Hair Loss - Why It Happens & How To Treat It

PCOS Video 

PCOS Podcast

We unpack why hair loss often follows stress or rapid weight changes, how to spot emergencies that need a dermatologist, and which treatments actually help. We clear up the GLP-1 myth, outline key labs, and share practical steps to protect regrowth.

• scarring versus non-scarring hair loss and when to refer
• pattern recognition for autoimmune and androgenic causes
• telogen effluvium timing and common stress triggers
• GLP-1 medications as indirect contributors via restriction and speed of loss
• essential labs: TSH, vitamin D, ferritin and when to add more
• biotin’s interference with lab accuracy and how to pause safely
• nutrition priorities: calories, protein, iron, vitamin D 
• minoxidil topical and oral options, pros and cautions
• finasteride and spironolactone for hormonal drivers 
• realistic timelines, pet safety, and avoiding low-value supplements

What has been your experience with obesity treatment, GLP1 medications, and hair loss? What has been beneficial for you? What questions do you still have? Please comment below if you are watching on YouTube, if you are listening on the podcast platform, then you could always email any questions to Support@MissouriMetabolicHealth.com. And please follow me on Instagram and TikTok. If you found this information helpful, please share with a friend, family member, or colleague. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health.

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Transcript

Welcome And Scope

Dr. Lindsay Ogle, MD 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. I've seen a lot of questions and comments about hair loss and patients not getting a lot of guidance about why this is happening and what to do about it. And many people associate GLP1 use with hair loss. And while it can co-occur, GLP1 medications do not directly cause hair loss. This is absolutely a myth. There is no known mechanism that GLP1 medications lead to hair loss. That being said, there are indirect causes which are consistent through any type of weight loss strategy that can lead to hair loss. But before we get into that, I'm going to take a step back and talk about hair loss in general and how we would approach it in a typical primary care setting. So the first thing that your doctor is going to want to differentiate is if this is scarring hair loss or non-scarring hair loss. Scarring hair loss is a follicular emergency. I heard a dermatologist say that once during a talk. And the reason this is considered a follicular emergency is because there is scarring that is happening at the hair follicle that, if left untreated, could lead to permanent hair loss. And so if you have any abnormalities of the scalp, definitely that you can see or that your doctor sees, you need to be urgently referred to a dermatologist to appropriately address that underlying condition to prevent permanent hair loss. So taking a look at your scalp or having somebody else take a look at your scalp or wherever you're having hair loss is very important because if there are skin changes, then you need to see a dermatologist as soon as possible to address that concern. I'm not going to get into all of the types of scarring hair loss, but again, if you see scarring or scalp changes, then definitely reach out to your healthcare provider and ask for that dermatology referral. Most commonly there are no scalp changes, which is a good thing because that means that the hair loss is likely not permanent and there is something that we can do about it. After we know that this is non-scarring hair loss, then the next major decision tree or thing that we're differentiating is where is the hair loss happening? Is it happening throughout the person's head? Is it patchy occurring in certain areas? Does it happen just at the crown of the head or on the sides in the front? Um, that can help us determine the underlying cause of the hair loss. Patchy hair loss can be alopatia areata, which is an autoimmune cause of hair loss that could be treated typically easily with topical treatments or sometimes oral treatments are required. But again, that's patchy hair loss. Um another type of patchy hair loss can be when somebody is actually pulling their hair out in certain areas, and this is typically subconsciously occurring due to anxiety or OCD or other stress that's happening in someone's life. Um also the specific hair loss at the crown or in the temporal region that is often hormonally um triggered and is androgenic. And so this could be related to just someone's underlying genetics and be passed on through generation. So this typically is seen as a pattern in families, or it could be for women related to PCOS, polycystic ovarian syndrome. And I did a whole talk about this that I will link below if you wanted to dive in further on PCOS. But that is a pattern that we see, or a symptom that we see often of PCOS is hair loss. But the most common is diffuse hair loss. And this occurs when the body undergoes a stressful event, and the effects of this are seen three months after that stressful event. So what happens is when that stress is occurring, the body focuses on its more important structures and mechanisms. It puts hair growth at the back burner. It's not important at that time. And so the hair growth cycle gets stopped at that period. And then usually that three-month mark down the line, then the hair starts to fall off because it was no longer growing and supported during that period of