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Hormonal Factors in Hair Loss: What You Need to Know

For many women, hair is a defining characteristic of their femininity. Hair is a public and private aspect of our bodies; when we alter its appearance by cutting, straightening, curling, bleaching, darkening, or other severe chemical treatments, we may be expressing a wide range of feelings. The way we style and care for our hair reflects who we are as individuals. That’s why talking about hair thinning can be so irritating for a lot of women: there’s just no easy way to make more hair appear overnight.

The inevitable thinning of hair that comes with advancing age is a source of great anxiety for most people. You go online in search of solutions because your hair has gradually thinned over the years, your shower drain clogs almost every day, your scalp becomes so vivid when hair is a dash too oily, and your hair part has been moved to a different spot to hide the thinning around your temples. You find countless articles offering anywhere from three to thirty-three helpful tips on how to get your luscious mane back. Some are self-evident, such as the advice to eat healthily and exercise to increase blood flow and nutrient delivery, while others, like sleeping on a silk pillowcase or tying your hair up in a T-shirt, are more obscure. Whatever advice you receive, if you want strong and healthy hair, you need to do more than just avoid heat and colors.

When discussing hair, the adage “beauty is only skin deep” is ironically inappropriate. Hair thinning and dryness are external manifestations of underlying physiological changes. Although hair loss is sometimes dismissed as a natural part of getting older or a reaction to stress, hormone imbalances are often at blame. In this post, we’ll examine how hormones affect hair quality.

The Growth and Rest Cycles of Hair Follicles

Let’s go over some anatomy first, then we’ll get into the nitty-gritty of endocrine logistics. The hair follicle, which is located just below the skin’s surface, can undergo change as a result of adjustments to the hair fiber, the hair cycle, or both. The hair follicle is a fascinating human structure. It is the ability of hair follicles to dynamically alternate between rest and active growth that makes them so productive. Hair follicles go through periodic phases of rest (telogen), regeneration (anagen), and degeneration (catagen).

The Link Between Stress and Tress

It’s common knowledge that stress wreaks havoc on your hair. Stress, plain and simple, causes hair loss. This is because, under stress, the body shifts into survival mode, reducing blood supply to the skin, digestion, sleep, growth, and other non-essential functions in order to conserve energy for the inevitable fight or flight. Furthermore, your body does not prioritize hair as a vital organ.

Cortisol and other stress hormones can directly attack hair follicles, causing permanent damage [1]. Many women in their twenties and thirties start losing hair owing to stress-related concerns, causing the circumference of their ponytails to decrease [2].

Telogen effluvium is characterized by hair in the anagen (growing) phase prematurely entering the telogen (resting) phase (Fig. 1) [3]. Symptoms include rapid bouts of hair shedding with little to no growth. The stress that comes with hair loss itself, which can be a significant psychological burden for many people, makes this “Groundhog Day”-like loop of causes and effects worse.

So stop for a second and think about how much stress you’re under and how you might start reducing it. Dialectical testing of cortisol in saliva or urine throughout the day can shed light on the physiology at play.

Hormones: They Have Other Uses, Too

Remember how you didn’t experience any hair loss during your pregnancy? During my pregnancy, my hair was thick, healthy, and gleamed with shine. The “pregnancy glow” wasn’t from me; it was in my hair. During pregnancy, more hair follicles enter the anagen (or rapid growth) phase. Hair benefits greatly from pregnancy’s increased supply of progesterone and estradiol, which lengthen the growth phase and reduce or eliminate shedding. I had no idea that around three months after giving birth, when my hormones were trying to re-equilibrate and adjust to a “new normal,” my hair would fall out in such clumps that it would literally wash down the sink.

Pregnancy causes a lot of hormonal shifts, including some that might affect the hair. Most women who have postpartum hair loss will eventually get it back, but it may take a while.

Menopause: Along these lines, hot flashes and night sweats aren’t the only symptoms that seem to emerge out of nowhere when estradiol and progesterone levels drop in menopause. What many women don’t realize and aren’t ready for is the possibility of experiencing hair thinning themselves. Hormones play a major role, just as they do in postpartum hair loss. Hair loss during menopause, however, is permanent unless hormone replacement treatment is used, in contrast to the postpartum period.

Since estrogen prolongs the developing phase of hair, its protective properties are diminished when estrogen levels drop.

The protective effects of estrogen on hair (and skin, brain, heart, bones, and many other tissues!) are diminished when estrogen levels drop. Dihydrotestosterone (DHT), a metabolite of testosterone, can cause the hair follicle to weaken and eventually die, amplifying the androgenic effects of testosterone [4]. Examining estradiol, progesterone, and testosterone levels with a simple salivary collection can aid in the diagnosis and treatment of menopausal symptoms.

