One of the most emotionally devastating concerns we hear about from our customers and readers is thinning hair and hair loss. At Women's Health Network, we understand that a woman’s head of hair is her crowning glory — and losing too much hair can be a serious and frightening blow to her self-esteem.
Reacting so strongly to the physical state of your hair may seem like vanity, but it’s not. Your hair is one of the first areas, along with skin and nails, to manifest signs of hormonal imbalance, poor nutrition, or illness. Understanding how hair naturally regenerates and paying attention to any changes in your hair growth and appearance are important parts of taking care of yourself.
The truth is, a certain amount of continuous hair loss is normal. Although more than one-third of women experience excessive hair loss or hair thinning at some point during their lives, it’s an indication that something is not right. Unfortunately, many conventional doctors downplay hair loss as an inevitable part of aging for both sexes, treating it with topical products like Rogaine that enhance existing hair but offer no real solution to underlying causes of hair loss, and therefore no prevention of continued hair thinning. This leads many women — especially those in menopause — to think that there is nothing they can do to stop their hair loss. The good news is that we’ve seen many cases resolve over time with a holistic approach.
While we wouldn’t claim to know the ultimate cure for all hair loss (don’t believe anyone who says they do!), we don’t think a balding woman should resign herself to shopping for hair thickeners or wigs when there are so many other natural choices she can make to support natural hair growth where it counts — at the root.
Your hair up close
A strand of hair is made up of extruded, compacted dead cells. It grows from living follicles in the skin of the scalp. At the hair follicle, or root of the hair, all of your major systems are at work, including your circulatory, endocrine, and nervous systems. That’s why it hurts when someone pulls your hair!
Every hair follicle has four distinct phases it cycles through on a regular basis: growth (anagen), transition (catagen), resting (telogen), and returning growth (mesanagen) (see figure below). A full cycle can last anywhere from two to five years per follicle. Unusual hair loss and thinning can occur for several different reasons, which is why it’s important to get a clinical evaluation. In some cases, the follicle is healthy but the hair cycle is thrown off (e.g., shortened growth phase or too many hairs at the same time entering the resting phase. In many cases, androgens (male sex hormones) are involved. In other cases of hair loss, the follicle itself is inflamed, resulting in abnormal hair growth. When a group of follicles are inflamed, bald spots can occur. Most of the time this happens gradually, but in some cases (especially a few months following a major stressor), it can happen all at once, causing clumps of hair to fall out.
© 2006 Women's Health Network
Do you have unusual hair loss? Take our “pull test”
Human beings lose hair every day, as many as 100 strands a day. This may sound like a lot, but in a normal cycle just as many hairs are coming in. You can test hair loss with the “pull test.” Take about 50 hairs between your fingers and pull gently but firmly. Normally about 2-5 hairs will come out — reflecting the average 10% of hair follicles that are transitioning towards the resting phase at any one time. More than 6 hairs may indicate a systemic imbalance (e.g., low thyroid function) or a hair loss disorder, such as telogen effluvium or alopecia areata.
Telogen effluvium, which occurs when too many hairs enter the resting phase, may happen suddenly, commonly about three months after a major stress to the body, or due to hormonal imbalances, nutritional deficiencies, or certain medications. Hair loss on the scalp may be diffuse, and armpit or pubic hair may thin as well. The thing to realize about the resting, or telogen, phase is that it is designed to be temporary. Hair follicles can be shocked into the resting phase by many stressors, and just as suddenly switch back “on” once the stress is eliminated. In other words, this type of hair loss often reverses with time, and that “miracle cure” for hair loss that you read about the internet may well be a waste of your money! A majority of women with moderate hair loss will notice big improvements just by paying more attention to their stress levels and nutrition.
