Many of my patients try to treat their hair loss with supplements containing biotin and silica, which they’ve been told promote hair growth, however, these supplements often produce very limited results if the underlying cause of hair loss or failure of hair regrowth are not addressed. More than 50% of both men and women experience hair loss, or alopecia, at some point in their lives. While often not indicative of a serious health disorder, hair loss can be a significant source of distress.
Causes of Hair Loss
As a naturopathic doctor, it’s important for me to ask the right questions to find and treat the root cause of hair loss in my patients. The most important questions that I ask a patient seeking treatment hair loss are:
Q. Are you losing hair all over or in one place?
Focal alopecia often results from a skin disorder such as psoriasis of the scalp or fungal infection, which must be directly treated. Focal or scarring alopecia can also be caused by chemicals applied to the head, allergies to shampoo ingredients or certain illnesses.
Thinning of the hair line and crown of the head may be related to hormonal changes. Female pattern hair loss, often occurs at the crown of the head, sparing the hair line. Male pattern hair loss occurs in a “M” pattern, with thinning of hair at the temples.
Telogen effluvium, which is the most common kind of hair loss, occurs in a more generalized pattern, resulting in hair that’s consistently thinner throughout the entire scalp.
Q. How much hair have you lost?
The average human loses between 50 and 100 hair strands a day. More than that can indicate alopecia, which needs to be explored further.
Patients with hair loss often notice distressing symptoms, such as being able to see their scalp through their hair, a smaller pony tail, or more stray hairs in the shower or on clothing and hair brushes. In telogen effluvium, almost 30-50% of hair on the scalp or body can be lost. Doing a “tug test” (hold about 30-50 hairs in your hand and gently tug in the direction of hair growth) that results in more than 5 hairs or more than 10% being released from the scalp is indicative of telogen effluvium.
Q. What happened 3-6 months before the hair loss occurred?
Telogen effluvium, the most common kind of generalized hair loss often occurs 3 months after a significantly stressful event. Crash dieting, sudden weight loss, illness, or psychological stress can all be sources of hair loss. Certain medications such as anti-thyroid medications and chemotherapy medications can also cause hair loss.
Q. Do you have a thyroid condition?
Hypothyroidism, or an underactive thyroid gland is one of the primary causes of telogen effluvium. Thyroid conditions are often under-diagnosed. Suboptimal thyroid function occurs when the TSH (thyroid stimulating hormone) is over 2.5 mU/L, however most doctors will only start to be concerned about thyroid function when the number is higher than 4 or 5.
Symptoms of underactive thyroid are:
- weight gain
- feeling cold
- puffy face
- water retention
- brain fog
- memory loss
- dry skin and hair
- hair loss
Eighty percent of underfunctioning thyroid conditions are autoimmune, displaying elevated anti-thyroid antibodies years before TSH levels start to rise. Therefore, checking for thyroid antibodies may be necessary if the rest of the thyroid tests come back normal and patients are still experiencing symptoms.
Some people experience underactive thyroid function in response to nutrient deficiencies, chronic stress, illness and extreme dieting. The thyroid requires nutrients such as iron, zinc and selenium to function optimally. These nutrients are commonly deficient in the North American diet, especially in vegetarian diets. Working with a naturopathic doctor to uncover and treat the root cause of hypothyroidism can help indicate if hypothyroidism is the cause of hair loss.
Q. What’s your iron status?
Iron deficiency is another cause of hair loss. While iron deficiency is more common in menstruating women, vegetarians or those with intestinal malabsorption, low iron levels can be more common than you think.
Ferritin is a protein that stores iron in your body. Having a ferritin level of at least 40 can improve symptoms of hair loss and thyroid function (if low iron is contributing to symptoms of hypothyroidism), however 80 may be needed for optimal hair growth and energy. Checking for thyroid status before supplementing and making sure that the source of iron you’re taking is an absorbable, non-constipating form is essential. Iron is toxic at high levels and should never be prescribed without checking blood levels first.
Q. What’s your vitamin D status?
About 70-90% of North Americans are deficient in vitamin D, especially those of us who live in colder, northern climates. Vitamin D is an essential hormone responsible for regulating over 1,000 genes in the human body. A common sign of vitamin D deficiency is hair loss, but vitamin D is also responsible for our bone health, mood, immune functioning and many other important bodily processes. Consider testing vitamin D levels at the beginning of every winter and supplementing with a well-absorbed form of vitamin D throughout the year, especially during the winter months.
Q. What’s your hormonal status?
About 50% of both men and women will experience hormone-related hair loss in their lifetimes. Menstruating women with cystic ovaries, acne, or male-pattern hair growth are most susceptible. However, after menopause, many women will experience a relatively high level of male hormones, or androgens, such as testosterone, as their levels of other hormones fall.
Hormonal hair loss often occurs at the top of the scalp for women, and in an “M” pattern for men. Doing a thorough workup of hormones: estrogen, progesterone, DHEA, testosterone and androstenedione may be necessary for women experiencing hair loss. Men may need their DHT (a male hormone) levels tested.
Working with a naturopathic doctor to balance hormones with herbs and diet, bio-identical hormone replacement or talking to your doctor about anti-hair loss medications may all be possible treatment options. Talk to your doctor about the pros and cons of medication and make sure all other possible causes of hair loss are ruled out before pursuing that option.
Home Remedies to Stimulate Hair Growth
While my primary treatment focus is to address the underlying causes of hair loss in my patients’ bodies, I sometimes prescribe home remedies to encourage hair growth while we’re healing hormones, thyroids and restoring vitamin D and iron levels, or treating fungal scalp infections.
Castor Oil for Hair Loss
I often recommend patients apply castor oil hair masks to their scalps 1-2 times a week. Massage castor oil into the scalp, covering the entire strand of the hair. Leave in for one hour or overnight. Castor oil is moisturizing and anti-fungal. It also encourages hair growth through promoting the circulation of blood flow to the scalp.
Melatonin for Hair Loss
A few clinical studies show benefits with topical melatonin for treating androgenetic alopecia (male and female pattern hair loss). I sometimes recommend patients apply their melatonin spray to their scalp a few times a week to encourage hair growth or as an alternative to androgen-blocking drugs. Melatonin is also a potent antioxidant, which may encourage hair growth.
Protein for Hair Loss
I make sure my patients are consuming diets that are high enough in amino acids to encourage keratin production and hair growth.
Consuming 1-2 tablespoons of gelatin or collagen powder a day can be helpful for promoting the formation of bone, skin and hair-building collagen. Japanese researchers believe that age-related hair loss is due to the destruction of collagen at the hair follicle.
Essential Oils for Hair Loss
Adding rosemary essential oil to the scalp (I have patients add it to their castor oil and melatonin hair masks) can be helpful for increasing circulation to the scalp and blocking androgen receptors in the hair follicles, potentially preventing female and male-pattern hair loss.