Help me not be bald!
February 17, 2013 7:28 PM   Subscribe

I am a fat woman and my hair is thinning dramatically. What can I do to stop becoming a bald fat woman?

A bit over a month ago I started to notice that the hair at the front and on the top of my head is thinning, drastically. I have always had very fine hair and not very much of it, but I am beginning to see a lot more scalp through my hair at towards the front, and when I run my hands through my hair I can feel that there is much, much less hair than there was previously.

I am in my late thirties and have a BMI over fifty. My blood sugar is normal and I do not have diabetes. I have not, so far, had any significant health problems, but last year I menstruated only three times, and started to get a bit more hair on my face and chin (which I pluck). My doctor sent me for a pelvic untrasound last year, and it found nothing unusual.

I asked my doctor for a referral to a dietician last week, and although I didn't specifically ask him about my hair loss, I said I was obviously experiencing some hormonal issues and asked if there was something I could do to curb them. He said "Obesity can have an androgenic effect" (which I had figured out for myself). 'What about the pill, or mini pill?' I asked. 'I know that there can be concerns about clots if you're obese, but might that be an option for me?' 'No, the pill is contraindicated if you're obese,' he said, and that was pretty much the end of the conversation.

Is there something else I can do to stop going bald? I am looking for answers other then weight loss, which I am pursuing in any case. I am very motivated to lose weight at the moment—I have a gym membership, a dietician, lots of knowledge about weight loss, and a keen interest in my future health. I do not need advice at this time about losing weight.

My questions are:

1) Is there something I can do right now to stop losing my hair? Are there any medications or other solutions I should ask my GP about?
2) I had previously asked my doctor if I might have PCOS and he was not very interested in that line of inquiry (and the ultrasound later showed no cysts). Should I be asking him for a referral to an endocrinologist or gynocologist or something? He was empathetic, but pretty dismissive about my options.
3) If I do manage to lose weight successfully, will that successfully arrest my hair loss? Will it reverse it?

I am in the UK and go to an NHS clinic.

Thanks for your help.
posted by anonymous to Health & Fitness (28 answers total) 16 users marked this as a favorite
Just because you are obese does not mean there is nothing that can be tried or investigated.

Full stop.

You shouldn't have to profess your desire and strategy to lose weight/get fit to have your doctor show concern and come up with a strategy for treatment. Plenty of obese women don't stop menstruating and/or lose their hair.

I wouldn't be satisfied with your doctor's (lack of) answers to matters you've brought up so far. It doesn't seem like failure to detect cysts rules out PCOS, for example. Can you see a different GP (I don't know how it works with the NHS)?

If that's not possible, then yes I think you should push for specialists. (I would hope a better GP would help you choose them.) I don't have any sort of training or firsthand experience to suggest what could be the source of your problem, but if I were you I would want to see an endocrinologist and a gynecologist. The irregularity of menstruation, if nothing else, would be something to investigate, especially since YOU are concerned. While a doctor may be concerned about your obesity and should support you in however you want to deal with it, don't feel like it can be the source of any and all health problems.
posted by Tandem Affinity at 7:44 PM on February 17, 2013 [3 favorites]

Thyroid issues can cause hair loss, and its very very common to have thyroid issues as a first thought.
posted by Sucht at 7:45 PM on February 17, 2013 [16 favorites]

It is definitely worth talking to an endocrinologist. Much of what used to be categorized as PCOS is now re-classified as Metabolic Syndrome (in part because of women like you - and me - who did not have the ovarian cysts that occasionally mark this collection of symptoms). There are some treatment options available. Talk to a doctor who will work with you on this.
posted by judith at 7:47 PM on February 17, 2013 [5 favorites]

Endocrinologist for sure, as this might well be a hormone issue, given what you've said about your menstrual changes and increased facial hair.

