Women of all ages can have hormone problems that cause a variety of changes in hair – from thinning to hair that falls out in handfuls to excess facial and body hair.
Hormone changes can alter hair texture from fine to coarse or from curly to straight. In my medical practice, I evaluate women from puberty to menopause and beyond who have experienced all of these problems. It becomes quite a challenge to sort out the many factors that affect our hair.
It is even more common for older women after menopause to experience rapid hair thinning or balding. Let’s look at the ovarian, thyroid, adrenal, and common metabolic causes of hair loss.
Women typically first think hair loss means “low thyroid,” because so many consumer books and websites focus extensively on “the thyroid connection.” Yet many fail to address the ovarian hormone changes that affect hair growth patterns, and fail to address other metabolic imbalances that can cause hair loss.
I often see patients who have had baseline thyroid function checked many times, without ever having any of these other endocrine and metabolic tests done.
When told the thyroid is “normal,” many women keep searching for someone to give them thyroid until they finally get a doctor who gives them a prescription for T3 alone or “natural thyroid” products that contain both T4 and T3, but in a higher amount of T3 than is normal for humans.
What often happens to these women – and I’ve treated thousands of them – is that they really didn’t need thyroid, but instead were low in estradiol or high in DHEA or testosterone or progesterone relative to estradiol.
Women like this who are given thyroid when they don’t need it are all too often pushed into thyroid excess syndromes, or iatrogenic (doctor-caused) hyperthyroidism.
What happens to your hair when you have too much thyroid? It starts becoming thinner and thinner, and falls out more rapidly. So if you are on thyroid medication and are still losing hair and it doesn’t seem to be getting better, go back to your primary care physician or a good endocrinologist and check to be sure that you are not over-replaced on thyroid medicine. Over-replaced thyroid is easily confirmed by a TSH of less than 0.5 and higher than normal levels of free T3 and free T4.
After menopause, loss of estradiol causes women’s hair to become thinner and thinner, with balding in the front of your scalp. Low estradiol combined with the higher levels of androgens (adrenal and ovarian) causes this “male-pattern” baldness in older women.
Loss of estradiol also contributes to loss of hair under the arms and on the legs. Scalp hair loss gets even worse if women with low estradiol are given excess thyroid, or DHEA supplements, or progesterone creams, or testosterone prescriptions without first having estradiol restored to optimal ranges.
But even while the hair on your head may be falling out, it seems to suddenly appear on your chin and upper lip instead, another effect of excess male hormones and low estradiol.
Excess and deficiency of the adrenal stress hormone, cortisol, can also cause thinning and loss of scalp hair. Cortisol excess leads to serious balding effects in women that can be very alarming.
Adrenal cortisol deficiency also causes loss of body hair, loss of axillary and pubic hair. Ask your primary care physician to check blood levels of total and free cortisol at 8 a.m. if you are concerned about a possible adrenal problem. Saliva tests are not reliable for accurate diagnosis of adrenal deficiency or adrenal cortisol excess.
Older women who are losing hair also need to check blood levels of iron stores (ferritin) and vitamin D. Deficiencies of both of these nutrients can cause hair loss.
Women typically don’t eat red meat as much as men do, so they have lower iron intake over the years and lose iron over their reproductive life and the years of menstrual bleeding. So rather than avoiding iron, women need to have a blood test for ferritin and see whether they may really need iron supplements instead.
Low vitamin D occurs as women have become more careful to avoid sun exposure and use sun block. Sunlight hitting the skin is needed to make vitamin D from precursors in the skin. Make sure your vitamin D is in the ranges we now consider optimal.
So it’s not just thyroid that gets out of whack as women get older. All our hormone systems are changing, but the more drastic one is loss of estradiol that in turn compounds the adverse effects of imbalances in other pathways. If it’s really your estradiol that’s too low, taking thyroid won’t help, and often makes the symptoms worse.
Check out my website, www.herplace.com, for free booklets that you can download to assist you in working with your doctor to get properly tested.
For more in-depth reading on all the many endocrine and metabolic problems that can affect your hair, read my book, It’s My Ovaries, Stupid!
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