Your hair is your pride and joy, but lately you’ve noticed hair thinning or hair loss. 

It’s heartbreaking, I know. 

The bad news? There is never going to be “just take this supplement” kind of answer, because there are so many drivers behind hair loss in women.

The good news? By digging down to the root cause of the issue, in many cases you can have thicker, fuller hair once again. 

So what causes hair loss in women? Glad you asked. Because in this blog post, I’m going to answer that question and let you know the natural treatments for this common and frustrating problem.

 

Searching for Clues

When seeing a patient who complains of hair loss or hair thinning, I look at the symptom picture and history. 

Most importantly, I observe the type of hair loss. 

If the hair loss is patchy, it could signal autoimmune psoriasis. Patchy hair loss could also suggest alopecia areata, an autoimmune condition that causes hair loss. 

Overall thinning tends to be a sign of hormonal hair loss in women, which may be due to high cortisol and stress or estrogen or progesterone imbalances. Overall thinning could also be a symptom of nutrient deficiencies. 

 

What Causes Hair Loss in Women?

There are many reasons for hair loss in women. That’s why it’s important to work with a functional medicine provider to help you figure out the cause (or causes) of your hair loss. (more on functional medicine providers later). 

 

Menopause and Perimenopause

As many as 40% of women notice their hair thinning in the years before and during menopause. This isn’t a given. It’s not like it happens to everyone. But it’s common enough to include it in this blog post. 

Hair is vulnerable to falling out after a drop in estrogen and progesterone, which occurs during menopausal stages. When these hormones fall, hair may become thinner and grow more slowly.

 

Medications

A number of prescription drugs can cause hair loss or hair thinning. Here are a few of the common culprits:

  • Birth control pills
  • Chemotherapy
  • NSAIDS
  • Acne medications

 

Your DNA

Unfortunately, hereditary hair loss is the most common cause of hair loss and the one that is the most difficult to treat. This type of hair loss is typically gradual and involves a receding hairline and bald spots in men and a thinning of hair along the crown of the head in women.

 

Blood Sugar Issues

Elevated insulin levels in women can cause excessive production of male hormones, excess levels of free testosterone, or increased sensitivity to male hormones. Androgens are a group of sex hormones found in all genders, but men make more of them. Important for bone, muscle, sex drive, and sexual development, androgens include testosterone, androstenedione, dihydroepiandrosterone (DHEA), DHEA-sulfate, and dihydrotestosterone (DHT). 

When these male hormones go unusually high in women, it’s called hyperandrogenism and may promote acne, hair growth on the face, or a deep voice. It can cause hair loss at the front and sides, in the male pattern. Women with insulin resistance and/or polycystic ovary syndrome (PCOS), for example, typically have high levels of testosterone (or it’s metabolites) due to high insulin levels. These women are also prone to hair loss. 

But testosterone is not the big culprit behind hair loss, it is testosterone’s downstream metabolite- dihydrotestosterone – which is ultimately responsible for hair loss. Testosterone converts to DHT thanks to the enzyme, 5-alpha reductase. Many hair loss supplements try to block this enzyme.

If a woman or a man is insulin resistant, they produce more DHT. DHT can trigger the death of hair follicles. In fact, the main culprit behind hair loss is not testosterone itself but rather the level of DHT binding to receptors in hair follicles. 

 

Hormonal Hair Loss in Women

Imbalances in hormones can lead to hair loss. If any of the following hormones are out of whack, it could lead to losing hair:

  • Estrogen
  • Follicle stimulating hormone
  • Luteinizing Hormone
  • Progesterone
  • Prolactin
  • Testosterone

Another hormonal imbalance that can lead to hair loss is high cortisol levels, combined with low DHEA. High cortisol levels are the main reason why stress is involved in hair loss and thinning.  

Low levels of sex hormone binding globulin (SHBG) also can cause hair loss. SHBG is a protein that grabs on to excess hormones. If it is low and your free testosterone is high, your hair loss treatment should include both increasing SHBG and lowering testosterone by balancing all hormones.

 

Mercury and Other Toxins

Exposure to some heavy metals are to blame for certain cases of hair loss. Hair absorbs metals like a sponge and could affect hair growth. Exposure to these metals also cause symptoms like fatigue, depression, insomnia, irritability, and memory loss.

 

Thyroid Problems

The thyroid produces hormones that facilitate and regulate cell reproduction, so thyroid disorders—hypothyroidism and hyperthyroidism—can affect hair growth.

