Anagen effluvium occurs after any insult to the hair follicle that impairs its mitotic or metabolic activity. This hair loss is commonly associated with chemotherapy. Since chemotherapy targets your body’s rapidly dividing cancer cells, your body’s other rapidly dividing cells such as hair follicles in the growing (anagen) phase, are also greatly affected. Soon after chemotherapy begins approximately 90 percent or more of the hairs can fall out while still in the anagen phase.
When your body goes through something traumatic like child birth, malnutrition, a severe infection, major surgery, or extreme stress, many of the 90 percent or so of the hair in the anagen (growing) phase or catagen (resting) phase can shift all at once into the shedding (telogen) phase. About 6 weeks to three month after the stressful event is usually when the phenomenon called telogen effluvium can begin. It is possible to lose handful of hair at time when in full-blown telogen effluvium. For most who suffer with TE complete remission is probable as long as severely stressful events can be avoided. For some women however, telogen effluvium is a mysterious chronic disorder and can persist for months or even years without any true understanding of any triggering factors or stressors.
Thank goodness! I am a teacher which requires me to get up about 5:30 during the school year. This summer, I will turn 62 and although I’ve always had problems waking up early in the morning – he it is so severe that I am sleeping 12 to 14 hours a day! This is terrifying as school starts in less than two weeks. I am postmenopausal for close to 20 years now and recently found out that my estrogen level is elevated. Your article is a godsend; I will now be able to have an intelligent discussion with my gynecologist and hopefully become a morning person for the first time in my adult life!
Growth on Eyebrows – Some common growths on brow aresa such as warts or any unusual growth could hamper eyebrow growth. Skin growth cause a thick barrier that is shell like and it will make it impossible for eyebrows to penetrate them thus you will not have regrowth. Some of the common growths include moles, hemangiomas, seborrheic keratosis among many others.
Estrogen and combined oral contraceptive (COC) drugs with estrogen or progestogen have been reported as effective, but data are limited (Adenuga et al., 2012, Raudrant and Rabe, 2003, Scheinfeld, 2008). They are thought to function through several mechanisms. Both components of COC drugs increase the levels of sex-hormone-binding globulin (Schindler, 2013). They also send negative feedback signals that suppress the hypothalamic secretion of gonadotropin and releases the hormone and pituitary secretion of the luteinizing and follicle-stimulating hormones, which results in a decreased androgen production (Gilman et al., 1990, Varothai and Bergfeld, 2014). These actions decrease androgen secretion from the ovary and the quantity of free, biologically active androgens, which reduces their effects on the hair follicles (Schindler, 2013). Our practice when prescribing COC drugs is a combination of ethinyl estradiol 20 mcg plus drospirenone 3 mg. Drospirenone is an analogue of spironolactone. This treatment combination is approved by the FDA for the treatment of acne but not alopecia.
Like with low thyroid, there can be a myriad of imbalances at play with PCOS related hair loss making it a complex issue that’s often written off as merely high testosterone. While androgen excess and hypersensitivity of the hair follicles to these hormones are part of the issue, these are other contributing factors to PCOS related hair loss as well:

At Hair Club, we’ll support you throughout your entire hair restoration journey because we know from personal experience what you’re going through. We understand the emotions you’re feeling and we know the questions you have. We’re here for you, every step of the way, offering advice, education and a welcoming space where you can feel comfortable being yourself. Rest assured, we have the answers you need and the solution you want. That’s why we’re the trusted leader in hair restoration.


Thyroid Dysfunction: Since the thyroid gland regulates many body functions by releasing hormones, any disruption in its functioning can cause loss of hair, including eyebrow hair. If your thyroid is underactive, it could cause you to lose the outer third of your eyebrow. The only way to treat thyroid dysfunction is through medication. However, there’s still no guarantee that your eyebrow hair will grow back.
Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate.
Hair loss on the eyebrows can be partial where the hair falls off in patches or the eyebrow thins and shortens abnormally. It may occur on one side or both sides. It can also be complete where all the hair on one or both eyebrows are lost. These patterns of eyebrow hair loss can give some indication of the underlying cause even when there are no other symptoms. Some of these conditions may be specific to the eyebrows (the hair follicles and skin in that region) or can be an extension of problems affecting surrounding skin like the face, forehead or scalp.

