Which of these zillion things could be causing my thinning hair?
November 14, 2013 3:15 PM   Subscribe

My hair has been thinning noticeably lately (I've noticed it in the past 2-3 months), but there are a bunch of things going on and I have no idea where to begin figuring out the probable cause. Short version: I have seborrheic dermatitis that's been particularly bothersome lately, I have PCOS (polycystic ovarian syndrome), I color treat my hair about once a year, and I've been under some stress. Long version under the cut.

Scalp: Ever since I was a kid I've had issues with my scalp getting severely itchy and often getting a crusty, flaky buildup that sometimes scabs over. To the best of my recollection I was diagnosed with seborrheic dermatitis, and I was told to use Neutrogena T-Gel (a pine tar shampoo) when it gets bad. I've been doing that most of my life, though lately it's been particularly bothersome and I've found that using T-Sal (a salicylic acid shampoo) works better than the T-Gel. I also use Aveda's Scalp Remedy (also salicylic acid) on a near-daily basis.

PCOS: Several years ago I was diagnosed with PCOS, via both doctor observation of symptoms and a blood test for hormone levels. I got the diagnosis and that was that. I don't have the actual ovarian cysts and am not concerned about my fertility because I don't want children, so haven't really done anything to manage it. However, I'm currently at the heaviest weight I've ever been, haven't been exercising this year nearly as much as I did last, and overall I haven't been feeling good physically or emotionally. I've very recently (past couple of weeks) started changing my eating habits and making a plan to get more active again.

Color treatment: Once a year I go to the salon and get them to bleach a couple streaks in my hair. I then dye those streaks purple with a deposit-only semi-permanent hair dye, and reapply the purple about once a month. I've been doing this for three years. I don't style my hair in any other way. In the mornings I wash it with whatever Aveda shampoo I'm currently fond of, occasionally use a leave-in conditioner, let it air dry, and brush it out. If I'm going out (once a week or so) I might blow-dry it and apply some grooming cream. I pull my hair back during the days I work from home, which is most days, but not particularly harshly. The few people I've mentioned my thinning hair to have automatically assumed it was related to the color treatment, but two small streaks of bleach once a year shouldn't have this drastic an affect, should it?

Stress: Let's just say there's been an unusually high amount of it in the past year, much of it on an ongoing basis.

Other relevant details: I'm 32, female, don't smoke or do drugs or take any medications other than hypertension and allergy meds, don't have any allergies that I'm aware of other than seasonal ones or any other skin conditions.

I used to have thick hair when I was young, and it's thinned slightly as I've gotten older, but lately it's been thinning a lot more rapidly and noticeably: I see much more hair come out when I run my hands through my hair, I shed more hair, and I can just see and feel that there' s not as much of it there as there used to be, though there are no particular bald spots that I can see.

Can anyone point me in the right direction as to what might be going on? I'm a little overwhelmed and have been letting my emotional fear of losing my hair get in the way of thinking about this until recently. I know you are not my doctor. I saw my doctor earlier this week and she told me hair loss was something we don't understand, wrote me an Rx for some different stuff to relieve the scalp itchiness and flakiness, and referred me to my GYN to follow up on the potential PCOS angle. Until I see my GYN in a couple weeks... any ideas? And is this the sort of thing I can stop?
posted by anonymous to Health & Fitness (12 answers total) 5 users marked this as a favorite
IAANAD and I'm not sure about all the rest of it, but low thyroid can cause thinning hair, weight gain, depression, and fatigue. That's one thing to ask your doctor about (assuming your doctor hasn't run thyroid numbers already).
posted by pie ninja at 3:33 PM on November 14, 2013 [1 favorite]

My vote would be the PCOS, especially if you've been gaining weight and not exercising. The more weight you gain the worse the symptoms get (including weight gain!) but whatever the cause the sooner you address it, the more likely it is that it can be reversed.

There is nothing you can do until you get a proper diagnosis though. You should ask to see a dermatologist rather than a gynacologist though. I had a double scalp biopsy to confirm AA.

If it is androgenic alopecia (the kind of hairloss you get with PCOS), if you're lucky you might get prescribed Spironolactone which tastes like ass and makes you pee like a racehorse but at high doses can prevent hairloss and even thicken the remaining hair. Some people also swear by Nizoral shampoo - its an over the counter anti-dandruff shampoo but the active ingredient is anti-androgenic. There is also Propecia which you may or may not be able to get a prescription for. All of these treatments have to be continued essentially forever though.

Changing to a PCOS friendly diet and losing weight may help reduce further loss. Your doctor may also suggest taking Metformin to combat insulin resistance.
posted by missmagenta at 3:59 PM on November 14, 2013 [3 favorites]

Yeah, basically you've just said "I have PCOS and have developed one of the annoying symptoms of PCOS". I've known people who've claimed some success using Rogaine, but I can't speak to it personally, otherwise I basically agree with missmagenta.
posted by Sequence at 4:04 PM on November 14, 2013

I think you should talk to a doctor about your concerns.


PCOS means high levels of androgens, as you already know. Androgens in women can cause: Acne/oily skin, dandruff, weight gain/ obesity as well as male-pattern baldness or thinning hair (and many more things). Yup.
Infertility is just the one thing they always scream first. It's a whole clusterfuck of symptoms, however.
Your scalp issues might be related to the hormonal imbalance as well - oily scalp -> clogged pores + flaky buildup.
Some women with PCOS have issues with insulin, which can cause weight gain and an even higher androgen production. I wonder if you might be in such a circle right now.

