Trichology Case Studies (how complex and different we are!)

It’s seemingly always been the nature of orthodox medicine to assess health issues in comparative isolation rather than evaluating the individual holistically …. and scalp hair loss is the classic example of this.

Commercial hair loss centres, paid endorsement influencers, and even some specialist medicos will often give anxious consumers the impression that one’s hair is somehow a ‘separate accessory’ to the body and any treatment should be focused on the hair alone through topical lotions, shampoos, immune-system suppressing drugs, or the taking of two old style blood pressure medications (1) to supposedly overcome the myriad causes and diverse hair loss conditions which can afflict an individual.

Here is a small cross-section of case studies from my practice to highlight just how different the causes of scalp hair thinning can be:

1. 55yo female corporate executive with nine-year history of nutrient-metabolic-hormonal disturbance: sought the opinion of numerous medical specialists who provided diverse opinions on cause and treatment; none of which made any difference to her chronic hair shedding. Self-supplemented with an array of products purchased online – again with little to no effect.

Persistent investigative and specific pathology testing established she was experiencing autoimmune thyroiditis (2), exacerbated by some nutrient deficiencies (Iodine, Calcium) as well as an underlying inflammatory process likely the result of autoimmune attack.

She was fortunate to connect with an integrative doctor who agreed she needed a specific thyroid medication and prescribed same for her (3). Through our collaborative compounding pharmacy, we provided her with an individualized nutrient-amino acid powder formulation to correct her nutrient deficiencies and support her general health.

We are very happy to finally be able to find some answers for this lovely lady after she had endured nearly a decade of increasing health issues and hair loss … she is now on her way to a managed recovery.

2. 35yo male professional with three-year history of alopecia: this man presented with alopecia in his beard (termed: alopecia barbae) with some slowly developing male pattern genetic thinning in his crown. Pathology investigations indicated metabolic disturbance as insulin resistance – a pre-diabetic state as well as an elevated Cortisol and Oestrogen (a predominantly female hormone).

These health issues appeared all related to being overweight – and since losing a substantial amount of weight (25 kg) with alterations in diet and lifestyle – all disturbances have returned to acceptable levels. His alopecia barbae and pattern thinning is being treated with a topical solution and ongoing nutrient support.

3. 24yo female with ten-month history of excessive scalp hair shedding: pathology testing specific to this young woman’s age and gender found low range Vitamin D, Zinc and Iodine deficiency. However, the driving cause behind her continual hair shedding (in my opinion) was elevated Prolactin levels (4).

Elevated out-of-range Prolactin levels – termed hyper-prolactinemia – is most commonly caused by high levels of the stress hormone Cortisol. Underactive thyroid function or the taking of certain medication can also elevate prolactin levels.

When Prolactin is grossly elevated (ie: >1000-2000 mlU/L), this is usually associated with a (typically) benign Pituitary tumour (adenoma/microadenoma) requiring medical management (5).

Elevated Prolactin levels adversely influence androgenic changes in hair because it stimulates Testosterone (TT) + DHT production whilst suppressing the protective effects of Oestrogen on female scalp hair growth.

Again – the cause/s of this young woman’s scalp hair loss was only revealed by undertaking specific pathology investigation which should always be the 1^st step after consultation.

4. 7yo female child with unrelenting alopecia areata (rapidly leading to a. totalis (total hair loss from the head, eyebrows and eyelashes): a two-week sudden-onset of scalp hair loss typical of alopecia areata, but the amounts of hair lost with brushing or styling was understandably devastating to her parents. This child had a strong inherited atopic (6) history of asthma, environmental and food allergies; alopecia areata being a part of that ‘cluster’.

Pathology testing revealed a number of disturbances typically found in patients with a. areata, but the standout was her IgE immunoglobulin grossly elevated at 2,646 kU/L; target <100 kU/L for adults and somewhat less for children.  

A faecal digestive stool analysis suggested significant gut dysbiosis; this is clinically important because the antibodies being produced to cause a. areata in this child are coming from the gut.

After unsuccessfully trialing some non-invasive treatments such as nutrient therapy, laser light therapy and a non-drug topical spray solution, it was agreed that referral to a paediatric medical allergist was warranted. A series of Allergen Immunotherapy injections (still ongoing) completely resolved this child’s a. areata (8) and her scalp hair, eyebrows and eyelashes quickly returned to normal density.

Summary: I’m trusting the interested reader will now gain an appreciation of just how complex and interactive our bodies are to internal disturbance or external sensitivity. Our hair is the 2^nd most metabolically active tissue in the body requiring constant nutrient-metabolic-hormonal stability on the inside, and a favorable environmental milieu externally.

As society transitions to be more and more dependent on AI problem-solving it’s now become easy as well as fashionable for practitioners and patients alike to load up a set of symptoms to obtain a diagnosis, cause and treatment.

Few if any of my client case studies discussed would have benefitted from an AI generated response to their concerns – and some actually tried this form of self-diagnosis.

Instead, I urge you to seek out an experienced practitioner for the area/s of concern you might have … our scalp hair is a barometer inner health; purely reflecting your inner health or changes to it.

1. Oral Minoxidil and/or Spironolactone is the combined drug treatment of choice for many orthodox medicos and Dermatologists. For a better understanding: https://hairlossclinic.com.au/potential-risks-of-oral-minoxidil-what-your-doctor-may-not-know/
2. Autoimmune thyroiditis occurs when thyroid antibodies are produced to attack the thyroid gland and destroy it. Autoimmune thyroiditis most commonly occurs in females.
3. Slow-release T3 ‘active’ thyroid hormone (often as Levo/Lio-thyronine or Tertroxin) – the thyroid hormone of choice where elevated levels of Reverse T3 (rT3) are found. Levo or Lio-thyronine are the synthetic forms of Triiodothyronine (t3) – synthesised primarily in the liver from thyroxine (produced in the thyroid gland). T3 is regarded as the most important hormone in the body.
4. The hormone Prolactin is produced by lactotroph cells within the pituitary gland in the brain and is responsible for lactation and breast tissue development during pregnancy. Prolactin also plays a role in regulating the immune system as well as other functions in the body. Prolactin is essential for >300 hormonal/enzymatic interactions within ALL mammals (Including human beings).

The hypothalamus, located directly above the pituitary gland, exerts primary control over prolactin secretion.

5. Although Pituitary gland tumours are generally benign, they are also space-occupying as they grow. An Endocrinologist would usually prescribe medication to limit or shrink the tumour’s growth and size.
6. Atopy is a clinical, hereditary predisposition of hyper-sensitivity to one’s environment.
7. IgE immunoglobulin – is an allergy + sensitivity bio-marker. An elevated IgE reflects increased sensitivity to inhalant allergens such as pollen, grasses, animal dander, moulds (+ mould spores) – or other environmental factors causing hay fever or other respiratory issues; more commonly reflecting Eczema or parasitic infections – especially in the Gut.

In terms of how this influences the activation of alopecia areata (AA), this elevated IgE causes the immune system to be hyper-vigilant and somewhat disorientated. The immune system then produces and mobilises antibodies to begin attacking certain areas of the body – and the hair follicles are a common target.

8. Autoimmune conditions such as a. areata can be pushed in to remission but not generally ‘cured’.

**These clinical case studies have been provided with the full (verbal) consent of the subjects. Any pointers to compromise the medical-in-confidence anonymity of the subjects have been excluded**.

Copyright 2026 – Anthony Pearce.