Hair Loss Mystery Solved: The Surprising Causes You Didn’t Expect

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
Coming up on this episode. So high insulin levels from high sugar and starch diets can stimulate the enzyme 5 alpha reductase, and that increases the production of DHT, which then leads to hair loss. So you see how it goes. Basically, being overweight, having belly fat is not good for men or women. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale.

And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products. Now are you concerned about what's behind hair loss?

Well, you're not alone. The most common culprit for men is called androgenic alopecia, also known as male pattern baldness. Women can get it too from high levels of androgens or male hormones. We'll talk about that. And this is largely driven by genetics, and sensitivity to a hormone called DHT, also known as dihydrotestosterone, a hormone that's derived from testosterone.

Now DHT binds to receptors in the hair follicles, and it shrinks them, leading to thinner hair or hair loss. But DHT isn't the only factor. Hormone imbalances, insulin resistance, inflammation, nutrient deficiencies, food sensitivities, all play a role in hair loss. Now in women, conditions like PCOS or polycystic ovarian syndrome often result in high levels of androgens or male hormones, including DHT, which causes both hair thinning and unwanted hair growth on the face. So you lose it on your head, but you grow it in places you don't want.

Now additionally, chronic stress, poor diet, even aging can accelerate hair loss, and that's why it's so important to address the root cause from hormone imbalances to nutritional gaps and lots more. And in this episode, we're gonna dive deep into how to manage and prevent your hair loss using functional medicine, dietary changes, supplements, and more. Now stay tuned as we uncover the real reasons behind hair thinning and most importantly, what you can do to fix it. So what are the root causes of hair loss? Well, the number one cause of hair loss is androgenic alopecia, which is commonly known as male pattern baldness.

Now women can get it too, and we'll talk about how that works when they have 2 high levels of male hormones, which is not uncommon in women who have insulin resistance or prediabetes or PCOS. Now this this condition of male pattern baldness is driven by genetic predisposition and also sensitivity to a hormone called DHT or dihydrotestosterone, and it results in gradual hair thinning and hair loss. So what is DHT? Well, DHT is a type of androgen or male hormone, sex hormone, along with testosterone that has a lot to do with hair growth, particularly on the scalp. Now testosterone is converted into DHT by an enzyme called 5 alpha reductase.

Now 5 alpha reductase is an enzyme that's activity is highest in the tissues such as the prostate gland, skin, liver, and hair follicles. And that's why, for example, drugs for the prostate, which we keep for enlarged prostate, which can be from high DHT like like, finasteride, is also used for male pattern baldness. So works for your scalp and your prostate. DHT stimulates hair growth but can also lead to hair loss when levels are too high. Now how does DHT cause hair loss?

Well, DHT attach to hair follicle receptors. And over time, the DHT shrinks the hair follicles, making them smaller and weaker. Now this leads to hair thinning and to hair loss as the follicles grow kinda sleepy and dormant. Now hair follicles on the scalp are more sensitive to this hormone DHT than the follicles on other parts of the body. For example, your chest or your under your arms or pubic hair.

And that's why hair loss is more common on the head than any other part of the body. Now in men, high DHT levels results in hair loss, typically seen as receding hairlines and thinning at the crown of the head and on the top. In women, DHT can cause thinning across the scalp, also particularly along the part where you part your hair. But it doesn't usually cause total baldness like it does in men. Now lowering DHT or blocking its action can help slow or stop hair loss.

And we're gonna talk about lots of ways to do that in the episode, both natural, dietary, supplements, and even medication. Now what causes increased levels of this hormone or DHT? Well, hormone imbalances such as high testosterone can cause it. Well, wait a minute. I thought high testosterone was a good thing you might be thinking.

Well, in men, yes. Testosterone is man's primary sex hormone and is associated with strength, performance, vitality, cognitive function, muscle mass. And women also produce testosterone, and it's involved in fertility and reproductive health, sex drive, bone density, muscle health for women as well as men. Now when testosterone becomes too high, it can have negative consequences. So what causes then testosterone to become too high?

The main driver for women is insulin resistance and obesity, the belly fat. Basically, that fat around your middle is a driver of inflammation, the hormonal dysregulation, and leads to a condition called androgen dominance where you have more male sex hormones. That's not a good thing. And now that androgen dominance is a common phenomena in women who have polycystic ovarian syndrome or PCOS, which is the number one cause of infertility in women. It affects up to 10% of women.

