Noticing changes in your hair can be distressing – excessive shedding, a more visible scalp, a receding hairline, a thinner ponytail, early greying or even eyebrow thinning are some things that women notice that cause them worry. In Singapore, many sufferers turn to non-medical settings to treat their hair loss woes when in truth, they should be seeking medical treatment for hair loss.
Female hair loss is a complex topic and could have a large number of causes that range from genetics to nutrition, from poor scalp care to stress, from autoimmunity to excessive hair styling. One of the more understated, but equally important, causes of hair loss in women is hormonal imbalance. (The term here is used loosely because it is not a diagnosis it itself, but rather, hormonal imbalance in this context refers to hormone levels in your body that are not favourable for good hair growth.)
At Terra Medical Clinic, we see a myriad of cases that present for female hair loss treatments and we look into every detail to diagnose and treat your hair loss. In cases of hormone imbalances, there is usually a need to seek medical treatment from a hair restoration practitioner as salons, spas and herbal solutions do not address the underlying issue.
What are Hormones?
The Oxford Medical Dictionary defines a hormone as “a chemical substance produced in the body or in a plant that encourages growth or influences how the cells and tissues function; or an artificial substance that has similar effects”
There are a few hormones of interest when it comes to female hair loss:
- Vitamin D3
- Dihydrotestosterone (DHT)
What are some examples of what an imbalance of these hormones can do to your hair?
Vitamin D aka cholecalciferol (the ‘sun vitamin’), while termed to be a ‘vitamin’, behaves very much like hormone. Vitamin D3 and especially, the Vitamin D Receptor (VDR) has been studied extensively in hair loss conditions and has been found to be an important factor in the formation of hair follicles in animal studies. Genetically-modified VDR deficient mice were born hairless! It is estimated that 91% of female pattern hair loss sufferers, 90% of chronic telogen effluvium sufferers and 83% of alopecia areata sufferers were found to be Vitamin D deficient. There are academic debates about how much Vitamin D is ‘sufficient’ for good hair health but there is general consensus that a level of 30ng/mL of Vitamin D3 is a good blood level. In Singapore, it is estimated that 40% of people could be Vitamin D deficient.
Dihydrotestosterone (DHT) is a more potent form of the male hormone, testosterone. Testosterone is present in both men and women and controls many functions of development, sexual maturity and function, sebaceous activity etc. Testosterone naturally breaks down into dihydrotestosterone and oestrogen in the body. When DHT levels are higher, this potent androgen binds to receptors at the hair follicle, initiating an inflammatory cascade that leads to hair follicle damage and eventual dormancy. Some people will not be susceptible to this type of damage as the hair follicle androgen receptors do not react to DHT.
The other breakdown product of testosterone, oestrogen, is somewhat protective of your hair. Oestrogen prolongs the anagen phase of the hair cycle i.e. prolongs the growth phase, allowing the hair to grow longer, thicker and stay on your scalp for a longer period of time before eventually shedding (telogen phase). Thicker hair is an often perceived side effect of pregnancy – a state whereby oestrogen levels are higher. However, after childbirth, oestrogen levels drop dramatically and can cause a shedding event (post-natal hair loss) 3-5 months later.
Thyroxine (T4), and its cousin, triiodothyronine (T3) are active hormones produced by a gland in the neck called the thyroid. Collectively, they are called ‘thyroid hormones’. They are known to be vital in controlling hair follicle cycling (read more about the hair cycle here) and involved in pigmentation of hair. Some thyroid conditions are medical emergencies e.g. “thyroid storm”, but a large proportion present as milder thyroid hormone imbalances. Even mild thyroid hormone imbalance, over a prolonged period, can cause hair to shed and thin.
Prolactin is a hormone (as the name suggests) is related to breast milk production, amongst other crucial functions in brain chemistry. In the laboratory setting, the prolactin hormone actually inhibits hair follicle development, causing hair thinning. Many academic publications have suggested that prolactin levels in humans have to be very high in order to cause female hair loss. The likely source of such a high prolactin level would be an abnormal signalling mechanism in the brain, or a tumour that is secreting prolactin. This condition is uncommon and not usually screened for but if all other diagnostic possibilities are ruled out, a blood test for prolactin can be done.
DHEA-S, also known as dehydroepiandesterone sulphate, is the most abundant androgen (male hormone) in the circulation. In excessively high levels, this can cause androgenising features and secondary male characteristics e.g hirsutism. Imbalance of this hormone can also cause once strong hair follicles to regress into miniature hair, or what is colloquially termed ‘baby hair’.
Imbalance in these hormones do not only cause hair related symptoms but also can cause problems with other bodily systems – the skin, heart, weight control, fertility, bone health, cognition and memory etc.
This list is not exhaustive, there are thousands of hormones (and probably many more that have yet to be discovered) that impact our health overall. As you can imagine, female hair loss treatment that aims to prevent, diagnose and treat hormonal imbalances should be approached medically, starting with a consultation to discuss your concerns.
How Terra Medical Clinic Approaches Female Hair Loss Treatments Caused by Hormonal Imbalances
A comprehensive consultation which assesses previous medical history, diet, lifestyle, elements of stress, genetics and a thorough physical examination and scalp and hair microscopy is conducted. If the presumptive diagnosis is that of a hair loss condition related to hormonal imbalance, a panel of blood tests may be ordered to confirm the diagnosis.
The entire panel of blood tests usually also include relevant nutritional parameters as they can be related. (But that is another article for another time)
Depending on other personal factors such as family planning, pregnancy status, concurrent medical conditions and chronic medications, a treatment plan will be formulated based on your expectations – both short and long term goals will be discussed.
It is not uncommon to prescribe androgen blockers (blocking the damage caused by male hormone excess), DHT-reducers (to reduce the ‘enemy’ of the hair follicle), hair growth promoters and nutritional supplements. This all depends on the personal context. To control underlying thyroid hormonal imbalances, anti-thyroid medication or thyroid hormone replacement may be initiated.
Rarely, further investigations will be warranted, such as further blood tests to diagnose the cause of e.g. excessive thyroid hormone levels, a scalp sample biopsy, ultrasound of the ovaries or thyroid gland. Sometimes, this will require a referral to a specialist centre that has the necessary equipment to carry out these tests.
Once the hormone imbalances are medically addressed, a treatment plan to boost hair growth can be done, usually involving a combination Regenera Activa, Terra Scalpboosters and in-clinic Low Level Laser Light.
Female Hair Loss is a Complex Condition; Female Hair Loss Treatment is a Complex Process
There have been whole volumes of textbooks written on this condition, which is not part of undergraduate medical school teaching. This article serves only in part to explain a small number of important hormones that could be affecting the normal growth of your hair. Due to the ease of access and cost-friendliness (as compared to spa/salon packages), it would make sense to start your journey to hair confidence by seeking medical hair loss treatment in Singapore.
For further enquiries on female hair loss conditions, and if you would like to get assessed for hormone imbalance-induced female hair loss, make an appointment using the contact form, e-mail us at email@example.com or drop us a WhatsApp message to (+65) 91870470.