TPMPC episode 8, bald suzanne

The speaker discusses hair loss as a common symptom of perimenopause and hormonal changes. They mention that there are various causes and potential solutions for hair loss, such as decreasing hair processing and using different products. They also explain that hormonal changes, decreased blood flow, and increased levels of testosterone can contribute to hair loss. The speaker emphasizes the importance of stress reduction and getting the thyroid checked as other potential factors. They also mention autoimmune-related baldness issues and advise seeking help from a dermatologist or specialist if experiencing patchy or total baldness. Okay. Hello. Hello. Hello. Hello. Hello. Looks like it's in the middle. Is that good? Hello. Hello. Hello. Yeah. This is way too much work. This is seven hours of work in a row. Make sure my phone ringer is off. Okay. Yes, I am recording. Thanks for the reminder. Although I'm a doctor by profession, I am not your doctor. All content and information on this podcast and on our website is for informational and educational purposes and does not constitute medical advice and does not establish any kind of patient-client relationship by use of our site. Although we strive to present accurate information, the podcast and website are not a substitute for your healthcare provider. Always consult a healthcare professional who knows your particular needs and circumstances before making any health-related decisions. Oh, gosh. Oh, I see. Sorry. Yeah, sorry. Hi, I'm Dr. Suzanne Ciotti. Welcome to the Perimenopodcast. Yeah, ever since fourth grade. Oh, man. Part of it. Mm-hmm. Sexy, sexy. Mm-hmm. Right. Well, first I want to say, Becca, you are beautiful just the way you are. I love the way you look. Well, maybe. Well, this symptom, hair loss, or we call it alopecia, that's the diagnostic term. It's a very common early symptom of perimenopause and hormonal change. So like sleep issues, it appears to affect women starting up to ten years prior to the last period. So it's one of those really early, early symptoms. Unfortunately, there's not just one cause or one solution, of course, like a lot of these other symptoms we talk about. There are a lot of reasons hair loss may be occurring and many possible ways to support hair growth. So remember that some hair loss daily is normal. So we think that it's, you know, typical for people to lose about 30 strands of hair a day, so keep that in mind. So maybe some of what you're seeing in the drain and the shower is actually pretty normal. Another thing, yeah. Right. Also, you know, sometimes people misunderstand that they think that they're losing their hair for some bigger reason, but really their hair is breaking. So breaking along the shaft of the hair where there's, because of dryness. And this might be due to overprocessing, like hair coloring, heat styling, versus being lost from the follicle at the base of the hair. So that's where growth starts. That's the living part of the hair. If you're noticing that hair loss is related to breakage, you may want to decrease significantly how much style and how much you process your hair or change the products that you're using. So that's a different approach. If you're experiencing breakage, yeah, and, you know, many of us in our 50s, you know, as we go from 50 to 60, really are starting to develop graying hair. So it's a common time for people to start to process. So especially bleaching. Bleaching is really hard on that hair shaft and causes a lot of dryness. So you may think in order to save your hair that you don't process it quite so much, maybe you don't wash it as much because chances are because your hormones are changing, you're not getting such oily hair anymore. So those are just some strategies for that hair breakage. So, yeah. No. Hmm. Mm-hmm. Yeah. Right. I think a lot of people have shifted to that definitely realizing what way that was taking a lot of resources and a lot of time. And I look great. Natural highlights. Let's just let those grow in. I mean, it looks beautiful. Right. Mm-hmm. Right. Yeah. Yeah. Good question. So in the science specific to perimenopause, we know that a woman's ovaries may be making less estrogen and progesterone. So these hormones are really helpful to promoting hair, skin, and nail growth. So we know that they help promote good blood supply to the epidermis, which is where hair and skin and nails come from. So you might have noticed also like when you're pregnant, you remember how your nails grew like crazy. Remember how your skin was pink and rosy? So that's due to increased blood flow to the skin structures and hormonal changes. And after having a baby, did you remember that your hair just fell out? Yeah. Right. Mm-hmm. Right. Yeah. Right, right. So that's also a big hormonal change, right? So there you go. It's just like after you're pregnant. Yeah. So some of this hair loss that we're experiencing is probably likely due to lower progesterone and estrogen. So it may be also somewhat decrease to decrease or be happening. Let me kind of stop. So some hair loss is most likely due to lower progesterone and estrogen, and it may be due to decreased blood flow to skin structures as we age. So also, in addition, during perimenopause, so during that time, especially in your 40s before that last period, there are those complex hormonal changes involving your body mass index, your sex hormone binding globulin and insulin that can be happening 45 to 60, say. And that can result in relatively higher amounts of circulating testosterone in women. So that's a male hormone, right? And we know, if we know anything, we know exactly. So in general, this can contribute to hair, more hair in a beard distribution. So kind of along the sides of the face, above the lip and on the chin. Also on the abdomen. So sometimes women will have more abdominal hair as well. And, right. Right. Yeah, yeah. That's right. Right. And maybe this also contributes some to this, some of the balding or hair loss that's happening, these increased androgens. So we know also that in the epigenetics of male pattern baldness, that that starts about the same. Yeah. So this is a great term. I know I just threw a term in there for you, but epigenetics is the science of when genes get activated. So, you know, you've got certain genes that you inherited. Some are recessive, some are dominant. That might be ringing a bell a little bit. It determines how you look, what you inherited from your family. And some of those genes just live in each one of your cells, the same genetic code, and they're not expressed. You know, they just lay there dormant. They're just a closed book waiting to be opened. Well, epigenetics is when that book is open and your cell starts reading it and acting upon it and the enzymes start activating. So that's epigenetics. And we know that epigenetics of female