So what exactly is androgen dominance anyway? Well, it's androgen dominance or hyperandrogenism means that testosterone, DHT or dihydrotestosterone, and another hormone called DHEA is high. Now this has negative effects on fertility that can cause a lot of other symptoms like PMS and I'd be bleeding and all kinds of weird symptoms, but it also causes hair thinning and hair loss and also causes unwanted hair growth in other places like your chin or your belly or your chest, which is not fun for women. In men, high insulin can lead to higher free testosterone levels. Now that might seem like a good thing, but insulin resistance is also linked to inflammation.

It's linked to heart disease. It's linked to obesity, to cancer, and many other chronic disease. So not a good thing overall. The cons outweigh the pros. So what's going on here?

Well, despite high free testosterone, most men with insulin resistance experience low total testosterone. So what does that mean? This is largely due to the impact of insulin on something called sex hormone binding globulin. So what does sex hormone buy binding globulin do or SHBG? Well, it binds to sex hormones and makes them unavailable for your body to use, sort of like the storage, like your bank account for your hormones.

It instead of the cash in your pocket, which is like the free hormone. So high insulin levels decrease sex hormone binding globulin levels. So when sex hormone binding globulin cells are low, less testosterone is bound and more remains free. When more free testosterone is available, that's when it gets converted to DHT by this enzyme we talked about, 5 alpha reductase. Well, that leads to more hair loss, and that's not a good thing.

So what is this 5 alpha reductase? Well, it's a an enzyme that converts free testosterone to dihydrotestosterone. Obesity and excess body fat, which is really common these days, upregulates this enzyme called 5 alpha reductase. So you get more conversion to DHT. So excess body fat is often associated with insulin resistance and prediabetes, metabolic syndrome, and it can stimulate this enzyme.

So high insulin levels from high sugar and starch diets can stimulate the enzyme 5 alpha reductase and that increases the production of DHT, which then leads to hair loss. So you see how it goes. Basically, being overweight, having belly fat is not good for men or women. Now women the research shows that women with PCOS have higher levels of this enzyme activity as well. So that's not good.

So what else increases this enzyme function, which is necessary, but you don't wanna overact it. Right? Stress. Stress will trigger the release of cortisol, and that targets and damages your hair follicles. So many women in their twenties thirties start losing their hair to distress.

Also, sleep deprivation can cause this. It's another form of stress, poor diet. I mentioned sugar and starch. That's probably the biggest reason for hair loss in women is sugar and starch, and I would say gluten's probably next on the list. When you eat too much sugar and starch, it causes accumulation of belly fat.

That belly fat leads to insulin resistance. That leads to the high levels of bivalpha reductase. That leads to higher levels of DHT. That leads to hair loss on the scalp and hair growth on the face. So you don't want that.

So if you're next time you're eating a sugar or ice cream, just think of that. Okay? Another reason for, increasing activity of 5 alpha Dictase is a deficiency in zinc. Now zinc is a mineral. It's a natural inhibitor of this enzyme 5 alpha reductase.

And and the zinc deficiency, if you have no low zinc and it's not uncommon in America to have low zinc because we process dye, and it doesn't have a lot of minerals in it. And that can lead to higher levels of DHT due to this uninhibited enzyme activity. Also, as we get older, men's total testosterone levels go down, but the dihydrotestosterone levels remain relatively stable or increased due to changes in enzyme activity and hormonal metabolism. So that's the reason why older men may experience a more noticeable hair loss even as overall levels of testosterone drop. Now what else can cause hair loss?

Inflammation. Chronic inflammation from any source can be a problem. Now it's present in about half the case of male and female pattern hair loss. Well, what is causing it? Well, insulin resistance, the biggest cause of inflammation.

Right? So when you're prediabetic, you have a belly fat. That's just a fire in the belly. That's just producing tons of inflammatory molecules or cytokines. So the biggest cause of inflammation in our society is sugar and starch and the consequences of that, which is insulin resistance, and that produces bat cells in in your belly that just spew out these inflammatory molecules.

Poor diet, which is obviously related to this, Ultra processed diet also cause inflammation through affecting the gut even if it's not full of sugar. Chronic stress will do it. Environmental toxins can do it. Lack of sleep. Nutrient deficiency is a big factor.

