Reasons for women's hair loss go beyond obvious; be thorough in work-up

By limiting their level of suspicion to age or androgenetic alopecia, the practitioner may overlook something that may be of help to their patients, according to Lynn Drake, M.D., dermatologist at Massachusetts General Hospital and lecturer at Harvard Medical School.

Other causes: telogen effluvium Dermatologists can often trace hair loss or thinning in women to nutrition, medicines, illness and some conditions, including hormonal conditions other than androgenetic alopecia.

"Any insult to the body that causes a marked constitutional trauma can give you telogen effluvium," she says. "A lot of women have anesthesia and four or five months later the hair falls out, only to eventually come back. The nice thing about telogen effluvium is that it usually is self-correctable over time."

Metabolic culprits Metabolic problems can cause hair loss. These include issues with people's eating habits, as well as supplement use.

Anorexia and bulimia are known to cause hair loss in women because these women become protein deficient. It is clear that essential fatty acid deficiency can cause hair thinning in women. And too much vitamin A can cause hair thinning or loss in women, according to Dr. Drake.

"Ingesting too much of what they buy at health food stores, or getting contaminated products can cause women to lose their hair," Dr. Drake says. "Years ago, there was some contaminated tryptophan that ended up in health food stores. It caused deaths, and a common denominator among those who died was that they also had lost hair."

Nutritional issues are often easy to correct, Dr. Drake said. Some patients with more serious food-related illnesses, such as anorexia or bulimia, might be willing to seek therapy if they know their hair loss is related to their eating disorders.

Vegetarian hair loss "The issue with being a vegetarian is that people do not realize how much protein they have to eat in order to get the protein they need," Dr. Drake tells Dermatology Times. "If you do not have protein, the body is going to pull it from somewhere, and sometimes it is your hair."

Female runners An odd category that falls under nutrition involves female runners. According to Dr. Drake, women runners are at risk for anemia, which can cause hair thinning.

"One of my residents made a great diagnosis in a young woman who was a big-time runner. With testing, he found out that she simply was not binding iron very well. He prescribed iron supplements and the hair started to grow," Dr. Drake relates.

Hormonal causes One of the most common hormonal causes of hair loss in women is thyroid disease. In fact, almost all hormonal diseases can cause hair loss, according to Dr. Drake.

Medicine use Another big category that notoriously causes hair loss: medicine.

Some of the medicines that are known to cause hair thinning and loss include: retinoids, beta blockers, anti-cholesterol medications, blood thinners, antidepressants and heparin.

"Several years ago, there were more than 270 medicines that had hair thinning or hair loss listed as part of the profile," Dr. Drake says. "The treatment is quite simple: switch, change or recommend that the patient stop taking the drug."

Underlying disease Systemic diseases, including renal and liver disease, lupus, scleroderma and others may feature hair thinning as part of the presenting symptoms.