"How can one investigate the cause of hair
loss beyond the expected thinning at the onset of
menopause. I took phentermine for a while but the
hair loss continued after stopping. I did lose 30
pounds in just a few months, but the hair loss continues.
Are there tests for deficiencies or other possible
causes?"
"I am 53 and have been 1 1/2 years without a
period."
E.S.
Hair loss can have many different causes from local
agents such as the chemicals in hair products, to
body wide substances that we ingest or are deficient
in from our diets, to natural hormonal changes such
as pregnancy or menopause, to disease states that
affect the skin and hair as an organ. Ingested causes
can be toxic substances from our water or food as
well as medical prescription drugs or over-the-counter
drugs.
In your case the menopause with its decreased estrogen
levels and the dieting are the most likely culprits
in explaining your hair loss. You did not mention
if you were taking any estrogen supplements for hormone
replacement or vitamin and mineral supplements while
dieting but these would be important to prevent hair
loss if you are not taking them. As far as I know,
the phentermine is not thought to be a drug that causes
hair loss although there are many drugs that can cause
it.
Hair cycle growth goes through different phases.
Agents that cause hair sloughing, called effluvium,
can be active in those different phases. Anagen phase
is the growth phase that a hair goes through and it
generally lasts about 6- 10 years for each individual,
randomly growing hair. Catagen phase is a very short
deactivation phase where the hair follicle prepares
to go inactive. Catagen phase lasts only about 2-3
weeks. Telogen phase is the final resting phase of
a hair follicle and it lasts about 30- 90 days. At
any one time, about 90% of hair is in the anagen growth
phase and about 10% is in the resting telogen phase.
When you brush your hair and it comes out in the brush,
that is removing resting phase (telogen) hair shafts.
After resting, a hair follicle sloughs its shaft becomes
active again, growing a new hair shaft as long as
the follicle itself has not been damaged.
If a disease or substance affects the growing (anagen)
phase of hair, hair loss is massive and a person can
actually lose most (90%) of her hair. If the disease
or substance affects only the resting (telogen) phase.
only about 10% of hair is lost (although that seems
like a massive amount also) and the loss only lasts
for about 3-4 months. Post partum effluvium and hair
loss associated with menopause is mainly due to the
lower estrogen levels put more hair into the resting
phase all at once and then in 1-3 months there is
a significant hair loss - "gobs of hair".
Hair growth will resume as soon as the hormones are
back to normal level.
From www.keratin.com, we can get some lists of the
different causes of hair shedding or "effluviums".
In addition to withdrawal of estrogen hormone, telogen
effluvium can be caused by:
diet deficiencies, particularly lack of iron
crash dieting
fever
ultra violet (UV) radiation
acute blood loss
hyperthyroidism or hypothyroidism
extreme physical stress such as surgery
emotional stress
severe illness
drugs such as:
cholesterol-lowering drugs, clofibrate, gemfibrozil
anti-histamines/ulcer drugs, cimetidine, ranitidine,
famotidine
anti-coagulant drugs, dicumarol, heparin, coumarin,
warfarin
anti-convulsant drugs, ethotoin, phenytoin, mephenytoin,
trimethadione, paramethodione, valproate sodium
anti-thyroid drugs, carbimazole, methimazole, itraconazole,
thiouracil
beta blockers/high blood pressure drugs, acebutolol,
diazoxide, nadolol, atenolol, pindolol, labetalol,
metoprolol, propranolol, timolol
non steroidal anti-inflammatory drugs, aspirin, fenoprofen,
meclomen, ibuprofen, naproxen, indomethacine, piroxicam,
ketoprofen, sulindac
arthritis drugs, penicillamine, auranofin, indomethacin,
naproxen, methotrexate
tricyclic anti-depressant drugs, amitriptyline, imipramine,
amoxapine, nortriptyline, desipramine, protriptyline,
doxepin, trimpramine
vitamin A and derivative drugs, retinoids, retinol,
acitretin , isotretinoin, etretinate,
miscellaneous drugs, allopurinol, aminodarone, azothioprine,
azulfidine, bromocriptine, carbamazepine, choramphenicol,
clomiphene, clonidine, colchicine, dixyrazine, ethambutol,
ethionamide, etretianate, gentamycin, haloperidol,
hydantoin, levodopa, interferon-alpha, methyldopa,
methysergide, metapyranone, nifrofurantoin, para-amino-salicylic
acid, prazosin, probenecid, pyridostigmine bromide,
sulphasalazine, terfenadine
toxic chemicals containing:
monomeric/dimeric chloroprene (rubber manufacturing),
potassium
bismuth (cosmetic formulations with "pearlescence"),
lithium salts,
iodine,
iron,
lead,
gold,
aluminum,
arsenic,
boric acid,
borates,
mercury,
selenium,
thallium,
zinc
Many of the same triggers that cause hair loss in
the resting phase can also cause hair loss in the
actively growing anagen phase. Since so many hair
follicles (about 90%) are in the growth phase at any
one time, this can result in massive amounts of hair
falling out at once. Causes of anagen effluvium include:
genetic hereditary disease
defective hormone production other than estrogens
nutrient deficiencies such as copper, iron, zinc,
biotin, essential fatty acids, or vitamin C
cancer treatments
excessive X rays or X ray therapy
toxic agents such as thallium, arsenic, lead, bismuth,
vitamin A and derivatives
Therefore to get back to your question of how you
can go about determining the cause of the hair loss,
be sure that you are on estrogen replacement and a
multivitamin/mineral supplement as you diet. If you
are already on those and are still having hair loss,
see your doctor and ask for the following:
Check the list of any prescription medicines or over-the
counter medicines that you take on a regular basis
to see if any of them cause hair loss
Check a complete blood count (CBC) and serum iron
looking for anemia or iron deficiency/excess
Check a TSH, thyroid function study
Check a screen for toxic metals and mineral deficiencies
There are at home thyroid tests (TSH) and mineral
screens you can order on the internet but of course
insurance does not cover the tests unless your doctor
orders them.
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