When big clumps of hair come out as they brush, wash or comb their hair, patients come running to me in a panic, afraid they will become bald. Balding is fairly common in men and can start in their 20’s. Most women’s hair will thin when they are entering perimenopause or menopause but they don’t go bald. While biotin is known as the hair vitamin and has little to no downside, it most likely will not turn a thinning mane into a thick one. Hormones, stress and nutrition play a big role in helping to grow hair.

The Stress Hair Connection: Telogen effluvium

Hair grows in cycles and has 3 phases: resting phase (telogen), growth phase (anagen), involution (catagen). A common form of hair loss called telogen effluvium occurs when the body experiences physical or psychological stress such as: childbirth, dieting, medications, surgery or trauma. Hair follicles shift from the growth to resting phase in large numbers. Hair loss is usually from all over the scalp and may be more pronounced in the front above the temple. It usually occurs two to three months after the stressor, which is why people don’t make the connection. Toxins such as arsenic, thallium, or mercury poisoning can also result in telogen effluvium. Measuring cortisol in saliva can be helpful in many cases.

The best treatment for this is understanding that hair will grow back as long as you manage the stress that caused it and eat a healthy diet that is not calorie restricted. In the case of toxins, it’s best to have them measured by a functional medicine doctor and use supplements and herbal formulas to help your body get rid of the toxins.

Thyroid: Essential to Hair Health

A low level of thyroid hormone called hypothyroidism is a common cause of hair loss. Metabolic processes are slowed down and common complaints are hair loss, weight gain, feeling cold, constipation, brittle nails, lack of energy and other symptoms. It is important to have an evaluation to determine the underlying cause. Low levels of thyroid hormone T4 (tetraiodothyronine or thyroxine)can be due to nutritional deficiencies, autoimmune disorders, infection and medication among other things. T 4 is converted to the active form of thyroid hormone called T3 (triiodothyridine. This can be low due to aging, stress, infection and nutritional deficiencies. Replacement of T4, T3 or both can restore your energy, vitality and hair. It’s important to measure TSH (thyroid stimulating hormone), free T4 and free T3. In some cases, micronutrient tests may be beneficial.

Androgenic: Male Pattern Baldness in Men and Women

Excess androgens such as testosterone, dihydrotrestosterone (DHT), dehydroepiandrosterone (DHEA) can cause hair loss that generally occurs on the top of the scalp and in the front above the temples. This is known as male pattern baldness. The key androgen related to hair loss is DHT, which is a very potent metabolite of testosterone. Testosterone is converted to DHT by the enzyme 5 alpha reductase. You can block the enzyme and slow the conversion to DHT by using herbs such as saw palmetto and nettles root extract or the pharmaceutical drug finasteride. It is important to measure ALL of these hormones as very few doctors measure DHT. Men and women with low free and/or total testosterone can have high levels of DHT.

Progesterone Protects Hair

Women as they enter perimenopause as early as the mid thirties experience significant hair loss. This is due to low progesterone. In the mid 30’s women start to run out of eggs and ovulation does not always occur on a regular basis. Progesterone is made after an egg follicle develops and releases an egg. Progesterone blocks the androgens that cause hair loss so replacement with bioidentical progesterone restores hair.


There are many causes of hair loss such as infections, autoimmune, scarring, calorie restriction, nutritional deficiencies, medications and more. It is essential to evaluate the underlying cause to determine the proper treatment. Your mane can be thicker and more lustrous when you have the proper nutrition and balanced hormones. Consult a functional medicine doctor to determine the root cause of your thinning mane.

Author's Bio: 

Lorraine Maita, MD is a recognized and award winning physician and author-transforming people’s lives through preventive and anti aging medicine. She is a Diplomate of the American Academy of Anti Aging and Regenerative Medicine and Board Certified in Internal Medicine and has over 20 years experience in Preventive Health and Wellness, Internal, Occupational and Travel Medicine and Executive Health.

Dr. Maita served as Vice President and Chief Medical Officer at Prudential Financial, Medical Director on The Pfizer Health Leadership Team and Medical Director of North America for Johnson & Johnson Global Health Service and was an attending physician at St.Luke’s/Roosevelt Hospital, Emergency Department and Executive Health Examiners in New York City. She is a consultant for companies wanting to develop or enhance their employee and occupational health and wellness programs and has a private practice in Short Hills, NJ. She is author of “Vibrance for Life: How to Live Younger and Healthier.”

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