Dr. Redmond On Hormones And Hair Loss

Dr. Redmond On Hormones And Hair Loss
August 2nd, 2011

hormones hair lossHormones and hair loss – Dr. Geoffrey Redmond talks all about this exasperating duo in his book It’s Your Hormones. Dr. Redmond, who is the director of the Hormone Center of New York, is an Endocrinologist who understands the frustration of female hair loss, and women travel from all over the United States to be treated by him.

It’s Your Hormones came out in 2005 but I didn’t buy it until this week for some reason, even though I’ve read Grow Hair Fast and a bunch of other hair loss books! So many women on the various hair loss websites have gone to see Dr. Redmond in person, but that’s not in my plans anytime soon (from what I understand an initial consultation is around $700 and is not covered under insurance, and you have to get all your blood work done, and of course travel to NYC). What’s different about Dr. Redmond compared to most doctors you’ll probably see is that he believes you when you say you have hair loss, he doesn’t act like you’re crazy or belittle you because “it’s only hair,” and he doesn’t just say “your only treatment option is Rogaine.” He also understands the devastating impact hair loss has on women’s lives.

It’s Your Hormones  – what the book says about hair loss

The book covers several hormonal topics – acne, PCOS, menopause, weight, PMS, sex, and more, but I’ll just summarize what Dr. Redmond says about hair loss. While there are several types of hair loss (such as alopecia areata), he believes most female hair loss is caused by hormones because many women have hair follicles that are overly sensitive to testosterone, so shedding occurs, even though testosterone levels may be normal. And a decline in estrogen levels can have the same effect. He’s treated over 5000 women with alopecia over the last 20+ years.

Dr. Redmond believes the reason it’s so hard to find a doctor that understands female hair loss is because it falls in between two medical specialties. Dermatologists are often the ones who treat hair loss because hair loss and skin go together, yet most Dermatologists don’t have a lot of training in hormones, which is the cause of most hair loss. Endocrinologists, who deal with hormones, aren’t normally trained in skin and hair issues.

• Thyroid

He mentions hypothyroidism and Hashimoto’s and says thyroid problems can cause hair loss if you have a severe over or under-active thyroid. And alopecia areata (autoimmune hair loss) is many times linked to Hashimoto’s, so make sure to get your TSH, thyroid antibodies, etc. checked if you do have alopecia areata. That’s about all he says about thyroid issues and hair loss – other than take thyroid medication only if you do have a thyroid problem. I believe thyroid problems can be extremely complex, and difficult to treat properly.

Hormonal Hair Loss

According to Dr. Redmond, most hormonal hair loss is caused by the dreaded androgenetic alopecia (AGA). And he believes most doctors downplay the role of hormones in hair loss. With hormonal hair loss, hair thinning is generally greatest on the top (starting right behind the hairline and), and somewhat on the sides, but not as much. And the temples often thin (even women who will not develop hair loss sometimes have mild thinning there). He doesn’t say anything about a receding hairline, which I know a lot of women have (myself included). And he doesn’t mention hair strands thinning over your entire head.

Estrogen and Testosterone

Estrogen and testosterone are the biggest influence in hormonal hair loss, according to Dr. Redmond. Estrogen = good for hair; testosterone = bad for hair. When you’re pregnant estrogen levels rise greatly, and your hair stays on your head longer and grows faster. After the baby is born, estrogen levels plummet. When estrogen levels fall (after birth, due to stopping birth control pills, rapid weight loss, or perimenopause, etc.) it can trigger hair loss. Signs you may have low estrogen include: hair loss onset in late thirties or after, perimenopause symptoms, being very thin, high amount of aerobic exercise, light periods (if not on the pill), dry or delicate skin, and fine or dry hair. Some women need more estrogen than others to maintain their hair.

