One of the most common symptoms I see in both men and women of all ages is hair loss. I think of hair loss as an outward symptom of some underlying imbalance in the body. Having a full head of thick hair is often a sign of good health! So if you are losing hair, we need to investigate for a root cause of hair loss. We all love our hair, so losing it can be very stressful and emotional!
In the diagram above, I’ve outlined some of the most common causes of hair loss.
1) Thyroid Imbalance. If your thyroid is overactive or underactive (high or low) you can have symptoms of hair loss. Remember, thyroid hormone is the “Goldilocks hormone” so having too much or too little can affect your hair. Are you converting your T4 to T3 (the active form of thyroid hormone) properly? If you are on thyroid replacement, is your dosage and form or thyroid medication optimal?
2) Low iron stores (ferritin). Iron is essential for hair growth. If you are suffering from hair loss, I typically aim to get your ferritin stores over 50, with 90-110 being more ideal for hair. I can advise you on taking iron along with vitamin C for optimal absorption.
3) Insufficient protein in the diet. You need protein for your hair! How much? Your body weight in pounds divided by 2 is the number of grams of protein you should eat per day. So if you weight 150 lbs, you should eat 75 grams of protein a day for optimal hair growth. One easy way to supplement protein for your hair is collagen protein. This is protein from bovine or marine sources broken down into the amino acid level, making it extremely easy to absorb! We see great outcomes for hair growth with collagen protein powder supplements. Blend some into your morning coffee or smoothie!
4) Low stomach acid. Did you know you need stomach acid to digest your proteins? If you have low stomach acid from long-term acid suppressive medications (like proton pump inhibitors) you may have problems in properly digesting and assimilating proteins. Some people have naturally low stomach acid, in which case supplementing with digestive enzymes or betain hydrochloric acid (with a doctor’s guidance) can make a world of difference in hair growth as well as nail strength! On gut microbiome tests, we can test the amount of protein in your stool, which gives us an indication if you need supplemental enzymes or hydrochloric acid to improve protein digestion.
5) Shift in hormones. For example, pregnancy, postpartum, or menopause are often associated with hair loss due to the big shift in hormone levels. Women with irregular periods, or women who are not ovulating regularly can also see hair loss. I can test your hormone levels and help balance your hormones if needed using bio-identical hormones to help stabilize hair loss.
6) STRESS!!! This is a big one! Stress and high cortisol levels will automatically trigger something called “telogen effluvium” where the hair follicles go the the shedding stage. Typically we see the hair loss 3-4 months after the stressful event (physical or emotional). Normally 5% of your hair follicles are in the telogen stage, but in telogen effluvium, up to 30% turn into the telogen stage! This is also why getting a good night of beauty sleep is important for your hair! If you are struggling with insomnia or other symptoms of chronic stress, I can evaluate your stress response with an adrenal saliva cortisol take home test which graphs out your stress hormones throughout the day.
7) Inflammation. If you have inflammation in your gut lining from poor diet, toxins, it will affect your absorption of nutrients and affect your hair. Systemic inflammation from insulin-resistance (diabetes), autoimmune disease, bacterial infections, and viruses can all affect hair growth. This is why I often evaluate the gut microbiome and dig deeper when we suspect systemic inflammation.
8) Autoimmune disease. If your hair loss is in circular patches, we must consider the possibility of an autoimmune condition called alopecia aerata. Other systemic autoimmune diseases like Hashimoto’s thyroid disease, Lupus, Rheumatoid arthritis, Crohn’s disease, Scleroderma, can all cause diffuse hair loss due to the systemic inflammation as well as nutrient malabsorption from the gut. I can help guide you on diet, supplements, and lifestyle to help reduce inflammation in your body.
9) Reactions to chemicals. Are you dying your hair? Is there chlorine in your shower water? Is your scalp irritated or red? Have you been exposed to heavy metals or toxins? Often getting a chorine filter for your shower head or making sure your house water is filtered can improve the health of your scalp and hair. We can also test you for heavy metals such as mercury, lead and arsenic.
10) High DHT. In both men and women, some of the testosterone in our body gets converted to DHT (dihydrotestosterone). The DHT can cause hair loss in the temporal areas (often called “male pattern baldness”). However this can happen in women too! I often test for DHT. If we find high DHT levels, I like to use saw palmetto, a natural supplement to block the testosterone to DHT conversion.
Each person has unique factors contributing to hair loss. I’m happy to have a more personalized discussion with you at your next visit to figure out what may be causing your hair loss.
Rajsree Nambudripad, MD