Women’s health articles

Hair loss in women

On the causes of female hair loss, the human hair growth cycle, and safe, natural options for women to help stop thinning hair and reverse hair loss.

by Marcy Holmes, NP, Certified Menopause Clinician

One of the most common and emotionally devastating complaints I hear from my patients is thinning hair and hair loss. At Women to Women, we understand that a woman’s head of hair is her crowning glory — and losing too much hair can be a serious and frightening blow to her self-esteem.

Reacting so strongly to the physical state of your hair may seem like vanity — who hasn’t had a bad hair day — but it’s not. Your hair is one of the first areas, along with skin and nails, to manifest signs of hormonal imbalance, poor nutrition and illness. Understanding how hair regenerates and paying attention to any changes in your hair growth and appearance are important parts of taking care of your self.

The truth is, a certain amount of hair loss is normal (anywhere from 50–100 strands per day), but excessive hair loss and hair thinning indicates that something is not right. The causes of accelerated hair loss are very individual and depend on a complicated set of factors, including hormonal and metabolic imbalances, emotional stress and nutritional deficiencies.

Unfortunately many conventional doctors downplay hair loss as an inevitable part of aging for both sexes, treating it with topical products like Rogaine that enhance existing hair but offer no real solution to the causes of hair loss, and therefore no prevention of continued hair thinning. This leads many women — especially those in menopause — to think that there is nothing they can do to stop their hair loss.

Regularly referred to with the catch-all term alopecia, female hair loss actually has different degrees of severity, causes and treatment. The good news is we’ve seen many cases resolve over time with an active, holistic and hopeful approach.

While we don’t claim to know the ultimate cure for hair loss (don’t believe anyone who says they do!), we don’t think a balding woman should resign herself to shopping for hair thickeners and wigs when there are so many other fundamental choices she can make to support natural hair growth where it counts — at the root, not just of her hair, but of her whole health picture.

So let’s talk about why women lose hair and what you can do about it.

Causes of hair loss in women

A strand of hair is made up of extruded, compacted dead cells. Everything you put into your body eventually comes out in your hair, usually within three to six months. Similar to growth rings in a tree, the strata of cells in a strand of hair paint an unflinching picture of where you’ve been and under what conditions. This is one reason many alternative practitioners look at the quality and quantity of patients’ hair as a valuable diagnostic tool.

But hair itself is only the visible part of the story. Hair grows from living follicles in the skin of the scalp. At the shaft, or root of the hair, all of your major systems are at work, including your circulatory, endocrine and central nervous system. That’s why it hurts when someone pulls your hair!

Every hair follicle has four distinct phases it cycles through on a regular basis: growth or anagen, transition or catagen, resting or telogen, and returning growth or mesanagen (see figure below). A full cycle can last anywhere from two to five years per follicle. Unusual hair loss and thinning occurs when a follicle is stuck in the telogen or resting phase. Bald spots occur when a large group of follicles turn off all in one place. Most of the time this happens slowly, but in some severe cases can happen all at once, causing a clump of hair to fall out.

© 2006 Women to Women

Why do certain hair follicles break their normal cycle and switch into a resting or “off” position — temporarily or permanently? And why do some women experience thinning hair on their head and darker thicker hair on other parts of their bodies? The reasons are highly individual, but can include any combination of the following:

• Stress (emotional and physical)
• Hormonal imbalance, specifically androgen sensitivity
• Genetics
• Immune system irregularities
• Thyroid disorders
• Nutritional deficiencies (especially iron or vitamin A)
• Cosmetics (allergies and harsh treatments)
• Radiation/chemotherapy
• Dental treatment
• Blood loss
• Drugs
• Disease
• Surgery
• Scarring

The thing to emphasize about the resting or telogen phase is that it is designed to be temporary. Hair follicles can be shocked into the resting phase by so many stressors — emotional, physical or cosmetic — and just as suddenly switch back to “on” when the stress is reduced. Hair appears to be amazingly adaptive, which is why so many scientists believe that a cure for hair loss is right around the corner. But the lack of a remedy now doesn’t mean you should give up hope. A majority of women with moderate hair loss may notice big improvements just by paying more attention to their stress levels and their diet.

No one knows for sure why some women maintain a thick, natural head of hair throughout their lives while others don’t. My grandmother was always very proud of her hair, which remained on her head with only minimal graying or hair loss until she died at age 95. Why was she so lucky? Probably some good Scandinavian genes and healthy living (which included a daily helping of native Maine blueberries). She had her battles, too, suffering thyroid disease and a thyroidectomy, osteoporosis and high blood pressure. On the plus side, she managed stress well, did not drink or smoke and kept a regular sleep schedule. Somehow in the individual give-and-take of her body’s needs, her hair was able to maintain its resilience.

