Hair loss and hair thinning can be one of the most personal and distressing health concerns among those in my office. For many of us, hair represents femininity. Although we may not notice it, we may even hold our own inherent biases about “lush” and “beautiful” hair. This is all to say that hair is often at the core of our identity. It is how we express ourselves. And hair loss can disrupt that, disrupting our self esteem in the process.

The Physiology of Hair Loss

There are many different reasons why hair loss may occur. In this article, we will focus on hair loss where the hair follicle remains intact and undamaged. Generally, when the hair follicle is in tact, then hair regrowth is possible.

Before jumping into hair loss itself, we need to think about the structure of the hair follicle. To support hair growth, there is a robust blood supply directed to the base of the follicle, known as the papilla. This is where the hair follicle receives nutrients to support growth. The hair growth cycle involves three phases: anagen (growth phase) , catagen (transition phase) and telogen (rest phase). Each phase lasts a different length of time and varies from person to person, but interestingly, the growth phase (anagen) lasts anywhere from 2-6 years! Once a hair transitions out of the growth phase, it will shed approximately four months later. On average, we shed 25-100 hair daily that have reached the end of their lifespan.

When we start looking at hair loss where the hair follicle remains in tact, we need to consider the hair growth cycle described above. In some cases, the time spent in the growth phase (anagen) is gradually shortening, leading to thinning hair. In other cases, we may notice an abrupt shift into the resting phase (telogen) leading to excessive shedding. By determining the underlying root cause, we can take an individualized approach to supporting hair regrowth.

Common Causes of Hormonal Hair Loss

Hair loss is a signal from our body that there is something going on. When approaching the symptom of hair loss, it is important to see where we can connect the dots between our body systems and symptoms. A thorough and complete health history is key for being able to do that. In many cases, there is a hormonal cause to the hair loss, so let’s dive in.

Stress

It may seem like nearly everything these days can be attributed to stress, but it rings true for hair loss. Stress causes an increase in cortisol, our stress hormone, which can signal to the hair follicle to abruptly transition to the resting phase. This means that the hair stops growing, moves to “resting”, and then subsequently is shed. This abrupt shedding is known as telogen effluvium. This can occur after a period of high stress, a major life event or illness, childbirth (think postpartum hair loss), or even dramatic weight loss. Stress can be physical or emotional, the body responds the same way.

androgenic INVOLVEMENT

Androgenic involvement is a very common cause of what is often referred to as female patterned hair loss. Androgens are sex hormones, which include testosterone and dihydrotestosterone (DHT). DHT binds to androgen receptors in the hair follicle, thereby causing the hair follicle to transition out of the growth phase more quickly than usual. An enzyme known as 5-alpha reductase converts testosterone into DHT, thus causing the decreased hair growth and increased hair loss.

Sometimes, we find testosterone and DHT to be elevated in conditions like PCOS. Other times these hormones are at a normal level in patients, which has lead to the theory that some women may have hair follicles with an increased sensitivity to those hormones, meaning that even at a lower level, their body still reacts by increasing hair loss.

Thyroid Dysfunction

Another type of hormonal hair loss is alopecia areata, which often shows as patchy. This types can often be due to thyroid dysfunction, especially autoimmune thyroid conditions like Grave’s and Hashimoto’s disease. In these cases, the immune system attacks the hair follicle, disrupting the hair growth process.

Nutrient Deficiency

Our hair requires vitamins, minerals, and fatty acids to thrive. As mentioned above, hair loss can occur due to rapid weight loss, fasting and dieting, which can be attributed to physical stress, as well as potential lack of nutrients. Another very common nutrient deficiency is iron. For those with periods, iron can be affected by heavy periods, fibroids, and even vegetarianism. This is why testing ferritin, our body’s stored iron, is important. One study found that nearly 80% of women with hair loss had ferritin levels under 70 µg/L. Amounts less than this may be seen as “within normal limits”, but that may not be a optimal level for those with hair loss.

Supporting Regrowth

Hair loss takes time to present, so treating hair loss can take time as well. Supporting hair regrowth requires some patience, but regrowth is certainly possible once the likely root cause is determined. From there, personalized recommendations can be made to best suit you and your body, which can include nutritional counseling, targeted supplementation, topical applications, and even pharmaceutical options.

About the Author

Dr. Hannah is a naturopathic doctor providing whole body adjunctive healthcare to patients in Maine and Massachusetts. She believes every patient has their own unique health journey, which influences her personalized treatment approach. She has a passion for helping women, mothers and families heal and thrive, all while uncovering the root cause of whatever ails them. Her goal is to empower and guide her patients on the path towards healing the mind, body and soul through natural methods of healing. Dr. Hannah sees patients locally in Portland, Maine. Through telehealth, she is happy to serve the people of Lewiston, Ellsworth, Belfast, Bangor, and all the towns in between! She now sees Massachusetts patients through telehealth as well!

Disclaimer

The information provided on or through this website is for educational and informational purposes only. This information is not a substitution for proper and personalized medical diagnosis or treatment. Always seek the advice of your physician or trusted healthcare provider before making an adjustments or changes to your healthcare regimen. Natural medicine is not inherently harmless, and therefore it is important to speak with your healthcare providers for personalized medical advice.