[Deep Dive Series] Hair Loss: Unpacking the key causes & reasons – more than just hormones

Today we're going to talk about Hair Loss and do a WAY DEEPER investigation.

Many of our patients come to us as a last resort, after a doctor has told them their hair loss is simply part of getting older. They may have been referred to a dermatologist for hair growth medication, but they really feel there's more to their hair loss than "just getting old."

It's a frustrating thing to hear, especially when you know your hair used to be thicker, your hair line was closer in (not receding), your eyebrows were thicker, and something in your body has genuinely changed.

Hormone shifts during perimenopause, during menopause, and after menopause can slow hair growth and follicles. But "ageing" is rarely the whole story.

Hair growth is one of the first things your body deprioritises when it's stretching limited resources to protect more essential functions. That's why hair loss is so often the visible, external sign of something running low internally.

In the clinic, we almost never see hair loss caused by just one thing. It's usually several factors layering on top of each other, and once we untangle them, the hair often responds.

The Baseline: Hormone Hair Shifts

Hormones are worth looking at closely, but not in the vague way it's usually explained. Let me explain:

Oestrogen has a specific job when it comes to hair: it keeps follicles in their growth phase for longer.

Progesterone helps by gently blocking the enzyme that converts testosterone into its more potent, follicle-shrinking form.

As both oestrogen and progesterone decline and drop further after menopause, more follicles slip into their resting phase at once

hair is shed before it's had the chance to grow long, and the scalp gets less of the blood flow that oestrogen has helped support.

This is also the window where an insulin-resistant induced androgen shift starts to show up, which is where we're going to start with the first, most common, hormone to blame causation of hair loss.

Follicles in the frontal and crown regions are more sensitive to androgens, carrying higher levels of the enzyme (5-alpha-reductase) and receptor density that let testosterone act on them.

So this shift can unmask or accelerate androgenetic-pattern thinning, a widening part and crown thinning, in women who were genetically predisposed all along, just protected until now by higher oestrogen.

Insulin plays a bigger role here than most women realise. When cells become less responsive to insulin, a very common shift through perimenopause, the body compensates by producing more of it.

Excess insulin does two things that make androgen excess worse:

– it drives the ovaries to produce more testosterone directly, and

– it lowers the liver's output of SHBG (sex hormone binding globulin), the protein that normally keeps testosterone bound up and inactive. Less SHBG means more free, biologically active testosterone circulating and reaching the follicle.

This is the same mechanism that drives hair loss in PCOS/PMOS (below), and it's why insulin resistance and blood sugar regulation are often central to treating androgen-driven thinning, even outside of a PCOS/PMOS diagnosis.

Beyond hair thinning at the part and crown, androgen excess often shows up as:

2. Hypothyroidism (OR Subclinical Hypothyroid OR Subclinical Free T3)

Many of our patients diagnosed with hypothyroidism or Hashimoto's are already on thyroid medication such as thyroxine, and are still losing hair. It's disheartening to be doing "the right thing" and not see it reflected in the mirror.

A number of the women we see, though, thyroid hormone levels are within subclinical hypothyroidism. TSH sits within the standard reference range, so nothing rings alarm bells for their GP, but their Free T3 (the active thyroid hormone your cells actually use) is sitting low , or their Free T4 to Free T3 conversion isn't working well . A "normal" TSH doesn't mean your thyroid is delivering what your follicles need.

Both groups tend to describe the same thing: more hair coming out when they brush or wash it, and thinning concentrated at the front of the scalp. Eye brows thinning, especially on the outer edges.

And because oestrogen affects how much thyroid hormone is available to your cells, peri-menopause can quietly worsen a thyroid picture that was previously just ticking along.

What we usually find is that thyroid-related hair loss needs more than thyroid hormone alone. It needs gut support and the nutrient cofactors the thyroid depends on, so the body has what it needs to bring itself back into balance rather than being propped up indefinitely.

If a sluggish thyroid is part of your hair loss picture, you may also notice:

3. PCOS, now known as PMOS

Conventional medicine often manages PCOS/PMOS with the contraceptive pill. It can help with symptoms while a woman is on it, but it doesn't address why the hormones went out of balance in the first place.

