ByKatarina Meister, ND •May 28, 2022
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.
1 – GROWTH PHASE (ANAGEN)
85-90% of follicles
The hair root is stick-shaped with pigment throughout the entire hair shaft
Avg length 3 years
2 – REGRESSION PHASE (CATAGEN)
1% of follicles
Between active growth and end of growth
Avg length 3 weeks
3 – DORMANCY PHASE (TELOGEN)
10% of follicles
The hair root is club-shaped with minimal pigment in the bulb
Avg length 3 months
4 – NEW HAIR PHASE (EXOGEN)
1% of follicles
Old hairs shed & new hairs grow
There are around 100,000 hairs on average on a person’s scalp!
Most hair follicles are in the active growth phase, otherwise known as the Anagen phase. As you can probably tell, the hair cycle is not synchronous throughout the entire scalp…
In general, it is completely normal to have hair shedding on daily basis. Around 100-150 hairs are lost daily as part of the normal hair cycle. This occurs after washing or brushing the hair… It is important to remember that as a hair follicle is lost, it is being pushed out by a new hair follicle that is growing. So don’t worry – the hair lost will regrow!
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.
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.
- 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
Hair Care At Home
- Hair Mask: Castor oil with rosemary essential oil massaged into the scalp daily
- End your showers on cold for at least 30 seconds! This will help to increase blood flow to the scalp to enhance the anagen growth phase.
- Avoid hair pulling styles, utilize hair clips, and scrunchies over rubber bands
- Adapt stress relief practices: Stress less exercise
- Seed cycling
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.