An Introduction to Women’s Hair Loss
The incidence of androgenic alopecia in women has steadily increased over the past decades, and is now thought to occur at least as frequently in the general female population as it does with males.
Tony Pearce was the first to identify two forms of androgenic alopecia in women – true genetically-inherited type, and ‘acquired’ androgenic alopecia from metabolic/hormonal compensatory mechanisms.
Other common causes of hair loss in women are nutritional – principally low iron levels – and metabolic disordering such as thyroid, blood sugar, or liver detoxification problems.
A temporary & self-correcting diffuse hair fall is often initiated by events such as childbirth, commencing/ceasing certain medication, febrile illness, blood loss in surgical procedures, or combination intravenous antibiotics for severe infections.
Overwhelming emotional/physiological shock or unremitting stress may also be the foundation for excessive hair loss. Autoimmune diseases – sometimes leading to permanent hair loss – are a regularly seen cause of alopecia in both sexes.
Female pattern hair loss not always “genetic”
As a Trichologist specialising in female hair loss since 1999, I’ve treated thousands of women across the world for thinning scalp hair.
The trends I’ve observed in many women has led me to believe – despite prevailing medical opinion – there are two forms of so-called ‘genetic or pattern’ thinning in women. One is manageable but not presently curable, whilst the other is often the result of metabolic homeostasis compensation mechanisms AND may be corrected.
It’s long been known that female pattern hair loss is a similar but clinically separate condition from that of male genetic balding. The hormonal conversion up to the most potent male hormone dihydrotestosterone (DHT), which has a miniaturising affect on the hair follicles across the top of the scalp, is different in males & females. So too the progression of the problem; androgen-sensitive (male hormones are collectively termed androgens) hair follicles in women are randomly affected, thus thinning of the scalp hair occurs rather than complete baldness. Unlike males, afflicted women generally retain their frontal hairline margin*.
True genetically inherited female androgenic alopecia is an autosomal recessive hereditary trait affecting numbers of women within an extended family. The woman will recount a family history of her mother, grandmother/s, sisters, aunts or female cousins with a comparable thinning hair problem. These women tend to exhibit the condition after puberty or in their early twenties, particularly following childbirth.
The majority of women presenting with pattern hair thinning show (in my opinion), acquired pattern alopecia due to the cascading affects metabolic/hormonal and sometimes nutritional disturbance within a number of body systems.
These women may be any age & relating a common history of lethargy, dry skin, menstrual difficulties, pre-menstrual mood disorders, weight gain, diminished libido, sleep disturbance or headaches. Their thyroid function testing* and/or salivary hormone profiles (SHP) will often be imbalanced; with elevated Testosterone (TT) and/or DHEA – the Adrenal gland endeavoring to stimulate thyroid function.
A dual presentation of ‘pattern’ AND ‘diffuse’ scalp hair density thinning will be evident in some women. Careful evaluation of the Client’s history and associated symptoms should be undertaken to exclude diffuse Alopecia areata – which presents in a similar way but is a condition of autoimmune origin.
The research of Dr. John Lee –Australia’s most prolific thyroid researcher – advocates that in pre-menopausal women particularly – the geneses of these problems are frequently found in deficient iron storage (termed ‘ferritin’) or other nutrient disturbance. Iron, Vitamin D + Iodine – are considered the three most essential nutrients for metabolic function.
Adequate iron storage is essential to ‘furnace’ intracellular energy output, from which adenosine tri-phosphate (ATP) is produced. To generate sufficient & quality ATP, iron storage (termed Ferritin) of 120-150ug/L (within a reference range of 20-300ug/L) is essential for optimal metabolic & liver detoxification functioning in a younger adult person**. Metabolic (thyroid) activity & Phase II liver detoxification pathways is ATP dependant.