Anything you put ON your skin/hair is just like a little band aid, it is unlikely to cure the cause. The issue is endogenous. There might be options to restore hormonal balance (by taking hormones or suppressing hormone production). Not sure if you're willing to go that route.

About the hair care routine (most likely not related to the thinning, but to your overall comfort): I found this article about what not to do to oily hair interesting.

Other avenues to explore are your vitamin levels. Vitamin deficiency can cause thinning hair, brittle nails, fatigue, etc.
You said you suspended your workout routine and work a lot from home. You might be low on vitamin D. Other than that, check for: vitamin B complex, possibly iron and folic acid.
posted by travelwithcats at 4:06 PM on November 14, 2013

There is evidently a correlation between PCOS and autoimmune thyroiditis (Hashimoto's), which can cause thinning hair. Your doctor may be able to prescribe thyroid medication that will counterbalance the Hashimoto's.
posted by janey47 at 4:08 PM on November 14, 2013

I can only speak to the scalp issues. I have the same problem and use T-Sal and a couple other medicated shampoos. That's not going to cause your hair to thin. If you haven't used it in a while it will cause a bunch of loose hairs to come out while it's lifting the flakes/buildup on your scalp but it's not going to cause actual thinning. (Memail me if you want some advice on this front, I seem to know way too much about scalp issues!)

My money is on the stress and PCOS.
posted by radioamy at 4:27 PM on November 14, 2013

My daughter has had similar symptons, and she was also diagnosed initially with PCOS and then thyroid disorder. She has to be careful to go to an endocrinologist, not a GP, or it will be pushed off as nothing (read: many frustrating years like Mystery Diagnosis). So while you can mention this to your gyno, I strongly urge you to get to an endo doc for further testing and a more definitive diagnosis and treatment.
posted by Marie Mon Dieu at 5:57 PM on November 14, 2013

If you have PCOS and hair loss, please consider talking to your doctor about testing your testosterone levels. If they are high, Spironolactone and a low-androgen birth control pill is currently the best recommendation. You may not get back all of your hair, but you can stop it from getting worse.

Experience: Fighting PCOS and hair loss.
posted by cecic at 5:57 PM on November 14, 2013

The problem is that a lot of the things you list have hair loss as a symptom. The only way to diagnose and treat the hair loss is to talk about it with your doctors. Because basically, your question is the equivalent of, "I'm dehydrated and just ate some bad food and I'm stressed out and there are fluorescent lights and I fell down the stairs yesterday; tell me why I have a headache." Any of the things you list could be a potential cause of (or could be contributing to) the issue. Or it could just be that you're getting older, and this happens sometimes. Or it could be something else entirely, and that something else could be minor or serious or anywhere in between. Strangers on the internet really can't tell you. I'd start with your endocrinologist, since s/he likely knows your hormones best, and PCOS is a really common cause of hair loss. But there's just no way for strangers on the internet to rule in or out any particular cause of your symptoms.
posted by decathecting at 6:03 PM on November 14, 2013

I used to have the same scalp condition you have and now it's gone. I can only trace this to when I started taking Evening Primrose Oil, which apparently is an anti-inflammatory among other things and this somehow affects seborrhic dermatitis. Anyway, I had a pretty bad case, and it's all gone for the first time....ever. And NOTHING else has worked.So you might want to give that a shot.

Evening Primrose Oil is also said to work for thinning hair on some women. My hair is thin too, and that's why I started taking it, although it is supposed to take a few months to work.

I agree that you should really be seeing a doctor, but you may also want to give Evening Primrose Oil a shot. It's not expensive.

Also, how is your nutrition? Thinning hair can also be the result of low iron or B vitamins. Of course, you probably should get that checked out by your doctor.

And dairy, wheat and sugar can cause inflammation and skin conditions in some people.

Lastly, getting exercise is really important.

Since focusing on my diet, exercise, and taking evening primrose oil and vitamins, my skin condition has cleared up and my hair has started to grow in a bit.
posted by bearette at 8:32 PM on November 14, 2013

PCOS is a progressive condition that has many symptoms and effects associated with it, some of which you've listed neatly in the description of your problems right now. It can also be linked, in some cases, to ovarian cancer - it's really not something that should be completely ignored for years - you should have a good gynecologist and be checked out at least yearly and when things like your hair loss come up.

I think the first place you should go is to an endocrinologist, though - absolutely. Every single thing you've mentioned and more all blend together into a couple of syndromes that endocrinologists pick up on immediately and other docs not so much. You need blood tests - specific blood tests - and a workup and follow-up with a physician who's dedicated to getting you in balance and keeping you there.

Good luck - please see an endocrinologist. Oh - and if your doctor noted your PCOS and then just let it go at that you REALLY need a new doctor.
posted by aryma at 12:22 AM on November 15, 2013

When I last moved, my hair started falling out like crazy. Apparently temporary hair loss can be a stress reaction and sometimes it's delayed by a month or two. Just another data point.
posted by bquarters at 3:35 AM on November 15, 2013

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