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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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July 04 2017

Hair Loss: Looking beyond Genetics

By Mark Sisson
34 Comments

Caucasian young man controls hair lossConventional wisdom teaches us to accept our fate when it comes to hair loss. “Runs in the family,” we’re often told—and sometimes it does (but that’s usually not the full story). “It’s just part of getting older,” people say, too—and there we again find only partial truth at best.

But the Primal path is one of thoughtful scrutiny, not blind acceptance. While most people would file hair loss under aesthetic concerns (ranging from neutral to negative depending on social norms and personal views), it’s not always that innocuous. Let’s look today the bigger picture behind hair loss and the situations in which it signifies a genuine health concern.

Hair Loss: Genetic Destiny?

To those in the know, androgenetic alopecia (AA) is the number one form of progressive hair loss. The term can be a little misleading: while it translates to male-pattern baldness, it also encompasses a condition called female pattern baldness. The “andro” derives from dihydrotestosterone, the so-called male hormone that specialists believe to be the primary cause of AA. It’s estimated that half of men over the age of 50 and half of women over the age of 65 have this form of hair loss, and the young people can be affected as well.

The theory goes that every hair follicle on your scalp is genetically predisposed to either be susceptible or resistant to increasing levels of dihydrotestosterone as you age. Those whose hair follicles are sensitive to this hormone will see a steady decline in hair as they age, while those who dodged the genetic bullet can retain their hair into their later decades…provided they don’t succumb to any number of other hair loss factors.

The theory implicating testosterone developed back in the 1940s, when James B. Hamilton reported the notable lack of hair loss in “old eunuchs who were castrated prior to sexual maturation.” It stood to reason that testosterone, which Hamilton assumed wasn’t being produced in any significant quantities post-snip, was the cause of hair loss in “intact” men. In 1980, a team of scientists refined this theory when they discovered a group of pseudohermaphrodites living in the Dominican Republic who had normal testosterone concentrations but lacked an enzyme that converted testosterone into the “hair follicle damaging” dihydrotestosterone.

The rest was history. Pharmaceutical opportunists caught onto the findings, and began pumping out early equivalents of today’s Rogaine and Propecia. Research-wise, not a lot of progress has been made since.

The Problem with a Fatalist View on Genetics

An study published last year in the International Journal of Trichology got me thinking. Researchers examined the medical and family history of 210 patients with female pattern hair loss, finding that close to 85% of the patients had a history of AA. Nothing new there.

But there was more at play: the study also found that the hair loss patients also had a high incidence of hypothyroidism and hypertension, and most were deficient in vitamin D. Clearly, all of these factors are influenced primarily by diet, stress, and other easily-altered variables.

This presents a problem for the fatalist alopecia soothsayers and drug companies alike. The issue with flat-out blaming genetics for something like hair loss is that there’s always confounding factors. For example, if someone has a family history of hair loss, does that family also have a gluten/dairy/egg/nut sensitivity that they don’t know about? Does that family have a ravenous sweet tooth, and therefore consume vast quantities of delicious but inflammatory sweeties? It’s easy to blame genetics for all of life’s maladies, but the waters muddy a little when a “predisposition” is intertwined with unhealthy habits, diet, or food allergies.

An alternative hair solutions blogger Danny Roddy agrees. Drawing on extensive research from Dr. Ray Peat, Roddy firmly dismisses the “genetic determinism” mindset and argues that the decades-old research upon which our current hair loss notions are based is inherently flawed. Roddy suggests that baldness and most genetic-derived hair loss conditions are due to environmental factors.

Crucially, Roddy also points out that those with androgenic alopecia don’t actually exhibit higher than normal levels of testosterone, implying that there are other elements at play here. Many recent findings also suggest that the so-called “sensitivity” of androgen receptors in the scalp doesn’t vary between balding and non-balding people.

The point here is that mainstream perceptions of common hair disorders may be a little off the mark. The other thing to remember is that “risk” doesn’t equate to “inevitable.” Just because your DNA puts you at a greater risk of losing your hair, that doesn’t seal the deal. Let’s examine a few other salient factors.

Hair Loss and Stress

Stress is bad news for your health. And your hair is no exception. Acute, extreme stress provides the primary mechanism by which your hair can start falling out, a condition known as telogen effluvium. This type of stress could come in any form—emotional trauma, physical pain or injury, that kind of thing. Cutting off blood flow and nutrient cycling to your hair follicles is the body’s way of focusing on the vital areas that are critical for survival during what it perceives to be a time of extreme hardship.

A recent study published in the American Journal of Pathology was one of the first lab tests to actually illustrate the short term effects that telogen effluvium can have on mammals. Using substance P as an acute stressor on mice, researchers were able to demonstrate that psycho-emotional stress altered hair follicle cycling, reduced the duration of hair growth, and exposed hair follicles to inflammation.