time. Stressful triggers could range from an illness like a COVID-19 infection or other viruses. Childbirth is a common trigger for this type of hair loss. Also, a just emotional stress or a hospitalization or decreased nutrients for a period of time could lead to hair loss. Um, again, three months down the line. And when we say hair loss, if it's pathologic meaning abnormal, what we're looking for would be 300 hairs in a day that you're losing. It is very normal and expected to lose about a hundred hairs a day. But if you're losing 300 or more, and of course you're not going to count this, but it's just something that you will notice as a you know, a person as an adult that you're losing significantly more than you typically do, then what I would want you to do would be think back about three months prior. And was there something that changed at the time? Were you sick? Did you start a new job? Was someone in your family sick or going through a difficult time? Were you worried about money? Did you start a new medication? Did you move? And that would likely be the underlying trigger. The beautiful thing about this, as terrible and distressing as it can be to lose your hair, it is not permanent. And that hair loss will reverse and recover over time, as long as that stressful incident is resolved over time. If it's an ongoing stressor, then that's different and it may lead to persistent hair loss. So we want to identify what that stressor was and address it if it has not already been addressed before. For anyone with this type of hair loss, we also want to check some blood work. We want to make sure that there is nothing contributing to or exacerbating hair loss. And there's several labs that may be done, but three main ones that I think of are checking for thyroid levels, thyroid stimulating hormone. We want to check vitamin D, and we want to check iron stores, typically with a ferritin level, but sometimes with a full iron panel. Sometimes we check other blood work, and that could be a complete blood cell count, comprehensive metabolic panel, possibly checking for infectious causes like hepatitis, syphilis, HIV if somebody is at higher risk. We also could consider checking for autoimmune markers, especially if there's a family history. But the TSH, thyroid stimulating hormone, vitamin D level, and ferritin checking for iron stores is pretty routine. What is extremely important to note is that if you are taking a biotin supplement or a hair, skin, and nail supplement that has high biotin in it, you need to stop taking this medication for at least three days prior to this blood work because biotin is typically recommended or marketed for hair, skin, and nail health. And so people are taking this when they're trying to improve their hair health, but it can interfere with your thyroid labs. It does not impact your actual thyroid in your body, but it will impact the lab result that is obtained. So if you are taking that hair, skin and nail or biotin supplement when you get your blood work done, you may have a false result that we can't interpret. So do not take your biotin, hair, skin, and nail supplement for about three days prior to your thyroid being tested. And that's at any point that you get your thyroid tested. So how does hair loss fit into GLP1 medication or obesity treatment in general? Like I said, GLP1 medications do not directly cause hair loss. But if somebody is on a GLP1 medication and they significantly change their nutrient intake, if their caloric intake you know drops significantly, or if the types of food that they're eating change significantly, the body can sense that as a type of stress, and it could lead to hair loss down the line. Also, if you are overly restrictive in your diet while on a GLP1 medication or any medication to manage your obesity, then you may not be getting the adequate nutrients that you need. You may not be getting adequate calories in general, enough protein, enough iron or vitamin D or other vitamins and nutrients, then your body does not prioritize your hair. Again, it's going to focus on maintaining your organs and your bodily functions required to live a sustainable and healthy life. And hair is kind of like a bonus, and so your body is going to, you know, shuttle all of the nutrients everywhere else, and then what's left can go to healthy hair. So you'll really want to prioritize your nutrition while on a GLP1 or off of a GLP1. And I recommend working with a dietitian if you are struggling to get your calories and nutrients in while on a GLP1 medication. They are excellent. They're an excellent resource to help troubleshoot this and help you reach your health goals. Also, if you are losing weight rapidly, then that is also seen as a stress on the body and can definitely trigger hair loss. So that is another reason why I definitely recommend slower weight loss for healthy, sustainable weight management and metabolic health, as well as you know, general well-being. But if you're someone who is experiencing hair loss now, what do you do? As I mentioned, we want to prioritize nutrition. And that is absolutely bottom line, most important and baseline requirement for healthy hair long term. But for many people, that's not going to be enough to help manage their hair, especially at that point. But it's a good foundation to focus on moving forward. What we can do to help with you know hair loss now, there's a couple of options. First line typically is topical minoxidil, which is uh the generic version of rogueine. So you can get this