But PCOS/PMOS, at its root, is usually a story of hormone imbalance and nutrient deficiency. Once those come back into balance, the body becomes a much stronger vessel for implantation, and the hair tends to improve alongside everything else.

Women with PCOS/PMOS often experience hair loss on the scalp alongside excess hair growth on the face, arms, or legs, a combination that takes a real toll on confidence. We wrote a deep dive article on PCOS if you want to read more about this, you can do here: https://thenaturopathyclinic.com/deep-dive-series-metabolic-syndrome-pcos-and-why-you-need-to-understand-it/

Iron is one of the most overlooked reasons for hair loss, and one of the most fixable.

During perimenopause, heavier or more erratic bleeding from unpredictable cycles can steadily drain iron stores, and

After periods stop, declining stomach acid with age often slows how well iron is absorbed from food, which is why iron can sit stubbornly on the low side of normal even in women eating plenty of iron-rich food and taking B vitamins.

Few women realise how directly iron feeds the hair growth cycle , and it's one of the most consistently missed factors in a standard work-up.

Alongside hair shedding, low iron often brings:

We like to see ferritin around 100. Thirty is considered the low side of normal in most tests Australia-wide.

5. Lowering Immune System

Nutrient deficiencies rarely announce themselves quietly. Long before they show up as a diagnosis, they show up as a lowered immune system, since hair follicles are one of the first tissues your body scales back.

Every body absorbs nutrients differently. What our bodies receive, and even what we were given in utero, shapes how well we absorb and use nutrients decades later. Hair and weight are two of the clearest external signs that something nutritional is out of balance.

The nutrients we most commonly see running low with hair loss include:

Many women come to us having already tried a hair growth supplement with little to show for it. That's not necessarily because the supplement was wrong, it's because if there are other factors at play (thyroid, iron, hormones, a specific amino acid gap), a general supplement was never going to be enough on its own. {It's why we look at all these factors.}

Alongside hair thinning, a lowered immune system from these gaps often shows up as:

Low amino acids aren't often on any woman's mind when she has hair loss.

At one point in my early forties, I was so scared to watch my hair because of how much hair would come out. I had dealt with my thyroid, my immune system, my hormones, my vitamin levels, but still my hair was falling out.

Sure enough, my amino acid, L-serine, was nearly gone. [ L-serine is an amino acid your body needs for healthy cell membrane production, including in the hair follicle.]

I supplemented a lot for several months, adjusted my diet to increase L-serine rich foods, and my hair came back and has restored it's thickness.

This was my case, but there are a number of amino acids involved, and we will look at your bloods to see why you are losing hair before we assume it's an amino acid.

Amino acids are the building blocks your body uses to construct pretty much everything, including the keratin structure of your hair. When your protein intake or digestion isn't providing enough of the right amino acids, or your body isn't absorbing and using them efficiently, hair is often one of the first places it shows , since it's a "lower priority" tissue your body will sacrifice before more essential ones.

Because amino acid gaps like this are less commonly tested for, the signs are subtler and easy to attribute to other things, but can include:

It's Rarely Just One Thing

Most of the women we see with hair loss have a combination of two, three, or even all of the factors above, hormonal shifts during perimenopause or after menopause, relative androgen excess, a thyroid picture that doesn't show up clearly on standard bloods, low iron, a lowered immune system from broader nutrient gaps, and/or low amino acids, often all sitting quietly underneath each other.

Conventional medicine is genuinely excellent at many things.

But when a doctor tells you your hair loss is "just ageing," what they're really saying is that nothing on your standard panel looked dangerous enough to treat. That's very different from saying there's nothing going on, and it's very different from saying there's nothing that can be done.

If you would like to learn more about how to unpack your unique pathology and symptoms, I highly recommend watching our brand new webcast, Genetics & Peri/Post Menopause:

If you would like support, and you can see that something is not right and want to dig deeper to find the root cause, I would love to invite you to book a free introductory consultation with us:

We look forward to connecting with you again soon.

Warmly,
Carrie Myton