Premature grey hair

Everyone goes grey sooner or later. Greying is called premature when it starts before 20 in people of European descent, before 25 in Asians and before 30 in people of African descent. Most often it runs in the family: if your parents went grey early, you probably will too.

Yet early grey hair sometimes comes alongside autoimmune thyroid disease, vitiligo, pernicious anaemia, nutritional deficiencies, the effects of medicines and smoking. That is why in our clinical trichology department we do not promise to bring the colour back. We look for a cause behind the grey that is worth treating and explain how to care for hair whose properties have changed.

This page draws on reviews by Professor Yuliya Ovcharenko, "The mysteries of grey hair" and "Biological foundations of hair follicle ageing".

When to see a trichologist

A few grey hairs after 30 need no tests. A consultation makes sense if:

grey hair appeared before 20 and nobody in your family went grey that early;
your hair is visibly greying within a few months, or the grey came together with hair loss or bald patches;
you notice other changes in how you feel: tiredness, pallor, weight change, palpitations, pale patches on the skin;
your hair started to lighten after you began a new medicine;
you have restricted your diet for a long time or have a digestive condition that affects how food is absorbed;
your hair, on the contrary, has clearly darkened without dye: that is a reason to get checked as well.

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Why hair goes grey early

Hair colour comes from the melanocytes of the hair follicle. They make pigment only while the hair is growing and are replenished from a reserve of melanocyte stem cells. When that reserve runs out, or melanocytes die from oxidative stress, the new hair grows without pigment. The size of the reserve differs from person to person, so the age of greying is largely set by genes.

Heredity

The most common case. Familial premature greying is probably inherited in an autosomal dominant way, which is why early grey hair is often seen across several generations of one family. Usually there is no disease behind it.

Autoimmune and endocrine conditions

Early greying is linked with vitiligo, pernicious anaemia and autoimmune thyroid disease. Greying can also follow a severe illness, endocrine disorders or major emotional shocks. How hormones act on hair is explained in the publication "Hormones and hair".

Nutritional deficiencies

Hair pigmentation is affected by protein-energy malnutrition and by deficiencies of vitamin B12, essential fatty acids, zinc, copper or selenium. Rare inborn metabolic disorders in which hair turns lighter have also been described.

Medicines

Some systemic medicines, antimalarials among them, change hair colour by interfering with melanin synthesis. These changes are described as reversible, but never stop or switch a medicine on your own: that is a decision for the doctor who prescribed it.

Smoking, ultraviolet and stress

Smoking is linked with premature greying and hair loss: tobacco smoke impairs microcirculation in the hair papillae, damages the DNA of follicle cells and keeps low-grade inflammation going. Ultraviolet light, inflammation and emotional stress add to the oxidative stress that kills melanocytes.

Rare syndromes

Early greying has been described in premature ageing syndromes (Hutchinson-Gilford, Werner), myotonic dystrophy and Böök syndrome, and in inborn disorders of melanocyte migration such as piebaldism. These are rare, which is exactly why the doctor asks who in your family went grey and when.

How greying shows

In men grey usually appears first at the temples and sideburns, in women along the hairline. It then spreads in waves towards the crown and the sides of the head, reaching the back of the head last. The beard and body hair go grey later. Grey is more visible in dark hair.

A grey hair differs in more than colour. It is usually coarser and stiffer, wiry, sometimes wavier, holds a style less well and resists dye. Recently greyed hairs are on average thicker than pigmented ones.

A different picture is a warning sign: hair that went grey within a few weeks. So-called overnight greying is now explained as an acute episode of alopecia areata: the disease selectively sheds pigmented hairs, while the grey ones, which it usually spares, stay and suddenly become visible. In that case thinning is visible too, and that already calls for treatment.

Examination at the Trichology Institute

The aim with early grey hair is to tell an inherited trait from a condition that needs treatment, and to check whether hair loss is going on alongside it.