Alopecia areata is a hereditary autoimmune disorder, in which the hair follicles are inflamed, so don’t function normally; the new hair that comes in is weak and more fine. Patches of hair loss may occur, and brows, eyelashes, and body hair may be involved. If you have one of these disorders , you may notice more hair than usual in your hairbrush or on your pillow or bathroom floor. Keep in mind that the darker and thicker your hair is, the more noticeable it will be against the shower floor or sink. I.e., you may think you’re losing more hair than you actually are.
Androgenetic alopecia (female pattern hair loss) — the most common hair loss disorder in women — typically involves higher levels of androgens (male sex hormones). When androgens are excessive, or when receptors in the skin become extra-sensitive to them, they can shorten the growth phase of the hair cycle and shrink the hair follicles. The quality and thickness of head hair diminishes, and a bald spot may show up. It almost always occurs at the crown and sides of the head, and may also involve unusual hair growth on the face and other areas on the body; acne and menstrual irregularities may also be present. The “pull test” in this case is usually negative.
Causes of hair loss in women
Why do certain hair follicles break their normal cycle and switch into a resting or “off” position, whether temporarily or permanently? And why do some women experience thinning hair on their heads but darker, thicker hair on other parts of their bodies?
Causes for hair loss are numerous and highly individual, but can include any combination of the following:
- Severe stress (emotional and physical) or recent life-threatening situation
- Hormonal imbalances, e.g., androgen sensitivity, recent childbirth, fluctuations through the menstrual cycle, or menopause
- Change in hormonal birth control
- Immune system irregularities (e.g., allergies)
- Yeast overgrowth or fungi
- Thyroid disorders
- Sudden, dramatic weight loss (e.g., from crash-dieting)
- Nutritional deficiencies (especially iron, vitamin D, vitamin A, or protein)
- Harsh hair treatments)
- Dental treatment
- Blood loss (resulting in iron deficiency anemia)
- Medications (including anticoagulants, anticonvulsants, anti-thyroid medication, and hormone therapy)
- Excess traction to the hair during styling (e.g., braiding, tight ponytails)
- Chronic illness
- Severe infection
- Major surgery
If you’re currently or have recently been under severe stress, providing your body with a little extra support through nutritional supplements and TLC can help normalize your hair cycle and boost hair growth. For this reason, we always tell women who report surprising hair loss to follow our Nutritional and Lifestyle Guidelines for three to six months, including hair–specific vitamins and supplements. But you can also ask your healthcare practitioner to review your symptoms and health concerns carefully before proceeding to more intrusive diagnostic or treatment methods.
A hair loss work-up
Most mild-to-moderate hair loss will often improve with some basic stress reduction and positive lifestyle changes, including nutritional. Hair loss that is more dramatic or persistent warrants a closer look. Here are the tests I’d recommend discussing with your practitioner. Depending on your history, hair loss pattern, and other possible symptoms, he or she can recommend the most appropriate tests from the following list:
- thyroid tests (e.g., TSH, T4, anti-thyroid antibodies)
- iron tests (ferritin) to check for iron deficiency
- sex hormone panel (e.g., free testosterone, prolactin, FSH, LH); total testosterone levels are usually normal
- fasting insulin and glucose
- CBC (complete blood count)
- ESR, ANA, RF (if suspected autoimmunity)
- allergy testing
It’s important to understand that conventional doctors have a wide range of test results that they consider “normal”; specifics vary by the type of test, but for argument’s sake, let’s say it’s 1–100. If your number falls near the edge of this range but still within it (e.g., 2 or 99), you are still considered “normal,” despite the fact that health and disease are on the same continuum. So, look for test results that fall near the midline. Anything well below or above this may is worth a second glance.
Hormones and hair loss — menopause, PCOS, and male pattern baldness
Let’s talk a little more about androgenetic alopecia, the most common cause of hair loss in both men and women. Like your body’s own version of Miracle-Gro, androgens (testosterone and DHEA) in both men and women are naturally converted into another androgen called DHT (dihydrotestosterone). Problems arise when DHT production speeds up or when the follicle’s receptors become oversensitive to androgens and shut down — like locking a door. This can happen when one or more of the following three conditions prevail: a genetic proclivity, abnormally high levels of free testosterone, or a change in sensitivity to normal levels of circulating androgens.