Reproductive hormone changes can also play a part, and dermatologists believe the same factors that cause hair loss from the scalp, a common problem for women as they age, may contribute to thinning brows. Nanette Santoro, M.D., ob/gyn and professor of reproductive endocrinology at the University of Colorado at Denver, says, “Abrupt hormone changes can cause sudden hair loss (telogen effluvium) that recovers over about six months' time. It happens postpartum to many women and can happen at menopause.”

Blepharitis is a chronic primary eyelid inflammation. It is fairly common in occurrence and being a condition with remissions and relapses, results in a decreased quality of life if adequate measures are not taken. Chronic blepharitis is the most common condition associated with madarosis.[10] Though there are various ways of classifying blepharitis, the most useful is the one proposed by Wilhelm,[24] wherein blepharitis can be classified based on whether there is a predominant involvement of the part of the eyelid anterior to the gray line (anterior blepharitis), or posterior to the gray line (posterior blepharitis). The gray line is an imaginary line dividing the eyelid into an anterior part consisting of the skin and muscle, and a posterior part consisting of the tarsus and conjunctiva.
If, however, you aren’t so sure that any of the causes listed above are a problem for you, then a good place to start may be to talk with your healthcare provider about testing. It is important to learn the root cause – especially if dealing with infertility – because that which is causing hair thinning and shedding may also be contributing to your inability to conceive.
Changing the shape, thickness and length of the eyebrow is a commonly practiced beauty technique. Some people even remove the eyebrow entirely only to replace it with a pencil-drawn mark (eyebrow pencil). As with any part of the body, repeated irritation can eventually lead to hair loss. Sometimes this is due to manual trauma, chemicals from cosmetics or even infections that arise when breaks in the skin occur. While eyebrow modification will not stop as a commonly practised beauty technique, it should at least be minimized.
Hormones are cyclical. Testosterone levels in some men drop by 10% each decade after age 30. Women's hormone levels decline as menopause approaches and drop sharply during menopause and beyond. The cyclic nature of both our hair and hormones is one reason hair loss can increase in the short term even when you are having a long-term slowdown of hair loss (and a long-term increase in hair growth) while on a treatment that controls hair loss.
Prostaglandins are modified forms of unsaturated fatty acids–those unsaturated or “essential” fatty acids (EFAs) that are also called Omega fatty acids. These EFAs cannot be produced by your body, but must be absorbed from our food. EFAs are naturally found in nut and seed oils in different compositions. EFAs have been shown to increase prostaglandin production in those with a deficiency (source, again). 

Giorgos Tsetis: Consumers are lost, and that's the sad part about it. You have a serious problem, you go on the internet and see thousands of products making similar claims, and you can't choose. Most likely, you're going to try the cheapest product with the most compelling claims, realize it doesn't work, and only add further stress. When an industry is not properly regulated, this is the result. Education is such a big component of what we do. Reverse engineering a solution requires a tremendous amount of time and research. What we did was connect all these dots reading hundreds of pages of scientific literature. Education, when it comes to this, is broken into education for the physicians and education for the consumers. It's always hard to educate, because what you're really doing is changing behavior. Slowly but surely, we're actively changing the mindset of physicians and consumers, evolving the way they view and treat hair loss. That is huge, and one of the key reasons Unilever invested in the company. What we did was raise the bar by introducing a new category in the medical channel that remained untapped. That's how we disrupted the market, where now you see hundreds of doctors using Nutrafol as a trusted alternative for men and women. We also have several writers in the company who imagine how we can make this world simple and digestible for people. We want consumers to make smart choices.
Hansen's disease, also known as leprosy, is an infection of the skin and nerves caused by the bacterium Mycobacterium leprae. The disease often affects the skin of the eyebrow region, leading to loss of sensation and permanent loss of the eyebrow hairs. There are numerous other rare and uncommon causes of eyebrow hair loss, including vitamin A toxicity, nutritional disorders and other dermatological disorders. If you experience loss of eyebrow hair, see your doctor to evaluate the cause and to discuss a treatment plan.
Contrary to popular belief, hair does not grow continuously but actually grows in cycles. It starts at the follicles which are embedded in the skin and the visible part, the shaft, is a consequence of active growth at the follicles over time. The living part of the hair in the skin has blood and nerve supply while the hair shaft is made up of dead cells and protein and does not have a blood or nerve supply. Therefore it can be easily cut without any bleeding or pain.
If you’ve undergone chemotherapy recently, you know the effects that it has on your hair, including your brows and lashes. First of all, I want to point you to this awesome resource by FairyHairs (click here), that shows in intervals, with pictures, what you can expect with regrowing your hair after chemo (Thank you, Jenny Mealy!). The article also includes ways to regrow your hair after chemo.

