54: It’s Not Just Your Thyroid – The Hidden Causes of Female Hair Loss with Dr. Breanne Kallonen

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. So, Bran, it's so nice to have you on the podcast. I know we've spoken before, we've chatted before. You have just a wealth of knowledge in the world of hair loss, which is literally the number one complaint of my patients. Even if they can't get out of bed, hair loss is like, please just fix my hair. I don't even care if I'm tired. It's devastating. So I just deeply appreciate your work and your dedication to this because it is a narrow niche but so needed in the expert space. So thank you so much and welcome to the podcast.

Thanks for having me. I'm excited to talk about this because it's often dismissed, so let's dive into it.

It really is. And it's viewed as like, not important. And it dominates the landscape of women's minds. You know, I honestly have so many patients who are like, I'm afraid to shower, I'm afraid to brush my hair. They just don't want to do anything that could continue the propagation of hair loss. Talk to me about some of the most common causes that you see as a person dedicated to this space in your patients.

So I would say that nutrient deficiencies are really big one. And making sure that we're not just looking at those really broad normal range. What are actually the optimal ranges that we need to have? Things like basic things like iron and vitamin D. What are those optimal levels that can prevent hair loss but also promote hair growth? I see, of course, a lot of hormone related hair loss and, and that could be anything from higher amounts of androgens. So things like testosterone, DHEA, or impairing menopause. And menopause, where our hormones start to fluctuate or estrogen levels go down. It could be thyroid disorders. Of course, Hashimoto's is a really big one that can impact the hair. Even hyperthyroid can impact our hair follicles as well. So I would say those ones are the big ones. Of course, there's autoimmune and stress induced hair loss, post viral infection hair loss. And really, if we can pinpoint what is the cause of an individual's hair loss, we have more success in treating it because we can get more specific with our treatment plans versus just recommending a blanket recommendation for everybody.

Yeah, and tell Me about, like, when you start that workup, how do you start? Is it layered? Do you look for specific things and go deeper or do you run full panels? Like, tell us a little bit about the labs that people should be getting, what they should be considering when they're trying to find answers.

So I always combine a patient history, right, Understanding how did this hair loss come about? Was it recent? Was it dramatic? Where on the scalp is impacted? Do you have any rashes on the scalp? Is it tight? Any sort of other symptoms? Is it progressive? Is the short lived? A health history is really important to pair with blood work. I always run comprehensive blood work on everybody and I like to start with blood work because we want to rule out the big things first. I think sometimes, especially in functional medicine or the naturopathic space, we can get excited about going down a rabbit hole of could it be heavy metals or could it be molds? And like, back it up a second. Let's make sure that we're ruling out the big things first before we go looking into some of those more nuanced conditions that can impact the hair. Looking at, how's your diet, looking at, you know, are you absorbing these nutrients? What are your hormones? Like, what stressors have been going on? Really getting to understand each individual and their unique experience, I think is really important. And a lot of individuals are just sick of being dismissed. They really want to share about, you know, how this is unique to them. And they're not necessarily opposed to medications, but they want to understand why they're being prescribed something instead of just feeling like, okay, I got minoxidil and spironolactone like everybody else.

It's interesting, there are parallels between hair loss and thyroid. Obviously thyroid people can lose hair too. But like, this idea of being dismissed, of not being taken seriously, of not looking under the hood and going deeper, just this one size fits all approach and presume it should work for everyone.

Right.

Do you find that a lot of people, when they go in for a workup from their primary care doctor, from their dermatologist, do you think a lot of these people are being told, oh, no, your labs are normal, everything's fine, this is just a random occurrence or something?

Absolutely. And when any. Whenever anybody says to me, I had blood work done, it was fine, my biggest question is, well, what was run right? Was even enough testing done? And iron deficiency is one of the top nutrient deficiencies that we see worldwide. And I cannot tell you the number of hair loss patients that I've seen who have not had A ferritin level. Done. And we know that there's an association between hair loss and low ferritin levels. So the fact that, yeah, maybe your CBC is fine. Right. Maybe your hemoglobin is fine, you're not anemic, where are those iron stores? And simply telling somebody their labs are normal when you really haven't run enough labs, I don't think is the best approach either.

Right. And again, parallels with thyroid. Right. Everybody's like, oh, well, I got checked for thyroid. All of my thyroid symptoms, they're not that because my labs were normal, but it's.

My TSH is fine.