But, before you know how to proceed, you need to know whether or not your hair loss is unusual. Let’s take a look at what causes hair thinning in women and how it is diagnosed.

Diagnosing hair loss

As I said before, human beings lose hair every day, typically 50–100 strands a day. You can test hair loss with the “pull test.” Take about 60 hairs between your fingers and pull gently but firmly. Normally about 5–8 hairs will come out — reflecting the average 10% of hair follicles that are transitioning towards the resting phase at any one time. More than 15 hairs may indicate a perfectly normal but more unusual period of hair loss called telogen effluvium.

Telogen effluvium is sudden and uncharacteristic loss of hair that is usually not localized. More follicles than average are shocked or move into the resting state. When this happens, you may notice more hair than usual in your hairbrush or on the bathroom floor. But I’ve also had patients suddenly lose a clump of hair or their eyebrows after shock. Keep in mind that the darker and thicker your hair is, the more noticeable it will be against the shower floor or sink. You may think you are losing more hair than you actually are.

You often hear of this kind of hair loss after a pregnancy or change in hormonal birth control. It is also a very common side effect of emotional stress (like a death or divorce) and physical stress (such as surgery or illness). Other causes of telogen effluvium are crash or liquid protein diets leading to sudden, dramatic weight loss; yeast overgrowth or fungi; hypothyroidism and other endocrine-related upsets; anti-coagulants and anti-convulsants; heavy metals; antithyroid medication; hormone therapy; and severe psychological distress or life-threatening situations.

There are also dietary causes of hair losses, such as vitamin D, vitamin A, iron and protein deficiencies. Working with your practitioner, you should be able to diagnose and treat any of these nutritional deficits with a more optimal diet and nutritional supplements.

Some women may experience periods of noticeable hair loss (and growth) at different times in their menstrual cycle, or during different seasons. If this is your experience, be assured that it is very common and tends to resolve itself naturally.

If you are currently under a lot of stress, providing your body with a little more support through supplements and TLC can really boost your hair growth. For this reason, I always tell my patients who report surprising hair loss to follow our Nutritional and Lifestyle Guidelines for three to six months, including hair–specific vitamins and supplements, before proceeding to more intrusive diagnostic methods.

Testing for more severe hair loss

If hair loss does not improve with some basic stress reduction and positive lifestyle changes, I often recommend that my patients look at all of the markers that indicate their hormone and thyroid status, including a hormone panel (testing specifically both free and total testosterone levels); metabolic panel (for kidney and liver function); fasting insulin test (to measure insulin resistance); ferritin stores (for iron deficiency) and CBC with differential (a hematological panel); allergy testing; and thyroid function test.

It’s important to know that conventional doctors have a wide range of test results that they consider “normal”; specifics vary by the type of test, but for argument’s sake, let’s say it’s 1–100. If your number falls near the edge of this range but still within it (say 2 or 99) you are still considered normal. At Women to Women, we look for test results that fall at the midline. Anything way below or above we take a hard look at. In our opinion, clinging to the edge of normal is not conducive to good health.

Testing for insulin resistance, testosterone levels and thyroid or other metabolic dysfunction can tell us if a woman is experiencing androgen sensitivity, hypothyroidism or other endocrinologic disturbances as possible causes for thinning hair. Many women will experience male pattern baldness if their bodies have too much testosterone or have become sensitive to normal circulating levels of androgens. Let’s discuss how that happens.

Hormones and hair loss

Many women experience more dramatic, localized hair thinning, even a noticeable bald spot. This condition is called male pattern baldness, or androgenetic alopecia (AGA) , and it is the most common form of hair loss in both men and women. It almost always occurs on the top and sides of the head and above the forehead, and may also include excessive facial and body hair. The range of severity is wide here, ranging from a barely noticeable thinning at the part line to bald spots at the crown of the head that spread forward.

While hair loss in women is different from that in men, there are some similarities in the way in which male hormones affect hair growth. Like your body’s own version of Miracle-Gro, androgens (testosterone and DHEA) are naturally converted into a substance called DHT (dihydrotestosterone) that stimulates blood flow to the hair follicle, promoting hair growth. Problems arise, however, when the follicle’s receptors become oversensitive to androgens and shut down — like locking a door. This can happen when one or all of the following conditions are present: a genetic proclivity, abnormally high levels of free testosterone, or a change in sensitivity to normal levels of circulating androgens.

Menopause, PCOS and male pattern baldness

Androgenetic alopecia partially explains why you may experience hair loss in one specific area and nowhere else — your hair falls out only where particular hair follicles have been sensitized. It also explains why you can lose hair in one area (where the follicles are sensitive) and grow coarser hair in another (where androgens have stimulated excessive hair growth).

