The Encyclopedia of Natural Medicine, 3rd Ed.

Hair Loss in Women

• Hair loss of any type: diffuse or focal, chronic or acute

Many women experience excessive hair loss. In fact, it is one of the most common complaints from female patients. In most cases the hair loss is not severe; rather, the patient perceives that hair loss is occurring at an increasing rate. Unfortunately, these complaints are often dismissed by many physicians. Hair loss is difficult to quantify, and it is certainly not a life-threatening disorder. Nonetheless, the complaint should not be dismissed.

Physiology of the Hair Cycle

The human scalp has between 100,000 and 350,000 hair follicles, which undergo cyclical phases of growth and rest. During the anagen phase, the hair is actively growing. As the hair matures, it enters into a resting (telogen) phase. Then the hair bulb migrates outward and eventually is sloughed off. It is during this migratory phase that the stage is set for new hair to come in after the original hair is lost. Age, various diseases, and a wide variety of nutritional and hormonal factors influence the duration of the hair cycle.

Generally speaking, hair loss is a normal part of aging. By the age of 40 or so, the rate of hair growth slows down. New hairs are not replaced as quickly as old ones are lost.

The hair pull test can help determine the relative formation of new hair. It involves taking a few strands between the thumb and forefinger and pulling on them gently. Hairs in the anagen phase should remain rooted in place, while hairs in the telogen phase should come out easily. Knowing approximately how many hairs were pulled, and the number that came out, indicates the percentage of hair follicles in a telogen state. For example, if 20 hairs were pulled and 2 came out, then the frequency of telogen hair follicles is 10%. As a very rough guide, a 10% telogen frequency is excellent, up to 25% is typical, and over 35% is problematic.

Types of Hair Loss

Hair loss—the medical term is alopecia—can be broadly divided into two types: focal (small patches) or diffuse (all over the head). Diffuse hair loss is most often due to metabolic or hormonal stress or to medications. It can vary from mild thinning to complete hair loss (e.g., as seen with chemotherapy drugs). Generally, recovery occurs when precipitating factors are dealt with. Women can also experience either male- or female-pattern hair loss. Focal hair loss is most often secondary to an underlying disorder, and it may be of two types, nonscarring or scarring alopecia. Nonscarring focal alopecia is usually caused by tinea capitis (a fungal infection) or alopecia areata (which is autoimmune-related), although there are other causes. Scarring alopecia is rare and has a number of causes, but the most common is lupus, an autoimmune disorder.¹

Causes of Hair Loss in Women and Therapeutic Considerations

Female-Pattern Hair Loss

Women can suffer from hormone-related hair loss just like men.¹–⁴ Female-pattern hair loss, however, is more diffuse than characteristic male-pattern baldness.^1,4 It is a relatively common condition affecting approximately 30% of women before the age of 50. Although genetic factors are clearly significant, testosterone excess, insulin resistance, polycystic ovarian syndrome, and low antioxidant status are also associated with female-pattern hair loss.²–⁸ Three recommendations that may help slow down this genetically predisposed process are: (1) improve blood sugar regulation through diet, lifestyle measures, and supplements; (2) increase antioxidant intake; and (3) consider saw palmetto extract.

Free radical damage has been shown to play a central role (along with testosterone) in male-pattern baldness. Higher levels of these damaging compounds are found in the hair follicles in men (and presumably women) with male-pattern hair loss.⁵ This appears owing to lower levels of glutathione. The use of glutathione-sparing antioxidants such as vitamin C, N-acetylcysteine, alpha-lipoic acid, and flavonoids may help slow down the process.

The potent androgen dihydrotestosterone (DHT) is formed from testosterone by the action of the enzyme 5-alpha-reductase. The activity of this enzyme is increased in both male- and female-pattern hair loss.⁶Saw palmetto extract can inhibit the formation and transport of DHT. This is the same mechanism as that of the drug finasteride (Propecia), which is often used in female-pattern hair loss.⁹ The dosage for saw palmetto extract standardized to contain 85 to 95% fatty acids and sterols is 320 mg per day.

Drug-Induced Hair Loss

A long list of drugs can cause hair loss, but they are not always the sole cause of hair loss in a woman who is taking one of them. Of course, some drugs, most notably chemotherapy agents such as fluorouracil, are obviously the cause because they are such powerful inhibitors of hair growth. When medically appropriate, natural alternatives to suspected culprits of hair loss should be employed.

Nutritional Deficiencies

A deficiency of any number of nutrients can lead to significant hair loss. Zinc, vitamin A, essential fatty acids, and iron are the most important.

If the fingernails have horizontal white lines, these may indicate poor wound healing of the nail bed even with the most minor trauma, which may be a sign of low zinc levels. If the backs of the arms are bumpy and rough, that may represent hyperkeratosis, a common sign of vitamin A deficiency. If the elbows are very dry and cracked, the condition may be due to essential fatty acid deficiency.

