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Getting To The Root Cause Of Hair Loss

2/27/2017

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Women and Hair Loss

American doctors with various specialties are locked into their own little silos. Dermatologists just look at the skin. Endocrinologists may test only for Thyroid Stimulating Hormone (TSH) and base everything on too narrow a view.

As a Holistic Functional Medicine doctor, I explore a broad sweep of the body’s functions looking for the central, underlying problem. Just finding a treatment for the symptom is not enough — the difficulty with hair loss is that it can result from many different issues. Some are treatable and some (at this point in time) are still untreatable. I have to cast a wide net as I check the function of many glands, sugar metabolism, hormone levels, diet and family history.
 
Some of the issues I investigate:

Excessive Stress
A stressed brain and body is just trying to survive and excessive stress can contribute to hair loss — this is not a good time for growth or reproduction. The adrenal gland makes stress hormones and the pituitary (the master gland), sends strong signals to the adrenal to make more stress hormones. At the same time, stimulation of the thyroid and reproductive organs is dialed down.

Low Thyroid
Hypothyroidism (low thyroid levels) is a common cause of hair loss. Other symptoms are cold hands and feet, constipation, weight gain and loss of the sides of the eyebrows.

There can be problems with the thyroid itself. The most common cause of low thyroid is an autoimmune disease called Hashimoto's Thyroiditis. To rule this out, I check the three thyroid antibody tests available.

In general, if thyroid production is low, the pituitary tries to stimulate the thyroid even more to increase production. Many doctors only measure TSH to assess thyroid production and just measuring TSH alone can be misleading. Under stressful conditions, the pituitary dials down TSH production. The doctor can see a low TSH reading and assume thyroid production is high, when it is actually low. It is very important to measure the full set of thyroid tests at the same time to really understand what is happening with the patient. Low TSH usually indicates high thyroid levels and high TSH usually indicates low thyroid levels (but not always).

Anovulatin and PCOS
Women who are not producing eggs on a regular basis, either because of a hormone imbalance or due to age, can have irregular periods, rising levels of testosterone and other male hormones such as DHEA and androstenedione. Excess male hormones can cause loss of hair from the scalp while stimulating hair growth on the face and other body areas.

Low Estrogen
As women near menopause, estrogen levels can fall. Scalp hair growth and maintenance is supported by estrogen and if there is a loss or reduction in estrogen, hair loss can result.

The high estrogen levels of pregnancy enables individual hair follicles to live longer than usual. After having a baby, the placental estrogens disappear. In addition, breastfeeding suppresses estrogen production. The sudden loss of estrogen can result in a large die off of hair follicles and major hair loss in the months after childbirth.

High Testosterone and Other Male Hormones 
In some people, the hair follicles on the top of the head are sensitive to male hormones and stop growing hair in their presence. Those hair follicles can change the strong male hormone, testosterone, into the even stronger male hormone DHT (dihydrotestosterone).

There are several treatment approaches:
•    Spironolactone is a medication that was originally used to treat high blood pressure. It blocks testosterone from stimulating the hair follicles.
•    Finasteride stops the hair follicle from turning testosterone into DHT.
•    Birth control pills can stop the ovaries from producing too much testosterone.
•    Diet changes such as eating sugar and other carbohydrates can raise insulin levels. Insulin can stimulate the ovary to make more male hormones. A low carbohydrate diet can help reduce the hair loss.
•    Metformin reduces insulin production.

Genetic Male Pattern Baldness
Some people carry a gene that makes their scalp hair very sensitive to male hormones. Their hair follicles turn testosterone into DHT which inhibits hair growth. It is only hair located in certain areas that experience this issue -- thus the male pattern of baldness occurs. The gene is on the X chromosome. Men have only one X, which is inherited from the mother signifying male baldness comes from the maternal side. The mother’s brothers are also an indication. Women have two X’s, one from each parent. They can inherit hair loss from either side or both parents.

Estrogen-Testosterone Ratio
Many menopausal women still make normal female levels of testosterone from their adrenal glands. As estrogen levels fall, the normal testosterone becomes dominant. This can cause hair loss from the top of the head while still stimulating facial hair growth. Estrogen replacement therapy can solve the problem by restoring the normal estrogen-testosterone ratio.

