Hormones 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.
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.
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!
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?