Hair loss is a great concern to many, there are also many theories as to why it occurs. Various studies have been done too, but no one seems to be able to confirm the actual cause.

Hair loss falls under several categories:

• alopecia totalis (AT)
• alopecia universalis (AU)
• alopecia areata (AA)
• female pattern hair loss
• female androgenetic alopecia (FAGA)
• androgenic alopecia(AGA)
• telogen effluvium

It can be caused by any one of the following:

• lack of vitamin D3
• stress, mental, physical or emotional
• excess insulin
• insulin resistance
• infections
• excess free testosterone
• surgery – anaesthetic
• thyroid problems
• lack of protein in the diet
• low iron – ferritin
• drugs
• contraceptives - Mirena
• HRT
• chemotherapy
• radiation therapy
• fungal infections
• persistent adrenarche syndrome
• adrenal or ovarian tumour
• hysterectomy
• menopause
• PCOS

It appears that all the above fall under the stress category. Stress causes a cascade of inflammatory cytokines to be produced, which in turn increases oxidative stress. This now leads to a drop in antioxidant levels which leads to inflammation.

90% of hair growing takes place during normal hair growth which is called the anagen phase and lasts between 2-6 years. Then comes the catagen phase which signals the end of the active growth of a hair and lasts for about 2-3 weeks. This phase is followed by the resting or telogen phase lasting 2–3 months. It is then that hair loss takes place. About 10% of the hair is in the telogen phase. Normal loss ranges from 50 to 100 hairs per day. After a hair is shed, the anagen phase begins again with new hair from the same follicle. Hair on the scalp grows about 1 to 1.5cm per month.

Estrogen is a known cause of IR, progesterone levels drop during Peri-Menopause, whereas estrogen levels remain normal until menopause. HRT and Contraceptives are also a cause, both normally contain estrogen and progestin.

Testosterone is another cause of IR, resulting in hair loss. The enzyme 5 alpha-reductase converts testosterone into dihydrotestosterone (DHT). DHT is connected to hair loss. Progesterone inhibits 5 alpha-reductase activities.

Androgen excess in women causes both hirsutism, including facial hair, and hair loss from the head. By reducing 5 alpha-reductase activities in the skin, progesterone assists in reversing this. Studies show that 2–5% topical progesterone can help in some cases of hair loss. Roughly 10% of pre-menopausal women show evidence of androgenetic alopecia. Women 65 years or older suffer from this condition.

Each month women produce more testosterone than estrogen, normally most is converted to estrogen. The enzyme aromatase affects the conversion, this conversion slows down as women get older. The menopausal ovary is an androgen producing organ. Adrenals also produce androgens.

Weight loss certainly reduces hair loss in hyperandrogenic women. This is more than likely because of a decrease in androgen levels. It is a known fact that testosterone causes weight gain in women.

Low levels of sex hormone binding globulin (SHBG) increase free testosterone levels. It is essential to increase SHBG, and avoid all sugars. Fructose reduces levels by 80%, sucrose by 50% and glucose by 50%. The increase in testosterone not only leads to hair loss, but to an increase in :

• visceral fat
• cancer
• cysts
• weight gain

Female pattern hair loss (FPHL) – no one seems to know what the reason is for female pattern hair loss in postmenopausal women with normal androgen levels. But the condition does improve with the drug finasteride. This now inhibits the enzyme 5 alpha-reductase, which prevents DHT from forming. It is also used for treating androgenetic alopecia, which implies that FPHL is caused by excess androgens. Quite often it is the total testosterone which is checked and not the free testosterone level. It is the only active testosterone, the remainder being bound to SHBG, therefore inactive. Total testosterone could fall into the normal range, but if free testosterone is higher than normal, this will not be found unless it is checked for.

Alopecia areata (AA)

• alopecia areata (AA) – patchy baldness, is found in 1 in 1000 people. It affects children, men and women equally
• alopecia areata universalis (AU) – total hair loss from the scalp
• alopecia areata totalis (AT) – total hair loss from the entire body

The above are usually regarded as autoimmune diseases (AA). Adults with AA have usually experienced extreme emotional and physical trauma, particularly in childhood. Various triggers have been found and oxidative stress is high on the list. This now leads to inflammation. The same applies to emotional and physical stress. Nutritional deficiencies and endocrine imbalances are other triggers.

The above are usually regarded as autoimmune diseases (AA). Adults with AA have usually experienced extreme emotional and physical trauma, particularly in childhood. Various triggers have been found and oxidative stress is high on the list. This now leads to inflammation. The same applies to emotional and physical stress. Nutritional deficiencies and endocrine imbalances are other triggers.

Hair loss during the anagen phase is usually as a result of chemotherapy or radiation.