Testosterone slows down the metabolism of hair follicles, and they get smaller and smaller, which equates to less hair. Within the follicles testosterone is converted to DHT, but Dr. Redmond believes both DHT and testosterone are hormonal hair loss culprits. Most women with AGA have normal levels of testosterone, but if they are hormonally vulnerable and predisposed to alopecia, even normal levels of testosterone could cause it. And of course elevated levels of testosterone could cause hair loss, and it’s also linked to PCOS, which he talks about in detail. To determine if testosterone is causing hair loss, check for other signs of testosterone problems: onset between teens and mid-thirties, oily scalp or oily hair or oily skin, itchy scalp, seborrheic dermatitis, acne, increased facial and/or body hair, being overweight, and irregular and often heavy periods. If you have hair loss plus some of these other problems, then you are probably vulnerable to testosterone.

Next both total and free testosterone levels must be checked. Dr. Redmond believes levels of testosterone approaching 50 ng/dL or higher will cause hair loss in those vulnerable to it, even if this is still within the normal lab range. But testosterone levels can fluctuate throughout the day, and levels change with age. And if you are vulnerable to testosterone, your levels will probably need to be lower (but he doesn’t say how low).

Telogen Effluvium

If you don’t know if you have AGA and think you might have telogen effluvium, you might hate reading this paragraph. Many women Dr. Redmond sees have been told by doctors they have telogen effluvium (temporary hair loss). Many doctors will do a hair pull test, and if you have increased shedding the test will be positive. But unfortunately it will be positive no matter what the cause, so the shedding could be from TE or AGA. While some people truly do have telogen effluvium (from having a baby, having surgery, experiencing extreme stress, etc.) Dr. Redmond thinks most cases of TE are really hormonally based, which means your true problem is AGA. He doesn’t go into a lot of detail about other TE causes or chronic TE. Unless you know you had an event that could have caused your TE, he suggests you start treating your hair loss as if it’s hormonal instead of wasting time. He believes most hair loss will get worse without treatment, so start treating it asap.

Scalp Sensations

Scalp itching and AGA often occur together, from excess stimulation of the oil glands, caused by testosterone. Testosterone blockers (like Spironolactone) should help with this, and a topical steroid lotion may be used. A burning scalp sensation, or the hair or scalp feeling uncomfortable to the touch, may be caused by low estrogen. Treatment with estrogen should help after a few months.

Scalp Biopsy

Unless there is scarring alopecia, which Dr. Redmond feels is rare, he doesn’t recommend a scalp biopsy. Scalp biopsies can’t tell you if your hair is falling out due to estrogen or testosterone, or both. Most women get scalp biopsies to also determine if they have TE or AGA, but since he seems to think TE is not common, he assumes most women just have AGA. I haven’t done a scalp biopsy because I have heard the results are often inconclusive, but they still have their place if your doctor suspects you have scarring alopecia, or if he or she feels it would help with your diagnosis.

Lab Tests

Dr. Redmond recommends these blood tests initially: Total and Free Testosterone (very important), DHEA-S – elevated levels may increase testosterone, FSH and Prolactin- only if your periods are irregular or you may be approaching peri/menopause, Estradiol – the main estrogen – helpful in some cases, but generally not necessary if you are under forty-five and have regular periods, are taking birth control, or are postmenopausal, TSH – thyroid function, and CBC blood count and chemistry profile – standard health tests, and Iron – deficiency may contribute to hair loss.

The Pill To Treat Hair Loss

I wrote extensively about birth control and hair loss recently on hairlosshell.com. To increase estrogen, Dr. Redmond believes birth control pills are the best way to do it. While birth control obviously causes hair loss in some women, he feels it’s generally because they were on the wrong pill – one that had testosterone-like activity. And many women develop hair loss after getting off the pill, but he believes this is often because these women needed higher levels of estrogen, so they pill was helping their hair (and they just didn’t know it). And many women may be on the pill, which is helping somewhat, but they still need further hair loss treatments. Just remember to read up on the potentially dangerous side effects of birth control, and any other medication, and check with your own doctor before starting anything.

Dr. Redmond suggests that rather than taking the pill for three weeks and then a week of placebos (how I take Yasmin), instead you could take twelve weeks of the pill, then take 4-7 days off for placebos. Talk with your doctor about this before trying it. He suggests it keeps your hormone levels more steady, with less fluctuation. I am curious about doing this, but am not quite ready to try it.

