Insulin-induced Pattern Hair Loss

It’s now a given that obesity and even morbid obesity (1) is an increasing health problem in modern societies. This gives rise to many potential health problems: Insulin Resistance (aka: Metabolic Syndrome), hypertension, diabetes – or other hormonal-metabolic disturbance, heart disease, certain cancers and orthopaedic problems to list a few.

There is also debate as to whether Insulin Resistance (I/R) causes the increase in truncal body fat or being overweight gives rise to Insulin Resistance. There is clear evidence to suggest that high sugar, refined carbohydrate diets are the origins of obesity, however Briden (2024) believes it’s the former: I/R is the major cause of weight gain in pre-disposed individuals. Fluctuating hormonal changes in the menopausal stages is also a driver of insulin resistance (Briden:2021).

According to Briden (2021) a continually raised insulin (i.e.: >10 mU/L) is a marker for metabolic dysfunction and inflexibility as well as a driver of body inflammatory process.

Elevated blood Insulin levels – termed Hyperinsulinaemia – is at the heart of I/R whereby the body’s cells lose their sensitivity to Insulin required for glucose to enter the cell for energy production. This point is crucial as many medicos often only assess blood glucose (sugar) or what’s termed HbA1c which would become elevated as I/R proceeds to pre-diabetes or a diabetic state.

Although a raised BMI is often associated with Insulin Resistance, one does not have to be obese or even overweight to be Insulin Resistant.

Insulin activity is also affected by the stress response. Chronic stress with persistent Cortisol elevation may counteract the effects of insulin, resulting in functional insulin resistance (DTI: 2016). The disruptive effects of oestrogen-copper dominance from synthetic hormone therapy can cause a functional insulin resistance also.

Signs + symptoms of Insulin Resistance:

• Constantly feeling hungry and unsatiated.
• Increasing amounts of skin tags found on the body.
• ‘Patterned’ scalp hair thinning across the top of the head.
• A darkening pigmentation in the armpits, groin and folds of the neck (termed: Acanthosis nigra or nigricans).
• Elevations in blood pathology particularly specific Cholesterol ratios, (ALT) liver enzymes, C-reactive protein (CRP) – an inflammatory response marker – and (obviously) Insulin.
• Increasing, perceptible weight gain felt under the diaphragm and around the waistline.

What to avoid:

• Refined, processed, hi-carbohydrate meals or fast food often created with excessive amounts of sugar, Omega-6 or trans-fat oils and emulsifiers.
• Avoid sugary, carbonated drinks and fruit juices; consume whole fruit instead.
• Seek to minimise refined wheat bread and wheat or corn-derived pasta. Seeded breads pasta made from soluble fibre grains are a better option (2).
• Moderate and seek to minimise alcohol intake as alcohol is empty calories with no nutritional value. Red wine in moderation does contain polyphenols.
• Look to minimise any situation causing continued or unnecessary increased stress in your life. If unavoidable look to balance these stressors with meditation, yoga, exercise, support groups or personal leisure activities etc.

Managing Insulin Resistance:

• Consume small, regular meals of unprocessed whole foods which are high in protein, ALL forms and colors of vegetables, some fruits and small servings of complex carbohydrates
• Avoid cooking with Omega-6 concentrated vegetable oils. Opt for small amounts of duck fat, butter or coconut oil instead.
• Intermittent fasting of 14-16 hours duration twice weekly is a known benefit for helping to manage I/R.
• Develop regular sleep patterns, discontinuing the use of EMR-generating devices at least 1-2 hours before retiring.
• Strength (weight) training 3-4 times weekly is preferable; brisk walking or swimming for 30-40 minutes per session is another physical option.
• . Hydrate well; don’t smoke cigarettes, vapes or take illicit drugs.

Helpful supplements:

• Magnesium (as chelate, glycinate/bisglycinate or citrate) are the preferred forms of magnesium (Mg) for regulating blood glucose levels. Briden (2024) refers to Mg as her ‘go to’ mineral in the treatment of early I/R.
• Taurine and Glycine amino acids.
• Choline is an essential nutrient found in eggs and organ meats (liver, kidney, heart).

• (Myo)-Inositol is naturally occurring carbohydrate sugar found in minute amounts in the brain and lipoprotein of blood plasma in humans and other mammals. Our bodies use Inositol to provide structural integrity for our cells.

• • Inositol aids in promoting:

• Insulin sensitivity; aids in stabilising blood glucose levels.
• As a non-drug therapy for polycystic ovarian syndrome (PCO-s).
• Aids in the management of hirsutism, acne and T-zone oiliness caused by elevated male hormones (termed: androgens).
• Assists in reducing thyroid antibodies in autoimmune thyroiditis (Dr. Isabella Wentz: 2018)
• Healthy ovarian function + ovum (egg) quality (in younger females)
• De-alkalising properties of Inositol can decrease inflammatory processes within the body.

Further discussion for the interested reader:

Hyperinsulinaemia in younger females is one factor in Polycystic Ovarian Syndrome (PCOS), resulting in pattern scalp hair loss, increased facial/body hair (‘hirsutism’) and reproductive disturbance. One published study (J Steroid Biochemical Molecular Biology: 1995) found obese women with PCOS had similar Total Testosterone levels to slim PCO females – BUT higher Free Testosterone levels – the effects of which can lead to thinning scalp hair and hirsutism.

