My Hair's Thinning Fast What Should I Do?

Question

Dear Karen,

I appreciate your service and hope you can offer me some advice.

I am an Australian living in Tonga, a small Pacific island country with no available specialists, however, there are doctors and if you recommend any pathology to assist in diagnosing the cause of my hair loss, I can arrange blood tests etc to be sent to Australia.  I am a 43 year old mother of 8 & 10 year old boys with very curly, fairly fine hair, but lots and lots of it, so it looks pretty thick - literally my crowning glory.

A couple of weeks ago my hair began suddenly falling out at about 8 times the normal rate at each wash. The roots don't look very distinct like they do when you pluck out a hair.  I've researched online and am hoping it's Telogen Effluvium (TE) and will grow back.

Twice, in early May and early June this year, I suffered from a severe fever (40 degrees plus for four days) - the first virus was not identified but the second was dengue fever.

I don't diet and my periods are light and regular. I don't appear to be suffering any menopausal symptoms at this stage. Heredity-wise, my father and brother bagan balding in their 20's. Dad's monk-like and my 41 year old brother is on his way. Mum has a great head of hair, as did my grandmothers as far as I know.

About 10 years ago the hair at the front of my head straightened, but then about a year ago, miraculously began to curl again. Now, just as the straightness has almost grown out, my hair's falling out. Call me vain, but I'm extremely distressed over this.   I look forward to your reply at your earliest convenience.

Yours sincerely,

Jennifer M

Answer

Dear Jennifer,

Thank you for your email. I'm so sorry to hear about your sudden hair loss issues. I know that it can be frightening.   One of the key challenges with hair loss issues is arriving at a solid diagnosis.

Although there may be some obvious causes, if sudden hair loss can't be explained easily, it's best to work with a physician who specializes in hair loss diagnosis and treatment.

The fact that you suffered from a severe fever twice in early May and June and that the second was dengue fever could definitely be behind your sudden hair loss.  At 43 you may also be entering into the beginning of peri-menopause which may not have any impact on your periods but could potentially impact your hair growth.

There are many reasons for sudden hair loss including the following possible causes:

1.  Serious illness such as high fevers, cancer, or other diseases.  Some experts have also linked sudden or excessive hair loss to the onset of diabetes as well as sugar or carbohydrate imbalances.  Chemotherapy, radiation, and surgery can trigger hair loss.  Any major physical illness is an assault on the body's immune system and a side effect can be loss of hair.  It doesn't happen to everyone but it is known to be a side effect.

2. Extreme dieting, fasting, or complete dietary change.  Sudden hair loss might also occur as a result of a serious vitamin or nutritional deficiencies, but usually, hair loss related to vitamin or nutritional deficiencies occurs over time in a slower or gradual way.  Eating disorders can also trigger sudden or severe hair loss, especially anorexia and bulimia.

3.  Sudden changes in hormones.  This can be related to pregnancy, giving birth, the onset of peri-menopause or changes during menopause or beginning of hormonal therapy such as birth control or fertility (IVF) cycles.   Sometimes early stages of menopause known as peri-menopause may start in the 30s.  Those changes might be reflected in hormone level testing through the blood.

4.  Thyroid issues.  When the thyroid is either under or overactive there may be hair changes or losses.

5.  Side effects from certain types of medications.  Not all medications can result in hair loss but there are some that do.  When starting a new cycle of medications pays close attention to any possible side effects including changes in your hair.  Discuss any noticeable changes with your doctor and evaluate if other formulations might offer the same benefits without the side effects.

6.  Extreme stress - Although uncommon, extreme stress has also been known to trigger sudden or unexplained hair loss.  One of the royal princesses of Monaco lost all of her hair suddenly due to the horrendous stress she experienced when her second husband died suddenly in a boating accident. All of her hair fell out, but eventually grew back over time.

Hair Loss Diagnostic Tests

Physicians who specialize in hair loss diagnosis may suggest a range of diagnostic tests to try and nail down the physical causes of sudden hair loss.   Not all doctors will recommend the same tests depending on what they feel would be most appropriate for your current hair loss symptoms.

Listed below are some examples of tests hair loss specialists might perform to determine if you're suffering from abnormal hormonal or thyroid levels which could be contributing to hair loss challenges.

Diagnostic Thyroid Tests For Hair Loss Analysis

There are 2 types of thyroid hormones easily measurable in the blood, thyroxine (T4) and triiodothyronine (T3). For technical reasons, It's easier and less expensive to measure the T4 level, so T3 is usually not measured on screening tests.

Please be clear on which tests are suggested for you. There tends to be some confusion among doctors and nurses with the "Total T3", "Free T3", and "T3 Uptake tests". There is a reason they can be confusing, but it's important to note that they are not the same test.

T3 Resin Uptake or Thyroid Uptake: This is a test that confuses doctors, nurses, and patients. First, this is not a thyroid test, but a test on the proteins that carry thyroid around in your blood stream. Not only that, a high test number may indicate a low level of the protein! The method of reporting varies from lab to lab. The proper use of the test is to compute the free thyroxine index.