The second hair-fall mechanism is chronic stress. Low-level but continuous stress, perhaps in the form of incessant background noise, poor diet, or drawn out work troubles, has been shown to contribute to hair loss. Chronic stress can also occur as a negative feedback loop, whereby the stress of worrying about your hair falling out actually contributes to it’s continuing demise—the self-fulfilling prophecy.

The solution is obvious but not always easy: identify the stress and minimize it. The building blocks of stress management are always going to include diet: eat nutrient dense foods like organ meats, a wide range of vegetables, grass-fed dairy and pastured eggs. In addition to providing a wide range of other vital nutrients, these foods are also rich in biotin, which has been shown to be an effective treatment for certain forms of hair loss. Otherwise, you know the drill: scale back on the stress-inducing lifestyle factors, take more time for yourself, ensure regular nature immersions, and consider beginning a meditation or other relaxation-focused practice.

Hair Loss and Hormones

Despite the doubt surrounding genetic precursors to hair loss, there’s no question that hormonal imbalances play a key role in the state of your hair. Long-accepted hormonal contributors to hair loss include:

While prescribing hormone-specific solutions for your hair is a whole article in itself, the key here is to focus on but one word: balance. As cliched as it sounds, true health is achieved by balancing all the systems, processes, inputs and outputs in your body…and the same is true for hair loss. Your first step might be to do a hormone test, or it might be to get back to basics with diet and lifestyle.

Luckily, a Primal way of life is a great way to start balancing out your hormones. Encouraging a shift away from excess carb consumption should go a long way towards improving insulin sensitivity, while steering clear of gluten and other potential food allergens (and making sure you’re getting ample selenium) can allow your thyroid to regain some semblance of normalcy. Excess testosterone typically isn’t an issue for folks like us, as a diet rich in whole foods helps to regulate its production and restore ratios between estrogen and testosterone.

Beyond CW, there’s a potential gollum lurking in the shadows: prolactin. Prolactin is secreted by the pituitary gland during pregnancy, and during times of stress. Prolactin is the mortal enemy of progesterone, one of the “female” hormones that also plays an important role in men.  Progesterone blocks the effects of testosterone, leading some to believe that reducing the levels of prolactin in the body and thereby promoting progesterone secretion is a key element of supporting healthy hair growth. Because there’s very little research to back up these claims, aside from the musings of Dr. Ray Peat, this is a difficult one to explore further.

Nonetheless, reducing prolactin activity in your body certainly can’t hurt. Getting plenty of zinc, along with calcium and its cofactors should help to keep prolactin in check. Reducing alcohol intake and cutting out sugar can also encourage estrogen regulation, which plays a role in prolactin secretion. Experiment with foods and ratios, and see what works for you.

Hair Loss and Disease

I could ruminate all day on the various health conditions that lead to hair loss. Cardiovascular disease, hypertension, diabetes, hypothyroidism. The list goes on.

To me, the one which slips under the radar time and again is autoimmunity—particularly in the case of alopecia areata. If your hair loss is patchy rather than general thinning or receding, look to common autoimmune triggers for the answer. Healing your gut should be the first line of defense, which may be as simple as cutting out grains and upping the probiotics. It could also require more focused action, with something more along the lines of an autoimmune protocol.

Hair Loss and Nutrients

I’ve already touched upon dietary changes that can be promoted to treat certain hair loss causes. Still, suffice to say that if you’re following a relatively Primal-friendly eating plan, but still lacking in certain nutrients, you may need to explore efforts more close in. Women should keep a close eye on ferritin levels, as iron deficiency has been associated with up to 90% of hair loss cases. Many women with thinning hair also respond well to lysine supplementation.

For men, zinc and copper deficiencies may play a role in hair loss—particularly in the case of androgenetic alopecia. Because zinc is often lacking in many a person’s diet, it’s worthwhile upping your zinc intake primarily from food sources like grass-fed dairy, red meat, and nuts.

At the other end of the spectrum, overdosing on vitamin A is also thought to contribute to hair loss. Vegetables like sweet potato, carrots, and dark leafy greens should be providing more than enough vitamin A to meet your daily quota, so cut back or cut out vitamin A supplementation if hair loss is an issue.

Thanks for stopping by, folks. What’s your experience been with hair health? Have any of you achieved hair loss reversal with certain key changes to your diet, lifestyle, supplementation or other means? To all celebrating today, Happy 4th!

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34 thoughts on “Hair Loss: Looking beyond Genetics”

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  1. So is there anyway to reverse hair loss? Once we’ve started going thin on top can we get a thicker head of hair back?

