Dr. Jillian Smithers
Hair Loss Causes and Treatments
I see a lot of patients in my practice who suffer from hair loss. If you’re noticing more hair coming out in the shower, on your brush, or on your pillow, it’s time to see someone about it. The problem is, for a lot of the women who see me for it, they’ve already been telling their other doctor about their concerns for a while. It seems like especially if a woman has thick hair to begin with, her doctor often dismisses her concerns because she still has a lot left even if she is losing her hair. This is crazy and totally unacceptable. Whether you’re used to a full head of thick hair or fine, thin hair, if you’re losing more than you’re used to then it is definitely something to look deeper into. The earlier you can figure out what the cause is the better.
What Labs Do I Recommend For Hair Loss?
Complete Blood Count (CBC), Iron, and Ferritin. Get your iron status checked because iron deficiency anemia is a common cause of hair loss. This is even more important if you also suffer from heavy periods because that can cause your iron and ferritin (the storage of iron) levels to drop. I do want to mention, though, if you are noticing thinning hair, PLEASE do not start taking an iron supplement without having a doctor check your levels first. The only people who should ever be taking iron are the ones who have a legitimate deficiency as seen in lab work. You can do way more harm than good if you don’t need it! I like to see ferritin levels 70, especially when hair loss is a concern.
Full thyroid panel including TSH, free and total T3, free and total T4, TPO antibodies, TG antibodies, and reverse T3. You can opt out of testing the total T3 and T4 because the free hormones are the active and bioavailable ones if cost is a concern, but what’s listed here is a full, comprehensive thyroid panel, which is definitely my preference. Low thyroid hormone, whether that’s true hypothyroidism or just sub-optimal levels, can definitely be a common cause of hair loss. Make sure that you see someone who knows the difference between “normal” thyroid levels and optimal ones.
Full Hormone Panel including estradiol, progesterone, free and total testosterone, DHEA-S, dihydrotestosterone (DHT), and cortisol. High androgens (testosterone and DHEA-S) are a common cause of hair loss that I see in my practice, but I also like to check the other sex hormones (estrogen and progesterone) to see if there are any imbalances like estrogen dominance. While that itself doesn’t specifically cause hair loss, the excess estrogen can bind up thyroid hormones and make them inactive or it can cause heavy periods, which could lower iron levels, all contributing to hair loss. Checking cortisol is also very helpful because it can cause hair loss if it’s high.
hs-CRP. This is a marker of inflammation, which we know is the cause of many conditions including hair loss. Our foods, medications, birth controls, environmental toxicities, infections, etc. can all increase inflammation. This level should be < 0.9 unless you currently have an acute inflammatory reaction and it’s increased temporarily.
Fasting glucose, insulin and Hemoglobin A1c. These three tests screen for abnormal blood sugar and diabetes. If your blood sugar is unregulated, it can actually interfere with the proper circulation to your scalp, plus set off other hormone imbalances, which can cause you to lose hair.
ANA. This is a marker of autoimmunity, which we can see hair loss associated with. When we’re testing for autoimmunity, we start with ANA and then do further testing if it comes back positive.
Heavy Metals. Depending on your occupation, hobbies, exposures, etc. this may be something to consider. In my office I run a urinary heavy metals test, but I typically only do this in cases where we know of a possible exposure or other labs are inconclusive and we want to look further.
What if you’re cash-pay or you want to start with the minimum number of labs for a number of different reasons, then what? In those cases, I started with the following: CBC, iron, ferritin, TSH, free T3, free T4, total testosterone, and DHT. Start with the most common causes of hair loss: low iron, low thyroid, and hormone imbalances. If these things come back in optimal ranges (not just in normal range) then you can continue looking further. Some people may prefer to test anything possible off the bat, which is also totally fine, but it’s easy to fall into a trap of over-testing and spend a lot of money unnecessarily.
How To Regrow Your Hair
Note: I have made an entire category on my online store of these supplements listed below. It’s super easy to create an account and then you can check out the category labeled “Hair Loss” and go shopping!
