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There’s no doubt about it: losing your hair is incredibly personal, and it can be devastating to your self-esteem. For our discussion today, I want to dive deep into the subject of hair loss, how it comes about, and what you can do to help it get better.
What I want to stress to you, though, is not to judge yourself. While it may bring up insecurities, I want to help you feel better about this and know if, and when, you can expect regrowth to occur.
Hair Loss As A Symptom
The first thing to note is that hair loss is a symptom, not a diagnosis.
It is a symptom that is occurring because your body is not repairing something correctly.
If things aren’t being repaired well in one part of your system and you are noticing a big symptom, like hair loss, it may be because bigger health concerns are occurring elsewhere.
Therefore, resolving hair loss is critical for its own concern, and for your overall health.
Key Insight: In many cases, hair loss can be one of the first symptoms to appear that signifies something else going on in your body.
Hair Loss As A Slow Indicator
Another significant concept we need to keep in mind is that hair loss is what we call a “slow indicator.”
That means that it is a slow symptom for you to notice, and it is also a slow process to reverse it. When your body shifts in some way, which causes hair loss to start, it typically means it’s based on something that happened in the past 3-12 months (and not 3-12 days).
This means that when you identify and start to treat this problem, you can start to see hair loss stop or slow down in any meaningful way in 1-3 months. So yes, it does take time, and that cuts both ways.
Finally, it takes about 12-18 months total before we see hair start to come back in again. While the time it takes could be a bit long, the results are certainly worthwhile.
How Does Hair Loss Overlap With Thyroid Disease?
Many people struggling with thyroid disease have hair loss, and many have hair loss simply because of thyroid disease.
However, there is a difference here. Let’s start by thinking about the demographics.
If we’re talking about women in their 30’s, 40’s, 50’s, and 60’s, there is a large number within that population that has hair loss. There is also a large number that has thyroid disease.
While those things can overlap, it is possible to be a woman with thyroid disease and hair loss, and have the hair loss not coming from thyroid disease.
It is also possible to be a woman, to have hair loss, thyroid disease, and anemia, and to have hair loss, not from either of those.
Why is that? Well, in those cases we need to look at a collection of different factors:
- The pattern of the hair loss
- When it first appeared
- What the levels are like
In some cases, we only know this after the fact. Once you fix it, we can make that determination, but it is not always clear from the outset.
Degrees Of Thyroid Disease And Hair Loss
Generally, too much or too little thyroid hormone can result in hair loss.
However, it’s not typical that small differences in doses have big differences in this case (with this particular symptom).
When we think about symptoms including:
There is strong data that suggests changes that are well within normal, like subtle differences in thyroid levels, can completely make or break those symptoms.
That said, that’s not as common in the case of hair loss. It is more typical that we are talking about more extreme thyroid abnormalities that contribute to this symptom.
Later on in this article, we’ll also dive into thyroid autoimmunity. How much hormone your body has, and whether or not your body is attacking your thyroid.
All of these things relate to hair loss in different ways, and I want to help you explore each and every one of them in today’s discussion.
Hair Loss: Terms To Know
If we’re laying the foundation for today’s discussion, it would be helpful to begin with some terms that I think will help frame our conversation.
Here are some terms that will come up in this article:
- Effluvium – Excessive daily hair loss
- Alopecia – Visible hairlessness
- Anagen – The growth phase of hair follicles (lasting 2-6 years)
- Telogen – The rest phase of hair follicles (where hair falls out and follicle rests 2-4 months)
In the case of healthy follicles, they come and go. Generally, they are “on” longer than they are off, but they do not stay on forever. That is why some hair loss is perfectly normal.
How Much Hair Do We Have?
Now that we know a bit more about the vocabulary, let’s break down some of the basic ideas that will help inform what we discuss today.
For both adult men and women, we both have about 80,000-120,000 hairs at any given point in time. Women may have thicker hair, but the number is relatively the same.
On any given day, a healthy person can have 100 hairs that are lost. There is a lot of variation here, though, where it could be between 40-300, it varies wildly!
