Healing Hair Loss from the inside out with functional medicine
Hair Loss
Functional Medicine protocol for Hair Loss
Hair loss is a common event we all go through: every person loses, on average, 50 to 100 scalp hairs daily. (1) However, when hair loss is greater than 50 to 100 hairs, or if hair growth has stopped, that can lead to the diagnosis of alopecia or unwanted hair loss. This protocol will discuss how common unwanted hair loss is, the signs of hair loss, and possible causes. We'll then discuss functional medicine testing to get to the root of hair loss and different treatment options.
How Common is Unwanted Hair Loss?
Hair loss is, unfortunately, a common condition, affecting 50% of women at some point in their lifetime and 80% of men. (2,3) Hair growth is a four-step cycle. (4) The first step is the anagen or hair growth. The second step is catagen or hair recession. The third step is telogen or rest. And the fourth step is exogen or shedding.
Anagen Phase
The anagen phase is where the growth of an entire hair shaft grows from follicle to end. For scalp hairs, this phase lasts two to eight years; however, this length decreases with age. The number of follicles in this phase will also decrease with age.
Catagen Phase
Catagen is the phase where the hair follicle regresses. This phase lasts about two weeks.
Telogen Phase
The telogen phase can last for two to three months. During this phase, there is no hair growth; instead, it lays dormant. Approximately 9% of scalp hairs are in this phase at any given time. New hair is beginning to develop in the follicle.
Exogen Phase
The exogen phase is marked by the continued growth of new hair that eventually pushes the old hair out of the follicle, leading to its shedding. Anagen then begins again.
Signs of Hair Loss
Alopecia is the medical term for hair loss. (5) Alopecia can be separated into two major categories: scarring, a form that leads to permanent hair loss, or non-scarring, which may be reversed. Nonscarring is the most common type of alopecia and includes focal, diffuse, and patterned hair loss.
Focal
Focal hair loss occurs when hair is lost in patches. It is most commonly seen on the head but can also occur in other areas of the body. The most common type of focal hair loss is alopecia areata, an autoimmune condition that begins in childhood.
Diffuse
Diffuse hair loss occurs evenly throughout the scalp. The most common type of diffuse hair loss is telogen effluvium, causing over 200 scalp hairs per day to fall out.
Patterned Hair Loss
Patterned hair loss occurs when the hair loss begins as thinning hair but progresses to bald areas. This type of hair loss is symmetric and can be seen on the sides, top, and front of the head. While this type of hair loss can occur in both men and women, men experience thinning and recession of the hairline more. The most common type of patterned hair loss is hereditary androgenetic alopecia.
Scarring Alopecia
Scarring alopecia, also called cicatricial alopecia, is a permanent condition. (6) There are different causes of scarring alopecia, including discoid lupus erythematosus (an autoimmune disease), folliculitis decalvans (an inflammatory disorder), dissecting cellulitis of the scalp (a rare scar-forming scalp disorder), frontal fibrosing alopecia (hair loss common in postmenopausal women), and central centrifugal cicatricial alopecia (a condition occurring as a result of hair styling products or styling techniques).
Can Hair Loss Be a Sign of Something Serious?
A practitioner should always evaluate hair loss to determine the cause, as autoimmune conditions, severe illnesses, malnutrition, and other serious conditions may be the cause.
What Causes Hair Loss?
Other common causes of hair loss include vitamin and mineral deficiencies, genetics, weight loss, hormonal changes (including thyroid issues), medications, stress, hairstyles, and hair treatments. (1)
Functional Medicine Labs to Get to The Root of Hair Loss
Since there are various causes of hair loss, a functional medicine practitioner may order the following labs to get a clearer picture:
Thyroid Panel by Boston Heart Labs ($200)
Thyroid hormones are produced by the thyroid gland and used by every cell in the body. Thyroid hormones can thus affect the cardiovascular, gastrointestinal, nervous, and integumentary systems, including hair cycles. Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormones, and hyperthyroidism is when the thyroid gland makes too many thyroid hormones. Both of these conditions can lead to hair loss.