Conversation. The doctor asks when the grey appeared and how fast it is spreading, whether relatives went grey early, which chronic conditions you have, which medicines and supplements you take, how you eat and whether you smoke.
Examination and digital trichoscopy on FotoFinder equipment: the state of the hair shafts, follicles and scalp, signs of alopecia areata, androgenetic alopecia or other hair loss. If needed, a TrichoScale phototrichogram records hair density and thickness for comparison at follow-up visits.
Tests when indicated, not everything at once: for example a full blood count, vitamin B12, thyroid hormones, iron status. The doctor draws up the list after the examination, and samples can be taken at the clinic (laboratory diagnostics).
Other specialists. If the findings point to thyroid disease, anaemia or another general condition, the trichologist refers you to the right doctor, and pale patches on the skin are examined by a dermatologist in the same clinic.

The cost of a consultation with trichoscopy and of tests is listed in the consultation prices and clinical trichology prices. The Institute is in Kharkiv at 17 Danylevskoho Street, by appointment.

What can be done and what not to expect

The honest answer: today there is no way to bring the colour back to inherited or age-related grey hair. No shampoo, procedure or supplement restores the melanocyte reserve in the follicle. Medical literature does report hair darkening with certain agents, but the effect did not last: once they were stopped, the hair went grey again.

Colour can return only when greying had a specific cause and that cause has been removed: a confirmed deficiency has been corrected, the doctor has replaced a medicine that may have affected pigment, the person has stopped smoking. Even then the result is not guaranteed, and new hair takes months to grow.

What is within our reach:

find and treat an accompanying condition, if there is one: thyroid, anaemia, deficiencies, alopecia areata. This matters for your health whatever the colour of your hair;
avoid speeding the process up: stop smoking, protect hair and scalp from excess ultraviolet, eat a full diet;
care for grey hair according to its properties. It is drier and stiffer, so trichocosmetics are chosen for moisture and gentle cleansing, and esthetic trichology offers hair reconstruction with a relaxing spa massage (it works on the shaft, not the follicle) and head massage, carried out by esthetic trichologist Katerina Beskorovainaya;
colour your hair if you wish: dye remains the main way to hide grey. If colouring has damaged the hair, care is chosen together with the trichologist.

What science is working on (protecting melanocytes from oxidative stress, activating their stem cells) is described in "The mysteries of grey hair". This is research, not a ready treatment.

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Related conditions and outlook

Alopecia areata. It is the most common reason behind sudden grey hair. Alopecia areata usually spares grey hairs, and during recovery hair first grows back without pigment and darkens later. Patients with alopecia areata more often have autoimmune thyroiditis and vitiligo: see the publication by Professor Inessa Serbina "Comorbidity in alopecia areata".

Androgenetic and age-related hair loss. Greying and thinning often go together, but they are different processes. In androgenetic alopecia hairs become finer and lighter as follicles miniaturise, while grey hair is less prone to this process. Age-related changes of the hair and scalp are covered in "Involutional hair loss" and "Scalp ageing and associated conditions".

Outlook. Inherited early greying usually progresses gradually and is not linked to disease. If greying has a medical cause, what matters is finding it in time. See the doctor again when the picture changes: the grey spreads quickly, hair loss or skin patches appear.

Doctors

Prices

Consultation of a trichologist using digital trichoscopy	2000/1500 UAH
Consultation of the trichologist, follow up (up to 2 months after the first one)	800 UAH
Online consultation with trichologist	2000 UAH
Quantitative trichoscopy using TrichoLab	1500 UAH

Frequently Asked Questions

I am 25 and already have grey hairs. Is that normal?

For people of European descent, greying is called premature when it starts before 20; at 25 a few grey hairs usually mean an early but natural start. As a rough guide, by 50 about half of all people have about half of their hair grey.

The age of greying is mostly inherited, so it helps to recall when your parents went grey. If the grey spreads very fast, or comes with hair loss or feeling unwell, see a trichologist to rule out an accompanying condition.

Is it true that two grey hairs grow where you pluck one?

No. Whether a hair is grey depends on the melanocytes in its own follicle, and plucking one hair does not affect its neighbours. The same follicle will simply grow another grey hair.