Right. And like, it's six, but it's fine. Right. So, I mean, that's the thing. There's so many layers of one. Did you get the right lab work? Did it really? Look at all the root causes of hair loss when they interpret that data, how are they interpreting it? Because that matters too. Like, what's their definition of normal? Because ferritin can go from 4 to 400 in some labs. Crazy, right? Absolutely. Tell me a little bit about ferritin. If it's like. Or iron. Iron deficiency, I should really say, what are some optimal ranges for people to be in that don't promote hair loss, that promote hair integrity, health growth? What are the numbers people should be looking for so they can be a little empowered and looking at their own data that maybe their clinician told them was normal.

Exactly. So I always run a serum iron. So what is the iron in the blood? A TIBC and a ferritin. Ferritin tells us how much iron is in storage. And we really need to understand the whole picture. Right. We need some iron in the blood and we need enough in storage to promote good hair growth. In my experience, I see good hair growth when the ferritin is at least 70 to 100. And it's quite interesting when we look at different countries and the different reference ranges and even the variations between states and provinces. Many states, like LabCorp, is like you said, five as the lower range. But there's one province in Canada in particular, Ontario, where they've changed the language around their ferritin panels, which I actually really like, where they say, iron deficiency doesn't become unlikely until your ferritin is 100 to 300. So if it's unlikely at those ranges, why are we telling individuals that a 20 is fine? Right. And no, it can't possibly cause hair loss. It may not be the cause of that individual's hair loss, but iron deficiency can impact so many other Things, mental health, your mood, your energy, brain fog, your ability to exercise. And it's a very simple thing to treat. When we understand why it's low, it's an inexpensive thing to treat. So why are we not at least trying it anyways, right?

And it's like, well, what if it is something else? What if it is hormones or, you know, another issue? But what if iron is in part contributing, right? Like what if the pie isn't completely something else? And it's kind of like how I, I give an analogy of thyroid and adrenals. Like if I fix your thyroid, but I don't fix your adrenals, you don't feel well. If I fix your adrenals and I don't fix your thyroid, you don't feel well. Sometimes you have to do both, right? So taking that holistic, that global look at everything I feel like is incredibly valuable.

And the same with hair. It's usually not one thing. It's a complex interaction of a variety of different things. And even if we want to go like right to the evidence, we know that genetic hair loss, female pattern hair loss, we also call it androgenic alopecia. The progression of that is substantially increased with iron deficiency. So maybe you do have a genetic component to your hair loss and it's progressive. But what if we're not treating something that is causing that progression to beat up? So it's definitely multifactorial and it's, it's all about treating the person as a whole and then asking why. Right? So if somebody has issues with iron, why is it low? Are you not absorbing? Do you have heavy menstrual cycles? What's your diet like? All of those things play a role is our gut infection. So that's where we can really dig deeper. Versus many of my patients will be told by their primary care, just take an iron supplement. Well, what iron supplement? What dose? For how long? When are we repeating the labs? There's so much that we still have to do.

Yeah, data, right? There's so much power in understanding the nuances and digging in for adequate amounts of data. I couldn't agree more. You said earlier, look, like before we start looking at these esoteric things like mold and heavy metals and things, we need to go back to the basics. And I think that's so valuable and we're taught really in medicine, look, think about the horse before you think about the zebra. Like think about the everyday, right? Like think about the everyday thing that most people are struggling with. Before you go to this really vague Distant esoteric thing. And I love that concept here because I do think it's empowering for people. Tell us about basic things like nutrition, hormones, metabolic, health. Tell us how those types of things that most of us experience at some point in our lifetime we struggle with. Tell us about how those can impact hair loss and growth, et cetera.