A full thyroid blood panel, such as the panel offered by Boston Heart Labs, will assess thyroid hormones, the pituitary hormone responsible for producing the thyroid hormones, antibodies that may be attacking the thyroid gland, and more.
Sex Hormone Panel
DUTCH Cycle Mapping Plus by Precision Analytical - ($700)
FSH & LH by Access Medical Laboratories - ($10)
Sex hormones include estrogens, progesterone, testosterone, dihydrotestosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and more. The two most common sex hormones that can cause hair loss are testosterone metabolite, dihydrotestosterone (DHT), and estradiol. DHT can cause the arrest of the anagen, or hair growth, phase. (4) Estradiol, the primary estrogen in cycling women, can also affect hair growth. Hair loss is a common symptom of women with low estradiol, such as postmenopausal women. When assessing hormones, it's always important to see a full panel, as many hormones can convert to each other, but also because many hormone levels can affect other hormones.
For both men and women, the DUTCH hormone panel by Precision Analytical is an excellent choice to assess the relationship between hair loss and hormones. The DUTCH test is a dried urine test that evaluates how hormones are broken down, including testosterone to DHT and estrogen metabolism.
Additionally, a serum FSH and LH panel, such as the panel offered by Access Medical Laboratories, can also be helpful. FSH and LH are two hormones produced by the brain that orchestrates the whole cycle for both men and women and thus can control the production of hormones, including testosterone which converts to DHT and estradiol.
Stress is a process that we all experience. The stress cascade in the body results in a hormone released by the adrenal glands, cortisol. Cortisol, the body's primary stress hormone, can affect the body in many ways, from gastrointestinal functioning to blood sugar, the immune response, and more. Stress can directly cause hair loss but also affects hormones, leading to an indirect pathway for hair loss. (1)
The Cortisol Marker in the DUTCH Cycle Mapping Plus by Precision Analytical, assesses cortisol levels throughout the day and one DHEA reading. DHEA is another hormone the adrenal glands produce that plays a role in the stress response. It is also a precursor to testosterone, and thus DHT, possibly contributing to hair loss in multiple ways.
Micronutrient Panel by SpectraCell Laboratories - ($800)
Micronutrient panels assess vitamins, minerals, and other nutrients that assess a person's nutritional status. These tests can show deficiencies and surpluses of various micronutrients, many of which can cause hair loss. The micronutrient test offered by Spectracell Laboratories assesses 31 different markers to give a comprehensive view of the patient's nutritional status, including a complete evaluation of micronutrients that may be causing hair loss.
Functional Medicine Hair Loss Treatment for Men and Women
The following treatments may be helpful for holistically treating hair loss:
Microneedling For Hair Loss
Microneedling is a treatment procedure introduced in the 1990s where tiny, fine needles create micro punctures in the skin. It is a minimally invasive procedure used for various dermatological conditions, including hair thinning, hair loss, and androgenetic alopecia (AGA). Most studies show promising results in significantly increasing total hair count. This treatment is commonly combined with a root cause approach to address the underlying factor of hair loss (i.e., micronutrient imbalance, thyroid conditions.) (7)
How to Stop Hair Loss Through Nutrition
The composition of our diets can affect numerous body systems and conditions, and hair loss is no different. Low protein intake has been associated with hair loss. Inflammation also plays a role in hair loss. (8) A low-inflammatory diet, such as the Mediterranean Diet, may be beneficial. The Mediterranean diet focuses on healthy fats, fresh fruits and vegetables, herbs, beans, legumes, and minimally processed whole grains.
Hair Loss Supplements
Supplements may be helpful in addition to a healthy diet. The following are particularly beneficial for hair loss:
Hair Loss Supplements for Genetic Causes
Hereditary causes of hair loss can involve genes that affect circulation, DHT production, inflammation, and more. The Practitioner evaluates an individual and makes supplement recommendations around the alterations that may be causing hair loss. Examples include L-Arginine, CoQ10, L-Carnitine, and more.