So all those things can drive inflammation. Also, from sensitivities or allergens, gluten, another big one. Nutrient deficiencies also play a direct role in hair loss. So if you're have low levels of certain nutrients because you're not eating enough of them or you have poor absorption because you have gut issues, that can lead to hair loss. For example, iron.

A lot of people are iron deficient. Even if your blood count is normal, if your iron stores are low called ferritin, which by the way we test on function health. I'm a co founder of this company called function health. You probably heard me talking about it. And we test for ferritin and iron studies and many of the other factors that are causing hair loss, including the EHE, sulfate, including testosterone, and so forth and some resistance.

So you'll get a very good picture. But even without causing anemia, if you have low ferritin, it's your iron stores that can cause hair loss. And the reference ranges on the lab test are, like, 16 or less, but it should be over 45 if you don't wanna get hair loss. So ferrit is approaching the stores ironing yourselves. It's used to measure body's total iron levels.

When the body's low in iron, it can then pull the ferritin from the hair follicles resulting in diffuse hair loss. So it's not a good thing. So, basically, if you if you're iron deficient, you're basically borrowing from your own stores. And that even if you're not anemic will still be a problem. Protein deficiency is another issue.

A lot of people don't think they're protein deficient, but particularly if you're vegan or you have certain gut issues or other problems, even if protein, you actually may get protein or amino acid deficiency. And hair is made of protein, made of keratin. So a lack of dietary protein can cause shedding of hair. So supplementing with collagen, zinc, vitamin d, biotin, vitamin b 12, they all play a role in hair follicle health and growth. And if you're low in these nutrients, it can contribute to thinning hair.

And, like, by the way, many people are deficient in particularly zinc, vitamin d, and b 12, especially if you're vegan. Now in in addition to high testosterone, there's other hormonal shifts that can lead to hair loss after pregnancy, postpartum. In that period, estrogen helps women maintain healthy, thick hair, which is why women tend to have thicker hair compared to men. Now during pregnancy, estrogen levels are much higher, often resulting in fuller, thicker hair and less shedding. Now after childbirth, estrogen levels drop dramatically, and that can cause what we call postpartum hair loss, but that's usually temporary.

Also aging and getting older often has an impact due to changing hormone levels. So for example, menopause, women have a lower level of estrogen. And as women approach menopause, estrogen levels can go down. This hormonal shift can cause hair thinning or loss. So just like with estrogen, also progesterone levels fluctuate during menstruation, during pregnancy and menopause.

Now progesterone actually inhibits 5 alpha reductase. So progesterone is sort of like the antidote, but it goes down, when you are in perimenopause and in menopause. Now it also it goes up during pregnancy, which is why you get such full thick hair because it inhibits this enzyme 5 alpha reductase. And this protects your hair from hair loss, which is great. When you have a drop in progesterone, which can happen after you give birth or with aging, after menopause, that can result in hair loss due to less inhibition of this hormone called DHT that we've been talking about.

Andropause is sort of male menopause. Also, you see a drop in testosterone levels. As men approach andropause, testosterone levels naturally go down. Now while total testosterone goes down, some men still experience high levels of this particular hormone DHT due to 5 alpha reductase activity, which converts testosterone to DHT. So even if your testosterone is dropping, if your enzyme level is high, you're gonna actually convert more testosterone to dihydrotestosterone, which means more hair loss.

So there's elevated levels of DHT, especially in genetically predisposed men, leads to this pattern of hair loss. Now thank god I don't have that, but, I know a lot of guys do. Now this process typically begins long before andropause, even in the twenties thirties, and it can continue into the phase of andropause. Also, there's other factors that affect hair growth besides hormones. Autoimmune diseases.

These are not uncommon, and they affect hair growth. One of the big ones is lupus, and that is an an, something that can really affect hair growth and hair loss. So inflammation is caused by lupus, which is a common autoimmune disease, can lead to skin issues like rashes or sores on the scalp that can result in hair thinning or loss. Autoimmune diseases like Hashimoto's or Graves' disease can cause hair loss. Both of these conditions affect the thyroid and can cause thin hair.