He says the best pills to take for hair loss include: Yasmin, Ortho-Cyclen, Ortho Tri-Cyclen, and Desogen. The worst for hair loss include: Loestrin 1/20, Alesse, Lo/Ovral, Levlen, Tri-Levlen, and Levlite. But make sure to read my other article about birth control because there are a lot of other pills you want to avoid as well!

Rogaine

Every doctor you’ve ever been to that believes you have hair loss has probably recommended Rogaine/Minoxidil. Dr. Redmond doesn’t prescribe it as his first choice because: he feels it doesn’t usually work!, it’s a pain to use twice a day, it’s hard to apply it over long hair, and it causes scalp irritation. He believes the 5% is more effective, and also more irritating, and I can’t use the 5% minoxidil strength personally. He suggests using it as a last resort, after trying other treatments, because if you start it first you won’t know if it’s helping or something else is, and then you will be stuck on it for life (once you stop, you will lose all the hairs it helped maintain on your head).

Dr. Redmond’s Suggested Alopecia Treatment

With treatment Dr. Redmond believes 80% of women get stabilization for their hormonal hair loss, and many see some regrowth after a year. So if you are peri-menopause or younger, his treatment protocol seems to be: take a hair friendly pill like Yasmin, and it’s best to take Yasmin consecutively twelve weeks, and then take a 4-7 day break (but I’ve also read doing it this way has extra side effects like erratic bleeding). For menopausal women he talks about other forms of estrogen you may use. If you believe you have signs of testosterone vulnerability, then he recommends Spironolactone in a dose of 100-200mg a day, and at a bare minimum 75mg daily. He doesn’t mention working your way up to the full dose gradually, nor does he mention a lot of side effects from spiro. He briefly mentions taking Propecia (if you are on the pill and absolutely not going to get pregnant while taking it), but then he says it’s not very effective for women. He says Saw Palmetto could possibly slightly work, and he negates just about every other treatment out there (vitamins, eating more protein, etc.) And later on you can add Rogaine if you want.

My Thoughts on the book It’s Your Hormones

I go to bed every night thinking about hair loss and how to fix it, and I’ll sometimes wake up a few minutes later in a panic thinking HORMONES. It’s HORMONES that are causing hair loss for most women! So I kind of feel stupid that I haven’t done even more research and testing on any and everything that has to do with hormones and hair loss. Personally I’ve tried so many different treatments that haven’t worked (iron pills, thyroid pills, diet, exercise, vitamins, Rogaine, etc.) so I am out of options and take Yasmin and spiro, as Dr. Redmond instructs. I can’t say if the Yasmin has helped my hair from getting worse, and my hair has definitely gotten worse since I’ve been on the spiro, but maybe it would have anyway, or maybe the spiro is making the shedding worse. He doesn’t mention that as a side effect. I think he downplays so many other possible causes of hair loss that women need to check out first, and I doubt only estrogen and testosterone cause hormonal hair loss – there are a lot of different hormones in the body.

From what I’ve read on several hair loss websites, Dr. Redmond seems to prescribe the same regimen to just about everyone. Some women say it works for them, but a lot of them don’t find success. First you need to find a good doctor to work with (which is easier said than done) and don’t try any of the treatments you read about online until you speak with a doctor first. Dr. Redmond is still taking appointments in NYC, but it’s expensive to see him. Have you visited Dr. Redmond? Have you read It’s Your Hormones? What’s your take on hormones and hair loss?

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Related posts:

  1. Birth Control & Hair Loss – My Story
  2. Another Dermatologist Visit For Hair Loss
  3. New York Hair Loss
  4. Is Genetics The Cause Of Your Hair Loss?
Tags: Categories: Androgenetic Alopecia

23 ResponsesLeave a comment
  • sara
    August 5, 2011 at 8:07 pm
    Reply

    Thanks. I have been reading a lot about Dr. Redmond but it seems weird if he’s telling most women to do the same thing. I wonder what his success rate is with his plan?

  • Tonya
    August 11, 2011 at 4:46 pm
    Reply

    I will check out this book. thanks for the info.

  • J
    September 1, 2011 at 11:58 am
    Reply

    Thanks for summarizing the book so nicely for us! From all of the reading I’ve done on the subject, everything he is saying makes sense. I actually do have Hashimoto’s thyroid disease, but I’m pretty much convinced my hair loss is caused by AGA. Also, I’ve been getting treated for my condition for over 2 years now and the thyroid medication has done absolutely nothing for my hair. :( Anyway, I was wondering if hair loss really is more common in young women nowadays than it used to be? Or am I just noticing it more now that I have a problem? Has anyone else observed this? Any theories? Thanks!

    • Jeni - Hair Loss Hell
      September 1, 2011 at 6:35 pm
      Reply

      I know thyroid medication can help hair loss, and it can make it worse too (or do nothing). It’s so frustrating! I was on thyroid medication for a year because I have about 50 symptoms of hypothyroid, but the medication didn’t help anything at all, and it made me too speedy to I had to stop it. I do think hair loss is more common that it was before – maybe from xenohormones in food/the environment, pollution, stress, crappy foods, more women on the pill, etc.

  • J
    September 1, 2011 at 12:40 pm
    Reply

    Hi, one more thing you might find interesting – I was just reading an article about PCOS and thyroid problems where the author references a study showing that a low glycemic index diet can lower androgens by 20%! For me, I’m not sure if I have elevated testosterone or not without getting tested, but in the meantime I think the diet is worth a try. It certainly can’t hurt anything. :) Here’s the link if you’re interested: http://dearthyroid.org/what%E2%80%99s-up-with-the-pcosautoimmune-thyroiditis-combo/

    • Jeni - Hair Loss Hell
      September 1, 2011 at 6:40 pm
      Reply

      I forgot about that website. I just subscribed to it so I don’t forget it again. For the last several years I’ve been trying to eat healthier to help my hair, and everything else. I keep falling off the wagon because when I do eat healthier for several months at a time, my hair doesn’t get better, I don’t lose any weight, and then I get frustrated and start eating bad carbs again! I don’t specifically do a low-glycemic index diet, but I try to cut out non-whole grains, processed foods, etc. But I don’t really cook, so sometimes I think my lack of cooking and lack of buying enough fresh produce is what’s ruining my hair. But then there are tons of people that live on McDonalds and they have no hair problems. Anyway, I know eating better is good for you – so it will definitely not make your hair worse, and it could help!

  • Noelle
    September 19, 2011 at 7:39 am
    Reply

    Hi, I just wanted to say that I really like your blog. I feel like I’m going through the same exact thing! My hair loss started at the age of 19 after starting birth control pills. I went from super thick hair to thin wispy strands in a matter of months. The shedding never ceased and after 2 years I went to see Dr. Redmond. This was about 10 years ago. I followed his advice religiously (in spite of seeing little to no results) and took his standard treatment of Aldactone, Finasteride and various birth control pills. At times it seemed like things were improving with my hair and then I’d go through a massive shed and it would be worse than before. Like you, I consistently shed hair throughout, almost nothing seemed to stop my shed completely. And each time I went to see Dr. Redmond, he’d look at my scalp and say I was doing great (!?). I began to lose faith in him. I felt like he was either lying to keep me coming in or his standards were just really low. I mean, after ten years of treatment, my part is extremely wide and I can see my scalp even in my dim bathroom lighting (I don’t want to know what it looks like in sunlight). So I decided to stop all medications a few months ago (I totally understand your other post about stopping Aldactone by the way – it doesn’t seem to help much and the side effects are awful) I’m not really sure what’s next. I’m still shedding an abnormal amount and I’m considering buying a wig too. Anyway, please keep up with your blog and your quest to stop hair loss! I look forward to seeing your new posts! Take care ;) Noelle

    • Jeni - Hair Loss Hell
      September 21, 2011 at 1:13 am
      Reply

      Noelle, thanks for telling your story about seeing Dr. Redmond. I know what you mean about doctors that tell you your hair looks fine when you think it doesn’t (I don’t know if they are blind, or if they are so used to seeing totally bald people, so if someone comes in with some hair, they think it’s enough). Sometimes I want to stop all medications, and other times I keep wanting to try everything I possibly can. The constant shedding is the worst:( Let me know how it goes after stopping everything.