Look for potential cause(s). The way to find the most effective treatment for you is ultimately going to be to figure out the cause and treat that specifically. Otherwise, we may notice improvements but it’s less likely that you will have full hair regrowth if there is still a deficiency or excess of something that caused the loss in the first place.
Take iron supplements (only if you need them!). If you have had your labs run and know that you have low iron or ferritin levels, then it’s time to start supplementing under the guidance of a doctor. I cannot stress enough that if you don’t know for sure that you are iron deficient, please do not take an iron supplement because excess iron levels can be very dangerous. I typically don’t see hair regrowing in someone with iron deficiency until their ferritin levels are greater than 70. Most often in my office I use a supplement called Iron Extra because it is a low dose of iron coupled with vitamin C for absorption and other blood building herbs and works very well without causing stomach upset or constipation.
Give your adrenals some love. Supporting your adrenals with adaptogens is going to assist your body in reacting and adapting to stress more appropriately while keeping those cortisol levels in check and supporting overall hormonal balance. I have an entire category of great adrenal support supplements in my online store and also included one called Adapten-All in my Hair Loss category as well.
Increase blood flow. Whenever we have an area of the body that’s not functioning properly, a holistic functional medicine doctor is always going to think of blood flow. Tight muscles? Not enough blood flow. Erectile dysfunction? Not enough blood flow. Hair loss? Not enough blood flow. By increasing exercise, scalp massage, or adding rosemary essential oil to your shampoo and conditioner, we increase blood flow directly to the scalp to help assist in new hair growth.
Biotin. Vitamin B7, or biotin, is definitely one of the most common treatments that people go to first when their hair is thinning, but research shows that it’s actually only beneficial when someone has a legitimate deficiency. This is something that we can test in blood work and then we’ll know whether it could be used as an effective treatment. One thing to remember, though, is that biotin is also an acne trigger, so if you have acneic skin and breakouts, you especially don’t want to take a biotin supplement unless you know that you are deficient. If I am recommending biotin for a patient, I typically have her take a formulation such as H-S-N Complex, which is a hair, skin, and nails powder.
Saw palmetto. This is an herb that I use all the time to stop the conversion of testosterone to dihydrotestosterone (DHT). When DHT is high, it’s common to see hair loss and acne. I like to use this in combination with other herbs and nutrients that support optimal testosterone, so I actually use a supplement called Prostate Supreme in women all the time. Yes, I know that women don’t have prostates, but we do still convert testosterone to DHT and sometimes that can be problematic!
Selenium. It’s all about supporting the thyroid. We know that hair dryness, breakage, and loss all come with low thyroid levels and selenium is a trace mineral that helps to convert the inactive thyroid hormone (T4) over to the active one (T3).
Get enough protein. Our hair follicles are made almost entirely of protein, so it’s no wonder adequate protein consumption is important here. I start my day every single day with a protein smoothie with pea protein, greens, and berries and it keeps me feeling full and without spiking my insulin levels, which is really important for hormone balance.
Collagen. This is definitely a hot supplement topic nowadays and can help with hair loss because the amino acids in it are used to build and strengthen hair. You can add collagen to a smoothie, your coffee, or if you’re vegan, take Collagen Factors instead so that you can get all of the building blocks to make collagen naturally.
Compound an oil or spray. If you have a functional medicine or naturopathic medical doctor, you may have him or her write you a prescription to a compounding pharmacy for them to make you your own specific hair formula. I have done this with many patients and used different formulations with great results.
Platelet Rich Plasma injections. PRP is a portion of your plasma from your blood and can be used to inject into joints to repair damage, onto the skin for scars/wrinkles/stretch marks, or into the scalp to regrow hair. This is a procedure that I do in my office and, for the right candidate, can have remarkable results!
All of the photos above are from the lovely Ashlynn, the owner of Local Habit Hair, a salon in Cave Creek, AZ.