Hormonal imbalance due to menopause or PCOS is the primary causes of male pattern baldness in women. Because so many women with PCOS have high levels of circulating androgens and are also insulin resistant, a growing number of practitioners are looking at the connection between insulin resistance, testosterone, and hair loss. It’s possible that receptor resistance to insulin and sensitivity to androgens go hand in hand. One Finnish study of women in their 60’s showed a definitive correlation between insulin resistance and increased risk of hair thinning, particularly when a subject had a paternal history of hair loss.

AGA happens to some degree to every woman as she ages and estrogen levels fall. Decreasing levels of estrogen may allow the body to convert more available testosterone without opposition. This is so common that many conventional doctors pay it little mind unless hair loss becomes severe. Conventional topical solutions like minoxidil (Rogaine) enhance and thicken existing hair — they do not generate new growth. This may be useful for some women who can deal with a small bald spot or expanding part line by changing their hairstyle but these products do nothing to restore your body’s natural hormonal balance or metabolic function — the factors that are causing the excessive hair loss in the first place.

New testosterone–blocking drugs like flutamide have been only minimally effective in reversing hair loss in women and should not be taken by women of childbearing age — they are generally only appropriate for men and could even exacerbate hormonal disorders in women. Besides, once again, these drugs only take aim at the surface of the problem; they can’t rebalance the body from the inside out.

Some women carry a genetic predisposition to male pattern baldness (usually inherited from their father). But before you panic, know that duration and pattern of hair loss, as well as where the hair is shedding (along the shaft or at the root) are all critical pieces of the puzzle. Some cases of AGA resolve or limit themselves once internal balance has been restored.

Immunological and infectious factors in hair loss

If hair loss worsens over time, or if hair falls out in great clumps creating patchy bald spots all over the head, it may indicate a more serious auto-immune condition called alopecia areata, or an infection-induced alopecia called cicatricial alopecia.

These hair concerns go beyond the scope of this article and must be diagnosed by a punch biopsy, in which a minute section of the scalp is removed and tested. As of this point, there is no cure for alopecia areata, only topical solutions and injectable steroids. But we believe our holistic approach can help boost immune function and help stem the progression of the disease.

Occasionally an overgrowth of fungus or yeast can trigger severe follicular inflammation that results in hair loss. This can be diagnosed by a dermatologist after a thorough scalp examination. Treatments vary depending on the practitioner, but usually involve some kind of topical anti-fungal shampoo or solution.

New inroads into hair transplants, laser stimulation and topical products are a great reason not to despair if you’ve been diagnosed with alopecia areata or other troublesome scalp conditions. You may not have the head of hair you were born with, but some of these developments may in the future provide the next best thing.

Natural hair loss solutions — the Women to Women approach

If your hair loss is mild to moderate, the most important thing to do is weigh the immediate stressors in your life against how much support you’re giving your body. Start with an honest inventory of your healthy and not-so-healthy habits. Then take some steps toward shifting the balance to the support side. Here’s what we recommend:

• Eliminate dietary causes of hair loss. Eat a balanced diet comprised of whole, protein-rich foods — the more organic the better. Avoid or limit refined sugar and other simple carbohydrates to ameliorate insulin resistance. Read how in our Nutritional and Lifestyle Guidelines.
• Address vitamin deficiency hair loss. Take a rich multivitamin daily that includes hair-healthy vitamins such as B, C and E. Other important nutrients are calcium, magnesium, copper, zinc, and iron. A fish oil supplement containing vitamin D and essential fatty acids will help boost immunity and soothe inflammation.
• Consider herbal supplements. Kelp-derived supplements add iodine to the diet, which assists in the manufacture of thyroid hormones. Ginkgo biloba increases blood flow to the scalp (without androgens).
• Scalp massage and acupuncture can be helpful in stimulating blood flow to the scalp and supporting normal follicle function.
• Balance your hormones. If you are premenopausal, consider gentle endocrine support to help naturally rebalance your hormones.
• Examine your emotional health and your relationship with anger. Rage may be associated with higher levels of testosterone. Finding healthy ways to express yourself and your anger can go a long way toward reducing stress. If you are under severe psychological stress, your hair loss should improve a few months after the stress is relieved.
• See your healthcare provider. If your hair loss does not improve with these measures after six months, talk to your practitioner. He or she may recommend undergoing the tests I outlined above. Ask to see the results and where they fall in the range of normal. The closer to the midline the better. If you notice any irregularities, talk to your practitioner about targeted supplements or treatment targeted toward hair growth.

Remember that the condition of your hair mirrors what’s going on inside your body. It only makes sense to consider natural options that nurture your whole health before you spend a lot of money on expensive shampoos, conditioners and hair thickening products. While some of these products may enhance the appearance of your existing hair, they don’t generate new hair. Nurturing your health from the inside out, including your emotional health, should improve the quality and quantity of your hair, as well as your life!

Related to this article:

References & further reading on female hair loss

 

Original Publication Date: 01/19/2006
Last Modified: 02/16/2010
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician