Why is My Hair Falling Out?

As a woman with hair loss, you’ve decided to look deeper at your health, asking “why me?” about this horrible problem.

And that is the right question to ask. If many of us ask “why?” enough, we discover that it probably didn’t just come out of the blue on its own. It most likely was accompanied or preceded by some other symptoms and stresses. So in addition to asking “why am I losing hair?” you must ask yourself “what else is happening in my body besides the hair loss?”

10 Questions to Narrow Down the Cause of Your Hair Loss

Questions like these are a good way to help learn more about the causes behind your hair loss (so you’ll know what to fix).

1. At what age did you first experience hair loss or notice your hair thinning?

Early and late onset hair loss types may have different causes. It’s generally considered that in younger women, hair loss may be due to many causes from anovulation, stress, hypothyroidism, low metabolism, and pregnancy. Plus there is the added factor of possible high androgen activity, because our ovaries produce more androgens before menopause. In post-menopausal women, androgens usually aren’t considered as a cause, and the more likely suspects are hypothyroidism, low metabolism, estrogen dominance, stress, toxicity, and lifestyle factors.

2. Did you have any abnormal medical or physical history prior to the onset of your hair loss?

This includes early puberty, irregular periods, reliance on any medication or drug, history of disease, infertility, complicated pregnancies, obesity, heart problems, thyroid problems, PCOS, anxiety attacks, depression, etc.

Certain factors such as early puberty and irregular periods may predict problems with hormonal balance, and symptoms like acne and skin disorders may be a marker of imbalanced hormones. Obesity during childhood that continues past puberty is often a good predictor of hormonal imbalance in women and may point to a problem with PCOS or thyroid. And a history of heart problems, depression, and anxiety, can point to a potential underlying thyroid problem or other condition. Treating any health conditions you have should help hair’s growth.

3. What kind of body shape do you have? What about the women in your family? Any differences between those with and without a hair loss problem?

A body shape that gathers fat on the abdomen, chest, back, and neck can also predict symptoms of hyperandrogenism such as hair loss and hirsutism in younger women.[1] This type of body shape is referred to as “android” because it is similar to the way that male bodies tend to distribute bodyfat. It often tells of an imbalance in stress hormones, reproductive hormones, and thyroid hormone. Women who are very healthy hormonally will have a more “gynoid” body shape, which gathers fat below the waist at the hips and butt. Women of any weight who have more fat on their upper body are at a greater risk for the type of imbalance that causes hair loss.

4. Any significant events that happened around the same time as the onset of your hair loss?

Examples include rapid weight loss, emotional distress, getting pregnant, having a baby, injury or surgery, starting or stopping birth control or another medication, starvation or fasting, over-exertion, relocating to a different altitude, etc.

Major life events have the power to impact your hormones, causing a domino effect within your body. If there is a problem between one hormone and its target tissues, your whole body will feel the effect eventually. And the body compensates by relying on other hormones, or by drawing from the stores of minerals within your tissues. The short term effect keeps you up and running as normal. But if sustained long term, it causes wear and tear in your body.

This is the difference between homeostasis and allostasis. Homeostasis is the natural balance achieved when your mind, and every cell in your body is healthy. You are resilient to stress and sickness in this state. Allostasis is an artificial sense of health and that is achieved through the straining and overworking of your glands and organs as they try to compensate for chronic stress, anovulation, inflammation, poor sleep or nutrition, too much body weight, etc.

The end results of allostatic load are the imbalances that ramp up aging and cellular deterioration. These cause us to lose hair where we want it, grow it where we don’t want it, lose our feminine shape, have low sex drives, age faster than we should, feel chronically stressed and depressed, get fatigued, and lose our joy. None of us want to be in this state.

5. What are your diet and lifestyle like?

The modern Western diet – high in refined carbohydrates, chemicals, and inflammatory fats, and low in nutrients – coupled with low physical activity, is a major cause of obesity and insulin resistance in women of all ages. And a high stress lifestyle causes the hormones of stress such as cortisol and adrenaline to rise. High stress, poor diet, and low physical activity all can add to underlying problems with ovulation, metabolism, and thyroid function. And together, these problems cause an imbalance in your body that leads to hair loss.

6. Is there dramatic shedding that seems to come and go?

This is one of the key signs that hair loss is caused by severe stress. It can also be a symptom of autoimmune-related hair loss.

7. How fast did the hair loss progress from being barely noticeable to something you needed to hide? Years, months, days?

The speed at which your alopecia progressed can help point you to its cause. The types of alopecia that happen very fast may point to an autoimmune condition such as alopecia areata, Hashimoto’s thyroiditis, severe stress, or a toxic insult to your hair such as a chemical exposure, heavy metal toxicity, or severe inflammatory response. If you have rapidly progressing hair loss, it would be wise to get a thorough medical examination by a doctor if you can.

8. Did it start thinning most noticeably in one area of your head or all over?

Alopecia areata tends to leave bald patches in one or more areas of your scalp. Hair loss due to stress tends to cause hair loss over the entire scalp. Thyroid-related hair loss can also do this, but it seems to cause shedding in the most susceptible areas (namely, the top of the scalp) first. Female pattern hair loss and androgenic hair loss usually starts with the top of the scalp, causing thinning out to the sides and front, behind the hair line. If you are losing hair from the upper corners of your forehead (the temples), this can mean an androgen imbalance in your body.

9. Do any other women in your immediate or extended family have hair loss?

It is hard to deny that there’s a genetic link in the cycle of women’s hair loss. If other women in your family have problems with hair loss, it is possible for you to be susceptible to the same things that caused their condition. COnsider getting together with women in your family who also have hair loss, and comparing each others’ hormone levels from blood tests, and any relevant diagnoses that you share with your relatives who have similar hair loss patterns as you.

10. Are there any other physical characteristics or pertinent medical history that you share with those women in your family who also have hair loss?

Why not interview those women in your family who have hair loss. Perhaps ask them the questions listed above. You can start to map out any lifestyle factors and other things that trigger it in your family line.

In conclusion, when we ask more questions about the cause of our hair loss, we help define the problem and its causes. This helps each of us to understand the role of our lifestyle, environment, and genetics, so we can know exactly where we need to do work to start correcting the problem.

1. Body Shape and Size and Insulin Resistance as Early Clinical Predictors of Hyperandrogenic Anovulation in Ethnic Minority Adolescent Girls Jessica Rieder, MD, MS, Nanette Santoro, MD, […], and Susan M. Coupey, MDJ Adolesc Health. Author manuscript; available in PMC 2009 August 1.Published in final edited form as:J Adolesc Health. 2008 August; 43(2): 115–124. Published online 2008 May 19. doi: 10.1016/j.jadohealth.2008.02.003 PMCID: PMC2517233 NIHMSID: NIHMS59798 Jessica Rieder, MD, MS,1 Nanette Santoro, MD,2 Hillel W. Cohen, MPH, DrPH,3 Paul Marantz, MD, MPH,3,4 and Susan M. Coupey, MD1

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