A plucking habit does injure the follicle and scalp, though, and if repeated often it can affect hair growth in that spot. If the grey bothers you, colouring it or trimming single hairs short is the safer option.

Can stress turn hair grey?

Stress is indeed linked with greying, but not the way legends tell it. Emotional stress adds to the oxidative load on follicle melanocytes, and over time this may speed up their exhaustion.

Going grey within days or weeks is now explained as an acute episode of alopecia areata: mostly pigmented hairs fall out and the grey ones stay. So existing hairs do not change colour; this is hair loss, and it needs diagnosis and treatment. If your hair turned grey and thin quickly after stress, see a trichologist.

Which vitamins should I take to stop greying?

There is no universal vitamin complex against grey hair. Pigmentation is affected by deficiencies of vitamin B12, zinc, copper, selenium, essential fatty acids and protein, but only correcting a deficiency that has actually been confirmed can help.

So the examination comes first: the doctor assesses your diet and general health and orders tests if needed. Taking supplements at random is not a good idea: too much of some trace elements does as much harm as too little. What to take, in what form and for how long is for the doctor to decide.

If I quit smoking, will the grey go away?

Smoking is linked with premature greying and hair loss: tobacco smoke reduces blood supply to the hair papillae, damages the DNA of follicle cells and keeps low-grade inflammation going. Quitting is one of the few steps that can influence the process.

We cannot promise the colour will return, though. It is more realistic to expect the grey to spread more slowly and the hair and scalp to be in better shape. Follicles that have already lost their melanocyte reserve will most likely stay grey.

My child or teenager has grey hairs. What should we do?

Grey hair in childhood or the teens falls under the definition of premature greying, so it is worth showing to a doctor. Often the cause is inherited, and then parents or grandparents also went grey early.

With children, though, the doctor checks more closely their diet, absorption of food, thyroid function, pale patches on the skin and patches of hair loss, and asks about family history, since early greying is occasionally part of an inborn syndrome. Bring any tests and medical records you have. Consultations take place in the clinical trichology department.

Can I dye hair that went grey early?

Yes. As long as there is no way to restore natural colour, dye remains the main way to hide grey, and colouring itself does not speed greying up.

Keep in mind that grey hair resists dye and is stiffer, so frequent chemical treatments dry it out more easily. Care products for coloured hair help between colourings, and badly damaged hair can be restored with hair reconstruction at the clinic. If your scalp itches, flakes or reddens after dyeing, show it to a trichologist.

Will mesotherapy, laser or other hair procedures bring the colour back?

No, and we do not offer them for that purpose. In trichology, injection methods, laser therapy, peels and massage are used to treat hair loss and keep the scalp healthy. They have no proven effect on restoring pigment.

Esthetic trichology procedures help grey hair in other ways: reconstruction gives the shaft back its smoothness and moisture, and head massage improves scalp microcirculation. If there is hair loss alongside the grey, treatment is chosen after trichoscopy, and the esthetic trichology prices show which procedures are available.

My hair went grey and started falling out at the same time. Are these linked?

Sometimes they are. Sudden grey with thinning or bald patches is typical of alopecia areata. Diffuse thinning together with greying occurs with thyroid disease and nutritional deficiencies, and with age, greying and androgenetic or involutional alopecia often run in parallel, though they are different processes.

Trichoscopy helps sort this out: it shows the type of hair loss and the state of the follicles. The diagnosis decides whether tests are needed and which treatment fits. Do not put off the visit: unlike grey, hair loss can often be stopped.

My hair suddenly got darker. Should I worry?

Hair normally darkens from childhood to adulthood, and that is fine. But a clear darkening of adult hair without dye can be linked to hormonal changes, for example a raised level of melanocyte-stimulating hormone in some adrenal disorders.

Darkening has also been described with certain medicines. So tell your doctor about any sharp change of hair colour in either direction, especially if your skin colour has changed or you notice weakness or weight loss. More on this in the publication "Hormones and hair".