The Root Causes of Hair Loss (And How to Reverse It) | 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. If you heard me talk recently, you probably know how much I love Himalayan Tattari Buckwheat, a gluten free seed loaded with longevity promoting nutrients. My good friends at Big Bold Health have been carefully growing and researching this ancient plant for years. After tons of positive feedback from me and thousands of customers, they produce the world's first 100% organic Himalayan tarty buckwheat sprouted powder that's easier to digest, richer in vitamins and minerals, and contains up to 10 times more plant nutrients like rutin and quercetin. I love this as a topper in my yogurt, a sprinkle on savory meals, or as an easy add to my smoothies and protein shakes. 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And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplementstore.com, 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. When this woman 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 going to 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 too high levels of male hormones, which is not uncommon in women who have insulin resistance or pre-diabetes or PCOS. Now 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 it 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 attaches to the hair follicle receptors and over time the DHT shrinks the hair follicles making them smaller and weaker. Now this leads to hair thinning and a hair loss as the follicles grow kind of 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 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 going to 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 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, of hormonal dysregulation, and leads to a condition called androgen dominance, where you have more male sex hormones. That's not a good thing. And 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 and 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 heavy 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 is sex hormone binding globulin? 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 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 levels 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, five 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 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 want it overactive, right? Stress. Stress will trigger the release of cortisol and that targets and damages your hair follicles. So many women in their 20s and 30s start losing their hair due to stress. 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 is 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 5-alpha 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 reductase is a deficiency in zinc. Now zinc is a mineral. It's a natural inhibitor of this enzyme, 5-alpha reductase. And, and this zinc deficiency, if you have no low zinc, and it's not uncommon in America to have low zinc because we processed diet and it doesn't have a lot of minerals in it. That can lead to higher levels of DHT due to this uninhibited enzyme activity. Also, as you get older, men's total testosterone levels go down, but the dihydrotestosterone levels remain relatively stable or increase due to changes in this 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 cases 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 pre-diabetic, 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 fat cells 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 food sensitivities or allergens, gluten, another big one. Nutrient deficiencies also play a direct role in hair loss. So if you 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 Functional Health. I'm a co-founder of this company called Functional Health. You probably heard me talking about it. And we test for ferritin and iron studies. many of the other factors that are causing hair loss, including DHEA sulfate, including testosterone and so forth, insulin 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 want to get hair loss. So ferritin is approaching the source. Iron in your cells is used to measure your 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're iron deficient, you're basically borrowing from your iron 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 B12, 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 by the way, many people are deficient in particularly zinc, vitamin D, and B12, especially if you're vegan. Now, 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 five 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 goes up during pregnancy, which is why you get such full thick hair, because it inhibits this enzyme five 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. Now, 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 five alpha reductase activity, which converts testosterone to DHT. So even if your testosterone is dropping, if your enzyme level is high, you're going to actually convert more testosterone to dihydrotestosterone, which means more hair loss. So this 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 20s and 30s, 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 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. In balance in the thyroid hormones is really common, either too much or too little. Although, by the way, too little hormone is common in a lot of people. It's one in five women, one in 10 men. A lot of people have low thyroid function and that can cause hair loss. So getting her thyroid can actually help when you have this problem. But it's usually not diagnosed in most people. In hypothyroidism, when you're 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 eye brow hair falls out. In fact, that's one of the ways we diagnose low thyroid is if you've 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. The use of 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 zero 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 lead 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 gluten 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. Immunosuppressants 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, although you put them on your hair all the time. So try to use more natural products. You can use the guide from the Aromatase 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 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.com/mark to jump the 3000 person wait list. 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 podcasts. 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 Dr. Mark Hyman. And we'll see you next time on the Doctor's Pharmacy. 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. 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