Hair loss is incredibly difficult to deal with and there is unfortuantely a lack of information surrounding it. This post explains the main causes of female hair loss and what you should get tested.
Real talk: This isn’t an easy topic for me to talk about, let alone share with the entire internet. I dealt with a lot of hair loss for about five years, starting when I was 19, and only just found answers recently. Unfortunately, what I went through was 100% avoidable. My doctors ignored my symptoms, deficiencies, and refused to run tests for YEARS, so my hair loss just got worse.
I hate that I’ve had to deal with it, but I also very firmly believe that everything happens for a reason. If I had not gone through this, I would not have learned all that I have about our (unfortunately very flawed) medical paradigm, about human health, and would not be able to share this with all of you today. If you’re going through hair loss, I 100% understand what you are dealing with, and hope this post provides some insight into what may be the cause of your hair loss, because everyone is different.
Your body is always, always, *ALWAYS* working in your favor. Everything your body does is to protect you. Losing your hair is a sign your body is pooling all of its resources to focus on more important things. Had I not experienced hair loss, I would not have discovered my deficiencies, heavy metal toxicity, gotten off hormonal birth control, and these things would have led to more severe issues later on. As much as I hate it, (and trust me, I really hate it) it’s been a blessing in disguise. Though it doesn’t feel like that right now, I’m sure I will 5 years from now 🙂
Stages of hair growth
- ANAGEN → The anagen stage of hair growth is the growing stage. This stage of hair growth lasts anywhere from 3 to 7 years. At any point, around 80% of the hairs on your head are in the anagen stage (ideally).
- CATAGEN → The catagen stage of hair growth is the transition stage. This is a short stage that lasts around 2-3 weeks. During this stage, the hair follicle shrinks and detaches from the dermal papilla.
- TELOGEN → The telogen stage of hair growth is the resting phase. The hair in this phase resting and preparing to fall out. At any point, around 10-15% of hairs are in this phase.
- EXOGEN → The exogen stage of hair growth is the shedding phase. It was previously believed that there were only three phases to hair growth, but it has become clear that hair in the above three phases are fully attached the scalp. However, hairs in the exogen phase are actively falling out. It is normal to lose between 50 to 150 hairs per day.
Months after restrictive eating, a stressful event (emotionally or physically), child birth, you may experience what is known as telogen effluvium. This occurs when the anagen phase is cut short and many hairs enter the telogen phase at the same time. Fortunately, hair follicles are not usually damaged from telogen effluvium, so hair should re-grow. Additionally, if your hair is continually unsupported due to low caloric intake, poor nutrient intake, or any of the causes listed below, you may find that your hair doesn’t grow past a certain length. This is because your hairs are unable to stay in the anagen phase for long enough for your hair to reach a certain length. This is very common with women who have low ferritin (explained later on). Other times, hair loss can be diffuse, meaning it occurs over your whole scalp, it can be gradual thinning as opposed to rapid shedding, so like me, you may not notice right away.
The Main Causes of hair loss
Hair loss is very complicated. There are a myriad of factors that can lead to hair loss, but in this post I go over the most important and common ones. This post is really dedicated to women experiencing hair loss, but can apply to anyone at any age or gender.
1. Iron Deficiency
I have a separate category for other nutrient deficiencies, but iron deficiency deserves its own category because it is often missed by health professionals, and is incredibly common among women.
Even if your iron levels are within the “normal” range, that does not mean they are OPTIMAL and are not contributing to hair loss. A ferritin above 20 ug/mL is considered “normal”, but a ferritin under 50 ug/mL is linked to hair loss, so your doctor may not say anything (source). I personally struggled with an iron deficiency for over 3 years that went undetected, so please make sure your doctors are thorough in their testing! There is research supporting the notion that ferritin levels play a critical role in both male and female hair loss, so it is worth looking in to.
Iron deficiencies can happen to anyone, though they are more common among women because we lose iron every month during our periods. Women with especially heavy periods are more prone to becoming iron deficient, but deficiencies can also be the result of parasite infections, low hydrochloric acid in the stomach, internal bleeding, pregnancy, or simply a lack of iron in your diet. Supplementing with iron can be very dangerous unless your levels are confirmed low, so please have blood work done and talk to a doctor before starting any supplementation.
When checking iron, you must check the following. Ferritin is a non-negotiable because low ferritin is one of the first signs of an iron deficiency, but it is important to have all four tests run to get a full picture of what is going on.
- SERUM IRON → This is a measure of how much iron is circulating in your blood at a given time.