 

Nutrient Deficiencies or Excesses

Certain nutrient deficiencies—including riboflavin, biotin, folate, and vitamin B12—are  linked to hair loss. Micronutrients and macronutrients play an important role in follicle development and regulating immune cell function, which is involved in healthy hair growth. 

But don’t rush to load up on biotin for hair loss! Biotin levels that are too high, as in people who take biotin supplements, can harm the thyroid gland and interfere with thyroid lab tests. High biotin also can cause insomnia, digestion issues, skin rashes, and problems with insulin release.  If you’re going to supplement with biotin, I recommend a supplement that has lower levels of biotin such as Viviscal Pro Hair Health.

To prevent low levels of key nutrients, take a high-quality multivitamin daily and get checked regularly for nutrient deficiencies, including iron and ferritin levels.  You can also take a B vitamin complex to make sure you’re not deficient in any of the B vitamins linked to hair loss.

 

Autoimmune Issues

In autoimmunity, your immune system is triggered and mistakenly attacks a part of your body, a phenomenon called molecular mimicry. 

Alopecia can refer to a number of hair loss conditions, but relevant to the discussion on autoimmunity is alopecia areata, an autoimmune disease that causes the body’s immune system to attack hair follicles. In cases of autoimmune hair loss, we have to dig deep for the root causes of autoimmune disease to bring back hair growth.

 

Other Causes 

Other causes of hair loss in women include using harsh chemicals or hairstyles that pull on the hair a lot. Dieting and calorie restriction can cause hair thinning or hair loss. In addition, inflammation of any cause can lead to hair loss or thinning. What’s more, women often lose hair during the postpartum period. Read my blog post on postpartum and hair loss here. 

 

Case Study — Here’s How It Works

This is a recent hair loss case from my clinic. It is still in progress, but I’m including it to show you what it looks like to address the factors involved in hair loss. 

The client was a 48-year-old female. I’ll call her Jill. She had put on more weight around the middle, was on a low-carb diet, suffered from insomnia, and had rapid skin aging and hair loss. 

Jill’s first test with another practitioner showed she had low estrogen (estradiol), progesterone, and DHEA, as well as relatively high testosterone, although not out of range. The practitioner jumped to address her hormones, but not in a comprehensive way. She was given progesterone, no estradiol, and nothing was done to address her testosterone levels. The practitioner also did not evaluate insulin resistance or glucose sensitivity. 

The next test showed low estradiol, progesterone levels through the roof, and very high testosterone. This was likely due to the fact the practitioner had given her too high a DHEA dose, since the body converts DHEA to testosterone. 

When she began seeing me, her symptoms had become worse. I didn’t attempt to adjust her hormone protocol right away because it was designed by another provider and she wanted to wait before changing it. She gained more weight and was sleeping worse. Her skin aging also was worse, she had developed mild acne, and was moody and irritable. 

I was concerned about her very high hormone levels in relation to a very low estradiol. I tested her for blood sugar balance to see if it might be part of the mix. I thought stress and cortisol might also explain her hormone imbalances and hair loss.

I had her detox for three months to bring down her progesterone levels using herbal detox support to help the liver clear out the excess hormones and lower her SHBG. I also put her on herbal androgen blockers, which protect the body from too many circulating androgens. In addition, I focused on blood sugar control after finding out she was mildly insulin resistant. I tested her SHBG, gave her low-dose estradiol therapy, and began adrenal support. I had her stop taking DHEA at first because her levels were high, but added it back in at a much lower dose at six weeks, when her levels returned to normal.   

Hormonal balance is still on the radar. Jill will need progesterone at some point, and I plan on retesting her after the three months’ detox period. 

Jill’s making progress. She dropped eight pounds without changing her diet or activity level. She is sleeping better most nights.  Her skin has improved moisture and fullness. She still sometimes has a tough time falling asleep at some times of the month, but progesterone treatment should help with that. I anticipate her symptoms—including her hair loss—will resolve after we finish balancing her hormones and eliminating other causes such as insulin resistance. 

 

Helping You Pinpoint the Cause 

If you’re losing hair, it’s best to work with a functional medicine provider to identify the root cause of the problem. Toxins, hormonal imbalance, malnutrition, blood sugar issues, or an autoimmune process are just a few of the possibilities that must be ruled out. Your doctor can order the right tests to figure out the reason for your hair loss. Then he or she can recommend potential remedies.

As a functional medicine provider, I’ve successfully used this approach in many patients. That’s why I invite you to reach out to me for a free 15-minute troubleshooting call to find out the best course of action for you. If after the call you come on board as a patient, I’ll suggest ways to balance hormones and address other causes of hair loss. We’ll work together to revitalize your health and get back your magnificent mane of hair at the same time.