Scalp hair loss may be a common complaint among men and women, but in my practice, loss of eyebrow hair is a major concern among my female patients. Because eyebrows frame the face, hair loss in this area can dramatically change one's appearance, and since eyebrow hair loss is not easily concealed, it can be, for some women, an even more devastating loss than scalp hair loss.


Traumas such as major surgery, poisoning and severe stress may cause a hair loss condition known as telogen effluvium, in which a large number of hairs enter the resting phase at the same time, causing shedding and subsequent thinning hair in men and women alike. The condition also presents as a side effect of chemotherapy. While targeting dividing cancer cells, this treatment also affects hair’s growth phase, with the result that almost 90% of hairs fall out soon after chemotherapy starts. 

There are numerous diseases that can affect the hair and scalp. Hair loss can be caused by a variety of conditions. Diseases such as alopecia areata, anemia, male/female pattern baldness, and infections of the scalp can all cause significant difficulty and loss of daily well-being. Stanford Dermatology has established a special clinic focusing on the diagnosis and treatment of these disorders of the hair.


THE TREATMENTS If no trigger is present, it’s likely you have androgenetic alopecia, a hereditary condition that causes the hair follicles to get progressively thinner over the years. The most effective topical medication for the condition is minoxidil (brand name Rogaine), the only treatment for hair loss in women that has been approved by the Food and Drug Administration.

For now, therapies include cortisone injections directly into the bald patches; topical cortisone; Minoxidil — known to many people under the brand name Rogaine; and anthralin cream. A less-widely available option is topical immunotherapy: certain chemicals applied to the scalp can trigger an allergic rash, which alters the immune response, NAAF notes.
A. Steroids are not for female pattern hair loss but are sometimes used for alopecia areata (spotty hair loss that is different than hair loss due to genetics and aging). Laser combs? There are some reports that low-level light therapy could stimulate hair growth in some people. It's something to try when people feel like they have no other good options. At $350, it's expensive and I'm not sure it's worth the money, but it is safe.

In extreme cases, such as disordered eating and anemia, an iron deficiency may be to blame for thinning brows. “Even if you don’t have anemia, and you have low levels of stored iron, that could contribute to hair loss,” says Rajani Katta, M.D., a dermatologist and clinical assistant professor of medicine at Baylor College of Medicine, who studies the link between nutrition and hair loss. Iron is found in meat, fish, and other animal products, plus beans and legumes, so vegans and vegetarians might be more likely to be low in iron. Your derm can do a ferritin blood test to check your iron levels. But don’t start an iron supplement without medical recommendation. Too much iron can also have negative effects, says Dr. Katta.


