targeting other factors is harder.

During menopause, we can use medications like finasteride and dutasteride, which are typically used in men, because postmenopausal women are no longer able to get pregnant. However, these treatments are not as effective in women as in men.

In addition to diet and a healthy lifestyle, women can benefit from regenerative treatments such as platelet-rich plasma (PRP) injections, laser therapy, growth factor treatments, and exosome therapy. While these treatments are still considered investigational and are often cosmetic, they hold promise. They are becoming more common in managing hair loss in women.

Jacobsen: What about solutions that people believe work because they’ve been sold by influencers, podcast hosts, or charlatans as the newest miracle pill or technique—things that don’t work?

Kazlouskaya: Hair loss is on the rise right now. If you analyze Google search trends, hair loss is one of the most commonly searched topics. Over the past year, my clinic has almost entirely shifted toward treating hair loss due to overwhelming demand.

Unfortunately, I constantly have to combat misinformation. Marketers use aggressive tactics to create fear around traditional medications while promoting their products, often for financial gain.

One of the most popular trends is oils, particularly rosemary oil. There is a small degree of truth behind this trend because a very limited study suggested that rosemary oil could be as effective as 2% minoxidil for hair loss. However, this study was extremely small, conducted in Iran, and not from a reputable institution. Additionally, we know that 2% minoxidil is not particularly effective, so we use 5% minoxidil instead.

So, while oils and other natural remedies may provide a small benefit, they cannot replace traditional treatments. The danger is that people who believe in these trends waste valuable time. If hair loss is not addressed promptly, the opportunity for regrowth may be lost entirely.

Androgenetic pattern hair loss is progressive—once a hair follicle is lost, it cannot be revived. The only solution at that stage is a hair transplant, which comes with challenges. Many people assume surgery is a simple fix and will guarantee a full head of hair. However, transplants involve scarring, and there is no guarantee that the new follicles will survive. Sometimes, patients end up with a more significant issue than originally.

Beyond oils, people often ask me about other natural remedies, such as caffeine, green tea, or chamomile. Unfortunately, I wish I could say they work, but they do not. That’s not how hair restoration functions.

Many people fear the medication, and there is a reason for that. We know that finasteride can cause side effects such as decreased libido, reduced sperm count, and, in some cases, worsening depression, which is a common concern.

Taking these medications is a commitment. There are additional concerns for young people experiencing early hair loss—what if they are planning to have children? What if they are thinking about starting a family? These are important questions; we do not yet have all the answers.

However, we do know that these medications work. So, it becomes a trade-off—do you prioritize your hair or other concerns such as family planning or mental health? It is always a balancing act when deciding how to manage these treatments.

Jacobsen: Dr. Kazlouskaya, thank you.

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