By Glenn S. Rothfeld, M.D.
In my nearly four decades of practice, I’ve seen countless women show incredible strength and steely resolve in the face of almost any sort of disability or devastating diagnosis you can imagine. But there’s one symptom that’s practically guaranteed to have a women crying in frustration and desperately seeing solutions.
And, believe it or not, that’s hair loss.
You see, men are basically conditioned to expect to lose our hair sooner or later. Oh we may not like it, but it doesn’t usually devastate us. And if you’ve ever seen a photo of me you know that I know what I’m talking about.
But for woman it’s different. When a woman sees clumps of her hair in the shower drain it can really wreak havoc with her self-image. Women are taught to think of their hair as their “crowning glory.” And when a woman starts to lose that crowning glory by the handful it’s really no wonder that she’ll try practically anything to hold on to as much of it as she can.
Over the years, I’ve researched strategies to help women ward off… and even reverse… this self-esteem destroying symptom. I’ll get to those solutions in just a moment. But first let’s take a look at what could be causing that hair loss in the first place.
Assessing the damage
Keep in mind we all lose anywhere between 50 to 100 strands of a hair a day. This is normal. But if you’re losing significantly more than this there’s likely a problem.
Hair loss can be caused by either damage to the living, growing hair roots, or to the dead and hardened material of the hair shaft. If it’s only a problem with the hair shaft, it’s usually temporary and can be improved by making some changes to the habits that damaged the hair shaft in the first place.
The most common example of this this type of damage is the breaking of the hair shaft that’s seen when a woman uses too much hair dye or other harsh hair products. Once the bleaches and coloring agents that damaged the hair are removed, the new hair should grow in fine.
But damage to the growing area of the hair follicle can be more widespread and a longer-term problem. This kind of damage can be all over the head, which is called alopecia capitis, or more at the temples in in a “male baldness” pattern that’s then called androgenetic alopecia.
To distinguish between normal shedding of hair and these other conditions a doctor may look at your scalp under a microscope. The hair follicles should all look fairly thick and uniform. But if some of the follicles are thin and anemic looking your doctor will likely diagnose you with androgenetic alopecia.
Contributing causes
There’s a super long list of toxic and metabolic factors that can contribute to hair loss, but on that list a few that stand out. Hormones, for example, could be behind your hair loss.
Low thyroid or certain kinds of synthetic hormones like those given for menopause can cause your hair to start falling out. (Bio-identical or natural hormone therapy generally doesn’t cause hair loss since it is typically synthetic progestin that leads to hormone-imbalances.) And a profoundly stressful period in your life can alter your adrenal and sex hormones leading to hair loss a month or two later.
Illness can affect your hair and extreme dieting or nutrition can play a role too. In addition, drugs are an often overlooked cause of hair loss. Acid blockers, anti-seizure medications and blood thinners are all notorious for causing thinning locks.
Genetics play an important role too. If your close female relatives lost their hair, you’re much more likely to lose your own. In fact, according to the American Academy of Dermatology up to 30 million American women are in this boat.
But the good news is despite your contributing factors, and despite your genetics, you don’t have to simply accept hair loss. You do have options.
Over the years I’ve developed a Halt Your Hair Loss strategy designed to (1) identify the cause, (2) stop the hair loss and (3) in many cases even reverse it. And with the help of an integrative medicine doctor you can put this same strategy to work for you. I’ll show you how.
Halt the Hair Loss!
I always start hair loss consultations with taking a good history. This will help you identify what’s causing your own hair to fall out. You can do this step with the help of an integrative physician, or prepare your history and take it with you to your next appointment.
Write down any recent stresses, exposures to toxins or any infections or illnesses you have had. Make a list of any medications you’ve taken recently, keeping in mind there’s a lag time so drugs taken three months ago can be affecting your hair now. And write down any close female relatives that have had thinning hair.
Next up is a thorough lab evaluation. Since low thyroid function, even if the numbers look to be normal, is a widespread cause of hair loss a thyroid test is almost always a good idea. There are a number of thyroid tests your doctor can perform, so talk to him about your options.
Ask your doctor about taking a 24 hour saliva assay to look at your cortisol levels as well. Cortisol is the main stress-responding hormone of the adrenal gland and this test can help narrow down if stress is contributing to your hair loss.
An extensive hormone panel that includes a look at sex hormone binding globulin (SHBG), which binds to testosterone and its more active metabolite, dihydrotestosterone (DHT) is also a good idea. When your liver—due to toxins, blood sugar elevations, etc.—fails to produce enough SHBG a lot of the testosterone and DHT becomes free and penetrates the follicular cells causing male pattern baldness. In fact, thyroid stimulates the production of SHBG in the liver, which is thought to be why low thyroid causes hair loss.
A test for heavy metals, usually through a urine collection after a “challenge” with a chelating agent, can reveal if these toxins are playing a part in your hair loss. And tests that evaluate the status of a number of important nutrients should be considered as well. In my clinic we look for an overdose of vitamin A and deficiencies of biotin, zinc, iron and ferritin, all of which can lead to hair loss.
Roll out the remedies
Once the cause of your hair loss is pinpointed it’s time to remedy it. This can include stress reduction, changing medications, treating adrenal exhaustion or combatting a heavy metal problem.
In almost all the cases I’ve worked on I find some sluggishness of the thyroid gland. This can be reversed using small doses of desiccated thyroid hormone or the active thyroid hormone T3.
Hormone imbalances can also be remedied using bio-identical hormones, usually low doses of estriol, estradiol and progesterone. The herb saw palmetto can help block the conversion of testosterone to DHT. And if more intervention is needed the hormone spironolactone, which blocks the DHT from getting into the cell and doing its damage, is another effective option.
A mixture of nutrients can be used to strengthen your hair and encourage new hair growth. I typically recommend…
▶ biotin and zinc, both of which are essential for proper follicular hair generation,
▶ the amino acid L-Lysine, which has been shown in studies to play a role in hair-growth factor (possibly due to its role in iron utilization), and
▶ methylsulfonylmethane (MSM), an important metabolic factor in the body.
If more help is needed I usually turn to a compounding pharmacist. I have the pharmacist make up a hair cream in a base that penetrates the scalp and into the hair follicles. Typically the cream contains saw palmetto, a small dose of the thyroid hormone T3 (usually about 1 mg) and biotin. In women who have documented high DHT a small dose of natural progesterone is added.
If all of the natural options are exhausted and you’re still having trouble it could be time to consider a pharmaceutical medication. In particularly stubborn hair loss cases I sometimes add the DHT blocking drug Minoxidil (typically 5 percent) to the hair cream.
Remember hair loss typically takes months to develop and you should expect it to take several months to reverse it. But with some time and patience I’ve found this treatment plan does the trick for most women, restoring their crowns of glory. GR
