You’ve seen the infomercials. You’ve clipped the ads with before and after photos. Rogaine (minoxidil) and Propecia (finasteride) are two treatments for hair loss. Before I tell you why I don’t think you should be in a rush to slime your hair follicles every day or remove every molecule of testosterone in your body, let’s first consider why women are doing so poorly with hair loss.
Thirty percent of women report serious hair loss by age thirty. By age fifty, that statistic climbs to 50 percent. This is a major problem, of both vanity and sanity. It’s demoralizing, and conventional medicine often pats you on the back, murmuring, “You’re getting older; you need to get used to it.” As someone who has struggled personally with hair loss and heard that same message from my primary care doctor, I find that answer completely unsatisfying and more important, unnecessary. So if you have hair loss, take heart, help is on the way.
Before my patients start looking for a solution to their hair loss in a box from the drugstore or a pill bottle from a dermatologist, I encourage them to look inside their bodies.
Sometimes hair loss is associated with a simple root cause. Most of the time, there are hormonal imbalances such as thyroid, insulin, or testosterone. Occasionally, hair loss is linked to physical and emotional trauma, and probably dysregulation of cortisol. Even more rare, I find underlying health conditions such as autoimmunity as the root cause.
Here are the most common causes of hair loss:
Rapid hair loss can be an early sign of a thyroid problem, often first diagnosed in the beauty salon. In addition to thinning and shedding, your hair can become coarse, dry, and easily tangled.
This kind of general hair loss will slow and eventually stop once your hormone levels are stabilized. But sometimes the problem continues even after treatment, especially if you’re taking levothyroxine, a synthetic hormone often used to treat hypothyroidism. Excessive or prolonged hair loss is a known side effect of this drug. Look into this if you’re still losing hair despite what your doctor calls sufficient treatment.
Work with a functional medicine practitioner with experience treating thyroid conditions. Get a full thyroid blood panel. Sometimes micronutrient deficiencies such as low selenium or zinc are a reason for faulty thyroid function, or you may have autoimmune thyroiditis (Hashimoto’s thyroiditis), which needs to be addressed with a full functional medicine protocol.
Low iron, low lysine
In one study, 90 percent of women with thinning hair were deficient in iron and the amino acid lysine, which helps transport iron, which is essential for many metabolic processes.
Make sure you get your daily dose of iron from grass-fed red meat and greens. Good sources of lysine are foods rich in protein. Add lysine to your diet with foods rich in protein, such as meat and poultry, soy, eggs, cheese (especially Parmesan), and some fish (cod, sardines). If you need additional doses of an iron supplement, be sure to have a functional medicine practitioner track your ferritin so you don’t get too much and trigger iron overload.
This is the most common type of hair loss and affects 30 percent of women. The typical pattern for hereditary female-pattern hair loss, or androgenic alopecia, is a widening part or noticeable thinning of hair, particularly over the mid-frontal portion of the scalp.
Sometimes women with androgenic alopecia have polycystic ovary syndrome (PCOS). Typical signs and symptoms are ovarian cysts, irregular periods, weight gain, blood sugar problems, infertility and hair loss. The problem may be exacerbated in some patients taking drugs for thyroid problems.
The good news is that you can often stop and even reverse the symptoms of hair loss once you balance your hormones. This is where evening primrose oil can help. Besides inhibiting DHT, the main culprit behind androgenic alopecia, evening primrose oil is a good source of essential fatty acids, and the symptoms of hypothyroidism are quite similar to those for insufficient essential fatty acids. As always, I advocate a “food first” strategy along with taking targeted supplements. If changing your food and supplement plan doesn’t result in more hair on your head, then discuss with your functional medicine practitioner.
Not enough protein
If you don’t get enough protein in your diet, your body may enter famine mode and shut down your hair growth. This may occur about two to three months after a drop in protein intake. Eat clean protein from fish, grass-fed meat, eggs, and quinoa.
Excess vitamin A
Maybe you just started taking a new multivitamin, or started on a supplement containing vitamin A. You may have driven your vitamin A levels too high, which may trigger hair loss.
Do this: Total intake of vitamin A should be no more than 5,000 International Units (IU) per day. When you remove excess vitamin A, your hair should grow normally again.
Sadly, hair follicles can shrink in menopause, making hair finer and more likely to shed. It’s called “miniaturization,” and it’s totally unfair. One study suggests that the ratio of estradiol-to-testosterone may influence in hair loss in women and that low ratios may be the culprit in some cases.4
This ratio typically decreases during menopause. Not surprisingly, another study showed that women treated with bioidentical estradiol had less hair loss. If you’re over forty, talk to your functional medicine practitioner about whether bioidentical estrogen may be right for you. You need to be followed by a gynecologist to make sure you stay safe and don’t develop side effects and adverse events, such as blood clots, endometrial cancer, stroke, breast cancer, heart disease.
Vitamin B deficiency
This can be exacerbated by stress or taking birth control pills, both of which deplete B vitamins in the body. Between food intake and supplementation, you should be able to correct the problem. Rich sources of vitamin B include meat, fish, starchy vegetables, and some fruits.
Lack of fat
If you go low-fat in your food plan, you may consume fewer calories, nutrients, and more carbohydrates than your body requires. Most importantly, you may miss out on essential fatty acids, omega 3 and 6, which nourish the scalp and stabilize hair growth. The stress of restricting a macronutrient such as fat (or carbs or protein) may force more hair follicles to enter the telogen phase. Similar to the low thyroid state, your body gets the message to ration; there isn’t enough fuel to support the growth phase.
Maintain a balanced diet rich in “good” fats such as from coconut, avocado, and nuts—good for your hair and your health. Don’t skip out on macronutrients, but find the matching diet for your locks.
Sometimes the problem is alopecia areata, which appears as hair loss in round patches on the head, and sometimes the problem is autoimmune thyroiditis. Either way the cause is an overactive immune system. The body misidentifies the hair as foreign and attacks it.
Work with a functional medicine clinician to reverse autoimmune thyroiditis. Consider starting an autoimmune protocol for food. In some cases, you may need to see a dermatologist for steroid injections.
Some medications such as beta blockers, antidepressants, lithium, blood thinners, methotrexate, NSAIDs (such as ibuprofen) can cause hair loss. If you’re taking one of these medications, talk to your medical professional about alternatives.
Overdoing hair care and products
Hair dye, frequent shampooing, other treatments, products, and vigorous styling can traumatize your hair follicles and lead to hair loss. Wash your hair less often. The American Academy of Dermatology suggests that you let your hair air dry and limit hot devices (like flat irons and curling irons) to once per week or less. I know, I know, I love blowouts, too. Once per week, max!
Insulin resistance and blood sugar problems
Insulin, that helper hormone in charge of regulating blood sugar levels, also affects hair growth. Half of female patients and 60 percent of male patients with androgenic alopecia have a constellation of signs and symptoms related to insulin resistance, blood sugar abnormalities, hypertension, and abnormal cholesterol. Another study found that androgenic alopecia may be an early marker of insulin resistance, metabolic syndrome, and cardiovascular disease in men. So it could be for women as well.
The good news is that cutting sugar and artificial sweeteners, being active, and losing weight can reverse insulin resistance and lower your chances of hair loss.