Having a high weight is not in and of itself a risk factor for hair loss in women. High body fat percentages are estrogenic. However, high weights and high body fat percentages can exacerbate and perpetuate hormone dysregulation, so intentional weight loss is likely to be recommended as part of a treatment plan if it does turn out you have hormone issues.

Here's a challenging thing, though: significant weight loss is also a major risk factor for hair loss in women. So although hair loss from that cause generally stabilizes within a few months of weight stabilizing, you're looking at a tough few months or years ahead vis-a-vis hair loss if you choose to pursue a significant intentional weight loss.

Some products that have been helpful for women I know and for me (I lost a bunch of hair after unintentional weight loss) are copper peptide lotions, anti-DHT shampoos and scalp treatments, and especially-for-women formulations of minoxidil (I can't speak to the efficacy of this last).

There are some good support forums out there for women experiencing hair loss.

Best of luck to you in getting good treatment for whatever is going on with your body and your hair!
posted by Sidhedevil at 7:48 PM on February 17, 2013 [1 favorite]

While you're doing everything else, why not try some silica (horsetail)? My hair has never been thick, but after 30 it has really gotten thin, and I do see regrowth after about a month. Just remember to tell the Dr. you're trying it.
posted by skbw at 7:48 PM on February 17, 2013 [1 favorite]

(IANAD but) I have heard good things about spironolactone and that ovarian cysts are not strictly required for a PCOS diagnosis, especially if you have menstrual irregularity and abnormal hormone levels. Also what Tandem Affinity said -- if I were you I would want to see an endocrinologist and a gynecologist. You deserve to have your concerns taken seriously!
posted by ecsh at 7:48 PM on February 17, 2013 [1 favorite]

Thyroid problems are very common, especially in women. Definitely have that checked out.
posted by selfmedicating at 7:50 PM on February 17, 2013

Seconding what Sucht said. Years ago my girlfriend started experiencing hair thinning, and it corrected itself after she got her thyroid diagnosis and started treatment.

Women can use Rogaine, and hair transplants are an option.
posted by Ursula Hitler at 7:51 PM on February 17, 2013

Get a new doctor! Not every PCOS sufferer has cysts - which is why there have been discussions about changing the name. You just need several of the symptoms for diagnosis, but not all. The most beneficial treatment is thought to be Spironolactone along with low androgen birth control pills that can stop the male pattern baldness in PCOS women. It may not reverse it if it's been happening for a few years, but it can arrest it.

One thing to also consider (though alone is probably not enough) is to use a shampoo that removes DHT (dihydratestosterone) from your scalp. Nizoral is one.
posted by cecic at 7:53 PM on February 17, 2013 [1 favorite]

Thyroid issues were my immediate first thought, too. I think a visit to an endocrinologist (esp. one who specializes in thyroid disorders, if possible) would be an excellent next step.
posted by scody at 8:05 PM on February 17, 2013 [1 favorite]

Another vote for thyroid. I am hypothyroid and skipping periods left and right was one of my big symptoms (and what made me go to the dr). And losing hair is also a common symptom.
posted by 58 at 8:44 PM on February 17, 2013

PCOS. Please look into this. Find someone in your area who is a specialist, or at least see a gyno.

Also, Nioxin is a wonderful product that promotes hair growth. I've seen dramatic results in clients (I'm a hairdresser). I've also seen awesome results with DSLabs systems. The only drawback with hairgrowth formulas is that you can't stop using them.

Good luck to you! It's easy for doctors to be dismissive, especially to those of us that are overweight. I love going to the doctor for a cold, or something like that, and being told that I need to lose weight.

PCOS may not be your answer, it's definitely a catchall for certain symptoms, but it may lead you to a doctor that is more informed and/or interested in helping!
posted by wickedfat at 8:44 PM on February 17, 2013

Chiming in to say it sounds like it could thyroid related. I'd go to an endocrinologist and get things checked out. A lot of your symptoms sound that at the very least thyroid related and could be related to other metabolic issues.