  • Val
    November 20, 2011 at 11:40 pm
    Reply

    I am debating whether to take Aldactone (low dose – start 25 mg and later increase it to 50 mg per day). My concern is regarding the long term use of this medication. I have read that the FDA has issued a warning that it causes tumors in rats. Does Dr. Redmond address this in his book?

    • Jeni - Hair Loss Hell
      November 21, 2011 at 2:40 am
      Reply

      I don’t recall Dr. Redmond discussing many of the potential side effects of Aldactone. I may have read about that rat study, but wasn’t it for a dose much, much higher? I am not sure. Whatever you do, make sure to talk with your own doctor. I know the standard dose for Aldactone for hair loss is 100-200mg per day.

      • Val
        November 21, 2011 at 9:59 pm
        Reply

        I can’t find the actual study they did on the rats so I have no idea what dose it was. I just read that the FDA issued a warning about this. My gynocologist presribed it to me after I asked her about it. She was not really helpful at all, though. She didn’t seem to understand the stress I was going through with hair loss. She simply said it’s normal to shed hair all the time. I didn’t really have the energy to explain to someone who couldn’t understand.

  • Angie
    February 9, 2012 at 3:06 pm
    Reply

    Hello,

    My story: my hair loss began when I was about 13; by the time I was 16, I heard a few classmates in school ridiculing my bald spot. I’ve had thinning hair ever since and I am 29 now! Reading these stories made me cry. I went to Dr. Redmond a few months ago and was put on Spiro and birth control…so far I have seen absolutely no improvement whatsoever, just continued shedding. I have tried everything else: Rogaine, Lasercomb, injections in my scalp, scalp biopsy. NOTHING WORKS! I don’t know what else to do. Sometimes I’d rather die than be totally bald. I feel so hopeless and ugly. I have so much difficulty in making friends, going out, meeting people, etc..all because of my thinning hair. It’s so unfair, this has affected literally every aspect of my life. I can’t even enjoy sex anymore, because I’m afraid my husband will see my bald spots. Sure I turn off the lights but then I’m afraid he’ll find random hairs that I’ve shed. Whenever I am in the presence of other women, I find myself STARING at their hair, their hairline and wondering WHY they get to have great hair and I don’t. What did I do to deserve this?!

    • Lisa
      September 14, 2012 at 9:47 am
      Reply

      I think you should try bio-identical progesterone which you can get over the counter. I use KAL brand – be sure you use a brand with USP Progesterone – this means it is bio-identical. Also Bio-identical estrogen may help if you are low. Find a practitioner (usually the good ones don’t accept insurance because then they would have to do things the way Insurance company’s want not the way that might work for the patient) in your area who specializes in bio-identical hormones. Feel free to email me for more information.

      Lisa

  • clc
    June 21, 2012 at 2:44 pm
    Reply

    I no longer trust doctors like Redmond and Elizabeth Vliet; read their books in the 2000s and followed their advice, hair kept falling out anyway.

  • Lisa
    September 14, 2012 at 9:43 am
    Reply

    NO ONE should be taking birth control pills!!! They DO make your hair fall out when you stop them because they are NOT bio-identical estrogen and progesterone. Bio-identical is the only way to go.

  • lisa
    October 9, 2012 at 11:17 pm
    Reply

    hey did you guys hear about something new in europe that helps with AGA?

    • Kelly
      December 29, 2012 at 3:21 pm
      Reply

      No, but do you have anymore infomation on it? I am thinking maybe you are thinking of viviscal? (called something else in the uk).

  • Cel
    December 4, 2012 at 2:51 pm
    Reply

    Interesting that he says estrogen is good for hair and that’s why pregnancy makes people’s hair thick etc. I’m 15 weeks pregnant and have been shedding hair since the week i concieved. It’s really thin now and looks like I’m obviously balding at the front and sides. Just another useless quack who doesn’t know the full story of female hairloss and doesn’t care. I’ve seen a few and none of them can tell me what’s going on but they happily take my money.

