Hair today gone tomorrow: androgenic alopecia, FPHL, and other causes of hair loss
- Losing hair. Shedding a lot
- Can see bald spots
- No one is taking hair loss seriously
- Bad hair days. Low self-esteem
- PCOS: androgenic alopecia.
- Autoimmune: alopecia areata
- Tension alopecia traction alopecia
- Telogen effluvium
- Side effects of medications like the pill
- Birth Control
Other therapies (that are currently being explored)
- Essential oils like rosemary (find research if it helps)
- Topical melatonin
- Correcting nutritional deficiencies!
- Herbs that correct the imbalance of hormones
- Scalp massage: to improve blood flow and decrease inflammation
Hair loss is a distressing symptom of a deeper imbalance in the body and is one of the symptoms that present in women with PCOS.
Hormonal dysregulation in PCOS presents with an increased amount of testosterone and androgens in the blood Which clinically manifests as acne, hirsutism (the growth of darker, more coarse hair on the chin, neck, and maybe cheeks), and alopecia.
Androgenic alopecia or female pattern hair loss (FPHL) is often experienced by women who have PCOS, but also by women who have a genetic sensitivity to testosterone and DHT (the more potent product of testosterone metabolism).
Understanding Hair loss Causes
- Female pattern: alopecia in women is seen as the loss of occipital hair and thinning on the vertex/crown area of the head. Often the thicker terminal hairs fall out and are replaced by thinner, lighter, and sparser vellus hairs. Unlike men who suffer from androgenic alopecia, women retain their frontal hairline. A current understanding of the mechanism of action for this pattern of hair loss, especially in men, is that the circulating testosterone gets converted to DHT by an enzyme called 5-a-reductase; DHT then acts on the hair follicles to minimize them. Research now suggests this is only part of the problem, as there is inflammation in the scalp about the follicles that also contributes to miniaturization.
- Alopecia Areata: present in both sexes, this type of hair loss presents as patchy spots of loss over the scalp. It is often worsened or triggered by stress, and some of my patients have also reported a tingling feeling in the scalp right before they notice the hair fall. This is an autoimmune type of hair loss.
- Hypothyroid hair loss: diffuse hair loss or hair that is dry, brittle, and breaks easily is a common symptom in those who also have an underactive thyroid.
- Nutrient deficiencies: Iron-deficiency (more common in menstruating women), presents with diffuse hair loss and low energy. Low levels of zinc, vitamin B1, biotin have also been linked to hair fall, while vitamin A toxicity can also contribute to alopecia.
- Tension or Traction alopecia: Tight ponytails, buns or updos pull on the root of the hair and subsequently lead to hair fall. This type of hair loss is usually noticed in the frontal hairline (where ever the hair is pulled the tightest).
- Telogen Effluvium: A non-inflammatory (and non-scarring) form of hair loss that occurs after an event (usually due to medications). This alopecia alters the growth cycle of hair, where the hair remains in the resting phase for longer periods of time. Hair shedding is noticed after medications like chemotherapy and generally begins to grow back after 2 months.
- Side effects of medications: Specifically, the birth control pills. Some BCPs are made with progestins (synthetic, almost-progesterone, which binds to progesterone receptors), that are more androgenic. Progestins such as Methyltestosterone, Gestodene, Levonorgestrel, -Norgestrel, and Desogestrel, contribute to the worsening of androgenic activity like hair loss, hirsutism, and acne.
Medications are used to treat the underlying root cause of hair loss. In patients suffering from hypothyroidism, treatments involve medications such as levothyroxine to replace thyroid hormones not produced by the gland. Hair transplants are available for moderate to severe hair loss patients.
Topical conventional treatments include Rogaine (minoxidil), that can be purchased at the pharmacy and applied to the scalp twice a day. A reported side effect is increased hair growth on the face.
Women with androgenic alopecia (with or without PCOS), are often prescribed a mix of birth control pills (with the least androgenic activity) along with spironolactone. Drugs that block the activity of 5-a-reductase are used to decrease the conversion of testosterone to its more potent form, DHT. Commitment to conventional medications is often life-long, once stopped, the hair fall returns.
Other therapies like PRP, protein-rich plasma, are cosmetic procedures that aim to stop hair shedding by decreasing inflammation in the scalp and stimulating new hair growth.
- Acupuncture: Done locally in the scalp, acupuncture causes a micro-trauma which stimulates blood flow to the area. Increased blood flow brings nutrients for the follicles, and may stimulate new hair growth while also decreasing local inflammation.
- Topical essential oils: Rosemary essential oil also may support new hair growth by improving circulation to the scalp.
- Topical Melatonin: Research suggests that a 0.1% melatonin solution applied nightly to the scalp improves hair growth in the occipital area of the scalp. It is suggested that melatonin may also act as an anti-inflammatory in the area. The same research finds that applying melatonin to the scalp did not affect blood concentration levels.
- Correcting nutritional deficiencies: while low levels of biotin are typically seen in rare genetic conditions, it is also present in patients taking medications for epilepsy, in those who consume large amounts of alcohol (also causes vitamin B1 deficiency), and smokers. Iron deficiency is common amongst menstruating women; while the range for “normal” ferritin levels is great, as a naturopathic doctor I like to see serum ferritin greater than 70 ng/mL.
- Herbs that may improve hair growth include those that support the elimination of excess testosterone and DHT from the body and others that block the conversion of testosterone to DHT. These include reishi, saw palmetto, nettle, licorice. Other herbs that support the production of estrogen and progesterone, like vitex and white peony may also help correct the hormonal imbalance in some women.
- Scalp massage stimulates blood flow to the hair follicles. Massage may also decrease inflammation. While more research needs to be conducted into the exact techniques, when and how often, massaging one’s scalp can relax the mind and decrease stress – win!
Female pattern hair loss (FPHL)/androgenic alopecia is a distressing symptom of hormonal imbalance and PCOS. FPHL may even trigger psychological symptoms of low mood and depression. In fact, hair shedding is often overlooked by many professionals as a reaction to stress or a short-term change in diet and lifestyle habits. Some women may not even notice that hair loss has occurred until at least 25% has fallen/not grown back. In my practice I focus on uncovering the root cause of hair fall, be it thyroid-related, hormonal, or even autoimmune; no one-size-fits-all approach is going to stimulate every patient’s hair growth. This process may take longer for some, but treating the appropriate root cause is worth it.
Note from Dr. Usman, ND
Please share this article! I personally know just how hard it is to find the right (and relevant) information out there. A lot of androgenic alopecia studies are conducted in men, and there isn’t enough evidence to support female hormonal balance and hair growth – yet. The more we talk about hair loss and natural therapies in women, the more we can support those experiencing female pattern hair loss.
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