Investigating Hormonal Hair Loss Woes
A few weeks ago, I had decided that my next hormone-related blog topic would focus on hair loss since that is a common concern amongst my patient population. Ironically last week while I was down in Rochester for some family events, one of my relatives approached me and asked if she could ask one medical question and guess what she asked about? Hair loss! This inquiry reinforced my decision to write this article. With hair loss in general, I always consider:
Anemia (iron, B12, folic acid): now a person can have micronutrient deficiencies without having anemia so when evaluating this potential cause, it is always important to not only rely on a complete blood count (CBC) to rule this out. I also like to order a vitamin B12, folate, homocysteine, methylmalonic acid (MMA), selenium, and ferritin at the very least. I also commonly order vitamin D, zinc, and copper levels as well as these micronutrient deficiencies can also contribute to hair loss. Please note that even if these vitamin and minerals are within the normal range, that does not necessarily mean they are optimal so you will get a better evaluation and outcome by consulting with someone who frequently orders these tests and aims for optimal levels rather than relying on standard reference range values. Hair cells are some of the fastest dividing cells in the body, so optimal nutrition is vital.
Protein deficiency: this could be as simple as inadequate intake or more commonly disrupted gut dysfunction. I generally like to evaluate blood total protein levels along with a 3 day comprehensive digestive stool test to determine if there is protein maldigestion/malabsorption, pancreatic enzyme insufficiency (specifically protease), gut microbiome imbalance, and/or intestinal mucosal inflammation (also known as leaky gut syndrome). In more complicated cases of gut problems, I may also order a 3 hour lactulose challenge breath test to rule out small intestinal bacterial overgrowth (SIBO).
Thyroid dysfunction: a thorough evaluation includes TSH, Free T4, Free T3, thyroglobulin & thyroperoxidase antibodies, and reverse T3; I will reiterate again that even if your levels fall within normal range, your values may be less than ideal and could be contributing to your hair loss so please do consult with someone trained in analyzing your lab values from a functional perspective.
Stress: your adrenal glands produce the hormones cortisol and DHEA which are both valuable for hormone harmony; if either of these hormones are out of balance, hair loss may occur. Cortisol signals our hair follicles to shift from growth phase into transition phase which causes the hair to fall out. Stress can also impact our digestive system and contribute to malabsorption and nutrient deficiencies.
Heavy metals: elevated heavy metals are a less common cause of hair loss but once in awhile I have had success with tough hair loss cases by identifying heavy metal toxicity and subsequent treatment with chelation. I used to order a lot of pre- and post-provocation urine toxic element clearance profiles (Genova) and have more recently begun ordering whole blood toxic & essential elements testing (Doctor’s Data). I have also ordered hair toxic element exposure profiles (Doctor’s Data) on occasion.
Other: overtreatment with heat or styling chemicals, certain hairstyles (tight braids, etc), medications (chemo, etc), autoimmune disease (Celiac, etc), and/or genetic predispositions can also cause or worsen hair loss.
It is important to remember that a certain amount of hair shedding is a normal part of this growth cycle. Adults lose approximately 50-150 hairs per day when normal hair loss accelerates, it can be helpful to reflect back on what happened 3 months prior to the hair loss since hair loss typically manifests three months after the onset of the cause. The hair loss pattern you are experiencing can also “shed” clues. Hair loss patterns include:
Patchy: this pattern may indicate cortisol imbalance, B vitamin deficiency, zinc deficiency, heavy metal exposure
Thinning: this type may indicate thyroid or other hormone imbalance
Crown of head: this pattern also supports a hormone imbalance (testosterone, progesterone, cortisol, estrogen)
Total body: this type may indicate an abnormal DHEA level, blood sugar dysregulation, or impaired circulation
Global balding: this pattern might be due to reduced circulation or deficiency of protein, omega 3 fatty acids, B vitamins, silica, or zinc.
Did you know that over 30 million women suffer from hair loss in the USA? Hormonal imbalances are a common cause of increased hair loss. Classic stages where women often see changes in their hair include after childbirth and during menopause. Postpartum hair loss typically occurs 3-4 months after delivery and resolves within the first year. Technically known as postpartum telogen effluvium, this phenomenon is a result of naturally high estrogen levels during pregnancy that prevent hair shedding, giving way to increased hair loss after delivery as the estrogen levels drop and the previous hair growth enters the telogen phase and begins to shed. Postpartum hair loss commonly occurs around the temples and hairline and is not permanent. Menopausal hair loss is also due to decreased estrogen; hair may start to feel finer and fall out especially around the crown of the head including the part. Hair loss with advancing age can be related to shrinking hair follicles, genetics, and elevations in testosterone levels or increased sensitivity to normal testosterone levels; this type of hair loss is not as easily reversed.
When evaluating hair loss, the following hormonal lab tests should be considered:
DHT: dihydrotestosterone is a derivative of testosterone; in women it is directly synthesized by the ovaries and adrenal glands. When DHT is elevated, the hair anagen (growth) phase is shortened and the telogen (resting) phase is increased which leads to increased hair loss. DHT binds to androgen receptors in hair follicles which leads to a shrinking of susceptible follicles and miniaturization of the hair itself, making it nearly impossible for hair to survive. This results in female pattern baldness, also knows as androgenic alopecia.
Thyroid (discussed above): thyroid hormones can alter hair follicle function.
Cortisol: any imbalance (high, low, fluctuating) can lead to hair loss.
DHEA: typically increased levels of DHEA can cause hair loss.
Testosterone: increased testosterone can cause hair loss.
Estrogen: estrogen protects against hair loss in women.
Progesterone: just like cortisol, any type of progesterone imbalance can accelerate hair loss.
Insulin: insulin resistance and metabolic syndrome can definitely be tied to hair loss as well.
Hair loss concerns are not a sign of vanity. Hair loss causes a lot of distress for most people. It is integral to identify the root cause of your hair loss so that a tailored nutrition and supplement plan can be created. If you are struggling with hair loss, rest assured that your hair loss can often be controlled and in many cases reversed! If you are seeking natural solutions for hair loss and would like someone to work with you to identify why, please contact us today to schedule a complimentary discovery call to find out if my approach is right for you!
Helping you find calm with creativity, clarity, and compassion!
Rachel Oppitz, ND
P.S. Check out my hair loss protocol here:
