The Dr Louise Newson Podcast - 035 - Hair Loss and Hormones - Dr Sajjad Rajpar & Dr Louise Newson

Episode Date: February 18, 2020

In this week's podcast, Dr Newson is speaking with consultant dermatologist, Dr Sajjad Rajpar all about hair. Hair changes can be very common during the perimenopause and menopause. Dr Rajpar eloquently explains how our hormones are important with respect to hair growth and also hair texture. They discuss in detail reasons why women experience hair loss and the importance of having a holistic consultation to explore reasons why hair changes. Dr Rajpar talks about the different treatment options and provides some simple advice which will help us all regarding our hair. Find out more about Dr Sajjad Rajpar here: https://belgraviadermatology.co.uk/ Dr Rajpar's Three Take Home Tips to help reduce hair loss: Avoid any tight hairstyles. If you can leave your hair down, it will help. Think about the health of your scalp too, it may be drier due to low oestrogen levels during the perimenopause and menopause. If you are suffering with brittle hair then by sensible with heat and styling tools.

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today, by popular request, I have Sajad Rajpar with me, who is a consultant dermatologist at Balgravia Dermatology and also he works in Birmingham. So thanks ever so much for coming today. Good morning, Louie. Thanks for inviting me. It's a pleasure.

Great. So we thought today I would talk about hair and hair loss because I speak to and see a lot of women who are perimenopausal and menopausal. And they have noticed that their hair changes in consistency, in growth, and some of them are losing hair. So I thought we'd just tap your brains, please, to demystify and to talk about hair and what it is. So before we talk about hair changes, can you just enlighten us? talk about hair and what it is because a lot of people think it's just something we brush and groom and don't realize how important and how alive it is for us. So could you just talk us through? Yeah, this is a really important aspect of hair, which is that it is a very complex biological organ in our skin. And hair follicles are really very complex. They go through

a cycle of growth, of rest, and then of shedding. And we've got at least a hundred thousand hair follicles on our scalp. So we've got a lot of them. And, you know, there are all sorts of evolutionary reasons why we've got hair on our scalp and on our body. One of them is to preserve heat. Another one is to possibly harbour pheromones. And another might be to define our features as what is male and potentially as what is female. And that's why hair is so important, especially when somebody suffers from hair loss because they may feel that they're losing their defining features, which can have a big effect on self-confidence. Yes, absolutely.

It really can make such a difference to people. We know that, don't we, people who have lost their hair for various treatments, sometimes, chemotherapy. And it's one of the first things that people, like you say, identify us, don't they, buy our hair? And it's often a compliment, oh, your hair looks great. and you think, oh, good. But actually, when your hair starts changing, it can really have a big negative impact. And as you know, many women who are menopausal

find that they have low self-esteem, loss of self-worth. And so it can really have a very negative effect. So how does our hair grow? What helps our hair grow? Well, I think the hair is programmed to grow if everything around it is healthy and well. So we've got to get enough nutrition to the hair. So if we're not consuming enough calories, for example, so there isn't enough

nutrition going into the body, then the body will say, well, what is most important to me to keep me alive? And it will not prioritize the hair. So we find that inadequate intake of calories can lead to hair loss. And in fact, some people who are going through very stressful periods, for example, during the menopause, may respond to stress. by not eating as much or not eating as well. And it can be something as simple as that that has a knock-on effect on their hair and that causes their hair to not be as strong as it was before.

And what food groups particularly are good for our hair? That's a really good question. I think the first and foremost point would be to say you must have enough calories for sustaining your body. So you're not short of calories and you're not rapidly losing weight. So those who lose a lot of weight in a short period of time. And that's probably the mechanism that very stressful episodes like bereavement may, for example, lead to hair loss. Then we've got this whole sort of component of micronutrients.

So if you think of the calories as macronutrients, and it really doesn't necessarily matter whether they come from carbohydrates, lipids or proteins or a healthy balance of all. Then we've got the micronutrients. And I guess the most important ones that we come across when we're thinking about hair are zinc and biotin. And these are nutrients that are thought to be very important for supporting hair growth. And many people will see on the internet lots of supplements that contain these that potentially may help hair growth. So we've got to get our macro nutrition correct, but we've also got to make sure that we're not deficient in things like zinc and biotin. And how can we get enough zinc and biotin from our diets or does it have to be a supplement?