Imbalance in the thyroid hormones is really common. Either too much or too little, although, by the way, too little hormone is common in in a lot of people. It's 1 in 5 women, 1 in 1 in 10 men. A lot of people have low thyroid function, and that can cause hair loss. So getting your thyroid can actually help when you have this problem, but it's it's usually not diagnosed in most people.

In in hypothyroidism, when your thyroid is underactive, your metabolism slows down. The hair is actually one of the first things to go, becomes dry, brittle, dull, thin. Even your eyebrow hair falls out. In fact, that's one of the ways we diagnose low thyroid is if you lost the outer third of your eyebrows. If you look in the mirror and you're missing the outer third of your eyebrows, you probably are hypothyroid.

Scalp psoriasis, which is common, leads to hair thinning and shedding. It's an inflammatory condition and other autoimmune disease. Rheumatoid arthritis, doesn't cause hair loss directly, but the stress of living with a chronic autoimmune disease or inflammation, these are certain medications like methotrexate also can cause hair loss. Here's another big one. And I've seen people with full blown alopecia, meaning no hair, like, just 0 hair on their body, no eyebrows, no underarm hair, nothing, pubic hair.

It's a big problem, and it's often caused by gluten. So celiac disease can manifest in that way, and the body reacts to gluten. It can leads to hair loss because you get this autoimmune disease in your scalp, which is basically what celiac disease is. And that can also cause deficiencies of certain nutrients because you're malabsorbing nutrients that are important for hair growth. So you can also get that even without full blown celiac, even non celiac sensitivity, which is a more minor version.

Okay. What else can cause hair loss? Well, certain medications, beta blockers, which are common for high blood pressure, anticoagulants or blood thinners, antidepressants like Prozac, zoloft, Paxil, Wellbutrin can affect your hair. Immune suppressants like methotrexate, chemotherapy, obviously, can cause hair loss, which we know with cancer patients. Environmental toxins, another big factor, can weaken hair and lead to hair loss over time because they trigger inflammation.

They mess up your hormones or endocrine disruptors. They can strip natural oils from the scalp. They weaken or damage hair follicles. So things like heavy metals, mercury, arsenic, lead, pesticides, endocrine disruptors, many of these are in personal care products like shampoo, conditioner, phthalates, sodium, lauryl sulfate, parabens, formaldehyde, propylene glycol, hair dye. All these things are not good for your hair, while you put them on your hair all the time.

So try to use more natural products. You can use the guide from the Amadamal Working Group to reduce your exposures and pick the best products. So that's it for today's episode. We've taken a deep dive into the root cause of hair loss from hormone imbalances to inflammation and nutrient deficiency. And remember, hair loss isn't just about genetics.

Your diet, your lifestyle, your overall health play a major role in the health of your hair. Whether you're dealing with androgenic alopecia or other forms of hair thinning, there's plenty you can do to address the underlying issues and promote healthier hair growth. If this episode resonated with you, make sure to test, don't guess, check out function health to discover what's going on in your body from hormone levels to nutrient deficiencies to gluten. Go to functionhealth.comforward/mark to jump the 300 1,000 person wait list. And and don't forget, diet and lifestyle changes are often the best first steps for everything for reclaiming your health and your hair health.

Thanks again for joining me today, and don't forget to rate, review, and follow the doctor's pharmacy wherever you get your podcast. And I'll catch you next Friday for another juicy episode of Health Bites. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts.

And follow me on all social media channels at doctor Mark Hyman, and we'll see you next time on The Dr. Hyman Show. For more information on today's episode, please check out my new video and audio podcast, Health Hacks. It airs every Tuesday and includes a more detailed breakdown of these Friday Health Bites episodes. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at doctorhyman.comforward/marxpicks.

I promise I'll only email you once a week on Fridays, and I'll never share your email address or send you anything else besides my recommendations. These are the things that helped me on my health journey, and I hope they'll help you too. Again, that's doctor hyman.comforward/marx picks. Thank you again, and we'll see you next time on the doctor's pharmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the chief medical officer.

This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Now, if you're looking for your help in your medical or other professional advice or services.

If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultra wellness center.com. If you're looking for a functional medicine practitioner near you, you can visit ifm.org. The search find a practitioner near you, you can visit ifn.org and search find a practitioner database.

It's important that you have someone in your corner who is trained, who's a licensed health care practitioner, and can help you make changes especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public.