So nutrition is a big one. And individuals, we always hear this, right? Protein, protein, protein. Protein is really the building blocks of our hair as well as, as we age, our ability to synthesize amino acids, our abilities to build proteins reduce. So as we go through hormone shifts and perimenopause, we even need more protein at that point in time. And one of the things, a lot of my patients don't like doing this, but tracking your protein, right? There's a difference between saying, I eat protein at every meal, but how much are you actually tracking it? So I like individuals just to do a simple exercise over a couple days, add up the amount of protein that you're actually getting and start with that. In addition, we want to look at, are you getting enough micronutrients in your diet? Do you have a diversity of vegetables? So many individuals are just not eating enough vegetables in their diet. I know it's hard, I know it's challenging, but there's small, simple things that we can discuss where we're not completely overhauling your life, where you have to spend every minute in the kitchen. There's pre chopped vegetables, take your already done cold, turn it into some sort of stir fry, the egg roll in the bowl. It's just finding those simple things that you can incorporate more protein and fiber. If you want to do protein shakes and collagen powders, go for it. At the very minimum. You need to be getting at least 100 grams of protein. It's a very, very minimum for the vast majority of my patients. So add that up, see how you're doing to know if you're getting enough vegetables. I usually have individuals aim for about 30 grams of fiber in their diet. Again, do the inconvenience of tracking over a couple days and just see how far off you are. Even with AI technology like ChatGPT, just send ChatGPT pictures of your meals and say like, how much fiber did I eat today? It might not be a hundred percent, but it's going to give you a rough estimate that's enough to satisfy our needs for the experiment. So nutrition is a big one. Then what you're going to want to do is again, go back to your blood work, the nuances in our nutrition is going to depend on what your blood work says. So for instance, if you always have iron deficiency and vitamin D deficiency and we've screened you for celiac and it comes up positive, then of course we need to follow a gluten free diet that's going to be more of like kind of that root cause of your iron deficiency. So looking at which foods are going to help you and which foods might be more inflammatory for you, I'm not a big. Everybody has to do this with their diet. I think 80, 20 healthy whole foods. You should have metabolic flexibility to sometimes have carbohydrates and sometimes have more calories and sometimes have less. When we lose that metabolic flexibility, that's what we call insulin resistance. And insulin resistance is another big driver for hair loss in androgenic alopecia. So if I see a lot of insulin resistance, we may slightly lower the carbohydrates or provide supplements that can help with insulin resistance, or there's medication options that are out there. But we need to see the data first. If you don't have insulin resistance and you're metabolically healthy, if you follow fad diets that are really low in carbohydrates, that might sacrifice your energy, that might not be a good plan for you. So I really like to refer back to where is this individual with the blood work to establish more of those nuances in the nutrition. Sleep is another big one. Stress management is another big one. When we see cortisol issues on blood work or maybe we're doing urine testing, there are some supplements that can help. But I always say you can't supplement out your lifestyle. So are you sleeping? Are you drinking water? How are you perceiving your environment? And that might be different for everybody. Some individuals might like to go for a walk. Some individuals might do really well with talk therapy, yoga. But finding what can help with your stress response in particular is what I would recommend for individuals because all of those foundational pieces really go into preventing the hair loss from coming back.

It's like they have to know so that they can work on that to maintain. I'm so curious. It's interesting when you do like one thing so often, you can analyze data and really get a sense of patterns. And I think that's where expertise lies. What do you feel like in your practice is the most common cause of hair loss? I mean, obviously you probably see mostly women, right? Those are generally, those are the people that come to the clinicians to see, to get help that they need in general. But usually, especially for hair loss, what do you feel like in terms of patterns? Like what are the top ones? Even 1, 2, 3, whatever it is.

I see a lot of insulin resistance and inflammation. And that's a big issue for a lot of us in North America, right. There are studies that only 12% of North America is metabolically healthy. And it's that insulin resistance that creates the inflammation. Now you're not absorbing your nutrients well, your liver is not making enough of the binding protein to bind up. Your testosterone free testosterone levels go up, aggravates the hair. I would say insulin resistance and inflammation is a really big driving factor for a lot of chronic conditions that I see. My practice really is focused on insulin resistance. That's where I started. But because of the insulin resistance and the weight loss piece of things, a lot of those patients were like, I'm also losing my hair. So that's where we kind of get into each of those subsets. Different conditions and different symptoms, but they all kind of fall back into that insulin resistance piece. Even probably with thyroid, you see a lot of that insulin resistance inflammation piece of it.

Yeah, absolutely. How interesting. I would not have guessed that that's like the most common cause that you see. So incredibly interesting. And I had a follow up question to that too, and now I can't even remember. But I was so curious. When you deal with these people who are insulin resistant and you're working on these root causes, right, of hair loss, how long until people can begin to see improvement? Because that's a big undertaking. Like that's a long game. Are there things that these people are able to do early on to shift? Because basically I always think about hair loss as like, look like we need to do all the things because every hair that these women lose takes like five years to grow back because it's so long, is there anything that they can do in the interim to shorten the cycle of loss?

