Hair Loss 101
Hair loss can be one of the most distressing symptoms! Up to 50% of people will experience hair loss as a symptom at some point in their lifetime. That is a lot of people! There are many different types and causes of hair loss.
A few EXAMPLES OF HAIR LOSS TYPES:
Telogen effluvium (TE) -usually caused by dieting or other stressor like infection, stress, hormonal changes ie) postpartum, loss of estrogen, discontinuing the birth control pill, hypothyroidism. There is usually 2-4 months delay from the trigger “event” to noticing you are experiencing TE hair loss.
Patterned hair loss -male and female, also known as " androgenic " hair loss. 20-30% of patients with PCOS report female patterned hair loss (FPHL) (Carmina 2019).
Alopecia areata (AA) -considered an autoimmune based hair loss mostly because scalp biopsies show T cell or immune cell infiltration. Comorbidities with the strongest associations with AA (Naik, 2021): Hashimoto thyroiditis, Diabetes mellitus, Lupus, Celiac disease, Hypothyroidism.
HAIR PHYSIOLOGY
Generally each 100,000 hairs on the head independently go through a growth cycle consisting of 3 phases:
Anagen = growth phase (90% of scalp hairs, 3-6 years long)
Catagen = transition phase (<1% of scalp hairs, 1-2 weeks long)
Telogen = resting phase (10-15% of scalp hairs, 2-4 months long).
At the end of the telogen phase (2-4 months), some of those hairs fall out. Losing up to 100 hairs a day is normal on non shampoo days and 200 to 300 hairs on a shampoo day! When a hair falls out, a new hair is grown in the same hair follicle to take its place, and the growing cycle begins again. Anagen →catagen →telogen. Signs of significant shedding are hairs found on your pillow, in food, in the bathroom and shower in abundance or on the kitchen counter. Hairs coming out in clumps during or after showering or brushing is considered significant hair loss.
TESTS TO CONSIDER IF YOU ARE EXPERIENCING HAIR LOSS:
Ferritin and CBC -hematology panel is best with CRP-hs -marker of inflammation
Vitamin D
Thyroid Panel
Prolactin -likely only very high levels interfere with anagen phase (Bhat 2020))
Rule out PCOS with lab work and clinical presentation -remember 20-30% of women with PCOS report FPHL.
STI screening -Syphilis infections are a cause of hair loss (Wolfe 2016)
Celiac Serology
Thyroid and other auto-antibodies - rare cause, but cheap and important screening measures
Scalp biopsy -almost never needed
Ask your naturopathic doctor to run some lab work for you to find out the root cause (pun intended) of your hair loss so that it can be treated with holistic evidence based medicine. Let’s feel good about the crown on our head!