Obesity and hyperinsulinaemia leads to a suppression of the hormone ‘carrier’ protein Sex Hormone Binding Globulin (SHBG) – with a reciprocal rise in ‘free’ Testosterone (TT). SHBG is significant because by manipulating SHBG levels, the amounts of available Oestrogen or TT can be controlled.

 Sex Hormone Binding Globulin (SHBG) – a brief overview:

SHBG is a glyco-protein produced in the liver, and a 2^nd tier ‘reserve storage’ carrier for Oestrogen and Testosterone in the blood. The levels of SHBG – and the hormones they carry – are influenced by a balance of stimulating and inhibiting factors (Baratosy: 2010). These may be dietary, hormonal (including hormonal therapy), nutritional, age, physical/sexual activity, illness or lifestyle determinants – all of which can impinge on Oestrogen-TT ‘bioavailability’.

Causes for elevated SHBG are:

• Oestrogen excess: synthetic oestrogens found in all contraceptives or HRT.
• Medications: anticonvulsants such as phenytoin sodium (Dylantin), Carbamazepine (Tegretol) or thyroxine (T4 thyroid hormone)
• Health issues: liver disease, anorexia or hyperthyroidism.
• Pregnancy

A raised SHBG may also cause symptoms of low thyroid function because SHBG partly binds + inactivates the thyroid hormone T4 (Thyroxine).

Factors that increase SHBG:

• Age
• Thyroid hormone T3
• Oestrogen including Phyto-oestrogens (plant derived such as Dong Quai)
• High fibre; low protein diet

Factors that decrease SHBG:

• Male hormone (termed ‘Androgens’)
• Progesterone (P4) – low P4 is a common concern for peri-menopausal women.
• Cortisol (Stress + anti-inflammatory hormone from our Adrenal Glands)
• High Protein/(good) Fats diet

Effects of Insulin on Testosterone and other hormones:

Explaining the physiology of TT stimulation, production/secretion and control is beyond the scope and intention of this article. Suffice to say how and where TT is stimulated and produced in females and males varies between genders.

In females, about 50% of TT is produced by the ovaries and 50% by the Adrenal glands. Unlike male TT production, adrenal androgens in females are not regulated by Follicle Stimulating Hormone (FSH) or Luteinizing Hormone (LH). FSH and LH stimulate ovarian TT production – but most is aromatised back to Oestrogen (3).

It’s important to note that in Insulin sensitive females, FSH and acceptable blood concentrations of Insulin (<10ng/ml) stimulate aromatase activity (i.e.: the conversion of TT back to Oestrogen); higher blood Insulin concentrations (100ng/ml) does NOT activate aromatase – hyperinsulinaemia (found in PCOS) suppresses aromatase activity (Steroids: 2001).

Insulin resistance of varying degrees are levels <10 mU/L with the optimised target to minimise inflammation being 5-7 mU/L (Van Zanden: 2023).

Hyperinsulinaemia disorders the negative feedback loop to the brain which monitors TT and Oestrogen blood levels, disrupting FSH (and LH) activity. FSH is stimulated for increased ovarian TT production in response to (perceived) low Oestrogen levels – but aromatase activity is suppressed, and TT levels continue to rise – and negative feedback response-aromatase failure disordering continues (Baratosy: 2010).

Scalp hair loss – commonly with an accompanying androgenic follicle miniaturisation and (sometimes) increased facial/body hair and a coarsening of the skin’s pores in the facial T-zone, results when TT cannot be aromatised back to Oestrogen and up-converts to Dihydrotestosterone (DHT). DHT is the biologically-active metabolite of TT – and three times more potent. DHT is formed in the hair follicles, adrenal and male reproductive glands; the important factor for causation here is the TT-DHT ratio – more than total or ‘free’ Testosterone per se (Chan: 2011).

Whilst not without their potential problems, TT and DHT are essential for developing sex-specific characteristics throughout a male’s life. It’s preferable for males to minimise aromatase activity and retain TT (Journal of Clinical Endocrinology Metab: 2002) – but elevated levels of these androgens in a female body comes with detrimental consequences.

For the interested reader: According to the research of Dr. Joanna McMillan (2017) with the late Dr. Michael Moseley, an 800 calorie per day diet formulated and undertaken with strict medical or dietitian supervision can reverse Insulin Resistance (and even non-insulin dependent diabetes [NIDD)). A meagre 800 calorie per day diet is not sustainable long term but purely used as a short-term driver for metabolic change.

1. ’Morbid obesity’ means DOUBLE the person’s normal body weight (height to weight ratio).
2. Pasta made from lentils/red lentils, chickpea etc.
3. By the enzyme ‘Aromatase’; mainly found in ‘fat’ cells of both sexes.

Writer’s note: Hyperinsulinaemia, obesity + TT-Oestrogen aromatase disordering may cause pattern hair loss in males also AND reduces efficacy of treatment therapies in both sexes. A dual presentation of ‘pattern’ AND ‘diffuse’ scalp hair density thinning will be evident in some women; purely diffuse (i.e.: from all over the scalp) in others

Copyright Anthony Pearce 2012 (fully revised January 2025)