The patient: Kerry, a 58-year-old accountant and mother of two teenagers and three adult children.
Why she came to see me: While Kerry assured me she was far from vain—“I have five children, after all,” she joked—she came to see me when her once-lustrous hair started falling out with alarming frequency. She was cleaning her brush every other day, strands of hair came out in her hands when she washed it, and she often woke in the morning to find clumps of hair on her pillow. Her ponytail also felt “thinner”—a fear her stylist confirmed at her latest appointment. Panicked, Kerry read everything she could about hair loss. Stress, she learned, was one possible culprit. In addition to five children, she also had two dogs, a full-time job, and home renovations underway. Nevertheless, she didn’t deem anything in her life “consequential enough” to cause stress-related health issues. She sought out a naturopath to determine if there was anything she could do to restore her formerly-radiant hair.
How I evaluated her: An in-depth discussion revealed that hair loss was just one of many symptoms Kerry was experiencing. Six years earlier—when she completed menopause—she’d started putting on weight and was now 20 pounds over a healthy BMI. She also complained of constipation, exhaustion, and irregular sleep—it took her mind a “super-long time” to calm down, and she woke up at least two times a night to use the bathroom. When I inquired about exercise, she said she’d long been a gym member but had recently been turned off about going. Every work out left her even more drained than before. “I just haven’t felt like myself lately,” she said, “and losing my hair feels like I’m also losing one of the last connections I have to the ‘old me.”
Given that her symptoms extended beyond hair loss, I ordered a number of lab tests: a complete thyroid panel, an adrenal salivary test, an iron panel along with ferritin (the storage of iron), a comprehensive hormone panel, and a lipid panel.
What my evaluation revealed: Kerry’s results underscored the fact that many of our systems are inter-related—and when one system isn’t up to par, the whole machine can be affected. First, her TSH (thyroid stimulating hormone), which is produced in the pituitary gland, was high, suggesting low thyroid hormones. Known as hypothyroidism, this condition can lead to weight gain, depression, constipation, and, yes, hair loss.
Her adrenal salivary test revealed an upside-down cortisol rhythm—her cortisol was high when it ought to have been low, and low when it should have been high. Fatigue when a person should have energy (such as after Kerry’s work outs) and energy when they ought to slow down (like her struggle to fall asleep at night) are just two of the symptoms associated with this reversed rhythm. And high levels of cortisol at the wrong time of day can impair the thyroid hormone T4 from converting to the active form, T3.
Her iron and ferritin panel demonstrated that she was in the low range of normal—both low ferritin and low-iron anemia are linked to hair loss.
Her comprehensive hormone panel, meanwhile, showed that her estrogen and progesterone were very low and, thus, that all the breakdown products of these hormones were low too. These results matched up to Kerry’s symptoms as well, as low levels of estrogen and progesterone can lead to poor sleep, low energy and depression. Her level of DHEA was within normal range, but her free testosterone was higher than optimal—this, too, could have been contributing to her hair loss.
Finally, her lipid panel illustrated that her cholesterol was 260, with her “friendly” cholesterol, HDL, being low and her “unfriendly” cholesterol, LDL, being high.
How I addressed her problem: I diagnosed Kerry with hypothyroidism but made it clear that she also had lab markers pointing to other imbalances in her body. Thus, I encouraged her to take a holistic approach to treatment.
For her thyroid, I prescribed a low dose of natural desiccated thyroid, which contains a combination of T4 and T3. (Most prescribed thyroid is just T4—for example, Synthroid—but, again, T3 is the active form of thyroid hormone, and most of my patients feel better with the natural thyroid that contains both hormones.)
For her adrenals, I recommended ashwagandha, an Ayurvedic herb that supports one’s natural cortisol rhythm and can help those who feel simultaneously wired and tired.
To boost her ferritin level—which is essential for proper thyroid hormone conversion—I suggested nutritional therapy in the form of a cup of Hijiki seaweed per day, cooking out of cast iron pans, and eating more vegetarian foods high in iron, including pumpkin, sunflower and hemp seeds, broccoli, kale, lentils, and chickpeas.
To address her low estrogen and progesterone levels, I explained that estrogen can encourage healthy hair and prevent male-pattern hair loss associated with excessive free testosterone. She chose a low dose of prescription estrogen (a combination of estradiol and estriol), plus some progesterone. To bind up some of her free testosterone, I recommended spearmint tea and eating soy products like tempeh, miso and tofu a few times a week.
Finally, to naturally lower her cholesterol, I suggested increasing her fiber intake, specifically through oat bran and psyllium husk, which can also enhance digestion.
The patient’s progress: Within 2 months of my recommended treatment plan, Kerry returned to my office with not only thicker hair but also a beaming smile. She reported feeling markedly better, thanks in part to the victories she’d had with losing weight—she’d already lost 6 pounds—and her newfound ability to sleep a solid seven to eight hours per night. Her digestion was “more regular” and her cholesterol had dropped 2o points. Galvanized by her progress, she felt she was well on her way to a healthier, more balanced and radiant life.
To learn more, visit Dr. Laurie Steelsmith’s website, https://drsteelsmith.com, or click her to read her most recent book, Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.