So telogen effluvium, for instance, kind of our stress induced hair loss. We know that a lot of those cases will actually get better within three months regardless if you do an intervention. So we have to keep that in mind because sometimes we glorify our treatment plans thinking that everything we did corrected the hair when it could have just been time. But with that being said, it depends on what the cause is. If it's an iron deficiency and we fix that really quickly in three months time, and this individual absorbs really well and they're not having heavy menstrual cycles, and it's a Simple fix that hair. We can see positive improvements in 3 to 6 months for hormone related hair loss, especially if we're focusing on the hormones, but also the underlying insulin resistance that is playing the long game. That can take six to nine months. Even when we look at data on a conventional medication like spironolactone for androgenic alopecia, those studies are six to nine months to see an effect. So if we're trying to use natural alternatives, maybe herbs like supplemental pygmium nettles, we have to give it at least six to nine months, which is really frustrating because we. I like data, right? I want see the blood works getting better, but we might not see that. So it definitely takes some time and it takes constant follow up and evaluation because like you said, the, the hair does take a long time to grow. To speed things up, there's some ingredients that have been shown to increase hair density and thickness. Chose is one that I like, Strava is another one. And varisol collagen. None of these are 100% guaranteed to grow the hair back. But I say, well, we're working on the root cause, let's at least stimulate more hair follicle growth and production. Because I know like once you lose your hair, you're like, okay, when is it coming back? Right? Just to get that density can take time. There's some studies on red light therapy, increasing circulation with caffeine based shampoos. Ketoconazole perhaps could help a little bit. But unfortunately with hair we have to set realistic expectations that it's a little bit of a long game for sure.

And I love the idea of working on things to stimulate the follicles because that's the whole end game, right? Is to keep those hair follicles healthy, vibrant, functioning. Because once they go dormant, it becomes pretty hard to reactivate them over time, right?

Yeah. And a lot of the time, by the time a patient comes to me, they've already lost 50% of their hair density. So it is something that's quite significant for them. And it doesn't matter if your hair still looks good because I have a lot of patients that will come to me saying, I know my hair looks fine, but this is not what it was. And they're like, I'll show you pictures, I believe you. Like, if you feel that you're losing more hair and you're losing that density, then it's worth investigating because let's say it is insulin resistance that increases your risk of prediabetes and diabetes. Alzheimer's and dementia, cardiovascular disease, that's not a small cosmetic thing. Right. And even iron deficiency, your risk of not being able to focus, having concerns with your mental health, that's a huge impact of your quality of life. So these are things that are really important to address. You know, even picking up perimenopause, there's lots of great supports that we have to help with those symptoms. So I want individuals to understand that it's not just a cosmetic concern, it's not something that's small and it deserves to be investigated.

Right. It's a manifestation of a deeper issue. Totally. I'm also curious in. I feel like in medicine at this point we've almost normalized women walking around with pretty crazy high levels of testosterone. Oh yeah, right. Women feel good, they feel great. But I mean, I've seen a woman at a level of testosterone that was over 2000, another one over 1200, another one over 800.

Right? Whoa.

Just for listeners, a thousand is a great, fantastic level for like a 25 year old man.

Right.

Women don't need to be walking around with a Testosterone level over 2000. I'm curious if you've seen an uptick in hair loss related to hormone replacement therapy to extremes over the last few years.

I definitely have, especially when it comes to pellet therapy. And it's interesting when we run consecutive blood work on individuals, even when technically that testosterone level should have come back normal by this point in time, three, six months, I still see the levels really high. And it's interesting because one hormone is going to impact the other hormones. Because once you significantly increase, let's say you have oral estrogen or you're, you're having a high dose of testosterone, your body's going to increase the amount of sex hormone binding globulin to compensate for that. Then when you're finally letting the medication come out of your system, you might actually feel worse because now you've got this high sex hormone binding globulin that also needs time to come down before you even get back to your baseline. I'm not a huge fan of really high dose testosterone replacement therapy. There's.

Oh, I bet you're not in the business of hair loss for sure.

Not with the hair loss piece. I mean, testosterone is important, right? It's a great, wonderful hormone for women, but we need it within that. I like normal physiological dosaging of testosterone. Just because it's not proven to be unsafe doesn't mean it's a great idea. And that's where we start to run into Some issues. Now, some women can push their levels of testosterone. They're just fine. They don't have acne, they don't have hair loss. And that comes down to the genetic predisposition to converting your testosterone to dihydrotestosterone. There's genetic tests like the trichogen test that you can run to see. But then we're at the situation where say I have a patient where they're like, I want my testosterone that high, I have to have it that high. Well then the only option if you have an elevated or fast 5 alpha reductase enzyme, is to now add on another medication, which we don't necessarily have long term safety studies in women and fully understand the risks of that. So now we're benefiting one thing, causing a side effect, adding another medication. I just think it's a slippery slope to go down that pathway.

