Alopecia in Women

The Spectre of Balding Women –

Caroline, a new mother in her mid-twenties, came for help in a state of deep depression. The first words out of her mouth were “I’m turning into my mother…” When I asked her what that meant, she said that both of them were moody, irritable with their loved ones and, the symptom that was upsetting them most of all, going bald. While many women (and men) will exaggerate the extent of their hair loss, there was no doubt that Caroline’s once-lush mane was noticeably thin and dry; her scalp was scaly and visible at the forehead and temples. I asked her if there was a history of thyroid problems in her family. She confirmed that there was not, and that both she and her mother had recently evaluated their thyroid status by blood test, because either over- or under-active thyroid function can cause hair thinning. However, I kept with my hunch that there was a hormonal component to this puzzle.

Caroline had a 4-month old and while she loved her daughter deeply was having a hard time adjusting to the demands of parenting. She was suffering from a very real phenomenon called “post-partum blues” which is triggered by a precipitous change in hormonal status at the time of delivery. During pregnancy, levels of estrogen (mainly E3, or estriol, the “safe” estrogen) are very high as is, of course, progesterone, the major hormone in maintaining gestation. Both the estriol and the progesterone drop off sharply during labor and delivery and the mother can be left hanging with this profound shift to the pre-pregnancy state. Similarly, Caroline’s mother was going through the thick of menopause and her estrogen and progesterone levels were declining steeply, especially the progesterone. Not all women experience hair loss at menopause but it is not an unheard-of side-effect of shifting hormonal status. One set of hormones effects all the other hormones; declining sex hormones will often up-regulate thyroid hormones and adrenal hormones.

To counteract the relative estrogen dominance in both women I prescribed a course of “natural” progesterone to help ease their transition back to a state of hormonal balance. There are numerous reasons why hormone imbalance is more prevalent today, not the least of which is use of synthetic hormones like the Pill, depleted nutrients in our soils, and thus in our foods, and environmental pollution. Let me also clarify that “natural” progesterone means manufactured in a laboratory from a plant base; usually yams (Dioscorea villosa or barbasco) or soybeans. This is in contrast to the completely synthetic progestins (such as Provera), which the body does not recognize as food, and may cause liver problems. I purposefully will not give a specific dosage for the progesterone because it is important to work with a practitioner familiar with natural hormone replacement therapy and get a prescription specifically tailored to your individual needs. Although plant-based progesterone is generally very safe, and widely available in health food stores and pharmacies, I urge you to work with an experienced doctor for this part of the treatment. In a nutshell, I adminstered progesterone to both these women to combat the symptoms of relative estrogen predominance: moodiness, depression and fluid imbalance (dry in some areas, swollen in others).

What about the hair loss? B vitamins are essential in the proper manufacture of hormones because hormones are fat-based molecules and lack of B-vitamins will impair long-chain fatty acid synthesis. One B vitamin in particular is well known for helping to combat dry, scaly scalp (including the infantile cradle cap), easily-splitting nails, depression, insomnia, and hair loss. This is the B-vitamin called biotin, who’s principal function in the body is the manufacture and utilization of fats and amino acids. Although no official RDA exists for biotin, my clinical experience has shown that 100 mcg daily is adequate to supplement diets high in cheese, organ meats and soybeans. But, not all folks eat that way. Also, antibiotic use can severely decrease biotin levels by destroying biotin-producing gut bacteria. I prescribed 8,000 mcg daily (8 mg) for Caroline and asked her to stay on this dose for at least 6 weeks. Biotin is extremely safe, including for lactating mothers, with no known adverse side effects. In addition, I asked Caroline to minimize her intake of refined foods, stand on her head 3-7 times weekly for 25-40 breaths (she practices yoga, so I knew I could include this in her treatment protocol!) to bring fresh blood to her scalp, and drink a cup of Horsetail (Equisetum arvense) tea daily for the mineral content, particularly silica, which is an essential component of strong, healthy hair. She started to notice an improvement in the lustre and thickness of her hair within a week, and at our last visit she told me her mother had agreed to start a yoga class.