Ah, hair loss.
So, hair loss is divided into two categories: focal or diffuse.
Diffuse (exactly what it sounds like) hair loss: shedding of the hair in a diffuse pattern, and is not associated with scarring alopecia. With a diffuse type of hair loss, women can experience either a male- or female-pattern hair loss – which is associated with hormones. A diffuse (but still somewhat patchy) alopecia areata can also occur. (1)
Focal hair loss: patches of hair loss, associated with scarring or non-scarring alopecia. Focal hair loss is often secondary to something else going on – a fungal infection (tinea capitis, scarring/non-scarring alopecia areata, trichotillomania, or even Lupus. (1)
So, when looking at hair loss, we need to figure out where the loss is occurring. Is it a typical female-pattern hair loss? Or does it follow male-pattern hair loss? Is it in patches? Or is it simply a thinning of the hair throughout the entire scalp?
Here are some areas to consider or investigate:
Iron status: even if you don’t have iron deficiency anemia, what’s your ferritin status like? Ferritin is the storage form of iron – and if this isn’t an optimal value, this can be a contributing factor.
Hormones: estrogen, testosterone, DHEA, thyroid.
Androgens - it’s important to consider the 5a-reductase (testosterone à DHT) pathway and the role it plays in male-pattern hair loss.
Thyroid: both hyper and hypo can cause hair loss. The TSH value isn’t always enough – and doing a more extensive thyroid panel can give more insight into the functioning of the thyroid.
Stress: need I say more?
What you’re putting on your scalp: are you using sulfate-heavy shampoos? Are you consistently pulling your hair into tight ponytails? What side of the head do you tend to sleep on? What kind of pillowcase do you have?
Postpartum: hair loss is common during the postpartum period.
Protein intake (in my clinical practice, this is a big one): simply stated, most people do not consume enough protein on a daily basis.
Infection: typically, fungal infections (tinea capitis).
Celiac disease: or even gluten intolerance can cause hair loss (2)
Zinc status: have you been eating plant-based for a long period of time? You may have lower zinc levels. (3)
Genetics: no need for explanation here.
Gut health: are you absorbing nutrients properly? Do you have appropriate levels of stomach acid?
Blood sugar dysregulation/insulin resistance: poor circulation (which we often see in pre-diabetic, diabetic or PCOS patients).
Medication-induced: there are too many to list, so check with your healthcare provider.
If you’re wondering about how to investigate your hair loss further, book an appointment with me here to get started! And if you have recent lab results, bring those in so we can check if everything is working optimally.
(1) Murray, M.T. Textbook of Natural Medicine: Hair Loss in Women. Chapter 170, pp. 1406-1408.
(2) Corazza G.R., Andreani M.L., Venturo N., et al: Celiac disease and alopecia areata: report of a new association. Gastroenterology 1995; 109: pp. 1333-1337.
(3) Salwen, M.J. Henry’s Clinical Diagnosis and Management by Laboratory Methods: Vitamins and Trace Elements. Chapter 26, pp. 416-427. E1.