Dr. Friedman introduces himself and discusses whether or not endocrine problems can cause hair loss.
Hi. I am Dr. Theodore C. Friedman. I am an endocrinologist in Los Angeles. I am the Chairman of Medicine and Chief of Endocrinology, Diabetes and Molecular Medicine at Charles Drew University in Los Angeles, and I am also faculty member at UCLA.
I specialize in hard to treat endocrine problems, especially problems affecting women, and my specialty in terms of endocrinology includes thyroid disease, pituitary disease, fatigue syndromes and menopausal issues.
And I am happy to be advisory member of the board for EmpowHER and happy to participate in today’s video.
Yes, endocrine problems can cause hair loss. Hair loss is a major problem among women, and it’s a serious problem and women are very bothered by both their appearance and this is just a part of an underlying problem that they want to get sorted out.
The most common endocrine cause of hair loss is hypothyroidism. And patients with hypothyroid are known to have thinning of their hair, losing their hair in the shower, and especially for example their hair on the outer portion of their eyebrows is very commonly lost.
It’s not clear that whether you have to have severe hypothyroidism or mild hypothyroidism to do it, but I would recommend all my patients that are experiencing hair loss to get their thyroid evaluated and make sure that their thyroid is properly replaced.
If they are on thyroid medicine that means the TSH should be optimized which is usually between 0.5 and 2. Patients that are maybe in the normal range as such have a TSH of 4.5 may still be a little bit hypothyroid and they are not optimizing the thyroid hormones to prevent against hair loss.
The other endocrine causes of hair loss are the hormones, the sexual hormones, and also patients with too high level of testosterone can also have hair loss.
So, too high of testosterone is usually but not always due to a condition called polycystic ovarian syndrome. It’s often abbreviated as PCOS, and this is also a very common situation that has a lot of manifestations in women.
But it usually manifests itself as irregular or no periods, extra hair growth on their face, acne, lack of ovulation, often women have trouble getting pregnant when they have PCOS –it’s usually associated with obesity and weight gain, although not always. And women with PCOS almost always have a high testosterone level.
So I think another thing I would recommend somebody that sort of fits that clinical scenario a PCOS such as extra facial hair, acne, irregular periods and is experiencing hair loss, to be evaluated for the polycystic ovarian syndrome.
And this would usually involve measuring their testosterone level. However turning points also measure what’s called their bio-available testosterone, which is the active portion of the testosterone as it’s bound up to a binding protein called SHBG, and in PCOS often the SHBG is low so the total testosterone may be okay but the bio-available or the active testosterone is high.
And that bio-available testosterone which is high can often give the hair loss, and there are many drugs out there that can decrease the testosterone and get the testosterone in a normal range and can often correct some of the hair loss.
I think it’s also very important when I am talking about drugs that will affect the endocrine system and improve endocrine abnormalities in terms of hair loss, to recognize the hair growth and hair loss is a very slow process.
The hair turns over about every 90 days. So if you stop the hair loss today you might not see an improvement for three months or so. You might not see a full improvement maybe for nine months or a year. So, patients have to be very patient with this.
The other causes of hair loss also can include low estrogen. Women that are pregnant are known to have very good hair and it’s common in that pregnancy is a state of nice hair growth in women.
And the condition that’s most different hormonally in pregnancy is higher estrogen levels. Women also, who go through menopause, can often have hair loss and this would be a indication, it’s not the only reason to put a person going through menopause on estrogen.
But if a person has other reasons to go on estrogen and they discussed sort of the benefits versus the risks of being on estrogen with their doctor, then I think it’s reasonable to try estrogen and that could also help with the hair growth or prevent some of their hair loss.
About Dr. Theodore Friedman, M.D., Ph.D., M.Phil.:
Dr. Theodore Friedman, M.D., Ph.D., M.Phil., specializes in hard-to-diagnose-and- treat cases of adrenal, pituitary, thyroid, and fatigue disorders. He's been with the University of California Los Angeles School of Medicine since 2005 and serves as Chief of the Endocrinology, Metabolism and Molecular Medicine Division at Charles R. Drew University of Medicine and Science. He also served as Director of the Multi-Disciplinary Chronic Fatigue Clinic at Cedars-Sinai Medical Center from 1998-2000.
Dr. Friedman has a private practice near Beverly Hills, California as well as privileges at Cedars-Sinai Medical Center and Martin Luther King Medical Center.