Typical Triggers For Hair Loss
So, what are some of the most common triggers that can result in hair loss?
Hormones. One can be oral contraceptives, either starting them or stopping them. Then, we have something called postpartum effluvium. This is hair loss that occurs after pregnancy.
What happens is that the stress and the hormonal changes of giving birth cause many follicles to go into their dormant stage (for 2-4 months post-delivery).
Key Insight: Just from the hormonal shift that goes on following the birth of a child, it is very common to lose hair as these follicles go dormant for a time.
Chemotherapy. Another important one to note is chemotherapy. There can be direct damage to the follicles (not just telogen, but real damage).
Oddly enough, when those follicles do come back they will do so in a synchronized way. For that reason, hair often comes back thicker than it was before.
Understanding the Types of Hair Loss
When it comes to just about any medical condition, it’s incredibly important to drill down exactly what you’re talking about. That’s because, as we know, hair loss is a symptom and not a diagnosis.
As we get more granular, we need to break down the types of hair loss and exactly how they are relevant to our discussion today.
There are three main types I want to talk about, which includes:
- Androgenetic Alopecia
- Alopecia Areata
- Telogen Effluvium (also called non-specific hair loss)
Key Insight: All of these are things that can be more common in those with thyroid dysfunction, especially diffuse alopecia (the more non-specific versions).
Of all of these aforementioned types, alopecia areata is the least relevant to thyroid function. We can see these as circular bald patches of complete hair loss.
I also want to distinguish that while we have the abnormalities of thyroid levels and autoimmune disease. This is something we’ll dive into a bit later during our discussion.
The first thing you need to be able to do is to tell what kind of alopecia you may be dealing with.
Sometimes you can tell by the patterns, and there is a tool called trichoscopy which is somewhere between a microscope and a magnifying glass.
This is used to take a much closer look at the pattern of hair growth and loss on the scalp. This allows a medical professional to evaluate the follicles in a more meaningful way.
Key Insight: The most common version of hair loss is called androgenetic alopecia.
Understanding Androgenetic Alopecia
In this situation, androgenetic hormones are related to hair loss. In women, this shows up in very clear hair loss around the middle line where you hair parts.
That is where it starts, and where it becomes the most dramatic. In fact, 40% of adult women can have some level of androgenetic alopecia.
This can relate to hormone levels when cycles are irregular, which can be cortisol elevation, HRT (women being given DHEA or testosterone), and PCOS.
For men, about 70% will have some sort of androgenetic alopecia. In these cases, it is most likely to occur temporal lines or the bald spot in the back of your head.
Much like women, hair loss in men can be aggravated by hormone replacement therapy, and it is a function of our hormones and how we turn testosterone into DHT.
Ultimately, it comes down to how the immune cells around the hair follicles respond to DHT. So, it’s not that we have too much hormone, it is what is happening in the cells rather than the levels in the body overall.
Treating Androgenetic Alopecia Hair Loss
Even if there is not yet a clear cause, or if that has been sorted out, it can still be a consideration to do things that would otherwise be helpful because it is such a slow process. So before you even know exactly what you are dealing with, you may want to treat potential core issues so you can get the process started.
In terms of conventional treatments that now exist, for androgenetic alopecia, these mostly relate to changing the local chemistry and how the body responds to hormones.
The main one for women is known as minoxidil. This is a compound that blocks the activity of DHT on the cell receptors.
It is applied topically, once or twice a day. It doesn’t have whole-body effects, and it can even cause more follicles to go into the telogen phase (with more thinning hair in the early phases).
With men, minoxidil is also an option, as is finasteride, which is an oral compound. For the latter, it is a smaller amount and is more effective than the topical application of minoxidil.
I do have mixed feelings about it, though, and that’s because there are strong concerns of the potential lasting side effects in men.
Some data argues that there is no real mechanism by which men could have any side effects, while others suggest that many men seem to have some sort of side effects.
