Hair loss used to be something that women suffered occasionally after childbirth or illness. It is now so common that doctors see it every day.
Hormonal birth control is largely to blame. It damages the hair follicle in a way that can take years to repair. Other conditions such as PCOS and thyroid disease also play a role.
6 Types of hormonal hair loss
1) Hormonal birth control
Some progestins are like testosterone, so they shrink and damage your hair follicle. Modern birth control tries to get around the problem by using different progestins, but they are not much of an improvement, and they have the unfortunate tendency to cause fatal blood clots. Ironically, birth control is often prescribed to treat hair loss, in the hope that the synthetic estrogens will counteract the progestins and promote hair regrowth. My advice: Get OFF the Pill and stay off it. Let your body’s own estrogen and progesterone run the show for a change. Yes, stopping the Pill may trigger a temporary increase in shedding (2 to 3 months later), but that will pass. As your own estrogen and progesterone take charge, you will slowly regain your normal hair.
2) PCOS, testosterone, and insulin resistance
Testosterone causes hair loss. This occurs in women with polycystic ovarian syndrome, a condition which, incidentally, is headed for a name change because it has very little to do with cysts on the ovaries. Most PCOS-sufferers have high testosterone on blood test. Some have normal testosterone, but still show signs of testosterone sensitivity such as acne and facial hair. For a discussion of all the different types of androgens, see my latest post: 4 Causes of Androgen Excess.
The testosterone of PCOS is usually caused by insulin resistance, which in turn is caused by sugar, and other factors. The Pill causes insulin resistance, which is why using the Pill to treat PCOS is just bad medicine.
3) Progesterone deficiency
Progesterone is our natural androgen receptor blocker. In other words, it protects the hair follicle from testosterone. Progesterone is why women’s hair grows so thick during pregnancy. To have adequate progesterone, we must ovulate regularly. Women on the pill and women with PCOS do not ovulate and do not make enough progesterone. (The progestins in the Pill are not progesterone but can be more accurately described as anti-progesterone.) Another cause of progesterone deficiency is stress, which forces the body to convert progesterone into the stress hormone cortisol. Magnesium is essential for progesterone production and calms the stress response. Magnesium is also an androgen receptor blocker. For this reason, I recommend magnesium for any woman trying to recover her hair. Natural progesterone is a treatment option but must be used with caution, because an overdose will worsen the problem (see below). The best way to enhance progesterone is to restore normal ovulation by correcting insulin resistance, thyroid, or other obstacles to normal ovulation.
4) Thyroid disease
Either too little or too much thyroid hormone can result in hair loss. The conventional blood test for TSH is not enough to detect subclinical thyroid disease. I recommend testing for thyroid antibodies, T3 and possibly reverse T3. Once a thyroid problem has been identified, thyroid hormone in the form of T4, T3 or desiccated thyroid can be used. Do not overdose thyroid hormone, because it will then cause the same hair loss problem that it was meant to treat (see below). The best treatment for autoimmune thyroid disease is not thyroid hormone, but instead to lower the autoimmune response (thyroid antibodies). This can be done by removing gluten from the diet, correcting intestinal flora, and supplementing selenium.
5) Estrogen deficiency
Hair follicles love estrogen, which is why the synthetic estrogens in the Pill are often prescribed. If you have low estrogen, then you probably have vaginal dryness and scanty light periods—or no periods at all. Estrogen deficiency is most often caused by low body weight, eating disorder, smoking, low carb diet, gluten intolerance, or stress. The solution is to address the underlying cause and get your periods flowing again. I do not recommend estrogen supplements for young women. The low estrogen of menopause is a different story. Post-menopausal women can consider low-dose body-identical estrogen and progesterone. See my estrogen deficiency post.
6) Hormone overdose
Don’t fall into the trap of causing hair loss with the very hormone that you’re using to treat it. Excess thyroid, estrogen, progesterone and DHEA supplements can all cause hair loss. When the hair follicle is exposed to higher-than-normal levels of hormone, it shuts down and stops responding. It is a case of hormone deficiency in a sea of hormone. Small doses of thyroid, estrogen and progesterone can be helpful, but there is a small window of therapeutic value. A hormonal sweet spot. If it feels like you might need more, then you probably need less. If in doubt, lower the dose.
Be a detective
Other causes of hair loss include stress, illness, surgery and deficiency of protein, iron or zinc. Hair loss can be a side effect of many medications including anti-inflammatories and antidepressants. Count backwards on your calendar. The problem typically begins 3 months AFTER the cause, but it may be much longer. If the damage to the hair follicle is cumulative—as it is with the Pill—it may take years for the shedding to begin in earnest.
Once hair loss is established, it is often not enough to treat just one thing. You may need to line up a few treatments to get results Example: stop the Pill, take zinc, and address an underlying eating disorder.
Play the long game
Hair loss is distressing because it takes SO LONG to respond to treatment. The most perfect treatment cannot start to work any sooner than 3 months, and it may take more than a year. My message to women is this: Play the long game. Identify the underlying hormonal cause of your hair loss, and correct that. Stick with it. Stopping and starting many different treatments will get you nowhere.
Stay calm. Trust your body.
Don’t miss Part 2 of my hair loss series: 9 Things to Know about Female Hair Loss.