I've had Hashimoto's Thyroiditis since I was 10 and my most noticeable symptoms when my thyroid meds weren't working were irregular periods and chin hair. Also fatigue but you don't specifically mention that.

Also if your tests come back and the doctor insists they are in a 'normal' range but you feel terrible, get a 2nd opinion!

Best of luck and know you are not alone!
posted by carmenghia at 8:50 PM on February 17, 2013 [1 favorite]

Another possibility if your bloodwork comes back without answers -- if you have begun losing weight dramatically and/or made substantial dietary changes, telogen effluvium could be what's going on.
posted by gnomeloaf at 8:59 PM on February 17, 2013

I felt I had good results with the Phyto range of shampoos for thinning hair - one formulation is more like a foaming tonic than a thick paste, and the instructions to sort of pat it gently into the hair rather than lather it up may have helped reduce the hair loss. They are available in UK chemists.

(PCOS with cysts, not obese but thinning hair at temples)
posted by pink_gorilla at 9:01 PM on February 17, 2013

One more suggestion for what you can do now is to make sure you are getting enough protein. Low protein intake could be the cause of thinning hair, and a nutritionist can work with you to determine how much you should be getting. But yeah, I would check out an endocrinologist, especially because of the irregular periods, which could be PCOS. Good luck!
posted by timespacewheredoifit at 9:26 PM on February 17, 2013

I've read studies and anecdotes that say that many doctors will not look beyond a patient's obesity, even if they are having symptoms that indicate something else is going on that has nothing to do with being obese. This is to say, yes, push for a referral to a specialist or look for a second opinion. You deserve an opportunity to figure out what is going on with you, and it sounds like your doctor isn't the person to help you do that.
posted by coupdefoudre at 9:34 PM on February 17, 2013

Yeah, your GP doesn't seem to be au courant with respect to PCOS definitions. Despite the fact that it has "polycystic ovary" right in the name, polycystic ovaries are neither necessary nor sufficient to merit the diagnosis (the Wikipedia entry Diagnosis section sums it up - basically, excess androgens and oligomenorrhea get you a card into the club. Here's what NHS says.)
(NHS on amenorrhea - you might be oligomenorrheic or amenorrheic but either way your doc shouldn't be dismissing your concerns even though you've got healthy blood pressure and normal insulin response.)

You haven't said anything about your sexual or reproductive life. I don't know what your situation is - for all I know you're asexual, happily married, babyfree, quiverfull, committed to celibacy - but your decisions around your fertility and your sexual life are still yours and still important even though you have a high BMI. Fat people can and do have sexual lives and family planning needs just like everybody else. (Which NO DUH but there seem to be people out there, including doctors, who deny this.)
posted by gingerest at 10:16 PM on February 17, 2013 [3 favorites]

(Uh, I understand that this is a question about hair loss. I am a reproductive epidemiologist. Everything looks like a reproductive problem to me, even baldness. Sorry if I got on my sexual rights soapbox. But you deserve whole-person care!)
posted by gingerest at 10:22 PM on February 17, 2013

I suffered from thinning hair for the last year and a half. I am not obese. If anything, I am too thin. I also have Hashimoto's Thyroiditis, had been taking a natural thyroid supplement whose formula was changed, to the severe symptomatic distress of many, and then was switched to a new drug (hair loss is a known symptom of thyroid drugs), was under severe prolonged stress, wasn't exercising enough, was eating poorly, and I went to see three doctors about the hair loss: my regular thyroid doctor, a good dermatologist whom I saw twice, and finally a dermatologist specializing in women's health problems, who was wonderful. She said the hair loss could have been caused by any of the above. And that in fact any little problem at all which upsets the body can result in hair loss; when the body feels a little under attack, it effectively says, okay, off with the hair, resources are needed elsewhere.