I think if you're already having a healthy, and my strategy, I should say, is if you're already having a healthy and balanced diet and you're not absorbing enough zinc and biotin, then it is likely that you require supplementation. What I don't necessarily agree with is for everybody to have supplementation and the belief that all hair loss will improve from taking zinc and biotin. That's the problem with this sort of catch-all solution to any physical issue. There are people out there who have low levels of biotin, which is vitamin B7, in fact, and it may be because they're not absorbing it,

or it may be because there are other medications that interfere with it, or they have gut issues. Now, my strategy is to test the levels first to ensure that somebody is actually low and then provide supplementation and then to decide whether that supplementation has helped because it could just be low but not be causing a hair problem. Yes. So it's very important, isn't it? I think it's like any aspect of medicine that people have individualised advice because it's so easy now, isn't it, to Google. hair loss and come out with all these recommendations, but it might not be the cause of the hair loss. And then you're potentially wasting your money on a lot of supplements maybe,

but actually taking things that you don't need. So if a woman is thinking that they might have a deficiency in something and they go and ask for a blood test, what would you recommend, you know, blood tests? Because we often do iron levels as well, don't we? Yeah. So I think, you know, iron is a really important contributor to hair growth and iron deficiency. is actually quite common. And the thing with iron is that it's not the fact that somebody has to be anemic for their hair to suffer. Because in the same way as the body will consider how best to preserve its calories, the body will also consider how best to preserve iron if it's got limited iron.

So it will keep the red blood cells going, whereas it might not keep the hair growth going. Yes. So we don't just check for anemia, which is a low level of hemoglobin. We actually check the body's storage of iron by doing a test for that called ferretin. So that's really helpful nutritionally for us to know. And sometimes somebody who's got a low iron level is actually undernourished. Yes. And it may be that they're not taking enough calories.

And it could actually be that it's, again, back to that macro nutrition issue that they're not consuming enough. Because it's really important, I think, with a lot of people, I mean, I personally don't eat meat and a lot of people now have a vegan diet. And looking at iron intake is crucial. And especially around the time of the perimenopause, a lot of women enjoy not having periods or less frequent periods, but there are a significant number who have heavy periods. And so they're losing more blood. So therefore, they're more likely to be anemic or have low iron. So I often look at results. And a woman has told me, oh, I'm not anemic. And they're right. They're not. but their ferretin, their iron store level is low. And as you know, the range is really big, isn't it? So it might be reported as normal. But you like to have, what's your level that you would say you'd like to have? I think, you know, I'd say a level of 50 or above. And for hair, hair responds quite slowly to any correction.

So we like to know that the ferretin level has been maintained above 50 for at least six months. She's a long time, isn't it? Because some of you might know the range, it depends on the laboratory, so we can't talk actual figures. But often I see women with levels in their 30s or 40s, and that's still normal. So the computer will report it as normal, but it's low if you're experiencing symptoms such as hair loss.

Absolutely. Yeah, and the normal range, I think in some labs can go down to 10. Oh, really? Yeah. Yeah. So, you know, there can be really, really wide ranges of normal. But as you quite rightly say, there are symptoms that could be associated with low levels.

I think the other thing is that if somebody is found to have a low iron and they take iron supplements, it's actually quite important to test at what the iron levels are. This is something I see time and time again, which is that, you know, I had a course, a one-month course of iron. Yes. And so that's okay. Yes.

Well, it may not be okay because... It takes a long time, doesn't it, to restore? And if it is due to a deficiency such as you're not eating, enough iron, you're going to need to continue having iron. So you're right, I saw someone in my clinic yesterday who had been seen by a nutritionist, had some blood tests taken and said, just take iron for a month. And this lady was vegan. So that's not going to help. It won't replace the stores and it won't maintain her stores either. Yeah. And this is exactly the strategy that we have, which is replace, you know, get it to a level of 50 and then keep it to maintain it at that level

and make sure that the absorption is taking place. You know, perhaps add in things like vitamin C, which helps iron. The absorption doesn't say, so not drinking coffee with your iron tablet because that makes the difference too. And then what about other blood tester? Can you do zinc and biotin as a blood test? You can. And I think I go down that route if I find that there is a need based on the clinical examination. Right.

So we've always got to kind of say what is likely to. to be going on here. What are the patterns of hair loss that are being seen on the scalp? And could that be, you know, nutritionally derived? And if it is, then those tests become appropriate. If it's not, then they're not necessarily primarily appropriate. Yes. I think that the other thing with hair loss, I think also,

is that there can be more than one factor going on. Yes. So it can take time to dissect out the relative factors. and target them each as they become apparent. Yes. And that's why, you know, even treating hair loss is not always a one-off, straightforward, take this, the problems will go away. No, and I think that's why it's very important to have a holistic approach. I see a lot of women who go to a trichologist because they are only focusing on their hair.

And as you say, it's from within as well, isn't it? and hair and skin can be a marker of something else going on underneath, can't it? Deeper. Yeah, absolutely. So hair loss can be a sign of other conditions, you know, thyroid problems, for example. And that's one of the things we may test as well. We'll frequently test, in fact, because, you know, either underfunctioning or even an overfunctioning, thyroid can cause shedding of hair. Yeah.