Thyroxine (T4): This shows the total amount of the T4. Also known as Serum Thyroxine T4.  High levels may be due to hyperthyroidism, however, technical artifact occurs when estrogen levels are higher from pregnancy, birth control pills, or estrogen replacement therapy. A Free T4 (see below) can avoid this interference.

Free Thyroxine Index (FTI or T7): A mathematical computation allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake tests. The results tell us how much thyroid hormone is free in the bloodstream to work on the body. Unlike the T4 alone, it is not affected by estrogen levels.

Free T4: This test directly measures the free T4 in the blood rather than estimating it like the FTI. It is a more reliable, but a more expensive test. Some labs now do the Free T4 routinely rather than the Total T4.

Total T3: This is usually not ordered as a screening test, but rather when thyroid disease is being evaluated. T3 is the more potent and shorter-lived version of thyroid hormone. Some people with high thyroid levels secrete more T3 than T4. In these (overactive) hyperthyroid cases the T4 can be normal, the T3 high, and the TSH low.

The Total T3 reports the total amount of T3 in the bloodstream, including T3 bound to carrier proteins plus freely circulating T3.

Free T3: This test measures only the portion of thyroid hormone T3 that is "free", that is, not bound to carrier proteins.

Thyroid Stimulating Hormone (TSH) : This protein hormone is secreted by the pituitary gland and regulates the thyroid gland. A high level suggests your thyroid is underactive, and a low level suggests your thyroid is overactive.  This is also known as Serum thyrotropin/thyroid-stimulating hormone (TSH).

Other Thyroid tests and/or measurements may include, but not be limited to

Serum triiodothyronine T3, Radioactive iodine-123, Radioiodine scan (gamma camera) - thyroid contrasted images, Thyroid hormone binding ratio (THBR), Thyroxine-binding globulin TBG,

TRH stimulation test Peak TSH, Serum thyroglobulin l Tg, Thyroid microsomal antibody titer TMAb

Thyroglobulin antibody titer TgAb

Tests To Measure Glucose

Glycohemoglobin (Hemoglobin A1 or A1c, HbA1c): Glycohemoglobin measures the amount of glucose chemically attached to your red blood cells. Since blood cells live about 3 months, it tells us your average glucose for the last 6 - 8 weeks.

A high level suggests poor diabetes control. Standardization for glycohemoglobin from lab to lab is poor, and you cannot compare a test from different labs unless you can verify the technique for measuring glycohemoglobin is the same. The only exception is if your lab is standardized to the national DCCT referenced method. You can ask your lab if they use a DCCT-referenced method.

Complete Blood Count (CBC):  The CBC typically has several parameters which are created from an automated cell counter. Listed below are the most relevant:

White Blood Count (WBC) is the number of white cells. High WBC can be a sign of infection. WBC is also increased in certain types of leukemia. Low white counts can be a sign of bone marrow diseases or an enlarged spleen. Low WBC is also found in HIV infection in some cases.  Note:  The vast majority of low WBC counts in our population are NOT HIV related.

Hemoglobin (Hgb) and Hematocrit (Hct): Hemoglobin is the amount of oxygen-carrying protein contained within the red blood cells. The hematocrit is the percentage of the blood volume occupied by red blood cells. In most labs, the Hgb is actually measured, while the Hct is computed using the RBC measurement and the MCV measurement. Thus purists prefer to use the Hgb measurement as more reliable.

Low Hgb or Hct suggest an anemia. Anemia can be due to nutritional deficiencies, blood loss, destruction of blood cells internally, or failure to produce blood in the bone marrow. High Hgb can occur due to lung disease, living at a high altitude, or excessive bone marrow production of blood cells.

Mean Corpuscular Volume (MCV):  This helps diagnose the cause of anemia. Low values suggest iron deficiency, high values suggest either deficiencies of B12 or Folate, ineffective production in the bone marrow, or recent blood loss with replacement by newer (and larger) cells from the bone marrow.

Platelet Count (PLT) : This is the number of cells that plug up holes in your blood vessels and prevent bleeding. High values can occur with bleeding, cigarette smoking or excess production by the bone marrow.

Low values may occur from premature destruction states such as Immune Thrombocytopenia (ITP), acute blood loss, drug effects (such as heparin), infections with sepsis, entrapment of platelets in an enlarged spleen, or bone marrow failure from diseases such as myelofibrosis or leukemia.  Low platelets also can occur from clumping of the platelets in a lavender-colored tube. You may need to repeat the test with a green top tube in that case.

The various tests listed above may be very helpful for a hair loss specialist who is studying any health issues ranging from thyroid or hormonal to anemia which could be causing any type of sudden hair loss.

It's important to note that any of the above tests should only be ordered through a physician or other hair loss specialist.

Best wishes,

Karen Shelton

AskKaren

By submitting your question, you grant full permission to HairBoutique.com to publish it. Due to the volume of mail we receive, Karen regrets that she cannot respond to every question personally.

To AskKaren a question, send an e-mail to: [email protected]