For both men and women, there are some additional well-documented treatments:
- Low-Level Laser Therapy – Appears to be effective, with some mixed data, and a wide variety of types and units.
- Hair Transplant Surgery – Where a strap of skin is taken from the back of the head and put where they are needed on the scalp.
- Platelet Rich Plasma (PRP) – The idea of drawing blood, concentrating the platelets, and leveraging the useful chemicals to help heal the scalp.
- Camouflaging – Using things like keratin fibers, extensions, wigs, or partials.
Understanding Alopecia Areata
This is the third most common type of alopecia that we may deal with in terms of hair loss.
The name itself essentially means “baldness in a circle.” While not always a perfect circle, it is best understood as a chunk of the scalp that is pretty much completely bald.
It can be very localized, or it can be incredibly wide-ranging. In fact, it may even be across the entire body — where you won’t find any hair, anywhere at all.
Over the course of one’s life, this isn’t a very uncommon condition. Around 1-2% of people get it at some point in their lives.
In the majority of cases, it is localized, and in the majority of cases, it spontaneously goes into remission. It can come and go with no clear reason why.
It seems that it is more common when it is secondary to the autoimmune process of Hashimoto’s and Graves’ disease. It may relate to the autoimmune process, not just to the level of thyroid hormones.
Key Insight: Again, the variability here is important to remember. It can be all over the body for the long term, or it could be a small area very briefly.
Treating Alopecia Areata Hair Loss
To be honest, there are not a lot of great treatments for alopecia areata (unless there is an abundantly clear cause that is found).
The one thing that can be a clear cause, which is treatable, is cortisol elevation1.
Chronic high cortisol can lower hair production of hyaluronan and proteoglycans by 40%2. For whatever reason, that can occur in some areas and not always all over the body.
A good thing there is to simply do a good screen for cortisol metabolism. That is best done by both blood tests and salivary tests.
If it is off, you can see from both of those tests whether it is due to adrenal stress or adrenal disease of some kind. They are both important but are completely different in treatment.
Other Types of Alopecia
Before we really dig into the main type of alopecia that I want to cover today, I wanted to address some more inflammatory (and rarer) types of alopecia.
- Folliculitis decalvans
- Folliculitis et perifolliculitis
- Lichen planus
As a generalization, if there is some hair loss and the scalp is red, inflamed, scaly, or scarred, any of these could be one of these inflammatory alopecias.
Key Insight: If you are seeing any of this, your first visit should be to a dermatologist. They can help provide a more specific diagnosis with specific treatments.
Understanding Chronic Telogen Effluvium (CTE)
This is what is otherwise known as nonspecific hair thinning, and it’s not only the most common, but it will make up the bulk of today’s discussion.
The way that CTE reveals itself is much more diffuse and even when compared to the other types of alopecia that we covered.
That means that it is going on, all over the head, and is occurring rather evenly.
The group that deals with CTE the most are women between the ages of 30-60. In many cases, there is really no clear cause — it can show up on a whim.
What CTE does is not harming the hair follicles, but an escalation of hair loss. That means that too many follicles are going dormant, all at once, resulting in rapid hair thinning.
Key Insight: In these cases, that daily amount of hair loss may be somewhere around 400 hairs.
Now, it is important to note that you can have CTE and not have thinning hair. What I mean by that is that you could be losing a lot of hair, but the growth is keeping up with it.
In most cases, though, that is not as noticeable. It is much easier to notice when otherwise healthy hair is now thinning.
How Does Thyroid Disease Relate?
I want to start by talking about thyroid levels.
This is something that is a bit counterintuitive, and that’s because it’s not just a matter of too little hormone. It can be, but it can also be a matter of too much (or big fluctuations).
More thyroid is not always the answer, which means that simply prescribing it as a way to combat hair thinning or hair loss doesn’t solve the problem, it can even make it worse.
So, what about autoimmunity and high thyroid antibodies? Do high thyroid antibodies affect hair loss, and what should we know about them? (Read More: The Essential Guide To Thyroid Antibodies)
I dug really deep into this, but the vast majority of the data suggests that it’s not an issue — one study did state that it may make hair more fragile, but nothing more. This was also done on a population without good thyroid function and a small population at that.