    • Kelly
      December 29, 2012 at 3:24 pm
      Reply

      When I was pregnant, I never noticed a difference in thickness or length, but my hair definitely thinned out and never recovered since then. I can’t believe this is just about 2013 and there are no advancements in modern medicine to regrow hair. I hear there are things on the horizon with stemcells and hairgrowth but they are still a few years away.

  • FJ
    December 16, 2012 at 2:16 pm
    Reply

    My first pregnancy I had horrible hair loss the first three months and then it thickened up during the rest of the pregnancy only to be lost after birth. My second pregnancy my hair fell out all through the pregnancy, during nursing and now after weaning it is awful. I have lost over half the volume of my hair. The only thing I found to be helpful for my hair loss was the use of the medicine bromicriptine to lower my slightly raised levels of prolactin. My hair loss stopped and my hair thickened up(my cycle also became regular) when my prolactin levels dropped to 2-4 but hair loss would begin again if my levels went up over 10(normal prolactin is considered anything up to 20). Interestingly, prolactin suppresses estrogen and also works on the adrenal glands increasing DHEA , both horrible for hair loss. I am now in the process of trying to get the stupid doctors here to listen to me and give me a prescription for bromicriptine to stop the hair loss even though my prolactin levels are within ‘normal’ range.

  • sarah
    December 20, 2012 at 9:14 am
    Reply

    I think Iron is as important to hair as hormones to be honest! most women have low ferritin due to menstruating and until the level is over 70 hair will shed and not re-grow. Ive been anaemic all my life, as well as hypothyroid and AGA. I take iron religiously as my ferritin level has NEVER been above 70 and every time i stop it sheds way more! Dianette also helped my hair but i had to come off cos it gave me a DVT so I would not recommend synthetic hormones….I sympathise with all you girls experiencing hairloss- Has been going on 15 years for me and is like a never ending nightmare :/ With regard to diet its interesting that those in eastern cultures with a higher content of fish and vegetable based diets do not suffer as much hair loss as those in the western world, so i wouldnt rule out diet practices completely, that said I have cut out gluten and seen a reasonable improvement but every now and then i slip up as it is a hard thing to follow…hope that helps, good luck with battling this :/

  • katie
    December 20, 2012 at 8:14 pm
    Reply

    This is the best website I have ever come across on this subject. Straight forward pros and cons of everything. Heartfelt thanks to all the contributors. How to find a doctor who is not waiting to milk you? Is it even possible? I am in NYC ….where the best and brightest of this planet reside….but have no way to find out how to find a doctor who is truly interested in helping contain the problem…rather than let it get worse.

  • Liz
    January 13, 2013 at 11:44 pm
    Reply

    This blog is a welcome relief. I am 38 and about 1.5 years after giving birth to my son and after taking 8 months of proton pump inhibitors for acid problems, I noticed significant shedding. I have not lost about 70% of my hair in less than 8 months. I’ve seen the hair loss expert in BC who also has a clinic in New York and had a scalp biopsy which showed “normal” and even he doesn’t know the cause. He prescribed rogaine which I haven’t done. My endocronologist and I are working on a creeping tsh (still only 1.6) but still rising despite my increase in thyroid dose? which is odd…but he has just given me a prescription for avodart. In reading the summary of dr. redmonds book, I have scalp itching but also my scalp is super sore and feels like it’s burning, so this to me says it’s both testosterone and estrogen. I am going to see my naturopath this week who does great work with hormones and discuss options for estrogen supplements (I’ve only been on the pill a few years of my whole life and horror stories with mood swings) so I’m reluctant to try them but will if I have to. I’m also seeing my GP tomorrow to order a full hormone panel testing for me, I had my testosterone done which was normal but I understand that doesn’t matter much. I don’t know what is going on, but it is definitely hormones. Wish me luck and thanks again for your blog!

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