Hair loss - testosterone, anemia, thyroid, stress or all of the above?

[Colleen]

Hello Dr. Redmond,

I've had long, beautiful hair most of my life. It's fine in texture, but I always had a LOT of it. I've also been going through a hair shed the past 2 months that seems to be slowing a bit (I hope). I am 48, and I'm also on bioidentical HRT, a biestrogen with 1.5 of estradiol and 100 mg progesterone. I do think my biggest culprit in this problem was the occasional use of testosterone cream, just a tiny dab once or twice a week during the past year. (Note, I had this same hair shed problem from using DHEA supplements several years ago, which my body could not handle, I got severe acne & the hair thinning - hair grew back normally within a year). I believe my body simply cannot handle any amount of testosterone (and I know DHEA increases testosterone in the body), I would get horrendous acne and it probably affected my hair as well.

Here's the kicker: I've been anemic for a number of years, my ferritin level dropped to FIVE and I've been getting weekly iron infusion therapy. We'll soon test the ferritin levels, as the hgb level finally went over 12! But my hematologist doesn't think it's contributing to my hair shedding. I also consulted with an endocrinologist. My TSH keeps fluctuating wildly. Two months ago, it was 4.5, last month down to 1.75. The endo was about to put me on low dose Thyroid hormone (not sure which), but now he is going to wait a few months & re-test. I have a family history of hypothyroidism and have been extremely fatigued, depressed, hair loss, itchy skin & scalp, you name it. This doctor looks at me and just says, "For your age, you have more hair than most women. I don't think you have a problem." I hate when doctors minimize when you have a problem! And when I tell my PCP who prescribes the HRT about my hair loss, he just kind of rolls his eyes. He says the hair loss is probably from the extreme stress I've been under the past year, (problems with my son which have been high stress).

All my doctors seem to think the hair loss is from something different. In fact, my therapist that I see for anxiety says I shouldn't be on oral estrogen at all, that it's very dangerous. I had no luck with the estrogen creams & gels - my skin just would not absorb it, I tried for a year and my estrogen level was nearly undetectable until I went on the oral.

My question is, with treating my iron deficiency and discontinuing the testosterone (which I'll never use again!), do you think my chances of regrowing my hair are as good as they were when I went through this 3 years ago? I've mainly got thinning all over, with some scalp showing through a bit above my forehead. When I went through this back in 2005/2006, my dermatologist said it was definitely AGA (androgenic alopecia), and I decided to discontinue the DHEA & the hair came back in. I am starting to see some little hairs regrowing. I guess I worry about my little bit of exposure to the testosterone for a short period of time, do you think micronization of the hair would occur in that short of a time period?

I do have your book, and it's been a great source of hope. Would love to hear any comments from you. Thank you!

Sincerely,
Colleen

[Colleen]

And I forgot to ask.... in a situation like this, is it best to let the testosterone levels drop and evaluate regrowth BEFORE adding spiro..... or would you recommend a course of spiro?

Thanks....

[Geoffrey Redmond, MD, FACE]

Testosterone and DHEA (which is converted to testosterone in the body) are being pushed on women by doctors who either do not know they cause hair loss, or somehow do not care. Testosterone can help sex drive but there is no other reason for women to take it. So far, every woman I have discussed this with would rather have less sex drive than less hair. Low libido can definitely be a problem but any woman considering testosterone should be fully informed of the possible problems.

In my experience, excess testosterone also sensitizes the hair follicles to the body's own testosterone so often just stopping the testosterone is not enough. A testosterone blocker such as spironolactone helps hair to recover.

After menopause, testosterone blockers may not work well without hormone replacement but are worth a try in some situations.

I have detailed the risk issues with hormone replacement in my book, It's Your Hormones and in response to other questions in this forum. The point I need to make here is that therapists and other non-physicians really are not qualified to tell their clients what to do about HT, especially if they are much younger than menopause age and so have no experience of their own,

Low iron is probably a factor in some women's hair loss but I have not seen iron work by itself.

As my readers know, I do not think stress causes hair loss, though stress is certainly unpleasant.

[Colleen]

Thank you for your response, Dr. Redmond! The excessive hair shed has slowed significantly, it seems to be normalized now. I am seeing some regrowth, which is promising. But still I am concerned about your statement that just stopping the testosterone is not enough. I have an appt with my dermatologist this week and will discuss the issue of spiro to block the testosterone effects. Fortunately I did not use the testosterone for very long and when I did... it was on occasion. (But enough to raise my level on one hormone test, maybe because I had used on the same day of the test? Since then, the testosterone levels have come down.)

Will keep you posted.....