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    Unexplained Hair Loss
    M_Mejia posted:

    My name is Michelle. I'm sure there has been a post about hair loss before but I'm new so all these discussions are too much to go through so I decided to start my own. So I'm 25 years old and my hair started falling out considerably in February of last year. At first I thought I was going through shedding phase but my suspicion became incorrect as the hair loss worsened. I have lost about half of my hair. Oddly, I don't have any bald spots but at the rate I'm going, I'm sure it won't take long for one to appear. My hair is thining in the front. I went to the doctor and dermatologist to get myself checked and nothing abnormal was found. I've tried using organic hair products and essential oils to slow down my hair loss but nothing is working. The doctors have been no help. They think it's stress or that I'm worrying to much, feeding the hair loss issues but i'm not. I know this isn't normal. Even my mother agrees. I don't know what else to do. What other kind of doctor should I go to to get another opinion?
    Jane Harrison Hohner, RN, RNP responded:
    Dear Michelle: One of the common causes of hair loss occurs when many of the hairs are suddenly synchronized in the loss, or shedding phase.

    For example, during pregnancy many women experience more fullness in their hair volume. This arises when the hormones of pregnancy artificially keep the hair in the resting ("telogen") phase—avoiding normal rates of shedding. Then, up to three months after delivery, much of the hair which did not shed during pregnancy begins to be lost all at once. A similar pattern can occur with birth control pill use, or after stopping the Pill. Other medications (e.g., amphetamines, Accutane, Coumadin, Depakote, lithium, vitamin A, etc.) might be linked to hair loss. Even emotional stress or a severe illness (e.g., high fever) can induce this pattern of diffuse hair loss.

    Fortunately, this type of hair loss ("telogen effluvium") generally improves on its own after three to six months, but it can take up to eight months. If there is a known trigger (e.g., a specific medication), it should be eliminated.

    The second kind of hair loss commonly seen is caused by either increased levels of male hormones ("androgens") or an increased sensitivity to the effects of male hormones. Because of links to male hormones, it is referred to as "androgenic alopecia" The gene which increases one's susceptibility can come from either the maternal or paternal side. It can begin in adolescence, but is most likely to be present as women age. While only 10% of premenopausal women will show this type of hair loss, 50-75% of women aged 65-70 years will (Scheinfeld, 2008).

    Among younger women with polycystic ovarian syndrome ("PCOS") the increased levels of male hormones can prompt increased facial hair, acne, and thinning hair over the crown of the head. While this is often referred to as "male pattern baldness" it does not progress to the usual shiny bald head one sees in men. Rather, the involved hair follicle replaces a lost long hair with a much shorter, finer hair. This can give a fuzzy appearance with the scalp clearly visible.

    Low thyroid, and uncontrolled diabetes are two endocrine diseases which can be linked to hair loss. Anemia, specifically low ferritin stores, can prompt hair loss. Secondary syphilis, where hair loss does not onset until well after the initial chancre has healed, is not commonly seen. Yet with each of these medical conditions some simple blood tests can establish a diagnosis. By treating the underlying cause, hair growth should normalize after treatment.

    Autoimmune problems such as Systemic Lupus Erythematosus (SLE) can be linked to female hair loss. Alopecia areata can produce patchy hair loss which can range from thinning to overt bald spots. Allopecia areata, like other autoimmune disorders, is characterized by exacerbations and remissions. Other autoimmune conditions which may involve hair loss include lichen planus, and scleroderma. I had a patient who lost eyebrows and lashes from allopecia areata along with all hair on her head.

    Michelle, you really need an accurate diagnosis. I do not know which of these causes has not been considered. Your best bet may be to seek a dermatologist who specializes in female hair loss. While stress can impact hair loss it is important to check out the more rare causes such as lupus or allopecia areata. A scalp biopsy may need to be done.