- TOTAL IRON BINDING CAPACITY → If your TIBC is above 400 ug/mL, that is indicative of an iron deficiency (source). TIBC levels become high when your body is “thirsty” for iron. A high TIBC indicates your body is ready to absorb any iron that enters your body and transport it to your cells. A lower TIBC often indicates your cells have plenty of iron and your body does not need to absorb too much from your food or supplements.
- TRANSFERRIN SATURATION → Transferrin is a protein that transfers (hence the name) iron throughout your body. Your transferrin saturation should be above 20% for optimal health, though many labs indicate a “normal” range above 15%, sometimes 13%. Normal does not mean optimal, so you can be within the normal range but still exhibit symptoms of a deficiency.
- FERRITIN → Ferritin is a protein that stores iron in your liver, spleen, bone marrow and skeletal muscle (source). Having a low ferritin but normal serum iron often means that your serum iron became low so your body borrowed the iron stored as ferritin to keep it circulating in your blood. For optimal hair health, you want your ferritin to be at least 50 ug/mL, but many Naturopathic Doctors will say 70 ug/mL is necessary to reverse hair loss.
When checking iron, it is also a good idea to check hemoglobin which is the protein in red blood cells that transports oxygen. Reversing an iron deficiency can take some time, so try to be patient! Get it checked regularly to make sure it doesn’t get too high.
2. Underactive Thyroid
Hair loss from thyroid disorders such as hypothyroidism or hyperthyroidism is often diffuse, meaning it occurs over your whole scalp and not only specific area. Hair loss from thyroid conditions is usually the result of prolonged hypo- or hyperthyroidism (source). Your doctor NEEDS to check more than just TSH (Thyroid Stimulating Hormone). TSH is released from your pituitary gland in your brain to signal your thyroid to produce triiodothyronine (T3) and thyroxine (T4). A normal level of TSH indicates that your pituitary is releasing the hormone, but that doesn’t mean your thyroid is responding to the signal. It is a good idea to get a full thyroid panel, including TSH, Free T3, Free T4, reverse T3, and thyroid antibodies to check for autoimmune markers.
T3 and T4 effect almost every process in your body, including growth and development, metabolism, heart rate, weight, and more. There is evidence to suggest that T3 and T4 alter many functions of the hair follicle, including pigmentation and the hair growth cycle (source). Hypothyroidism is also associated with low ferritin, so correcting an iron deficiency can often help with this problem (source).
3. Vitamin Deficiencies and Toxicities
The main thing to look out for is nutrient deficiencies, but I included toxicities as well because there are a few to keep in mind. Nutrient deficiencies do not happen overnight, and therefore cannot be corrected overnight. Even once the deficiencies has been corrected, it can take some time before changes can be seen in your hair and overall health. There are many deficiencies that can contribute to hair loss, but the most common are listed below.
- VITAMIN A → Too little vitamin A is not good for your hair, but too much vitamin A is arguably worse (source). Vitamin A toxicity is a common cause of hair loss, which is why people taking the acne medication accutane often report hair loss. Normal amounts of vitamin A are needed to keep the scalp healthy and repair hair. However, Vitamin A toxicity can cause liver damage so it is important to not over-supplement.
- ZINC → Disturbances in zinc metabolism have been linked to hair loss, and those with lower zinc levels are more likely to experience hair loss than those with optimal zinc levels (source). While “normal” levels of zinc are generally between 60-125 ug/mL, but optimal zinc levels are between 90-150 ug/mL (source). Zinc can block the hormone DHT, which is a known contributor of hair loss.
- VITAMIN D→ Because most of us are spending our days indoors, vitamin D deficiencies are incredibly common. While the standard range for vitamin D is 30-100 ng/mL, you ideally want your vitamin D levels above 50 ng/mL. Vitamin D stimulates hair follicles, so too little can be detrimental to your hair (source).
- B VITAMINS → Most B vitamins are intricately involved in metabolism and help give you energy. They are also involved in red blood cell formation, which helps transport oxygen and nutrients to your scalp. You’ve probably heard that biotin (B7) is especially good for your hair. There is little evidence to support this, though many people have reported impressive hair growth from taking high doses of biotin. However, biotin is not the only B vitamin important for hair growth. B12 is especially important for red blood cell production, DNA, healthy nervous system function and more. B12 deficiencies are common and have been linked to hair loss (source). Taking higher than normal doses of certain B vitamins is relatively safe since they are water soluble. Severe Niacin (B3) deficiencies have also been linked to hair loss (source). Niacin helps dilate blood vessels and is therefore necessary for healthy hair. I take a high quality b-complex to make sure I’m meeting my needs every day.