Hyperandrogenism plays a central role in polycystic ovary syndrome (PCOS), a common endocrine disorder in women [5]. PCOS is the “Alice in Wonderland” equivalent of elevated androgens, causing hair loss on the scalp and increased hair growth in areas such as the face, chest, and back, all of which are more typical of men. Treatment for PCOS typically involves symptom management rather than a cure. Saliva steroids, hemoglobin A1c, and fasting insulin levels are routinely checked in the lab.

It’s Not That Sort of Store, Ferritin

If iron is the product on display, then ferritin is the backroom warehouse where they are kept. A low serum ferritin level is a strong indicator of anemia. Anemia develops when serum ferritin levels are too low.

Those of us who have experienced anemia (thanks to heavy periods) are all too familiar with its symptoms, which include extreme fatigue and a grayish appearance. Half of those with low ferritin stores experience hair loss [6], though it is not the most common symptom of iron-deficiency anemia. Ferritin is retained by hair follicles. When iron stores are low, the body can take ferritin from places like hair follicles that aren’t as vital as, say, making red blood cells. Diffuse balding is the end result.

If anemia causes hair loss, treating the condition should stimulate hair growth again. Iron overload and toxicity can occur when iron supplementation is given to individuals whose iron levels are already normal or high [7].

Human Growth Hormone

Thyroid hormone controls nearly every physiological function. When the thyroid gland is underactive, as in hypothyroidism, the body’s metabolism slows and resources are diverted away from less essential processes. Unfortunately, hair (and skin) are usually the first to go [8]. Dry, brittle, dull hair and diffuse thinning are common symptoms of hypothyroidism; even eyebrow hair loss is possible [9]. Hair thinning also occurs with Graves’ disease, in which there is an excess of thyroid hormone.

Thyroid disease has noticeable effects on energy and disposition. The symptoms of hypothyroidism are fatigue, sluggishness, depression, and constipation. Anxiety, insomnia, restlessness, and irritability are all symptoms of hyperthyroidism. Check your thyroid levels and discuss thyroid hormone replacement therapy with your doctor if you experience any of the aforementioned symptoms. Once thyroid dysfunction is addressed, hair growth typically resumes.

The “sunshine” vitamin does so much more than just that!

Vitamin D is an essential nutrient for a variety of reasons, including keeping our immune systems and bones healthy. In terms of hair, it kicks off the anagen phase, which is when new hair follicles are formed. It does this by controlling the expression of genes that function during the hair follicle cycle. Lack of vitamin D can cause a variety of symptoms, including hair loss. Therefore, the finding that women with telogen effluvium or female pattern hair loss have below-average serum vitamin D levels [10] is not unexpected. Alopecia areata patients, who experience hair loss due to an autoimmune condition, also have low serum vitamin D levels [11]. New clinical studies are proposing that patients experiencing hair loss have their serum vitamin D levels assessed [12].

Most people can easily obtain vitamin D through their diets or sun exposure. Fatty fish (salmon and mackerel), mushrooms, and foods fortified with vitamin D (certain cereals and milk) are good natural food sources. Vitamin D is often in short supply on a vegan or vegetarian diet, so dietary supplements may be necessary. Optimal vitamin D levels may also require striking a balance between limiting the skin’s exposure to the sun and maximizing its absorption.

The “Energy Vitamin” B12.

Hair follicles can’t function properly without an adequate blood supply; the oxygen-rich red blood cells in the blood nourish the follicles. Cobalamin (also known as vitamin B12) aids in the formation of RBCs, which in turn stimulate healthy hair growth.

Weakness and fatigue seem to overlap with other types of deficiencies described in this blog, so it’s no surprise that vitamin B12 deficiency goes by the moniker “the energy vitamin.” A serum vitamin B12 test can rule out abnormalities if you’re worried about a possible deficiency. B12 deficiency is more common in people who are vegan or vegetarian, over the age of 60, have low stomach acid, have gastritis, or have celiac disease. Meat, dairy products, and certain fermented vegetables are all good sources of vitamin B12. Plants do not produce vitamin B12, but certain strains of bacteria can produce it through fermentation.

Clinical Assessment: Consult Your Physician!

Hair loss often prompts a trip to the lab for testing. You may also be asked [13] additional questions to help narrow the differential diagnosis.

When did the hair loss start? A sudden onset of hair loss may be suggestive of a disruption of the hair cycle.

Where is the hair loss most prominent? Hair loss can be patchy, diffuse, or patterned. Diffuse shedding may indicate disruption of the hair cycle, while patterned thinning could be attributed to hormonal dysregulation.

What is the normal hair care routine? Certain hair care practices can have a tremendous impact on the loss of hair health.

With proper evaluation and appropriate testing for hormonal imbalances or nutritional deficiencies, help is on the way!

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