    M_Mejia replied to Jane Harrison Hohner, RN, RNP's response:
    Geez, there are so many variables. Well my dermatologist did blood work on me and she told me I have no thyroid issue or vitamin deficiencies and I definitely don't have an autoimmune issues. I am not on birth control or have been pregnant. The only thing that I'm thinking can be a possibility is an increase in male hormones, but aside from more acne breakouts lately I haven't seen anything else (ie. more facial hair). Could this be traced with just the blood work my derm did on me or would that be a seperate analysis? I asked if I could get an analysis that would tell me whether I have the hair loss gene and I was basically denied from it by her changing the subject on me. I personally feel that I haven't been getting the medical attention that I deserve because I do not have health insurance, but that would be another topic. This is why I turned to this website as an alternative because I don't know what else to do or where else to go....
    Jane Harrison Hohner, RN, RNP replied to M_Mejia's response:
    Dear M_Mejia: You are so right, there are so many variables! Often the increase in male hormones can be found via blood test for free testosterone. If you have a copy of your dermatologist's lab results you can check to see if testosterone, DHEA or other androgens (male hormones) tests were done. In younger women androgens come from both the ovaries (especially in polycystic ovarian syndrome) and the adrenal glands. Increased acne and facial hair can be markers for increased androgens.

    I am not aware of a test for the "hair loss gene" (but then I am not a dermatologist). If there is a family predisposition (male or female) to early hair loss, that may give you some important information about your own risks.

    Here is some additional information, including a blood test for autoimmune antibodies for alopecia areata:

    You are also correct, lack of health insurance is THE major barrier to care in the USA. I would wager that many of the persons who visit WEB MD are without this "safety net." In your specific case, my recommendation would be as follows. Get complete copies of your dermatologist's exam and labs. Try and find a female hair loss specialist in your geographic area. Save up for a consult appointment for a second opinion. From what you have shared (50% hair loss currently in a 25 year old woman) you merit a second opinion.

    M_Mejia replied to Jane Harrison Hohner, RN, RNP's response:
    Dear Ms. Hohner,

    No, they didn't do a DHEA examination. Can I go to a regular doctor to get this kind of testing and to see if I have PCOS? I did some research to see what testings they did on me and one thing that was a bit off was my white blood cell count. It was about 3 pts higher than the maximum limit. I researched into the problem and found that one of factors can be acute stress. So maybe it is that I am stressed and it's causing the loss, but something tells me that's not it just because while I was in college I experienced higher levels of stress and did not have this kind of hair loss. Thank you so much for link and your advice. You listened to me more than my dermatologist did. I have one more final question. Is panthenol bad for your hair? I promise I won't be asking you more questions. I feel like I'm taking advatange of you or something.
    Jane Harrison Hohner, RN, RNP replied to M_Mejia's response:
    Dear M_Meija: Yes, any healthcare provider can order a DHEA or other androgen tests if indicated. A GYN should be able to help you sort out PCOS as a possible culprit.

    The white blood cell (WBC) count is unlikely to be causing the hair loss. WBC levels can vary quite a bit, so a small amount over the normal is not usually clinically significant unless it just keeps rising. Interestingly, what the body perceives as stress can also vary. Acute vs chronic stress can create different responses as well.

    Stress can be very difficult to pin point. I took on a very challenging new job; bit off way more than I was expecting. Days before starting this new position we had completed a round the mountain backpacking trip. When I started the job I developed severe gut issues. I though I had picked up giardia or other parasites backpacking. Then I noticed that the symptoms were only present Monday through Friday!

    I reviewed several definitions of panthenol as an ingredient in hair products. The following was the best of the lot:

    I have been told by our moderators (the Mod Squad) that MANY more persons read this Exchange than ever write a post. Thus, a concern like female hair loss may be important to numerous readers. You may be asking questions which another woman has been wondering about. Your questions also enter into an archive which can be accessed by future readers with female hair loss questions.

    M_Mejia replied to Jane Harrison Hohner, RN, RNP's response:
    Hi Jane,

    Thank you for the link. It's funny though because I had read that before. For a moment I believed panthenol was causing my hair loss because my hair loss began after I started using organic hair products for two years. These products had panthenol. I noticed a change in my hair structure when I was using Jason Natural Cosmetics Vitamin A,C,E shampoo/conditioner. My curls were looser and it left this weird smell in my hair; kind of like the after smell a relaxer has when you wash it out (after 4 years of being relaxer free, my hair is natural in case you were wondering) so I stopped using it. The smell lingered on for several months even after using other products. The reason why I'm telling you this is because I thought the products was to blame for my hair loss, but I dismissed it because it's organic and I didn't find any complaints or controversies online about the product.

    Anyway, I plan to do what you have suggested which is to get tested for androgens. I'm thinking about taking saw palmetto supplements on a trial basis to see what kind of effect it'll have, but I'm afraid it'll be unsafe.

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