over the counter, and I always recommend the one that is marketed towards men, which is 5%. The one marketed towards women is I think it's 2%, 2 or 3%. Um, but women can definitely, you know, handle and take the 5%. So might as well get more for your money there. So topical monoxidil, um, you put it on the areas where you're experiencing hair loss, and the way that it works is that it helps to open up the blood vessels in that area to allow those nutrients to the hair follicle to encourage it to grow. Um, so you put it in the areas, you can do it once or twice a day. Some people get a little bit of scalp irritation. Um, it is important to know two things that are important to know. One is that it can be toxic to animals, so you want to keep it away from any animals, and you, you know, after using it, you want to wash your hands, make sure your cat or dog isn't, you know, messing with your head afterwards or doesn't sleep by you or sleep by your head at night. Um, the other thing is that it can lead to more hair loss initially because of the opening of the of those blood vessels. It could release some of the hair that is already quote unquote dead, but it will then be replaced by more hair. So that could occur. So just a warning with that. But if you keep using it, more hair will come in its place. It's something that you do have to continue to use to maintain that healthy increased hair growth. So this is a long-term treatment, just like treating the disease of obesity. If you are someone who is not going to keep up with that um routine, with the topical treatments, or if you have the irritation on your scalp, or you have a large area of hair loss that is difficult to apply topically, there's an oral version of minoxidil that is a prescription that is absolutely a great option. The really important thing to know about the oral option is that because you're taking it orally, it gets into your body's systemic, the whole system. And so it will lead to increased hair growth on your scalp, but also potentially on your chin or neck or your arms or legs, armpits, everywhere where you grow hair, you will likely grow more on oral monoxidone. And then two other options that can be used for um more of the hormonal underlying causes of hair loss, so the um PCOS or the genetic hormonal androgenic causes of hair loss, um, phenasteride and sporonolactone. Phenasteride has a little bit more evidence specific to hair regrowth and maintenance, but both of these medications cannot be used in women of childbearing age who are at risk for pregnancy because it will affect the hormone um production and development in a potential fetus. So if you are of reproductive age, then you do need to be on a very effective birth control if you are going down this route, or if you are postmenopausal or um of male gender, then it would be safe to take. And again, these would also be long-term treatment options. There are many, many supplements, um and oral supplements, shampoos, conditioners, um, topical treatments. I'm not going to get into the weeds here. Most of this is not as effective as the topical monoxidil or the prescription treatment options. I will say pumpkin seed oil has pretty good evidence to help with hair regrowth, and that's topical. But um, a lot of the other ones I think would be reasonable to try. But if you're not seeing an effect, please don't keep spending your money. I will also say with biotin and the hair skin and nail supplement, there is not a lot of evidence that biotin, especially at high doses, if you are not deficient, it's probably not going to make a difference. And like I mentioned, biotin can negatively impact your lab results and not only on your thyroid hormone, but recently I have learned that at some laboratories it also could um affect the results of heart enzyme testing. So if they were looking you up for a possible heart attack, if you are on high levels of biotin um and that are often found in hair, skin, and nail supplements, then you could have an abnormal um cardiac enzyme test, which could then affect the care that you get if they were thinking that maybe you had a heart attack. So that's a whole nother conversation about taking supplements that um may or may not be effective and how it can impact your health and your medical care in the future. So I just encourage you to always, always, always, if you are taking a prescription or anything over the counter, run it by your doctor, every doctor that you come into contact with, because it may change the workup that they do on what labs they draw or how they interpret them, and or the medications that they recommend. So just keep that in mind for just general care. I hope you found this helpful, um, a better understanding of hair loss that can occur for many different reasons, how it can occur alongside GLP1 use and obesity care, and what to do if you encounter or experience hair loss. What has been your experience with um obesity treatment, GLP1 medications, and hair loss? What has been beneficial for you? What questions do you still have? Please comment below if you are watching on YouTube, if you are listening on the podcast platform, then you could always email any questions to support at Missouri Metabolic Health.com. That email will be below. And please um follow me on Instagram and TikTok, and I will continue to provide more information on those platforms in between our weekly segments here. So thank you for listening, and we will talk again next week. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.