In the end, that doctor also tested my iron levels which had tested normal several times before by all these other doctors. She told me that the range of normal for iron is very wide (at least in the US), spanning from something like 12 to 110 (roughly, can't remember), and that women with iron levels under 40 often lose hair. So she put me on a megadose of iron for 4 months + 5000 mg of biotin/day (all three doctors recommended the biotin), and my hair grew back.

Interestingly, that doctor's nurse said she'd also had the same hair loss problem, and had been put on an identical regimen with success. She also said her daughter, also a nurse, had also had hair loss problems, and had also done the iron + biotin thing, too, again, with success.

Iron may not be your problem, but so many assumed it was a thyroid problem and then that it was an aging problem, I wanted to mention it. In the US, at least, there are endless reports that more than half of women 40+ suffer from thinning hair—and that it's just an age thing. This doesn't seem right to me, largely because I don't recall this kind of conventional wisdom reigning so supreme even 10 years ago. The iron thing, however, makes sense. So many people I know don't eat that well, or skip meals, or eat well, but not well enough. That half of all women have low iron levels, and as a result are losing hair makes far more sense.


Best of luck!
posted by Puppetry for Privacy at 12:49 AM on February 18, 2013 [4 favorites]

If this is linked to PCOS, eating foods with a low glycemic index and taking saw palmetto and evening primrose supplements may help.
posted by KateViolet at 1:14 AM on February 18, 2013

Rosemary essential oil helps to stimulate hair growth. Try and find a qualified aromatherapist in your area, preferably registered with IFPA, to make up a blend suitable for you taking into consideration your medical history. I'd advise this alongside conventional medicines and always tell your doctor what you're using. Good luck.
posted by billiebee at 1:58 AM on February 18, 2013

PCOS and Hashimoto's here, also fat, one of my first signs was thinning hair. I would so find a new doctor.
posted by SuzySmith at 4:03 AM on February 18, 2013

Like others have said, thyroid. Get it checked out, especially the level of the hormone T3 which it produces.

From experience, the thyroid affects all manner of things directly and indirectly. It could be that if that is the problem, and you get it fixed, then it becomes easier to address stuff other than the hair loss.
posted by Wordshore at 4:17 AM on February 18, 2013

You sound as though you don't believe you're entitled to competent medical care because you're overweight.

This is hogwash. Everyone, regardless of their personal circumstances, deserves competent medical care. Doctors can be terrible to obese patients, but that doesn't mean they're right to behave that way. I encourage you to look into the Health at Every Size movement, they do a lot of advocating for appropriate medical care, nutrition, and exercise programs for overweight/obese people. This is a good place to start. The HAES manifesto (pdf) is also worth a look. Notable authors in the field include Linda Bacon and Marilyn Wann.

These resources can help you learn how to advocate for yourself in a medical setting to get the care you need without allowing doctors to push aside your concerns under the guise of needing to lose weight. Appropriate medical care ought to help you get to the bottom of this, because a few periods a year/hair loss is not normal given your age and it needs to be checked out.
posted by zug at 5:46 AM on February 18, 2013 [2 favorites]

As the people above mentioned, you don't need to have cysts to have PCOS. I would think menstruating only three times in a year would be cause of alarm enough to see an ob/gyn.

Your size does not mean you don't deserve competent medical care. IANAD, but it seems ridiculous that a doctor wouldn't want to investigate the problems you are experiencing further especially because of your weight. Thyroid issues and PCOS can have an effect on weight. You might be fighting an uphill battle with trying to lose weight if you don't figure out what the issue is.
posted by inertia at 8:09 AM on February 18, 2013

Just wanted to drop in to say that I'm currently on spironolactone for hormonal acne and the side effects of the medication are very mild. (I peed a lot the first few days but have been fine since then.) The other benefit of the medication is that it helps with hair loss.
posted by nubianinthedesert at 9:03 AM on February 18, 2013

Biotin worked well for a friend's hair loss (stress related though). Good luck!
posted by cestmoi15 at 11:06 AM on February 18, 2013

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