Hair Loss in Women, by Mary PreFontaine, RPh, FAAFM

The symptom checklist used on my intake form for women seeking hormone replacement therapy includes hair loss. The actual pattern of hair loss I am inquiring about is body hair. So I follow that up with 2 questions: Are you shaving your legs or underarms less? Or has your pubic hair thinned out? These “clarification” questions are trying to pinpoint a lowering in their level of testosterone which may need to be addressed. But what I often hear instead is “head” hair thinning, receding, falling out in clumps, becoming brittle, etc.
There are 100,000 to 350,000 hair follicles on the human scalp that go through cyclic phases of growth and rest. Hair growth slows by age 40 and several hormonal factors can influence duration of hair cycle. Sex hormones can affect hair growth in women through two different pathways, testosterone metabolism issues and estrogen dominance.
Testosterone replacement in a small percent of women can cause androgenic female pattern hair loss. This resembles the receding hairline and thinning crown seen in male pattern baldness. These women seem to metabolize an unusually large percentage of their testosterone down a specific pathway resulting in an increase in the metabolite DHT (dihydrotestosterone). Some women benefit from adding Saw Palmetto to their regimen to prevent this shift and others simply discontinue all testosterone replacement.

The second possible factor causing a more general overall hair thinning, loss or lack of re-growth could be estrogen dominance. Estrogen dominance is a term defined by John Lee, M.D. and refers to the relative deficiency of progesterone levels in relation to estrogen levels that often develop in our late 30s or 40s. Other symptoms of estrogen dominance would be irregular periods, heavy periods, water retention, breast tenderness, forgetfulness, mood swings, insomnia and depressed mood or anxiety. This can be confirmed with hormone levels during the luteal phase of woman’s cycle and treated with cyclic progesterone supplementation.
Hair loss is a cardinal sign of hypothyroidism. Thyroid issues can be assessed and ruled out by blood testing. Prevalence of hypothyroidism in American women is 12% and many are undiagnosed. Other symptoms of hypothyroidism include constipation, cold extremities, weight gain, and fatigue. If a patient is diagnosed with hypothyroidism, the treatment is an oral medication containing thyroid hormones.
If both thyroid and sex hormone factors have been treated or ruled out, there are still options. Some prescription and over the counter medications (NSAIDS, antibiotics, antidepressants, anti-epileptics, gout medications, ulcer medications and of course chemotherapy medications) can cause hair loss. Some of these medications like ulcer medications actually cause nutritional deficiencies in Zinc, Vitamin A, Essential Fatty Acids, or Iron that in turn cause hair loss. Keystone Pharmacy proudly offers a complimentary nutritional assessment on an appointment basis with Brandi Grimmer, CPhT, CNC to explore these possibilities.

Sources: The Clinician’s Handbook on Natural Medicine, Second Edition 2008

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