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Some medications have side effects that include hair loss. Talk to your doctor if you are experiencing significant hair loss and you think that your medication might be the cause. Your doctor might be able to switch you over to another type of medicine without any reported side effects. Don’t stop taking your medications until you’ve spoken with your doctor, as this could be dangerous for your health.
A little farther up the follicle is the mysterious feature called the bulge. That's where follicle stem cells live. When they get the right set of chemical signals, these self-renewing cells divide. They don't divide like normal cells, in which both halves become new cells that keep splitting and developing. Only one half of the follicle stem cell does that. The other half becomes a new stem cell, and stays put for future regeneration.
Some cancer chemotherapy drugs cause temporary hair loss, which affects all body hair. Along with the loss of scalp hair, people undergoing chemotherapy also commonly lose their eyebrows and eyelashes. Chemotherapy drugs that frequently cause hair loss include paclitaxel, 5-fluorouracil, carboplatin, cisplatin, actinomycin-D, bleomycin, vincristine, cyclophosphamide, altretamine, etoposide, docetaxel and doxorubicin. Hair loss typically begins 2 to 3 weeks after the start of chemotherapy. Lost eyebrow hair regrows in the weeks to months following completion of treatment.
Skin infections can cause hair loss at the affected area. One of the more common causes is a fungal infection of the skin, also sometimes referred to as a ringworm. Eyebrow fungus is more likely to be related to a scalp fungus (tinea capitis) and both areas are often affected at the same time. A bacterial infection is another possible cause. Folliculitis for example is a condition where the hair follicle becomes infected usually with bacteria like Staphylococcus aureus. Eventually this can lead to loss of the hair in the infected follicle.
Hair loss on the eyebrows can be partial where the hair falls off in patches or the eyebrow thins and shortens abnormally. It may occur on one side or both sides. It can also be complete where all the hair on one or both eyebrows are lost. These patterns of eyebrow hair loss can give some indication of the underlying cause even when there are no other symptoms. Some of these conditions may be specific to the eyebrows (the hair follicles and skin in that region) or can be an extension of problems affecting surrounding skin like the face, forehead or scalp.
Dutasteride is a 5-alpha-reductase inhibitor that binds both types I and II enzymes. Compared with finasteride, its inhibition of type II enzymes is three times more potent; its inhibition of type I enzymes is 100 times more potent (Clark et al., 2004). Dutasteride is not approved for the treatment of FPHL by the FDA, and ongoing studies on the efficacy of the inhibitor are promising but largely focus on male patients (Gupta and Charrette, 2014, Olsen et al., 2006). A study of women after 3 years of therapy showed that dutasteride may be more effective than finasteride in women under 50 years of age as measured by hair thickness (not hair density) at the center and vertex scalp (Boersma et al., 2014). One case report of a 46-year-old female with FPHL showed some response after 6 months of treatment with a dose of 0.5-mg dutasteride daily despite a minimal response to treatment with finasteride and minoxidil (Olszewska and Rudnicka, 2005). Data with regard to the treatment side effects in women is extremely limited. Dutasteride is classified as pregnancy category X because of teratogenicity and should have the same theoretical risk of breast cancer as mentioned in relation to finasteride (Kelly et al., 2016).
Dutasteride is a 5-alpha-reductase inhibitor that binds both types I and II enzymes. Compared with finasteride, its inhibition of type II enzymes is three times more potent; its inhibition of type I enzymes is 100 times more potent (Clark et al., 2004). Dutasteride is not approved for the treatment of FPHL by the FDA, and ongoing studies on the efficacy of the inhibitor are promising but largely focus on male patients (Gupta and Charrette, 2014, Olsen et al., 2006). A study of women after 3 years of therapy showed that dutasteride may be more effective than finasteride in women under 50 years of age as measured by hair thickness (not hair density) at the center and vertex scalp (Boersma et al., 2014). One case report of a 46-year-old female with FPHL showed some response after 6 months of treatment with a dose of 0.5-mg dutasteride daily despite a minimal response to treatment with finasteride and minoxidil (Olszewska and Rudnicka, 2005). Data with regard to the treatment side effects in women is extremely limited. Dutasteride is classified as pregnancy category X because of teratogenicity and should have the same theoretical risk of breast cancer as mentioned in relation to finasteride (Kelly et al., 2016).
That's why I've designed a system I call The Gottfried Protocol, a step-by-step, integrative approach to natural hormone healing that emphasizes lifestyle design first and foremost. It's based on decades of research, my education at Harvard Medical School, my own experiences with hormonal imbalances, my belief in peer-reviewed, well-performed randomized trials to support my recommendations, and what I've learned from patients over the past 20-plus years of practicing medicine. The Gottfried Protocol engages only the top hierarchy of scientific evidence and has been proven in scores of women in my practice.