An ATP-deprived liver is ‘sluggish’ & readily overloaded when a woman is taking hormone therapy (contraceptive or HRT medication), consumes some daily alcohol, caffeine or nicotine. These combined substances occupy the total capacity of the liver’s Phase I detoxification pathway, & the liver’s ability to process other substances such as the body’s own hormone by-products or other toxins is progressively impaired – ultimately resulting hormonal disturbance & cellular toxicity. Iron ‘switches on’ on ALL other body systems + functions – hence its fundamental importance.
***Older post-menopausal women (>65+) will often show a decline in overall scalp hair density as well as pattern thinning. This is in part due to the ageing process and post-menopausal decline in female and metabolic (thyroid/adrenal) hormones. They are frequently Vitamin D (or other nutrient) deficient and a blood pathology baseline should always be assessed.
In the very complex way body systems influence & compensate for each other, weaker male hormones – partly produced in the adrenal glands – are up-converted to Testosterone (TT), and used as an auxiliary ‘fuel source’ to ATP in an attempt to stimulate thyroid-metabolic function. Some of this Testosterone is further up-converted to DHT which has a miniaturising influence on ‘androgen-sensitive’ hair follicles across the top of the scalp.
Compensatory Adrenal output and lowered TT production can be achieved by providing the body with the basic nutrients (Iron, Vitamin D, Iodine, and Zinc) and restore metabolic homeostasis. In some individuals medication to support the thyroid-adrenal axis/ other hormonal pathways may also be required.
Increased facial or body hair (hypertrichosis) often accompanies pattern scalp hair thinning because follicles across the top of the scalp are androgen sensitive – causing follicle miniaturisation & hair shaft thinning (vellus hairs),whilst facial/body hair is male hormone (androgen) dependant – leading to increased growth.
‘Pattern’ thinning may also present from the hormonal consequences of being overweight, refined food diets and decreasing physical activity****. At the heart of this is elevated blood Insulin levels (hyperinsulinaemia) – and its disordering effects on Oestrogen-Testosterone ‘aromatization’; hormone carrier proteins, and the delicate balance of hormones within the body. Specific blood and/or Saliva hormone testing should be done to evaluate these areas.
Finally, stress as a cause for hair loss is often prematurely diagnosed by some practitioners, who are either unsure of what to look for or what to ask. Nevertheless severe or protracted stress from emotional, physical, chemical, or dietary causes can wreak havoc on many of the body’s vital hormones.
Adrenal gland production of cortisol is raised in times of acute stress. When this is prolonged, excess cortisol affects production of the hormones themselves & their target tissue sensitivity. Hormones that regulate ovarian/testicular function (gonadatrophins) in the respective sexes are decreased – resulting in lowered oestrogen in women & decreased testosterone in males.
The pituitary gland’s production of growth & thyroid stimulating hormones are blocked by the indirect influences of excess cortisol, diminishing & disordering the conversion of the thyroid hormones from inactive to active.
Adrenal hormone production (including Cortisol) cannot be sustained at elevated levels indefinitely, and ultimately results in adrenal fatigue or adrenal ‘burnout’. Low Cortisol levels adversely influence thyroid function – particularly with a concomitant Vitamin D deficiency (<50nmol/L). Symptoms of low or high Cortisol OR hypothyroidism frequently mimic the other.
Successfully treating women for hair loss problems requires careful review of their medical, nutritional, hormonal & lifestyle history undertaken in an organised & sequential way. Specific baseline blood & functional pathology (where appropriate) should be undertaken before deciding on a treatment regime. This will provide a clearer representation of what other areas are influencing the primary problem, & treating the cause of the condition rather than just ‘band-aiding’ the symptoms can then be undertaken.
TSH, T4, T3 REVERSE T3 (rT3), Thyroid antibodies and TSH thyroid receptor antibodies (TRA) IF REQUIRED (not usually 1st encounter)
**A ferritin of around 90-120ug/L is adequate for a child of senior primary school age or a post-menopausal woman.
***Some older women may show frontal hairline margin recession – with or without fibrosing.
****See article – ‘Insulin-induced’ pattern hair loss for more information