- SELENIUM → Selenium is a crucial trace mineral, and while selenium toxicity is rare, it can cause hair loss if left untreated (source).
Always work with a practitioner before supplementing. Remember that the RDA’s for most vitamins are based off what is needed for normal function of your body. Not what is needed for optimal function and hair re-growth.
4. Heavy Metal Exposure/Toxicity
Despite what many health practitioners say, heavy metals are everywhere. We are all exposed to them on a daily basis, and they can greatly effect the health of our hair (source). They can be found in canned food, pesticides, tap water, amalgam fillings, and the air. To help your body detoxify heavy metals, you’ll want to add in foods like cilantro or try a binder like activated charcoal. Always work with a health professional if you suspect you have a high level of heavy metals in your body, as they need to be removed safely to prevent your health from worsening.
I worked with a naturopathic doctor and we did some heavy metal testing and found out I had high levels of cadmium and slightly high levels of mercury. Cadmium has been shown to be related to chronic telogen effluvium (source). Other symptoms of heavy metal toxicity can vary depending on the severity, but include brain fog, memory problems, headaches, restlessness, insomnia, metallic taste in the mouth to name a few.
5. Hormone Imbalances
If you suspect your hormones are imbalanced, you want to take a closer look at your liver and gut health. You can check out my posts about supporting your liver, and healing your gut. Unfortunately, for women, one single blood test does not give you enough information into your hormone production and metabolism. Because we have hormonal cycles that vary from 21-35 or so days, we need to check hormone levels on various days throughout the month to get a deep understanding of what’s going on. DUTCH (dried urine test for comprehensive hormones) tests provide a deep understanding into your hormone production and metabolism on various days of your cycle.
One of the most common types of hormone imbalances linked to hair loss is having elevated androgen levels. DHT (Dihydrotestosterone) is an endogenous male hormone that causes miniaturization of hair follicles. All women have a certain degree of androgens, but when they become too high or get converted to the more potent DHT, that is typically when problems arise. Several things can help to naturally block DHT such as lowering refined sugar intake, lowering caffeine intake, increasing zinc, drinking spearmint tea, and eating a nutrient rich diet. DHT sensitivity can be genetic, but as they say, genetics loads the gun, but diet and lifestyle pulls the trigger. A gene will not become activated unless it is confronted with environmental and lifestyle factors that set it off. This post further covers various hormones and how they influence hair.
6. Poor Liver Detoxification & Overall heavy toxin load
Your liver has over 500 functions in your body. Some of which include processing and metabolizing hormones, nutrients, and toxins that can either help or hurt hair growth. Sluggish detoxification can lead to hormone imbalances and a build up of toxic material in your body which can impair your ability to grow healthy, strong hair. Going back to the point about hormone imbalances, they often stem from poor liver health because your liver is responsible for filtering excess hormones and preventing them from circulating back into your blood stream.
I take this herbal supplement that works to support both phase 1 and phase 2 liver detoxification. It keeps my hormones balanced, improves digestion to ensure I’m absorbing all of my nutrients, and supports clear skin.
7. Physical and Emotional Stress & HPA axis dysregulation
Adrenal dysfunction is a major cause of hair loss. Your adrenal glands are two glands that sit on top of your kidneys and essentially manage your body’s stress response. If you’re losing all of your hair, I’m not going to tell you to “stop stressing because it’s making it worse” because it’s hard. Trust me, I get it.
Chronic stress and activation of the sympathetic nervous system (fight or flight) can lead to HPA (hypothalamic-pituitary adrenal) axis dysregulation. This can lead to a host of issues such as insomnia, feeling “wired but tired,” loss of periods, and more. The bottom line is, your body cannot heal in fight or flight mode. You need to activate your parasympathetic nervous system (rest and digest) in order to repair, absorb nutrients, and heal your body.
While training for my first marathon last year, my hair loss got worse and worse. This is due in part to the fact that my iron deficiency got worse throughout training, but also because of the sheer stress I was putting on my body. When taking on an event like running a marathon or other major athletic event, your body will pool all of its resources to fuel your muscles and repair the damage. When your adrenal glands are busy making cortisol and adrenaline, they make less of the hormones needed for healthy hair. Similarly, extreme emotional distress can contribute to hair loss because of how it impairs your adrenal glands. Other stressful events that can lead to hair loss include very high fevers, major surgeries, or acute physical trauma.
Taking time to relax, get outside, take a few deep breaths, or even taking some CBD can be helpful. To support your adrenal glands, be sure to eat at regular intervals and keep your blood sugar balanced which I will discuss later on. Try to get to bed before 11 pm and sleep in a completely dark room to encourage melatonin production and ensure you enter deep, restful sleep.