Hair Loss Supplements for Thyroid Health
As discussed above, hypothyroidism occurs when insufficient thyroid hormones are produced. Hypothyroidism should always be treated with thyroid replacement medication, as lack of treatment can lead to death. Various supplements, including iodine, magnesium, selenium, and probiotics, may help with hypothyroidism and thus can affect hair loss. Hyperthyroidism is the result of too much thyroid hormone. Hyperthyroidism can also be treated with medications, as well as the supplements L-carnitine, selenium, and probiotics; thus, these may improve hair loss symptoms.
Hair Loss Supplements for Sex Hormones Imbalances
The sex hormones dihydrotestosterone (DHT) and estradiol specifically play a role in hair loss. Serenoa repens, commonly known as saw palmetto, is a botanical that may aid in lowering DHT levels. (9) It inhibits the enzyme 5-alpha-reductase responsible for creating DHT and may affect the DHT receptor, making it less active.
Phytoestrogens may support estradiol. Phytoestrogens are plant compounds that may activate the estradiol receptor leading to similar effects of estradiol. Phytoestrogens include red clover, black cohosh, and hops.
Hair Loss Supplements for Micronutrients Imbalances
A variety of high and low micronutrient levels can lead to hair loss. Examples of micronutrient deficiencies that cause hair loss include riboflavin (B2), biotin, zinc, vitamin D, and iron. (8,5) Examples of excessive levels of micronutrients can also lead to hair loss, including selenium and iodine (low levels of these nutrients can cause hair loss, too). Micronutrient testing can help determine if a micronutrient imbalance is the cause of, or contributing to, hair loss and can also help create the proper dosage.
Hair Loss Supplements for Stress
High stress can lead to hair loss. As discussed above, the primary hormone of the stress response is cortisol. High cortisol levels may be reduced with adaptogen supplementation. Adaptogens are a group of botanicals that, as their name implies, help the body to adapt to stress. Ashwagandha, Holy Basil, and Rhodiola are examples of adaptogens that can aid in healthy cortisol levels.
Summary
Hair loss can significantly affect the quality of life for both men and women. (10) Thus, hair loss should always be evaluated, and the root cause always searched for. Functional medicine testing, including genetic, thyroid, and sex hormones, micronutrients, and stress testing, can all be useful tools to assess the underlying cause of hair loss. The results can lead to the creation of a personalized treatment plan, with various functional medicine treatments as options.
The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Lab Tests in This Article
Thyroid Panel by BostonHeart Diagnostics - ($200)
SERUM
BostonHeart's Thyroid Panel measures eight biomarkers to assess overall thyroid health and function. Please be advised that Boston Heart Diagnostics policy states that practitioners cannot order labs on themselves or their immediate family members.
DUTCH Cycle Mapping Plus by Precision Analytical (DUTCH) - ($700)
URINE
SALIVA
The DUTCH Cycle Mapping Plus by Precision Analytical is a comprehensive assessment of sex and adrenal hormones and their metabolites and includes the daily, free cortisol pattern, organic acids, melatonin, and 8-OHdG. The Cortisol Marker measures DHEA-S and diurnal cortisol to assess the effects of stress on adrenal hormone balance. This test cannot be ordered for patients under 12 years of age.
FSH & LH by Access Medical Laboratories - ($10)
SERUM
This test measures the levels of FSH and LH in serum. FSH is used in the differential diagnosis of gonadal and pituitary insufficiency. LH is used to evaluate the normalcy of the hypothalamic-pituitary-gonadal axis and to diagnose and treat infertility in women.
Micronutrient Test by SpectraCell Laboratories - (800)
WHOLE BLOOD
The SpectraCell Micronutrient Test analyzes over 30 vitamins, minerals, and other nutrients to determine nutritional deficiencies. It also analyzes the performance and functional deficiencies of these micronutrients. This test is not recommended for patients under 12 years of age.
Myron Ubungen, RN
Functional Medicine Registered Nurse
References
https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
https://www.aad.org/public/diseases/hair-loss/causes/18-causes
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