And so talk us through, obviously, we need to talk about the menopause. because you're talking to me. So talk us through how hormones can have an effect on our hair growth and texture and pattern. Yeah, no, I think, well, if we're just looking at the menopause and hair loss generally, you know, hair loss is really quite common with the menopause. And there's some studies show that about 40% of women suffer from some form of hair loss, either at the perimenopause or after the menopause. That's a lot.

Four out of ten women. That's significant, you know, that's almost half. And it's already a difficult time. And we just mentioned how important the hair is to femininity, to the appearance, to all sorts of aspects of self-esteem. And often the thing with hair loss is that it can be gradual so that there's a stage, especially in the early stages, where only the woman knows or appreciates that there's a change in her hair, either the texture or the volume. And often at that stage, when they say to others, perhaps, their partner or their GP that I'm suffering from hair loss, it may be that because it's not as obvious or as visible to them, that it's disregarded. And I think that can actually add on to the stress significantly because they know there's a problem, there's a change. And how does the hormones work then? How does estrogen? Because estrogen obviously gets everywhere. And a lot of women are surprised when I say it can affect their bones, it can affect their skin, it can affect their blood vessels. but how does it affect hair?

Yeah, well, I think, you know, we don't absolutely know how estrogen stimulates hair growth, but there are estrogen receptors in the hair follicles. Now, when we look at the women who suffer from hair loss with the menopause, we find that roughly two-thirds have a general loss of hair over their scalp, and a majority of them will also find that they've got thinning of hair on the hair. the body. About one third have hair loss localized to the frontal area of the scalp, and often they may have additional hair where they don't want it, perhaps on the face, the chin, the upper lip. So that tells us that perhaps the absence of estrogen in at least that proportion of women

is allowing the testosterone levels, which may still be okay, to sort of proceed and cause what we call a pattern type hair loss, where it's affecting specifically that frontal area, but it's also stimulating those what we call vellus hairs, which are really fine hairs, to become thick. Now, the other group that get, you know, generalized hair loss, we don't know why the lack of estrogen in that category causes that because replenishing the estrogen with HRT doesn't always bring about hair growth. So this is the important thing that HRT does not always restore hair growth. No, and I think I see quite a few women who find that they have these subtle changes, but they make.

maybe started a type of HRT, often a combination tablet with a synthetic progestogen, and they find their hair hasn't improved. And then, as you know, we give body identical HRT, usually the estrogen through the skin, with a natural progesterone. And they often, when they have the right levels, they then start to find that their hair does change and improve. And often then, like you say, we look at iron levels and look at their nutrition. And because it takes a while, it's not often until several months later that they're starting to notice. And it's often their hairdressers that pick up and say, gosh, what are you doing? What are you having because your hair's changed?

So it's very important. I know the synthetic progestogens can often have a negative effect on hair as well, can't they? Yes, sometimes. And I think this is really important that you kind of have to give it time. So that if you haven't given enough time, the hair cycles are so slow to respond that any change takes between three to six months to actually see an effect. Now, some progestogens can have androgenic effect, and that can be a mechanism through which they accelerate or promote hair loss.

So I'm interested to hear that you then manipulate that and you're finding good results. Yeah, it's all very interesting, is it? But then, as you know, we see some women who I wonder that their hair loss is related to their hormones, and I refer them to you. you and then you quite rightly say no it's not related at all there's other conditions that can occur especially more commonly in women in the midlife that are unrelated to their hormones but it's just transpired and they think it's associated so there are other conditions aren't there we can't

blame hormones and everything yeah no and i think you know we've got this condition of pattern hair loss which is the genetic form of hair loss and so it runs in families and everybody recognizes that men get that because it's very obvious. But actually one in three women also have the genes for female pattern hair loss. And of course, as we get older, that's more likely to be apparent. And it may well coincide with the time of the menopause. So it may well be that there's a hereditary hair loss component going on. The other thing that, you know, you find often is that there can be scalp disorders. So things like a seborate dermatitis, which in its mildest form is eczema or dandruff, but actually can become, you know, quite a problem and quite common. And sometimes that can actually cause an unhealthy scalp

and cause hair to not grow as well as it would otherwise. So often it can be a component of hormones, a component of pattern hair loss, a level of mild. dermatitis and possibly even some nutritional component going on. And as we said at the beginning, it's really important to personalise treatment according to what the relative factors that are present that are important are. Yes, and I think that's so key. A lot of women I see are very scared about taking HRT for lots of reasons. Often they're unfounded and they're based on myths.

