There are many possible causes of hair loss. Hormone imbalance is one of them. People with PCOS struggle with their hair because of high male hormone levels. Excess testosterone, DHEAs, prolactin, and/or dihydrotestosterone can all be responsible for hair fall. Hair loss is also called alopecia. In the case of PCOS, it is often referred to as Androgenic or Androgenetic Alopecia. Here’s an overview of the potential causes:
Androgenetic Alopecia (Pattern Baldness)
This is the most common form of hair loss in both men and women. It is often hereditary and involves the gradual shrinking of hair follicles. The term androgenetic, or androgenic, refers to the fact that male hormones such as testosterone, DHEAs, and dihydrotestosterone (androgens) are the root cause of the problem. This is the usual cause of hair loss in women with PCOS. Testing should be performed for these hormones, and then I’ll help my patients target optimal levels (which are not what the lab considers acceptable).
The good news is that there are natural treatments to address these hormones and improve hormonal balance. This reduces hair fall and, in some cases, allows hair to regrow.
Hair Loss Due to Thyroid Disorders
Hypothyroidism or hyperthyroidism can lead to hair loss, as thyroid hormones regulate metabolism and influence hair growth. Sometimes, PCOS symptoms are the result of thyroid problems. Testing for the thyroid needs to be thorough to fully understand how your thyroid is working. I recommend testing TSH, free T3, free T4, anti-TPO, anti-thyroglobulin, and reverse T3 to determine if hair loss is thyroid-related. I would also target optimal levels for each test rather than just staying within the lab range.
Menopause or Perimenopause Hair Loss
Hormonal fluctuations during perimenopause and menopause can lead to thinning hair. As estrogen levels decline at this stage, hair growth is negatively impacted. While we can’t get back to the level of estrogen we had when we were younger, we can mitigate the hormonal effects on your hair.
Pregnancy and Postpartum Hair Loss
Many women experience hair shedding after giving birth due to hormonal changes. There is a drastic decline in estrogen and progesterone immediately after giving birth, which can become evident about 3-6 months after giving birth. Supporting the entire hormone-producing or endocrine system is the best way to moderate this hair loss.
Medical Conditions That Cause Hair Loss
Alopecia Areata
An autoimmune condition where the immune system attacks hair follicles, causing patchy hair loss. Stress often seems to be a catalyst for this type of hair loss. As a naturopath, I will support your body’s stress response so that your body handles stress as well as possible.
Lupus
Lupus is an autoimmune disease that can cause inflammation in various parts of the body, including hair follicles. A comprehensive autoimmunity protocol can help control this immune dysfunction.
Non-alcoholic Fatty Liver Disease (NAFLD or MASLD)
Poor liver health is associated with hair thinning and PCOS. Your liver helps with hormone balance. The cause of NAFLD is often related to blood sugar and insulin issues. These same issues can create high androgen levels, leading to hair thinning.
Scalp Infections
Fungal infections like ringworm can lead to hair loss. Ringworm, despite the name, is not caused by a worm. It is the result of yeast or fungal overgrowth. The most common cause of dandruff is a yeast known as Malassezia.
Iron Deficiency Anemia Hair Loss
Low iron levels can reduce hair growth and cause hair loss, especially in women. Hormone imbalances can cause heavy periods, resulting in excessive blood loss and iron deficiency. Correcting hormonal imbalance moderates period flow, allowing you to retain iron more effectively.
Cancer Treatments (Chemotherapy or Radiation)
These treatments often cause hair loss because they affect rapidly dividing cells, including hair follicles. In this instance, there is no way to moderate this without potentially negatively affecting the outcome of cancer treatment.
Nutritional Deficiencies
- Lack of Protein: Hair is primarily made of protein, so inadequate intake affects hair health.
- Vitamin Deficiencies: A deficiency in vitamins such as vitamin D and B12, as well as in minerals like zinc and iron, can contribute to hair loss.
- Crash Dieting: Sudden, extreme calorie restriction or poor dieting can lead to nutrient deficiencies that affect hair growth.
- Extremes of exercise or caloric restriction. Low body fat and high stress can create a hormone imbalance that causes ovarian dysfunction (lack of hormone production and ovulation).
Medications and Hair Loss
- Blood Pressure Medications (Beta-Blockers): Can cause hair thinning as a side effect.
- Antidepressants: Certain antidepressants, like selective serotonin reuptake inhibitors (SSRIs), have been associated with hair loss.
- Anticoagulants (Blood Thinners) can affect the hair growth cycle and cause hair thinning.
- Birth Control Pills: Hormonal contraceptives may cause hair loss, especially if there’s a family history of male or female pattern baldness.
Stress
- Physical or Emotional Stress (Telogen Effluvium): Stressful events, surgeries, illnesses, or sudden weight loss can trigger hair to enter the shedding (telogen) phase prematurely. Stress-reduction techniques, paired with support for your stress glands (adrenal glands), can help reduce stress-related telogen effluvium.
Environmental Factors
- Chemical Hair Treatments: Excessive use of hair dyes, perms, or bleach can damage hair, leading to breakage and thinning.
- Heat Styling: Frequent use of hot styling tools, such as flat irons and curling wands, can weaken hair strands over time.
Aging
- As people age, the rate of hair growth slows down, and hair may become thinner and less pigmented (gray). Circulation to the scalp decreases, so hair follicles may not receive vital nutrients. Regular exercise is the best way to retain healthy blood flow to the scalp.
Lifestyle Factors
- Smoking: Smoking can impair blood flow to the hair follicles, potentially contributing to hair thinning.
- Lack of Sleep: Poor sleep habits and chronic fatigue can impair the body’s repair mechanisms, including those that support hair health.
Traction Alopecia
- Tight Hairstyles: Repeated pulling from tight hairstyles, such as ponytails, braids, or extensions, can damage hair follicles and cause hair loss.
Skin Conditions
- Seborrheic Dermatitis: A skin condition that causes scaly patches and dandruff can lead to hair thinning. The scaly patches are related to hormonal imbalances, such as excess androgens. Balancing hormones reduces seborrhea and improves this type of hair loss.
- Psoriasis: Scalp psoriasis, characterized by thick, red patches, may interfere with hair growth. Psoriasis is associated with an imbalance in gut bacteria. Rebalancing gut flora can moderate psoriasis-related hair loss.
Understanding the cause of hair loss is essential for appropriate treatment, as different causes require different approaches (e.g., herbs, lifestyle, dietary changes, stress management). If hair loss is sudden, severe, or accompanied by other symptoms, it is recommended to consult a healthcare professional to diagnose the underlying cause. Whatever the underlying issue, as a naturopathic doctor, I can use natural treatments to address the cause and moderate or reverse hair loss.
Hair Loss References:
Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo R, Olsen E. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2875-2891. doi: 10.1210/jc.2018-02548. PMID: 30785992.