The best data we have is that thyroid antibodies should not be a culprit for hair loss. That is not to say that you couldn’t have high antibodies and have hair loss, it can still happen, but in cases like that, we wouldn’t focus on thyroid antibodies.
Instead, we might focus on:
- How is your cortisol?
- Are your thyroid levels good?
- Are you nutritionally-replete?
- Is anemia an issue?
If your hair is thinning, and your antibodies are dialed in, that is probably not the most powerful lever you should focus on pulling. Elsewhere in your body is the key.
What Else Can Be Relevant?
As we mentioned before, high cortisol can be a factor (as in the case with androgenetic alopecia).
That said, I have not found suggesting that chronically-low cortisol or a bad cortisol curve that it can be a clear trigger. On the other hand, high cortisol definitely is one.
Key Insight: By and large, most high cortisol is a matter of adrenal dysfunction. It is really treatable, but it is important to identify and begin that treatment.
We also need to consider high levels of androgens. In rare cases, they can be a factor when it comes to CTE (and not just related to androgenetic alopecia).
This takes us back to thinking about HRT if you are too much DHT or testosterone, or if you are dealing with PCOS.
This can be a huge thing for women dealing with hair loss. This isn’t just about being anemic, but latent iron depletion (the first stages where ferritin gets low). (Read More: A Deep Dive On Iron)
While it takes more of a deficiency to cause hair loss then it takes to reverse hair loss. This means that while you may be able to get super low before your hair starts thinning, you will need to get much higher (almost back to full) before it returns to normal.
Key Insight: Your goal for ferritin should be 70/100 ng/ml3.
I was a bit surprised seeing the data on this, but it is really on the rise. Those who are not in long-term relationships, it is not that rare to have syphilis.
In fact, someone may have no real symptoms apart from hair thinning or hair loss, there may be no other way that syphilis is revealing itself.
On top of all that, it is easy to screen for and diagnose. For all these reasons, it should factor into your thinking if you’re getting to the bottom of hair loss.
Other Contributors To Hair Loss
Apart from some of the more obvious causes that we have detailed above, I wanted to include some additional contributors that may help you make sense of hair loss…
Low Protein Diets
Somewhere below 15-20% of protein, by calorie, may result in hair loss. Of course, this doesn’t happen to everyone, but it can for some4.
The idea here is that proteins are essential, and your body uses them in some ways that are more important than others.
When it comes to picking and choosing between maintaining cardiac function or immune response or keeping your hair going, your body chooses the former options.
Hair fibers themselves are about 98% keratin proteins, so it is critical that you are getting adequate essential amino acids to form that.
Stress, Anxiety, and Depression
There is a little bit of controversy about this one.
We do know that, if they do accompany chronic cortisol elevation, they can be culprits for hair loss. But, we are not sure if they do it by themselves or only through mediating cortisol.
There are also times where stress and anxiety can result in higher rates of pulling out your hair. Eventually, this can damage and cause loss when you are constantly pulling it out.
Micronutrients to Consider
It is also helpful to consider some micronutrients that may be contributing factors to hair loss. Here’s a couple I want you to be mindful of — besides iron, the best-studied ones are:
Zinc seems to be the most relevant for all types of hair loss5. Not only did studies surrounding zinc show that those suffering from hair loss were low in serum zinc, but that zinc supplementation did improve symptoms.
That’s an important thing because it shows that zinc is something that is useful when it is supplemented correctly.
Being low in Zinc can happen to those who are on diets that cut out a lot of food categories, but we generally don’t know exactly why it is relevant.
It is also common for those who are low in zinc to notice that:
- Their nails are brittle
- They have a poor sense of smell
- They have difficulty with wound healing
Biotin, on the other hand, has formed its own sort of urban legend when it comes to hair growth and hair health. So, I was a bit skeptical at first.
