A Different Approach to Treating Hair Loss
Hair Loss in Women
Alopecia is the medical term for excessive or abnormal hair loss. Losing hair is a natural part of the hair growth cycle. The hair growth cycle is ongoing, and on an average day, 90% of your hair is in the resting phase while the other 10% is either growing or shedding. Hair loss occurs when the hair sheds, and no hair re-grows to replace it. When hair does not grow back as it should, we start to notice thinning hair and a more visible scalp through the hair. Hair loss can be a symptom of a short-term events such as stress, pregnancy, and the taking of certain medications. In these situations, hair will often grow back when the event has passed.
The stages of hair growth: Anagen (growing) –>Catagen (resting) –>Telogen (shedding). Longer time in the Telogen phase and delayed entry into the Anagen phase leads to hair loss.
Female Pattern Hair Loss (FPHL) also known as female androgenetic alopecia primarily affects the top and front of the scalp (bald spot on crown). Forty percent of women suffer from this type of hair loss. Heredity (father’s side) plays a major rule and if both woman’s parents carry the hair loss genes, it is likely that she will suffer from female pattern hair loss. Other causes include androgens (high testosterone and DHT), thyroid issues (hyper and hypothyroidism), low iron stores (ferritin), stress, and menopause (low estrogen stats). Estrogen helps hair grow faster and stay on the head for a longer duration, leading to thicker, healthier hair.
Alopecia Areata is an autoimmune disease that causes hair to fall out in small, random patches. This type of the hair loss usually affects the scalp, but it can also occur in other areas of the body. It is due to the immune system attacking hair follicles, resulting in hair loss. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria.
However, with Alopecia areata your immune system mistakenly attacks your hair follicles which are the structures for hair growth. In alopecia areata, the follicles become smaller and stop producing hair which leads to hair loss. Alopecia areata most often occurs in people who have a personal family history of other autoimmune disorders, such as Hashimoto’s hypothyroidism, Grave’s disease, Addison’s disease, Type 1 diabetes, Lupus or Rheumatoid Arthritis. In Alopecia Areata, the hair may grow back at any time and then may fall out again. A scalp biopsy can be used to diagnose Alopecia Areata. Hair will tend to pull out more easily along the edges of the patch where the follicles are already being attacked by the body’s immune system than away from the patch where they are still healthy.
There is no specific treatment for Alopecia Areata.
Diffuse alopecia areata is autoimmune disease that causes diffuse hair loss over the whole scalp.
Alopecia totalis, is an autoimmune disease that cause hair loss across the entire scalp.
Alopecia universalis, is an autoimmune disease which causes the loss of all hair on the entire
Alopecia areata incognita(AAI), which may or may not be the same as diffuse alopecia arreata, is a rare form of alopecia areata. It is occurs predominantly in young women and the typical patchy distribution of hair loss in classical alopecia areata is absent, but abrupt and intense hair loss is characteristic.
Telogen effluvium occurs after the body goes through something traumatic such as child birth, malnutrition, a severe infection, major surgery, or extreme stress. Hair in the anagen (growing) phase or catagen (resting) phase can shift all at once into the telogen (shedding) phase.
About six weeks to three month after the stressful event, usually hair loss begins. It is possible to lose handfuls of hair at time when in full-blown telogen effluvium. As long as stressful events are avoided, complete remission can be expected.
Anagen effluvium occurs after any insult to the hair follicle that impairs its mitotic or metabolic activity. Commonly seen in patients after chemotherapy which targets the body’s rapidly dividing cancer cells, the body’s other rapidly dividing cells such as hair follicles in the growing (anagen) phase, are also greatly affected. The characteristic finding in anagen effluvium is the tapered fracture of the hair shafts. Eventually, the shaft fractures at the site of narrowing causing the loss of hair.
Medications associated with hair loss
- Anticoagulants (blood thinners)
- Cholesterol drugs (Lipitor, but not Crestor)
- Anti-depression drugs
- Some Antifungals (not ketoconazole)
- Beta blockers
- Nonsteroidal Anti-Inflammatory Drugs
- Prednisone and other steroids
- Birth Control Pills (usually have high progesterone and low estrogen)-especially high androgen birth control pills. Desogen is the lowest androgen birth control pills, Loestrin is the highest
- Progesterone, Depo-Provera, Norplant
- All forms of testosterone
Diagnosis of hair loss
Scalp biopsy can be performed to determine causes of hair loss. This is usually done by dermatologists. A hair pulling test is another way of determining if there is excessive loss of hair. This is done by pulling small amount of hair. Normal range is one to three hairs per pull. As an endocrinologist, Dr. Friedman will focus on hormonal causes such like hypothyroidism (Hashimoto’s), hyperthyroidism, fluctuating thyroid levels, Cushing’s Disease, vitamin D deficiency, growth hormone deficiency, high
testosterone/DHEAS/dihydrotestosterone (DHT), polycystic ovarian syndrome (PCOS), Congenital Adrenal Hyperplasia (CAH), excessive progesterone, high prolactin, low estrogen, or iron deficiency (low ferritin).
Treatment of hair loss
Dr. Friedman’s approach to hair loss is optimizing hormones. This includes optimizing thyroid hormones, examining for growth hormone deficiency, treating low ferritin (target level around 70 ng/mL), treating low estrogen (target estradiol 50-100 pg/mL), raising 25-OH vitamin D to at least 30 ng/mL, and gluten-free diet is recommended for celiac diseases). Dr. Friedman will also test for lower bioavailable testosterone (> 8 ng/dL) and/or DHEAS (>250 ug/dL).
Commonly used medications are metformin, flutamide and spironolactone for high androgens. Cimetidine, a drug used for ulcers is often helpful. In some cases, topical corticosteroids, clobetasol or fluocinonide creams can be offered. However, these are only moderately effective and takes a long time to see results. Steroid injections can be given by a dermatologist in sites where the areas of hair loss on the head are small.
Elocon (mometasone) ointment, irritants (anthralin or topical coal tar), and topical immunotherapy, such as cyclosporin can be considered in severe cases. Nizoral shampoo contains 2% ketoconazole and can be given once or weekly.
Supplements such as Ovasitol, Resveratrol, Omega 3s, NAC, Biotin, Viviscal Extra Strength Oral marine protein), Betaine Hcl pepsin, ginseng, black cohosh, Macafem (contains Lepidium meyenii) can be used to treat hair loss. All are mildly effective and can be used in combination.
Nutrients deficiency also can play a role in hair loss. Optimizing iron, vitamin D, zinc, and selenium can be helpful in some cases. Lifestyle changes with good diet such as avoiding crazy diet fads that may throw hormones into a tizzy and consuming protein-rich foods, along with essential fatty acids, iron, and vitamins D and E, are all healthy options for treating hair loss.
Regular exercise promotes multiple health benefits, including hormone balance. Stress reduction is key to slowing hair loss, since chronic stress can lead to hair loss as stress moves the hairs out of the growth or resting stage and into the shedding stage of the hair cycle. Poor sleep habits can worsen stress and increase hair loss. Dr. Friedman recommends at least 7 hours of sleep per night for adults 18 and older.