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Hair Loss/Hair loss due to medications?

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Hello
I am a 38 year old woman that has begun to experience diffuse hair loss all over my scalp since August 2012 (at least that is when I noticed the worst of it).  I am seeing a naturopath and my family doctor both have differing opinions so I was hoping to give you my story and all of my “numbers” and I am praying you will give me some direction and of course hope.
I do not have a family history of thinning hair everyone has or had thick hair.  I was on Yaz for 3 years and stopped Nov 2011 and began bioidentical progesterone in April 2012 instead.  The doctor that prescribed it specialized in that area and even though my hormone numbers were normal he said that may not be normal for me (I was experiencing depression, not easily losing weight, acne).  Within a few months my periods became heavier and longer and my nails continually broke and peeled (I normally have to cut my nails they get so long).  He wanted me to increase my dose and to continue even during my cycles which I did.  I continued this until my hair became extremely thin.  
I had my numbers tested and here are the current numbers”
Ferritin 32 up from 29 a month and a half ago
B12 700 pmol/L
TSH 2.17 mU/L up from 1.81 a month and a half ago
Vit D 79 NMOL/L
T4 free 11 up from 10 a month and a half ago
Had saliva hormone testing and the only ones out were DHEAS (15 ng/ml healthy range 3-11 and 6 months ago DHEAs was 6 umol/L from a blood test) and Cortisoal AM 2.4 ng/mL on a range from 2-11. Progesterone was on the highest of the scale 250 pg/mL (range 50-250) and the saliva test was done on day 19 of my cycle.
Today I am taking C,D, B complex, Fish oils, iron, multi, probiotic, biotin, and adrenal support supplements. I lose over 100 hairs a day and everyone I look at has a small bulb at the end of it.
Any help and of course hope that I will get my hair back would be a blessing.
Jen

Answer
You have a telogen effluvium where the hair goes into a shedding phase. In our office we treat this condition with B12 shots once a month. Rogaine for Men is also helpful. Below is information about a telogen effluvium.

It is normal to lose up to about 100 hairs a day on one's comb, brush, in the sink or on the pillow. This is the result of the normal hair growth cycle. Hairs will grow for a few years, then rest for a few months, shed, and regrow. Telogen is the name for the resting stage of the hair growth cycle. A telogen effluvium is when some stress causes hair roots to be pushed prematurely into the resting state. Telogen effluvium can be acute or chronic.

If there is some "shock to the system", as many as 70% of the scalp hairs are then shed in large numbers about 2 months after the "shock". This sudden increase in hair loss, usually described as the hair coming out in handfuls, is acute telogen effluvium. This is a different problem than gradual genetic hair thinning. However, this can be seen in the less common chronic telogen effluvium, only after a significant amount of hair has already been lost.

A considerable number of different causes for telogen effluvium exist. Among the common causes are high fevers, childbirth, severe infections, severe chronic illness, severe psychological stress, major surgery or illnesses, over or under active thyroid gland, crash diets with inadequate protein, and a variety of medications. Most hair loss from medications is this type and causes include retinoids, beta blockers, calcium channel blockers, antidepressants, and NSAIDS (including ibuprofen).

Typically, abrupt diffuse hair loss is noticed several weeks to several months after the incident has initiated the biologic program for hair loss. While the most often noticed hair loss occurs on the scalp, some individuals may also notice hair loss elsewhere on the body. Significant hair shedding usually occurs when shampooing, combing, or even when gently manipulating the hair. Shedding usually slowly decreases over 6 to 8 months once the cause for the hair loss is no longer present. As some of the causes represent ongoing problems, it is important to determine the likely cause when possible and take appropriate measures to prevent continued hair loss.

These shed or loose hairs all have club-shaped "roots" typical of resting, telogen hairs and may be easily identified under the microscope. After shampooing, the bulk of existing loose hair has often been shed and loose hair may not again appear until additional hairs enter this resting phase. When there is any doubt about the presence of this condition, a small piece of skin may be taken from the scalp as a biopsy to be examined under the microscope. In this way, the condition of the hair follicles, the tissues that produce the hair, may be determined.

No treatment is needed for most cases of telogen effluvium. Remember that the hairs fall out when a new hair growing beneath it pushes it out. Thus with this type of hair loss, hair falling out is a sign of hair regrowth. As the new hair first comes up through the scalp and pushes out the dead hair a fine fringe of new hair is often evident along the forehead hairline.

The most important issue in telogen effluvium is to determine if an underlying cause for the problem is present. Blood tests may need to be done if the cause is not obvious, such as mild iron deficiency. If the telogen effluvium is caused by a medication, the medication needs to be stopped. When the cause of the hair loss is something like giving birth, a transient illness, or other self-limited problem the induced telogen effluvium is also usually self-limited and requires no treatment.

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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