• mast cells
• natural killer cells
• substance P
• IFN-gamma
• interleukins
• TNF- alpha
• MIG
• IP-10
• BAFF
• HLA antigens
• MIG
• stress hormones

Inositol – often called the anti-alopecia vitamin. It increases the action of insulin and decreases insulin resistance, decreases serum androgen concentrations, bloody pressure and helps reduce cholesterol level.

Thiamine Vitamin B1 – is a coenzyme important in intracellular glucose metabolism. It is essential for glucose oxidation, improving glucose tolerance and insulin productions by pancreatic cells

Biotin – stabilises blood sugar and eliminates cravings for carbohydrates, in some cases is better than chromium. It reduces high blood sugar and is needed for healthy hair and skin.

Vitamin D3 – is vital for the anagen growth phase in hair, a deficiency is implicated in:

• Insulin resistance
• cardiovascular disease
• hypertension
• glucose metabolism disorders
• hypercholesterolemia
• cancers
• high insulin
• obesity

and much more.

N-Acetyl Cysteine (NAC) – is found in hair, skin and nails. It improves high sucrose diet induced obesity, glucose tolerance, lipid profile, in vivo LDL oxidation and serum oxidative stress and enhances antioxidant defences. Oxidative stress can lead to abnormal changes in intercellular signalling, resulting in insulin resistance and chronic inflammation. NAC is also one of the precursors to glutathione, an essential antioxidant within cells.

Suggested amount of the above nutrients to take:

• Vitamin D3 – 5000iu’s per day as a minimum. Children under 5 years of age should take 2000iu's per day
• Insolitol – 2000 to 4000mg per day
• NAC – 1000 to 2000mg per day
• Biotin – 2 to 3mg per day
• Thiamine – 100mg per day

Vitamin A (Retinol) Toxicity - there is strong evidence that too much vitamin A is linked to hair loss. For this reason it is advisable not to take any form of fish liver oil including Cod Liver Oil (CLO). Too much also interferes in the uptake of Vitamin D3 - see here.

Vitamin D3 deficiency links the above. A deficiency is implicated in the following:

• over 20 different disorders
• insulin resistance
• high cholesterol
• inflammation
• heart disease
• high blood pressure
• PCOS
• autoimmune diseases

It regulates gene expression and has a fundamental effect on cell differentiation and growth. It positively affects the nervous system by stimulating neurotrophic factors, quenching oxidative hyperactivity and regulating autoimmune responses.

For more information on Vitamin D3 please see Vitamin D Council, GrassrootsHealth and Birmingham Hospital websites.

Medical Treatment for Hair Loss

Minoxidil – is a vasodilator, given primarily for hypertension. Side effect, increase in hair growth.

Finasteride – used for the treatment of androgenetic alopecia and inhibits the enzyme 5alpha-reductase, it converts testosterone to dihydrotestosterone.

PUVA treatment – has led to some success in alopecia areata totalis and universalis. It comprises a combination of psoralen and UVA light! Psoralen is a tricyclic lactone and has been used in sunscreens, it has now been banned as a melanoma risk increased by four-fold.

Ezetimibe and Simvastatin – A study found a combination of these 2 drugs, together with corticosteroid injections, showed a significant benefit in refractory alopecia. It has been shown that statins act as Vitamin D analogues, hence their benefit in treating high cholesterol levels. Vitamin D3 reduces cholesterol.

Alefacept – is a genetically engineered immunosuppressive drug used to treat psoriasis. A study on a patient who had alopecia universalis, found that she responded with complete regrowth of scalp and body hair after 12 weeks.

Other therapies incude:

• Contact immunotherapy
• Corticosteroids
• Cyclosporine
• Dutasteride
• Dithranol
• Flutaminde
• Fluvestrant
• Spironolactone
• Cyproterone acetate – with or without ethinyl estradiol

Hair Loss References

New study finds derivative of activated vitamin D helps manage hair loss

 Researchers Target Vitamin D to Coax Dormant Follicles to Grow Hair; Early Promise, but Years to Go

 The 1,25-dihydroxyvitamin D3-independent actions of the vitamin D receptor in skin

Cytokines and other mediators in alopecia areata

Androgens associated with advanced glycation end-products in postmenopausal women

Reproductive Hormones and Obesity: 9 Years of Observation From the Study of Women's Health Across the Nation

Hair follicle is a target of stress hormone and autoimmune reactions

Male androgenetic alopecia and cardiovascular risk factors: A case-control study

Higher Serum Testosterone Concentration in Older Women is Associated with Insulin Resistance, Metabolic Syndrome, and Cardiovascular Disease

Keratinocyte growth inhibition through the modification of Wnt signaling by androgen in balding dermal papilla cells

Increase in Visceral Fat During Menopause linked with Testosterone

Diffuse hair loss: its triggers and management