Our hair can be a symbol of our overall health and wellbeing. The growing hair follicle, a hair follicle in the anagen phase, requires a substantial amount of nutrients to sustain the rapid production of new cells, and thus is highly vulnerable to nutrient deficiencies, hormonal fluctuations, metabolic disruption, and medications. To fully understand hair loss, you first must understand the hair cycle. There are 4 phases in the hair cycle: Anagen, Catagen, Telogen, and Exogen.

Normal hair loss can get accelerated by a few different scenarios… the most common is called, Telogen Effluvium. Telogen effluvium hair loss happens after around 20-30% of hair follicles are prematurely cycled into the telogen phase causing dramatic shedding. The onset of the shedding is around 2-4 months after the initial insult. This can be caused from metabolic disorders, hormonal imbalances, or medications.

In other words, to fully assess a person’s hair loss, we must look 2-4 months prior to the onset of hair loss to determine the root cause. For example, 3 months after having a baby there is accelerated hair loss due to the changes in hormones.  

Common causes of Telogen Effluvium Hair Loss

Hormonal Hair Loss

As previously discussed, post-partum hair loss results from the fluctuations in hormones after delivery. Similarly, menopausal hair loss occurs due to the fluctuations in estrogen. Throughout perimenopause, estrogen and progesterone are fluctuating. Once a woman hits menopause, estrogen is at an all-time low. Low estrogen is associated with hair loss due to its impact on hair prematurely cycling into the telogen phase. To alleviate hormonal related hair loss, I recommend seed cycling. Seed cycling includes flax seeds which are part of a group called phytoestrogens, which works to balance high and low levels estrogen in the body. See a seed cycling recipe here.

Androgenic Hair Loss

Androgenic-associated hair loss affects men and women. It is primarily due to the conversion of testosterone into the more potent dihydrotestosterone (DHT). A full assessment of how you metabolize your hormones either through a urine or saliva test is crucial. The main treatment is blocking the conversion of testosterone into DHT through 5-alpha reductase inhibitors. Green tea is one example of a natural 5-alpha reductase inhibitor, I recommend ingestion of green tea daily. Some people have found DHT blocking shampoo to be helpful although research is limited. 

Nutrient Deficiency Hair Loss

As previously mentioned, a growing hair follicle is highly vulnerable to nutrient deficiencies. The most common nutrient deficiency associated with hair loss is iron deficiency anemia. Iron deficiency is common among vegetarians/vegans and menstruating women, especially women with heavy bleeding. One of the biggest myths surrounding hair care is that biotin is the single most important nutrient necessary for maintaining healthy hair. Biotin can be helpful, but there are other nutrients that can support healthy hair as well. Other nutrient deficiencies that can result in hair loss include niacin, folate, vitamin D, vitamin E, vitamin A, zinc, selenium, essential fatty acids, and all 9 essential amino acids. Poor hair quality can directly relate to a person’s nutrient status.

Chronic Elevated Stress

The stress hormone, cortisol, can be a cause of hair loss since cortisol is responsible for prematurely shifting your hair follicles into the telogen phase. Cortisol or stress can also cause poor nutrient absorption in the gut, which may also impact hair loss. To learn more about chronic stress read this article on adrenal fatigue.

Hypothyroidism Hair Loss

Sub-optimal thyroid function can cause hair shedding, hair loss, and changes to hair texture (coarse and brittle). To fully assess thyroid function, a complete thyroid panel must be ordered to rule out autoimmune thyroid disease (Hashimoto’s thyroiditis). A complete thyroid panel consists of TSH, Free T3, Free T4, and thyroid antibodies.

Medication-induced hair loss

Fluctuations in medications can lead to hair loss, below are the most common:

• Hormones (testosterone, estrogen, hormonal contraceptives) *use caution around your significant other if they are using topical transdermal hormones.
• Beta-blockers
• Oral retinoids
• Levothyroxine: Over-medication of thyroid conditions with Levothyroxine, for example, can lead to hair loss. Therefore a proper thyroid panel workup is essential for assessing hair loss.
• Tricyclic antidepressants

References:

Kanwar AJ, Narang T. Anagen effluvium. Indian J Dermatol Venereol Leprol 2013;79:604-612

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.