Autoimmune Alopecia
Rarely, some individuals develop an immune condition where antibodies attack the hair follicles and kill them off. This can result in total baldness. There is no current FDA approved treatment that is known to be effective. There are a few individual reports of an intestinal parasite that can affect the immune system resulting with the hair growing back.

Other Causes
Some dietary deficiencies can contribute to hair loss (such as iron deficiency). Vitamin and mineral supplementation should also be considered.
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T3, The Other Thyroid Hormone — What Your Regular Doctor or Endocrinologist Might Miss

3/8/2016

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Picture

​Most U.S. doctors prescribe only one thyroid medication known as levothyroxine T4. Physicians usually test TSH levels (Thyroid Stimulating Hormone) to measure the success of the therapy. The science has moved on but not the general medical community. 

Let’s look at what your doctor might be missing. 
There are two main thyroid hormones — T4 (levothyroxine) and T3 (triiodothyronine). 90% of the hormone in the blood is T4 and 10% is in the form of T3. T3 is much more powerful than T4 but only lasts in the blood for a few hours. T4 is weaker and can hang around for weeks. T4 is also considered a prohormone and must be turned into T3 to function fully, and is identified as the active form of the hormone. The enzyme deiodinase makes the change and because it is such a large enzyme, individuals can inherit different versions. Deiodinase works fine for some people but not so well in others. 

Thyroid hormone regulates energy, body temperature and the rate the body burns food into fuel. In the past, thyroid levels were very hard to measure because they are found in small amounts in the blood. Doctors used to measure resting oxygen consumption in a difficult, laborious test known as BMR (basal metabolic rate). 

In the 1960s, measuring total thyroid hormone levels was possible but not precise. By the early 1970s, TSH was added. The pituitary gland evaluates thyroid hormone levels in the blood and sends a signal to the thyroid gland to make hormones. The TSH coming from the pituitary gland in the brain regulates how much thyroid hormone is produced. TSH is the most common thyroid test done in the U.S. and many doctors only use a TSH test to determine how the thyroid gland is doing or if thyroid replacement therapy is adequate. 

Most of the thyroid hormone in the blood is carried on a protein called Thyroid Binding Globulin (TBG). Levels of TBG can be measured and can vary a lot, and is affected by liver function and the effects of other hormones such as estrogen. The portion of thyroid hormone not attached to TBG is called Free Thyroid. Total T4 and Total T3 can now be measured as well as Free T4 and Free T3. Despite the advances in laboratory testing, many doctors still measure only TSH. Some may measure TSH and Free T4. 

Bodies are complex and problems and variations can occur at many points in the thyroid system. Problems can arise in the pituitary measurements, which throws off TSH. Lack of iodine can cause thyroid production problems. There may be normal amounts of T4 but poor conversion of T4 to T3 because of a variant form of deiodinase or a lack of dietary selenium, which is required as a catalyst. Changes in levels of TBG can affect the relationship between Total and Free Thyroid levels. 

Take Home Message:
At Georgia Hormones, we not only measure all parts of thyroid performance but we also look at adrenal hormones and sex hormones which can also affect thyroid function. One or two tests simply don't tell the whole story. Sometimes the laboratory makes mistakes. An incorrect lab test becomes obvious when it is telling a different story from the rest of the set. Just getting one or two thyroid tests can result in false conclusions and incorrect therapy. That is why we do a full evaluation of all of the major hormones. We are looking for balance and health, not just a single prescription. If all you have is a hammer, everything looks like a nail. Simply measuring TSH and prescribing only T4 (levothyroxine) may be OK for many people but may not be adequate for those who don’t exactly “fit the mold.”

Bioidentical T4 and T3 are available at any drugstore as well as freeze dried pork thyroid, which contains both T4 and T3. If needed, compounding pharmacies can make special combinations.
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    Robert P. Goldman, M.D.

    Dr. Robert P. Goldman provides guidance for female and male hormone balance, menopause management, holistic therapies and routine gynecological care.

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