It is an impulse-controlled disorder characterized by compulsive plucking or breakage of hair.[91] The most frequent site of hair pulling is the scalp, but the eyebrows, eyelashes, and pubic hair may also be involved. Trichotillomania manifests in eyelashes and eyebrows as irregular patches of alopecia containing hairs of varying lengths. Inflammation, scarring, and atrophy are conspicuous by their absence. Patients often attempt to conceal their alopecia by cosmetological camouflage. In case of a diagnostic dilemma, histological features such as increased numbers of catagen hairs, pigment casts, and traumatized hair bulbs provide a clue.
Androgenetic alopecia, commonly called male or female pattern baldness, was only partially understood until the last few decades. For many years, scientists thought that androgenetic alopecia was caused by the predominance of the male sex hormone, testosterone, which women also have in trace amounts under normal conditions. While testosterone is at the core of the balding process, DHT is thought to be the main culprit.
Changing the shape, thickness and length of the eyebrow is a commonly practiced beauty technique. Some people even remove the eyebrow entirely only to replace it with a pencil-drawn mark (eyebrow pencil). As with any part of the body, repeated irritation can eventually lead to hair loss. Sometimes this is due to manual trauma, chemicals from cosmetics or even infections that arise when breaks in the skin occur. While eyebrow modification will not stop as a commonly practised beauty technique, it should at least be minimized. 