8. Poor circulation
In order to have healthy hair, you need adequate nutrients. But what carries nutrients to your scalp and hair follicles? Blood and oyxgen! Your hair is “fed” by blood vessels that reside at the base of the scalp. Many people have poor circulation to their scalp which can be a result of stress, over-exercise, or lack of movement on the contrary, gut imbalances, and more. This study revealed men with male pattern baldness receive less blood and oxygen to their scalps than controls (source).
9. Side effect of medication
There are many medications that can lead to hair loss. Medication can cause mitotic activity to cease and cause too many hair to enter the telogen phase at one, thereby causing hair fall (source). It can take months before drug induced hair loss becomes evident, especially in cases of telogen effluvium. Some of the medications that contribute to hair loss include (source):
- Accutane (this goes back to the vitamin A toxicity)
- Blood Pressure Medications
- Hormonal Birth Control (can be rapid or gradual)
- Cholesterol lowering medication
- Psoriasis treatment (acitretin)
- Oral antifungals like ketoconazole
Fortunately, hair loss after drug use is often reversible when you stop taking the drug, but may take some time to fully reverse.
10. Weight loss or Caloric Restriction
As humans, our hair is important to us from a beauty and self image perspective, but it is not very important to our bodies. Your body has priorities of where to put the energy it gets from food. Hair, unfortunately, isn’t one of them. At any point when calories are restricted, your body will choose where the energy should go to keep you alive. Your body cares more about keeping your heart beating and lungs breathing than it does growing hair on your head. Ensuring sufficient calorie intake is very important in keeping your hair healthy and strong. Caloric deprivation may not manifest as hair loss for several months, so it can be hard to know if that was the cause.
Losing weight gradually instead of rapidly can help prevent hair loss. Additionally, if you are trying to lose weight, make sure you get plenty of nutrients to prevent nutritional deficiencies that would further complicate hair growth.
11. Metabolism & Imbalanced blood sugar
Both high and low blood glucose levels can have a negative effect on your hair. When you consume too many monosaccharides (simple sugars like glucose and fructose), you experience a spike in insulin to help bring your blood sugar back to normal. In addition to the insulin, your body will release androgens (male hormones) that can bind to hair follicles and cause them to either fall out or miniaturize. The miniaturization occurs over time, so you many not notice your hair is thinning for several months or even years.
On the other hand, if your blood sugar is too low, your cells won’t have the energy and fuel they need to grow hair. Imbalanced blood sugar also places a lot of stress on your adrenal glands (see point 7). To keep your blood sugar balanced, eat at regular intervals and ensure you have adequate carbs, protein, and fat at every meal to prevent a rapid spike in insulin.
12. Poor Gut health
Poor gut health can affect hair growth and lead to hair loss for a number of reasons. One of which is because if your gut health is poor, your nutrient absorption will also be poor. If you have low hydrochloric acid, you won’t be able to properly absorb the nutrients from your food. Your hair follicles will therefore not receive the nutrients they need to grow. Some common symptoms of low HCl include heart burn, gas/bloating after meals, iron deficiencies and even skin conditions such as acne.
I’ll keep this section short, becuase I have a long post with my 10 tips to heal your gut to understand how to support gut health. This will also be helpful if you’re struggling with any skin conditions!
How do you stop your hair from falling out?
As you can probably tell, there are many causes of female hair loss and it is unfortunately very complicated. There is no magic bullet to stop it. It will require a comprehensive treatment protocol that assesses vitamin and mineral levels, hormones, adrenal (dys)function, medication use, detoxification, etc. If you discover that you have nutrient deficiencies, reversing those should at least make a difference in the amount of hair you are losing. However, as I mentioned earlier, nutrient deficiencies take time to develop, so they take time to correct.
Have faith that even if you don’t see visible changes in your hair, healing is (hopefully!) happening. Don’t give up hope if your doctors aren’t giving you answers. I made the biggest strides with my health when I finally sought help from a naturopathic doctor who was willing to order more comprehensive tests. If you invest in your health now, you won’t have to pay for it later.
So, can hair grow back after thinning/falling out?
YES! All of the above causes for hair loss are reversible and you can regain the health of your hair. Keep in mind this is a process that can take months, even years, depending on the severity of your hair loss and the extent of your deficiencies, imbalances, and toxicities. Chances are your hair started falling out or thinning due to several months or years of poor diet, caloric restriction, toxin exposure, etc. It will take some time for new healthy hairs to grow on your head. Hang in there and know you are not going through it alone!
Stay tuned for part 2 about what I have personally done and supplements I have taken to stop and reverse my own hair loss!