Yeah, no, I agree and I too, I'm a huge advocate for testosterone replacement. I'm on it. I put women on it every day. But staying within physiologically normal range we can certainly presume is pretty darn safe. And 10xing, that seems a little risky and certainly comes with consequences. Not even, I mean, hair loss. Sure. But like other permanent consequences that can happen as well, that can be devastating. So, yeah, and I mean, it's a strange time to be in medicine because I almost feel as though we've accepted it now and that it's fine and that no one's really doing anything about it. And it seems like a strange time to be alive. I'm like, really, like we're just going to allow this to happen pervasively, ubiquitously, where it's now accepted as normal. So I can only imagine you see quite a few patients due to that for sure.

And I think it's problematic because individuals have been dismissed for so long. Right. Women, low libido, low energy, they're seeking support, they're seeking answers. Dismissed, Dismissed. Now they find a practitioner that's going to supercharge their testosterone levels and make them feel wonderful so they feel validated. But then that does come with potential long term consequences. And I think there's a happy medium. And if we're using really high dosages of testosterone for kind of like that quick fix, energy reset, we're missing a lot of the other root problems that are going on.

Yeah, we're masking them. We're overcompensating in one area and not addressing another. Yeah, no, I could not agree more. So tell me about, for anyone listening who's Struggling with hair loss. Who's dealing with this reality? Tell me some first steps that they can take to get started on their journey to create a reset and put their train on a new set of tracks, so to speak.

My top recommendation is going to be try not to become hyper vigilant about counting the number of hairs. Right? So if you're experiencing hair loss, we know it's hair loss. Try not to cause more stress on yourself, factoring in every single hair that you're potentially losing. Instead, go for blood work. I have put together a hair loss blood work bundle where I list out these are all of the markers that your doctor should be running. If your doctor won't run them. There's so many private lab companies that at a very reasonable price, it's not free, but a reasonable price, you can have all of these markers drawn. Once you have your blood work drawn, you can go to somebody who can help you interpret this from an optimal range. In the hair loss blood work bundle that I put together, I do have a cheat sheet where it says optimal ranges. Although when we comes to hormones, that becomes tricky because it depends on where are you in your reproductive cycle, what would be considered normal or not. So make sure that you're working with somebody who can help you understand normal versus optimal for hair. Then increase protein in your diet. Focus on sleep, like doing all those basic healthy living activities. Get outside, get sunlight, right? Fresh air, go for walks, do your exercise, drink your water, go to sleep at a decent time. Focus on all those lifestyle factors first. Once you have the blood work, review all of your options. I think it's important to understand everything that's out there for you, both from a pharmaceutical perspective and a natural perspective. What can you do to best support your body with your diet, with supplements, with medications if needed, and then weigh out the pros and cons. So I go through the labs, explain them to individuals, what each thing means. We talk about all the options, and then an individual would choose an option they feel best for. Then if we're following something like iron or vitamin D, we're repeating those blood work levels to make sure that what we're doing is working. Because if it's not working, we need to figure out why. So I would start there. Because if you end up going to the supplement store and picking up a grocery bag of 20 different supplements, let's say it does work for you. Now you're stuck on 20 different supplements and you have no idea what has worked at that point.

Amen. And you're committed to Taking those forever at this point. Absolutely. Which is not sustainable or probably not.

The healthiest, not realistic. And I think a lot of individuals are surprised by how simple my treatment plans are because it's very much, let's focus on this thing first and let's see what happens. Let's focus on this first and see what happens versus kind of throwing the kitchen sink at it. And I can't take a million supplements throughout my day, so I also don't expect my patients to take a million different things either.

Amen. Well, thank you for this, for sharing your knowledge and also just dedicating yourself to learning the nuances of all of this because there aren't many people as knowledgeable about this as you and it's so desperately needed. I would love for you to share a little bit about how listeners can work with you or in a program in any format or fashion and of course, like where they can find you online and social, all the things.

So I have a lot of different resources for individuals. The best way to learn about my practice is to follow me on Instagram or TikTok, Brianne Callanin. You'll be able to find both of those channels. There's a lot of education on there as well as. If you go to my profile, you'll be able to view a ton of free YouTube videos. So I have YouTube videos on insulin resistance. I have YouTube videos on hair loss. I have YouTube videos on your optimal ranges for your labs. A lot of free resources will help you gather a lot of information. Those would be the best places. And maybe I'm unique as a naturopathic doctor, but I actually see my patients one on one. So individuals can book with me one on one to review their health history, review their labs, get an understanding of what's optimal versus what's not. And then of course, I have health coaches as well that they can work on their nutrition side of things with.

I love that. Well, thank you. Thank you so much. And it was an absolute pleasure having you here today. And yeah, I just truly value your work. Absolutely.