Dr. Boz [Annette Bosworth, MD] - Thinning Hair? 4 Hormone Deficiencies

This topic comes up all the time with men and women freaking out because they go keto and their hair falls out. Let's look at the four hormones that are responsible for hair loss and what role keto actually plays. If your hair looks like this, even if you're a man, you have pathological hair loss, and that means that your hair is falling out because of your hormones. It's not normal. Your hormones are not getting to the hair follicle fast enough to turn over new hair. Maybe this isn't you yet. Well, here's a chart showing what is normal, what's pathologic, and what's on the road to looking worse.

I'm Type 1, and when I was 15 with a full head of hair, you could barely see my scalp. Now I'm almost 52, and I fall in the middle with a noticeable white line where my part is. When I'm 80, I'll be over here on the right, and that will fall in line with what happens to my hormones when I go through menopause. But I should never progress to this second line of Type 2.

To explain what goes wrong with your hormones, causing that pathologic hair loss, I need to go a little deeper into what happens in a hair follicle. This is a picture of a hair follicle, and you'll notice at the bottom there we have a blood supply feeding this purple spot where the hair is alive and dividing. It needs a supply of oil, and that section of oil lives in your skin, deeper, right near the dermis. The top layer of your skin is actually dead, much like the hair that you touch. This brown part is where the hair comes out of your head.

When I see patients with hair loss, I ask them how their sleep is and what stresses they have in their life right now. Hair is one way to evaluate how stressed you are. This slide showing the life cycle of your hair is actually what happens when people's hair falls out. Most of the hairs on your head are in this anagen phase, and a small percentage are always in the catagen phase. What marks the start of this catagen phase is stress, and that can be something little, like the age of that hair follicle, or something major, like chemotherapy. Either way, this blood supply pulls away from the bottom of the hair, and this hair follicle actually dies at the bottom, going into a restorative phase. The hair follicle is technically dead, but it's still in your head, and it can be activated back into the telogen phase shortly. What's strange about this phase is you notice nothing on the outside. Those hairs aren't falling out yet. You have no clue that in three months this hair is going to all fall out.

That time to go from the dormant phase, where the blood supply isn't connected, to the time where the blood supply is restored and that new hair follicle is growing, well, that depends on the health of you. When I say stress affects hair growth, I don't just mean the stress from work or home life. Chronic inflammation is the worst kind of stress on hair follicles. That's the same type of patient that comes to me because they can't lose weight, they have autoimmune problems, arthritis, they have a rash that is chronically there and not going away. They can have foggy brain, digestive issues, pre-diabetes, you name it.

But to get their hair follicles out of this catagen phase and back into the healthy anagen phase, we are going to need some fat-based hormones to the rescue. This starts with cholesterol in our bodies. That cholesterol turns into things like progesterone, aldosterone, estradiol, testosterone, and vitamin D. The problem is when you have high insulin, that insulin hormone dictates to these fat-based hormones that they belong in the fat cells. So those fat-based hormones you're depending on to rescue your hair growth are being shoved into fat cells thanks to insulin. You can't use these fat-based hormones properly. Even if I injected you with testosterone, which would be a worst-case scenario, these vital hormones are locked up and can't get to your hair.

Now enters keto, that ketogenic state where you lower the carbs, which lowers your insulin. Your glucose goes down, the ketones go up, and what else goes up? The fat-based hormones. They come out of your fat cells and are now free to circulate around your body and get to your hair follicles. Once that blood supply is delivering them to the root of your hairs, you are actively in that catagen phase and about to be in the anagen phase, and that is great for regrowing hair.

But why are these people losing hair on keto in the first place? Here's the thing: weight loss is a stress. Using a ketogenic state, where you go from a high-insulin state to a low-insulin state, is also very stressful. It's good for you, but it causes a shock to your system, especially at the beginning when you're becoming fat adapted. These insulin-resistant people are more likely to end up with a hairbrush full of hair, especially at the beginning, because of that ketogenic shock. They don't notice it at first. It actually takes a few weeks for that hair to start thinning. They come to the office desperate and worried that this ketogenic diet is causing the hair loss. Well, it kind of is. It was the stress that stimulated this hair cycle to fall out, but it's also the delivery mechanism that now makes the better hair follicle that will last two to six years of strong growth.

But they can't quit. When they're showing up in my clinic, their hair is actually already growing back, but it's happening beneath the skin. Without fail, they go buy the fanciest shampoos or treatments that cost an arm and a leg. Don't do that. Remember, the hair follicle has a cycle. It takes three months for that hair to push through the skin, and about the time they're adding their fancy shampoos, they can see the new hair growth and give all the credit to that shampoo. I don't buy it. All you need to do is wait. Your hair will grow back better than before, because now you've given it healthy fat-based hormones.

You want to know which hormone I replace first when patients come in with hair loss? Vitamin D. Yes, it's a hormone. Check out this video and I'll teach you all about it.