Hormonal imbalance due to PCOS (polycystic ovarian syndrome) or perimenopause is the primary cause of male pattern baldness in women. Because so many women with PCOS have high levels of circulating androgens and are also insulin-resistant, a growing number of practitioners are looking at the connection between insulin resistance, testosterone, and hair loss. It’s possible that receptor resistance to insulin and sensitivity to androgens go hand in hand. One Finnish study of women in their 60s showed a strong correlation between insulin resistance and increased risk of hair thinning, particularly when a subject had a paternal history of hair loss. Some women carry a genetic predisposition to female pattern hair loss, but the process occurs to some degree in every woman as she ages and estrogen levels fall. Decreasing estrogen levels may allow the body to convert more available testosterone to DHT. The good news is that many cases of female pattern hair loss resolve or limit themselves once hormonal (estrogens, androgens) and metabolic (glucose, insulin) balance have been restored.
What about drugs for hair loss?
New testosterone–blocking drugs like flutamide and finasteride have been only minimally effective in reversing hair loss in women and should not be taken by women of childbearing age — they are generally only appropriate for men and could even exacerbate hormonal disorders in women.[Shapiro ‘07]
Keep in mind, these drugs only take aim at the surface of the problem; they can’t rebalance the body from the inside-out like a more natural approach can.
Immunological and infectious factors in hair loss
If hair loss worsens over time, or if hair falls out in big clumps, creating patchy, bald spots all over the head, it may indicate a more serious autoimmune condition called alopecia areata, mentioned above, or an infection-induced alopecia called cicatricial alopecia, in which scarring destroys the hair follicle. In the case of alopecia areata, it’s not uncommon to also have at least one other autoimmune disorder.
These hair concerns go beyond the scope of this article and are definitively diagnosed by a punch biopsy, in which a minute section of the scalp is removed and tested. As of this point, there is no cure for alopecia areata, only topical solutions and injectable steroids. But we believe our holistic approach can help balance immune function and stem further progression of hair loss.
Occasionally an overgrowth of fungus or yeast can trigger severe follicular inflammation that results in hair loss. This can be diagnosed by a dermatologist after a thorough scalp examination. Treatments vary depending on the practitioner, but usually involve some kind of topical anti-fungal shampoo or solution.
New inroads into hair transplants, laser stimulation, and topical products are a great reason not to despair if you’ve been diagnosed with alopecia areata or another troublesome scalp condition. A new type of minimally-invasive hair transplant procedure called follicular unit extraction (FUE), or “NeoGraft” is offering promising results, though it is costly and not yet widely available. You may not have the head of hair you were born with, but some of these developments may provide the next best thing.
Natural hair loss solutions
Conventional topical solutions for hair loss, like Rogaine (minoxidil) enhance and thicken existing hair — they do not generate new growth. They also must be used continuously, or hair loss will resume.[Shapiro ‘07] These products may be useful for some women who can deal with a small bald spot or expanding part line by changing their hairstyle, but they do nothing to restore natural hormonal balance or metabolic function — the factors that are causing the excessive hair loss in the first place.
If your hair loss is mild to moderate, the most important thing to do is weigh the immediate or recent stressors in your life against how much support you’re giving your body. Start with an honest inventory of your healthy and not-so-healthy habits. Then take some steps toward shifting the balance to the support side. Here’s what we recommend:
- Eliminate dietary causes of hair loss. Eat a balanced diet comprised of whole, protein-rich foods — organic, if possible. Avoid or limit refined sugar and other simple carbohydrates to ameliorate insulin resistance. Read how in our Nutritional and Lifestyle Guidelines.