But, what I found was some strong studies showing that many can be low in biotin — and that it may even be a contributor to hair loss6.
Much of what you read may argue against that, but one paper showed that with women with no clear explanation of why they were suffering from hair loss, 38% of them were measurably low in biotin.
By and large, it is fairly easy to absorb biotin orally. That said, we do see fewer vegan food sources that are dense in biotin. Yeast and mushrooms are a good start, but as a vegan, you will need those in your diet to keep your levels of biotin up.
Key Insight: It doesn’t take a tonne of biotin. Even if you are getting over 100 micrograms per day is typically enough to keep you in good shape.
You can test for biotin pretty readily in blood. Serum levels are available, and it is important to avoid biotin 73 hours before testing. Here’s the breakdown:
- Deficient: <200 ng/l
- Suboptimal: 200 – 400 ng/l
- Optimal: >400 ng/l
By and large, if you are consuming a good variety of protein sources and get some in supplementation, biotin shouldn’t be a huge factor for your health.
Does Anything Else Help For Hair Loss?
So, what else can you do to help with hair loss? While there are some things, they mainly revolve around CTE (not as much on the other two that we covered earlier).
Some things that have been studied include:
- Green Tea – One meta analysis showed that green tea in supplementation can be helpful in cases of CTE7.
- NAC – One of the building blocks of keratin, oral NAC has some good effects on its antioxidant actions and to help with keratin production8.
- Bamboo Extract – One randomized placebo study found that a silicate compound could have positive effects on hair thickness and density9.
- Grape Seed Extract – More as a topical solution, it may work in the same way as things like Minoxidil10.
Key Insight: The hair, skin, and nails blend that we have formulated includes all of these things, all designed around evidence-based ingredients to help promote hair growth and your health.
Hair Loss: Action Steps
The first thing to remember, always, is that hair loss is a symptom and not a diagnosis.
In the spirit of that, you will want to ensure that you get a proper diagnosis. This will help make sense of what you’re dealing with, and how you can treat it most effectively.
Once you are aware of your type, you need to consider some of the most common causative factors for hair loss. This includes things like:
- Thyroid disease
- Iron levels
- Cortisol levels
Building on that, there could be additional contributing factors:
Key Insight: After any of these abnormalities have been corrected, you can expect 1-3 months to see changes in hair loss, and 6-12 months to see changes in hair density.
Another key thing to note is how frequently you are washing your hair. Washing does not accelerate loss, while the physical motion may loosen hairs that are about to fall out.
Frequent washing, though, may reduce the build-up of DHT around hair follicles that cause androgenetic alopecia. Many dermatologists recommend daily shampooing for this reason.
Bottom Line: Figure out your diagnosis, determine any issues that may be at play, treat them, and wash your hair frequently. From there, you can begin to properly treat hair loss and help your hair get back to its best.
Test Your Thyroid Today
The more you know about your body, the better you can correct things that may be revealing themselves as issues. Hair loss is no different, and it may begin with your thyroid.
That’s why I hope you will start today by taking the Thyroid Quiz (Click Here: Take The Quiz). It can help you understand the state of your thyroid, and what you can do moving forward.
After all, having all of the information you can about your body is key. I’d like to help start you on that journey to better health today.
1 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908932/
2 – https://pubmed.ncbi.nlm.nih.gov/27538002/
3 – https://pubmed.ncbi.nlm.nih.gov/16635664/
4 – https://sci-hub.se/10.1016/j.jaad.2014.04.070
5 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315033/#b39-dp0701a01
6 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989391/
7 – https://pubmed.ncbi.nlm.nih.gov/23346663/
8 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017824/#!po=20.8333
9 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938278/
10 – https://www.medicaljournals.se/acta/download/10.1080/000155598442719/
P.S. Whenever you are ready, here is how I can help you now:
1. Schedule a Thyroid Second Opinion with me, Dr. C, Click Here for Details
2. Download and use my Favorite Recipes Cookbook Here
3. Check out my podcast Medical Myths, Legends, and Fairytales Here
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.