For evaluating iron status, a blood test for serum ferritin is recommended. If the serum ferritin is less than 30 mg/l, iron intake must be increased via diet and supplementation. When serum ferritin levels fall below this level, hair growth and regeneration are impaired, as the body seeks to conserve iron.¹⁰ There is a very strong association between low body iron stores and diffuse hair loss in women.^11,12 For more information, see the chapter “Anemia.”

Typically, women with noticeable generalized hair loss suffer from apparent deficiencies of all of these nutrients. Treatment of hair loss due to nutritional deficiency is straightforward—increase dietary intake of these nutrients and supplement appropriately. One caveat is that many of these women may not be secreting enough stomach acid. In these cases, hydrochloric acid supplementation at meals may be all that is necessary. (See the chapter “Digestion and Elimination” for more information.) A general recommendation for women with hair loss related to nutritional status is to take a high-potency multivitamin and mineral formula that contains iron, along with 1 tbsp flaxseed oil per day.

Another general recommendation for hair loss is to take a special form of silicon, an essential trace element required for the normal growth and development of hair. Studies show that choline-stabilized orthosilicic acid (ch-OSA or BioSil), a highly bioavailable and stabilized form of silicon, increases levels of hydroxyproline, the key amino acid required for the production of collagen and elastin—compounds that are essential to the strength, thickness, and elasticity of hair. In one double-blind study, 48 women with fine hair were given 10 mg silicon as ch-OSA per day for nine months. Oral intake of Ch-OSA had a positive effect on tensile strength, including elasticity and break load, and resulted in thicker hair.¹³

Hypothyroidism

It is a well-known fact that hair loss is one of the cardinal signs of hypothyroidism. The prevalence of hypothyroidism in American women is estimated to be as high as 20%. For more information, see the chapter “Hypothyroidism.”

QUICK REVIEW

• Although some hair loss is a natural part of the aging process, excessive or accelerated hair loss should be investigated and treated appropriately.

• Hair loss can be broadly divided into two types: focal (small patches) or diffuse (all over the head).

• Five common causes of hair loss in women are female-pattern hair loss, drugs, nutritional deficiencies, hypothyroidism, and the presence of antigliadin antibodies.

• Deficiencies of zinc, vitamin A, essential fatty acids, and iron are the most important nutrition-related causes of hair loss in women.

• Oral intake of a special preparation of silicon had a positive effect on tensile strength including elasticity and break load and resulted in thicker hair.

• Antibodies to gliadin can lead to cross-reacting antibodies that attack the hair follicles.

Antigliadin Antibodies

The protein gluten and its polypeptide derivative gliadin are found primarily in wheat, barley, and rye. It appears that antibodies to gliadin can lead to cross-reacting antibodies that attack the hair follicles, leading to alopecia areata—an autoimmune disease characterized by areas of virtually complete hair loss.¹⁴

Celiac disease is characterized by malabsorption and an abnormal small intestine structure that reverts to normal on removal of dietary gluten. Evidence is growing that many people with gluten intolerance do not have overt gastrointestinal symptoms. Instead, they may demonstrate gluten intolerance in less obvious ways, including hair loss. Rather than testing for antigliadin antibodies in patients with general hair loss or alopecia areata, the test for human antitissue transglutaminase antibodies (IgA anti-tTG) is recommended, as it has a greater sensitivity compared with antigliadin antibodies (see the chapter “Celiac Disease”). This recommendation is especially important if there are any gastrointestinal symptoms that might indicate celiac disease.

Key Diagnostic Features of Celiac Disease

• Bulky, pale, frothy, foul-smelling, greasy stools with increased fecal fat

• Weight loss and signs of multivitamin and mineral deficiencies

• Increased levels of serum gliadin antibodies

• Diagnosis can be confirmed by biopsy of the small intestine

TREATMENT SUMMARY

Hair loss in a woman should not be dismissed, and a thorough clinical evaluation can be very valuable. Clinical studies have investigated the psychological impact of hair loss in women and found that is a significant source of anxiety, fear, and depression.^1,4

Diet

• Follow the recommendations in the chapter “A Health-Promoting Diet”

• Rule out gluten sensitivity; see the chapter “Celiac Disease”

Nutritional Supplements

• Follow the general recommendations in the chapter “Supplementary Measures”

• If serum ferritin levels are below 30 mg/l, take iron bound to either pyrophosphate, succinate, glycinate, or fumarate, at a dosage of 30 mg twice per day between meals (if this recommendation results in abdominal discomfort, take 30 mg with meals three times per day).

• Choline-stabilized orthosilicic acid (ch-OSA or BioSil): 10 mg per day