- Address vitamin deficiency hair loss. Take a rich multivitamin like the one we offer in our Hormonal Health Program that includes hair-healthy vitamins such as B, C, D and E. Other important nutrients are calcium, magnesium, copper, zinc, and iron. (Iron status should always be checked with a lab test; higher doses than found in a multi will be needed if you’re determined to have anemia.) A fish oil supplement containing vitamin D and essential fatty acids will help support immunity and soothe inflammation.
- Balance your hormones. If you are going through menopause or have been experiencing hormonal fluctuations, consider gentle endocrine support like our Herbal Equilibrium to help naturally rebalance your hormones.
- Consider alternative approaches. Scalp massage and acupuncture can be helpful for stimulating blood flow to the scalp and supporting hair follicle function. Ginkgo biloba also increases blood flow to the scalp by stimulating overall circulation.
- Examine your emotional health. If you have been under severe physical or psychological stress, your hair loss could be a result and should improve within six months after the stress is relieved. Finding healthy ways to express your feelings can go a long way toward reducing stress, as can gentle meditative exercises and practices, and restructuring your lifestyle in ways that support yourself.
If you’ve tried these measures first on your own, but seen no improvement after six months (it will take time to notice changes), talk to your healthcare practitioner. He or she may recommend undergoing some or all of the tests outlined above. If you’re told that the results are normal, ask to see the results and where they fall within the reference range. If close to the abnormal range, discuss supplements or treatment targeted toward hair growth with your practitioner.
New growth in every way
Remember that the condition of your hair mirrors what’s going on inside your body. It only makes sense to consider natural options that nurture your whole health before spending a lot of money on expensive shampoos, conditioners, and hair-thickening products. While some of these products may enhance the appearance of your existing hair, they don’t generate new hair. Nurturing your health from the inside out, including your emotional health, should improve the quality and quantity of your hair, as well as your overall quality of life!
1 Shapiro J. Clinical practice. Hair loss in women. N Engl J Med. 2007 Oct 18;357(16):1620-30.
2 Mirmirani P. How to approach hair loss in women. Dermatol Nurs. 2007 Dec;19(6):531-5.
3 Springer K, Brown M, Stulberg DL. Common Hair Loss Disorders. American Family Physician Web site. http://www.aafp.org/afp/2003/0701/p93.html. Accessed June 13, 2014.
4 Mirmirani P. How to approach hair loss in women. Dermatol Nurs. 2007 Dec;19(6):531-5.
5 Shapiro J. Clinical practice. Hair loss in women. N Engl J Med. 2007 Oct 18;357(16):1620-30.
6 Mirmirani P. How to approach hair loss in women. Dermatol Nurs. 2007 Dec;19(6):531-5.
7 Springer K, Brown M, Stulberg DL. Common Hair Loss Disorders. American Family Physician Web site. http://www.aafp.org/afp/2003/0701/p93.html. Accessed June 13, 2014.
8 Springer K, Brown M, Stulberg DL. Common Hair Loss Disorders. American Family Physician Web site. http://www.aafp.org/afp/2003/0701/p93.html. Accessed June 13, 2014.
9 Herskovitz I, Tosti A. Female Pattern Hair Loss. Int J Endocrinol Metab. 2013 Oct 21;11(4):e9860.
10 Matilainen V, Laakso M, Hirsso P, et al. Hair loss, insulin resistance, and heredity in middle-aged women. A population-based study. J Cardiovasc Risk. 2003 Jun;10(3):227-31.
11 Springer K, Brown M, Stulberg DL. Common Hair Loss Disorders. American Family Physician Web site. http://www.aafp.org/afp/2003/0701/p93.html. Accessed June 13, 2014.
12 Avram MR, Leonard RT Jr, Epstein ES, et al. The current role of laser/light sources in the treatment of male and female pattern hair loss. J Cosmet Laser Ther. 2007 Mar;9(1):27-8.
13 Hair-Raising Breakthrough. May 13, 2010. Medical Breakthroughs Reported by Ivanhoe. Ivanhoe Web site. http://ivanhoe.com/channels/p_channelstory.cfm?storyid=24105. Accessed June 13, 2014.