No one wants to lose their hair, but for a woman it is particularly distressing. While men can look perfectly presentable — even sexy — with their exposed scalp, no such options exist for the 30 million American women who grapple with thinning tresses. Dr. Maria Colavincenzo, a dermatologist at Northwestern University Feinberg School of Medicine, has a practice that specializes in preserving those precious strands — especially in cases of androgenetic alopecia, a hereditary condition that causes hair loss, mainly on the top and crown of the scalp. Without an appointment, she answered some of our questions:
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Menopause is a natural biological process that all women experience at some point in their lives. During this time, the body goes through numerous physical changes as it adjusts to fluctuating hormone levels. Many women have unpleasant symptoms during menopause, including hot flashes, mood swings, and insomnia. Hair loss is another common occurrence.
Dozens of other causes of eyebrow loss are also possible including a variety of infectious, autoimmune and inflammatory conditions. Consultation with a dermatologist or hair transplant surgeon is recommended. I strongly advise consulting a dermatologist before proceeding to hair transplantation for women over 40 with new onset eyebrow hair loss after age 40.
Every child deserves the opportunity to just be a kid—to fit in and feel normal. Kids experiencing hair loss don’t get that chance. That’s why we offer the Hair Club For Kids® program. Hair Club For Kids provides non-surgical hair replacement services, completely free of charge, to children ages 6-17 who are suffering from hair loss. These services are available at all Hair Club locations throughout North America to help reach as many kids as possible. Call 800-269-7384 for details.
FPHL or androgenetic alopecia is the most common cause of hair loss in women and one of the most common chronic problems seen by dermatologists worldwide (Varothai and Bergfeld, 2014). FPHL is a nonscarring form of alopecia in which the frontal hairline is maintained, but there is progressive hair thinning at the vertex of the scalp. Thinning of the hair is secondary to alteration of the hair cycle with shortening of the anagen phase and simultaneous lengthening of telogen. This increase in the resting phase and decrease in the growth phase of the hair cycle results in the miniaturization of hair because long terminal hairs are gradually replaced by short vellus hairs (Messenger and Sinclair, 2006, Sinclair et al., 2011).
Another reason that you have thinning eyebrows might be low thyroid (which is called hypothyroidism. The thyroid gland controls the rate of use of energy sources, protein synthesis by producing thyroid hormones. I the thyroid gland does not produce enough hormones, you might feel tired, freeze in the cold, gain weight or lose your hair. The most common cause of hypothyroidism is iodine deficiency.
Thinning hair, noticeable bald spots, receding hair line, large clumps of hair showing up in your hair brush or shower drain, these are typically things you hear about from men, not women. More and more though, we are contacted by women who are experiencing hair loss who want to know if this is a sign of something wrong with their hormones and how they can fix the problem. Fortunately, hair loss is not a sign of infertility, but is a side effect of hormonal imbalance which can impact your fertility.
Postpartum hair loss is related to the drop in estrogen experienced after giving birth. During pregnancy, the body has higher levels of estrogen (and progesterone) and estrogen increases hair’s “resting phase,” or the time hair stays on your head before naturally falling out (which is what accounts for the 100 or so hairs that healthy heads shed every day). When estrogen drops after pregnancy, all the hair that had been “resting” starts to shed. Post-pregnancy hair loss is usually temporary, lasting for several months.
It is known that during pregnancy, because of an increased level of estrogen, there is a tremendous growth of new hair. However, during menopause it is noticeable that the reduced level of estrogen hormone tends to cause hair loss. When the estrogen hormone levels tend to drop, the hair follicles fall under the influence of the male sex hormone or the testosterone, which cause the shortening of the growth phase of hair. Subsequently there is a noticeable hair loss. This hair loss caused due to the drop down of estrogen levels may cause patchy hair loss or complete baldness.
Another reason why hair falls out is lupus. Lupus is an autoimmune disease that may make your immunity system begin attacking your various healthy body tissues. According to Medical News Today, “this results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys, blood, the heart, and lungs”. It can also attack eyebrow follicle resulting sudden hair loss and including brows.
Reproductive hormone changes can also play a part, and dermatologists believe the same factors that cause hair loss from the scalp, a common problem for women as they age, may contribute to thinning brows. Nanette Santoro, M.D., ob/gyn and professor of reproductive endocrinology at the University of Colorado at Denver, says, “Abrupt hormone changes can cause sudden hair loss (telogen effluvium) that recovers over about six months' time. It happens postpartum to many women and can happen at menopause.”
Postmenopausal frontal fibrosing alopecia, a variant of lichen planopilaris, is a distinct form of scarring alopecia which is described in postmenopausal women. It consists of a receding hairline with scarring associated with a partial or complete loss of eyebrows in most affected individuals. The loss of eyebrows may be the presenting sign; however, the hairline reveals evidence of perifollicular erythema on closer observation. Histologic features are identical to that of lichen planopilaris.[42]
Topic prostaglandin analogues are used for the treatment of glaucoma. Uniocular increase in length, thickness, and pigmentation of the lashes were described by Johnstone in 1997 by patients using latanoprost in one eye.[184] There are reports of a response of alopecia of eyelashes to cutaneously administered latanoprost,[185,186] though others report limited success.[187] Eyelash growth has also been reported following bimatoprost 0.03% topically to the base of the eyelashes in healthy individuals[188–190] and in individuals with alopecia areata.[191] Bimatoprost ophthalmic solution 0.03% is the only Food and drug administration (FDA)-approved product to safely and effectively enhance the growth of a patient's own eyelashes.[192,193]
Growth on Eyebrows – Some common growths on brow aresa such as warts or any unusual growth could hamper eyebrow growth. Skin growth cause a thick barrier that is shell like and it will make it impossible for eyebrows to penetrate them thus you will not have regrowth. Some of the common growths include moles, hemangiomas, seborrheic keratosis among many others.
There’s a reason why we’re the leading provider of hair loss solutions in North America. Trust. Many of our 1,100+ licensed cosmetologists and hair loss experts started where you are—as a client themselves. So we truly understand what hair loss feels like and what it takes to get your hair back. It’s why you can trust that we’ll walk you through every step of your hair restoration journey, from consultation and analysis to solution and maintenance. We’ll listen to you and make sure your Hair Club experience is everything you want it to be. We’re here for you, and that makes all the difference.
If you have any more concerns about licorice, just remember that licorice candies are a Dutch treat, and overseas, plenty of Dutch people are consuming the stuff on a regular basis with no ill effects. In moderation, this may be an effective (and tasty) way to raise your estrogen levels. While you are at it, you can reduce any heartburn problems you happen to have.
FPHL or androgenetic alopecia is the most common cause of hair loss in women and one of the most common chronic problems seen by dermatologists worldwide (Varothai and Bergfeld, 2014). FPHL is a nonscarring form of alopecia in which the frontal hairline is maintained, but there is progressive hair thinning at the vertex of the scalp. Thinning of the hair is secondary to alteration of the hair cycle with shortening of the anagen phase and simultaneous lengthening of telogen. This increase in the resting phase and decrease in the growth phase of the hair cycle results in the miniaturization of hair because long terminal hairs are gradually replaced by short vellus hairs (Messenger and Sinclair, 2006, Sinclair et al., 2011).
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