  2. Collagen definitely improved the health of my hair. Within about two months of using collagen peptides regularly, my hairdresser noticed that I had a lot of new hair growth and my hair was healthier at the scalp. Collagen helped my skin a lot as well. I wish I could say I use bone broth every day, but I don’t get around to making it. I mostly rely on the collagen peptides and products like the Primal Kitchen Collagen Fuel and Bars.

  3. Part 2: how to reverse hair loss. Seriously… for those of us following a primal lifestyle, but have already experienced some degree of hair loss, it would be good to know if there are there are foods or lifestyle changes that can spur hair regeneration. Personally, I have been primal for a number of years now, but I started thinning before that and have not had any regrowth. Thanks Mark!

      1. I’m going to add a +1 to this as well. Hopefully this spawn a future article.

  4. Interesting, I blame stress on my thinning hairline then. 🙂

    Mark one should note your Master Formula does contain 10,000 IU of vitamin A.

    1. HealthyHombre, that’s correct and for good reason. Vitamin A contributes much to overall health (everything from skin integrity to disease prevention), and optimum absorption is a common issue for many people. That said, if you’re one of the few taking ample doses of vitamin A each day AND experiencing hair loss, it’s worth cutting back to see if it makes a difference.

      1. There is no plant form of vitamin A and all the carotenoids listed in the foods you mentioned digest in the rear gut where the vitamin A produced is not only very little, but wasted as fecal matter. The Weston Price Foundation has a scientific article for this very subject if you are interested, and “daily quota” from guidelines is based on vegetarian pseudoscience in which supplements were used, not real vitamin A which is found in liver and pastured dairy/fatty tissues. Increasing vitamin D and K2 intake alters your reaction to vitamin A, in that it negates harmful effects and makes even supplementation safer based on the ratio ingested. You cannot overdose on something like pastured liver, ever, but can on a supplement if not adding vitamin D supplements to counter the effect of imbalance.

        Again, balance plays a role in this.

  5. Iron overload can also be a cause of hair loss. Please don’t automatically assume you need more iron if you are suffering from hair loss. It is best to test ferritin before supplementing with iron since the symptoms of iron deficiency and iron overload are often the same and iron overload can be extremely damaging to your body.

    1. Absolutely – it happened to me. My ferritin was over 400 when I was losing hair……….once I donated blood several times to get it below 200, the hair started growing back (and other symptoms resolved themselves also). Iron overload is a very dangerous condition……..get your ferritin level checked (guys, especially).

      1. So right Rob. It’s very dangerous to supplement ferritin without knowing your levels. For men and women.

  6. I thought I’ve read (from Denise Minger maybe?) that many older adults don’t convert beta carotene to vitamin A efficiently and that it is easy to get deficient despite eating lots of carrots, sweet potatoes, etc if you don’t eat organ meats. Is that not right?

    1. Correct. There’s an entire article from the Weston Price Foundation “The Vitamin A Saga” which goes into extreme detail about this and shows that it’s not only not vitamin A, it’s also completely inefficient in the body and animal sources like liver and raw butter will have the correct type and proportions of all fat-soluble vitamins needed by the body.

  7. Hair loss can also result from certain hormone therapies–my daughter started losing her hair in clumps, and lost all of her eyebrows, when her ob-gyn put her on a high androgen birth control pill. As soon as she stopped, the hair loss halted, and now her eyebrows have grown back in and her hair is looking healthy again. What is shocking is how ignorant medical providers are of these issues. I had to do my own research to discover what was going on. Always keep reading, but try to stick to reputable sites (( like that Mark is a research rat like me). I always go first to the Mayo Clinic and Harvard Medical School sites.

  8. Dihydrotestosterone is definitely a culprit. How do I know? Well, when it turned out I had too high levels of estradiol, a form of estrogen (I’m a bloke), I started supplementing diindolylmethane (DIM). And it did indeed lower my estradiol levels significantly, *and* also caused my hair to grow in places I thought it would never grow again. DIM does a number of things – it enhances the breakdown of estrogen and helps make sure it morphs into the “right” metabolite (mostly 2-hydroxyestrone as opposed to the “bad” 16?-hydroxyestrone), and also reduces your dihydrotestosterone levels; while actually *increasing* total testosterone and free testosterone. One of the consequences of lowered dihydrotestosterone – which, let me stress this again, does *not* lead to a reduction of total T – is the resumption of hair growth, and this is exactly what happened to me.

    1. At 25, I’ve experienced much better hair growth since making efforts to maximize DHT.

      1. I think I should add that I’m over 40. Dihydrotestosterone is important for young lads but an excess of it can cause all sorts of problems as one gets older. Hair loss, benign prostatic hypertrophy etc. can all be traced back to excessive levels of DHT.