But some people worry that their hair is going to worsen. And often it doesn't. I often say to them, well, if it's related to your hormones and we get your hormones right, then it often improves. But it doesn't make it worse. If it's another condition like you're describing, because the other conditions are usually irrelevant to their hormones, aren't they? Yeah, no, I entirely agree that I've never seen a situation where HRT actually makes hair loss

worse. And with HRT, you are replenishing and restoring what was there anyway. Indeed. Yes, and especially with the body identical, it's very easy because it is natural. It's derived from the yam, the root vegetable. It's very safe. So it's very different to older synthetic medications. So it's a bit like, like you say, when someone has an underactive thyroid, it can cause symptoms that affect hair and we just replacing the hormones, which is really important. So, and we've already spoken, I know, about skin. So for some of you that haven't listened to our previous podcast, it's well worth tuning into and listening, because. Because skin also responds to hormones and lack of hormones can cause skin changes. Yeah, definitely. I think we discussed the variety of changes that we see from the lack of estrogen. And the hair and skin are intimately related. Yes. And there are some conditions, like you say, if someone's got exmodermatitis or even something like psorias, it can affect the scalp because the scalp is obviously skin.

So people often just think of the hair, but they have to think, you know, how the hair's growing from the hair follicles. So anything that irritates the scalp can affect it. Yeah, I mean, last time we discussed how the lack of estrogen causes a tendency for dryness on the skin because of all the important natural moisturising elements that estrogen stimulates in the skin. Well, the same occurs in the scalp, and you often find that the lack of moisture in the scalp, causes dryness, itching, and even dryness of the hair itself. And sometimes simple measures just to replenish the moisture in the scalp and actually bring about a healthier scalp.

And, you know, something is called coconut oil or almond oil a couple of times a week, believe it or not. And if you look at all the very sexy sort of hair treatments by many of the major brands, and you actually look at the ingredients, you will find a lot of moisturising agents like coconut oil, which is a really simple remedy. Yeah. It's actually spruced up into a nice sprayable product. But that's all it is. You're just moisturising the stuff.

You're keeping the skin healthy and you're enabling the head grow better through it. Which makes total sense. I mean, I've got a very cheap oil that I found actually from Morocco. And it's not got any fancy labelling, but I often. massage it into my scalp overnight and it works really well. But it is important we moisturise our skin. So we should be thinking about our scalp as well, shouldn't we? Yes.

And I think the irony is that if you see a GP or even a hairdresser and say I've got a scaly scalp or an itchy scalp or an itible scalp, you'll get a shampoo. Now shampoo is soap and we talk in our skin chat about how bad soap is. And suddenly, you know, people with dry scarps are giving you. in shampoes which actually, paradoxically, dry their scalp out even more, even though these shampoes may have some active ingredients. So those active ingredients are required, but it may still be necessary to replenish the grease with something like as simple as what we're doing. It all makes so much sense. You're brilliant to talk to you because everything you say makes

complete sense, but often you don't think about it because we're sucked into all this commercialism and marketing. And when you take a step back, you listen to the... voice of reason it will make sense. I mean, it's really difficult with hair especially. And, you know, there is this phrase called trico quackery to reflect, you know, the amount of advice and solutions that there are on the internet, which is a one-size-fits-all. Yes. I will see people who may bring, you know, bags worth of treatments that they've bought from the

internet and from others that they might have seen, who whom perhaps are not medical, and, you know, come to me. really late down the line. And I appreciate how confusing things are. It is. And we're all desperate to have the perfect skin, perfect hair, everything else. And the social media sort of forces us almost. And it's very easy to get carried away. And you're right. I see a lot of women with bags of supplements, bags of products. And it's not only is it maybe not helping, but it's also costing them a lot of money. Yes. So I think having this little overview about hair interaction with hormones, other reasons their hair changes has been really useful. So thank you ever so much for your time. Finally, just before you go, could you just give us three tips about healthy hair in the menopause? Yeah, okay. Well, I guess tip number one is to

avoid any tight hairstyles. The hair, especially if it's at a vulnerable stage, does not traction or pull. If you can leave your hair down, it will be better for the hair. The second is, what I think we've just said, which is think about the health of the actual skin of your scalp. So it's not just the hair, it's the skin around the hair that you've got to keep healthy. And just have a think about whether you need any moisture replenishment, especially if you're in the perimenopause. And we know that there's biological reasons why you've got less natural moisturising agent in the scalp. And I think the third is that if you're suffering from very brittle hair, then just be sensible about any sort of heat-based treatments that you're using,

hair drying, tongs, all sorts of things. You know, it does take its toll on the hair. And if it is already fragile because of the other reasons, then you kind of want to moderate that as well. So I think those are just the simple ones that may help. Yeah, no, but that can make sometimes even a small difference can really help. So that's been really useful. Thank you ever so much

and we'll put links with the podcast notes about how to get more information from Zadad. It's been brilliant. So thanks ever so much for coming today. Thank you. You're very welcome. It's always a pleasure. For more information about the menopause,

please visit our website www. wwwmenopause doctor.com.