        1. Estrogen also contributes to prostate growth, and some studies have found that nonbalding men have higher serum DHT.

          1. Perhaps there’s a difference between serum and tissue levels?

  9. Chaste Berry and vitamin B6 will also lower prolactin, however you don’t want to lower it too far as that will cause libido and other issues. Also, I think red light therapy has helped some people regrow hair or improve hair quality.

      1. Copper deficiency can cause grey hair. Emphasis on CAN. Don’t go supplementing copper without testing though. Copper has a narrow optimal range and it has to be kept in balance with zinc. Test them both, and ceruloplasm also, which transports the copper.

  10. As a 62 year old female hairstylist since 1980, I’d like to weigh in on this subject. I had excessive hair loss about 10 years ago. I’d wet my hair and have to peel the strands off my hands. I’d lather with shampoo and have more hair to remove. Then I’d rinse and my fingers would again be covered in loose hair. Then I would put conditioner on and there was MORE hair on my hands, then I would rinse that off and still have to pick hair off my hands.

    Cosmetologists do learn about DHT, and how for men, it’s connected to prostate conditions and that it plays a role in hair loss. It took some time for me to find a connection between prostate problems for men and hair loss issues for men AND women. I eventually found that connection in “The Green Pharmacy,” by James Duke PhD.

    Here’s what works for me … I take Saw Palmetto because it blocks the aromatization of testosterone into dihydrotestosterone. I’ve taken huge doses and small doses. When this first happened to me, it took about 10 days to notice that the hair loss had returned to “normal” levels. I get mine fro Puritan’s Pride, ignore the warnings that it’s for men only and take 1-3 capsules at 160 mg. daily.

    Warning: Saw palmetto also functions as a diuretic, so those on blood pressure medications need to be wary of getting the blood pressure too low. If I were to advise, I’d say cut back on the pharmaceuticals, but some people are too married to the advice of their physician.

    The second thing I do is to apply a growth stimulator to my scalp. That is called Nutri Ox 3C, which I buy from Sally Beauty Supply. It has vasodilators in it, which will open the capillaries and cause the skin to become red, raised and possibly itchy for about 10-20 minutes. I also apply this to my eyebrows. There are other brands of growth stimulants, but this is inexpensive and readily available in the U.S. This brings nutrition to the follicles and carries away toxins.

    The third thing I do is comb my scalp with a D’arsonval High Frequency Violet Ray device, using the glass comb filled with Argon gas. I got mine from Amazon.com and I use it daily.

    Thanks Mark, for such thorough information that may help people in despair over extreme hair loss.

  11. Too much iron (iron overload) can also lead to hair loss (among other troubling symptoms). I know, as it happened to me. Once I got my iron levels back to normal (mostly through donating blood), my hair started to grow back. I recommend that all guys check their serum ferritin levels to see where you stand – if you are over 150 or so, you need to get it reduced.

  12. Mark, Paleo is great and I’ve been on a Paleo diet for some time now and will never go back to doing anything else. I think its amazing and have achieved some amazing results with it, but its not the cure to everything. I’m 32 years old and have suffered with male pattern baldness for years. I’m in great shape physically, all my labs at the doctors office look great, and I’m taking all the right supplements. Sometimes its just genetics. Although you can argue that maybe my balding would be worse if I didn’t follow a Paleo lifestyle etc. it still comes down to genetics that can’t be fixed by diet or lifestyle modification. There are plenty of unhealthy blokes out there with full heads of hair at your age eating garbage, getting fat, and enjoying a full head of silver hair like yours. While other chaps like myself do everything right but still struggle with male pattern baldness.

  13. Thanks for the read. I can now blame hypothyroidism and hypertension to hair loss. Will definitely take up more Vitamin D in the diet.

  14. Since I went Primal it seems to have at least arrested my hair thinning,and may have even reversed it slightly

  15. An employee who recently started under chiropractic care says that she has had to up her hair cut schedule… that’s it’s coming in a lot faster. In relation to this article, this could be explained by balancing of hormones and stress-reduction from the care (correction of dysautonomia).

  16. How about guys with the issue of hair loss on top (head) as they get older but more hair everyplace else??? This article is about head hair so is the point that “hair is hair” or “head hair is different?”

  17. Androgenetic Alopecia is the most common type of male hair loss and is responsible for 95% of alopecia cases. It also affects women though with differences compared to men (Female Pattern Hair Loss).

  18. Hair loss & stress are equally proportional to each other. More the stress more will the hair loss. having proteins & other rich nutrients can avoid hair loss.

    1. Hormones are responsible for the growth of hair and nails. imbalance hormones are responsible for hair loss.