pattern baldness may be starting about the same time as perimenopause. So it gets better. I know. So this type of balding pattern is very much genetically determined, and it occurs in an all-over pattern generally. It's unfortunately generally permanent, but it might respond to some treatments. So we're good to get at it earlier. Yeah. Right. Right. Yes, exactly. Yes. Right. And there's more. There's more reasons for this, too. So we're not completely done with all our reasons. So do you remember maybe hearing some complaints about hair loss during the pandemic? It became a topic for a lot of people. I know. I do, too. Right. And it was in the news, too. We know that emotional stress also plays a role in hair loss. So if you lose somebody close to you, if you suffer a job loss, if you're really working a couple of jobs over time, you might experience hair loss from stress. And remember, in our last episode, we talked about the complexities of emotional state for a woman in midlife, right? Higher stress contributing. And this higher stress might be contributing to that hair loss. So following up on some stress reduction, taking time for yourself, avoiding alcohol and increasing exercise can help mitigate some of that stress and reverse some of that kind of hair loss. Right. Right. Right. Right. Right. Right. So there's other possibilities that can be happening at this time in life, too. So one other thing that we've talked about even in the past episodes of our podcast are that thyroid affects your body in a lot of similar ways to what menopause and perimenopause do. And we talked about that sometimes this phase of life is when low thyroid starts to come on because it's an autoimmune-related disease. So low thyroid also contributes to hair loss. That's one of the common symptoms of low thyroid. The other symptoms are weight gain and fatigue, similar symptoms to menopause. So, you know, that's another reason why it's very important if you're having hair loss and you're, you know, even if you're around menopause and we think, well, maybe that's it, get your thyroid checked to make sure that that's not part of the issue. Yeah. Yeah. Mm-hmm. Right. Yeah, exactly. It's really hard to tell the difference. So we also know that perimenopause is a time when the body is kind of going in turmoil in a sense. You know, there's these hormonal changes and hormones are little messengers that affect a lot of different cells. So it tends to be a time when autoimmune inflammation can start to be triggered. And one of those autoimmune sorts of disorders is alopecia totalis is one and alopecia areata. Those are autoimmune-related baldness issues. So that just results in the immunoglobulins of your immune system attacking the hair follicle and causing hair loss. Yes. So, right, areata. It's area. It means in patches. So it just actually like full patches where it's totally smooth. There's not even any kind of stubble at all. It's just that you've just destroyed that hair follicle. Your immune system has destroyed that hair follicle. And that's something that can actually is reversible. So it's something that a dermatologist can certainly help you with or a specialist, an MD who specializes in hair loss. So that kind of autoimmune issue can result in that patchy baldness or total baldness. But this is actually a less common form of baldness to start in menopause, and it can happen at any age. It can happen as a teenager. It can happen in your 20s. It can happen when you're older. But I just wanted to mention it because usually it's a good idea to get in to see somebody pretty quickly if that might be part of what you're experiencing. And it might be just coming on with menopause. It might be the changes in menopause are stressing your system out and causing this to kind of wear its ugly head. Yeah. Sure. So the earlier you seek treatment, the better it is in most cases. And that, you know, because we're trying to support the hair follicle. And that hair follicle is a living part of the hair that's located in the scalp at the very base of the hair shaft. It's the only alive part of the entire hair strand. So the hair is created there, and then when it grows out, it becomes the shaft. And that's pretty much just collagen. It's just dead. There's no blood supply. So there's nothing that medications or topicals can really do to that shaft. So really important to seek treatment when you're starting within the first three to six months of noticing some changes so that we can start either medicines or topical treatments that might help. And, you know, if you're noticing that, well, hey, this is happening with my hot flashes. My periods have stopped, and now my hair is falling out. Well, we've got a good, you know, medication that will help all of those symptoms, which would be estrogen. And we'll talk about that some more. Yeah. So remember that we're trying to nurture that hair follicle so that any medicine or supplement that you take will need to go through that hair follicle in order to get to the shaft and affect the hair. And remember, yeah. Bless you. Yeah. So remember the hair, your hair strand. Remember that if it's six inches long, remember that if your hair strand is six inches long, at the very end of the hair, it's probably at least two years old. So even after we start treatments, it might take at least a year for your hair to grow to a point where it is apparent and affecting the total hair fullness and volume. So it takes a little while, like three months to start seeing any effect, you know, six to 12 months before you start to notice some more fullness in your hair. So good to do it earlier to help nurture that hair follicle. Right. Yeah. Mm hmm. Mm hmm. Right. Right. Mm hmm. Right. Mm hmm. Right. You've got to be in it for the long haul. So if you're using a topical, it means that you need to just commit yourself to doing it as prescribed or on the label for three to six months. You just need to keep up with it, even if you don't see any changes, because you won't really see it in that first couple of months for sure. So just remember to note that if you have breakage versus loss from the hair follicle, make sure that you clarify that. And remember that that hair breakage occurs when the hair bends and breaks due to brittleness halfway down the shaft. And because we have that lifeblood of the hair in the follicle, early treatment and oral medications and supplements will take a while to have effect. So if you have any breakage, you may need to change your hair washing and styling and coloring routine. So next time you see your hairdresser, you might want to mention that to them if you have hair breakage, since they're really good and trained in this area. And they may be able to recommend other products for you to use that are less drawing to the hair shaft. So for the majority of women who have hair loss related to menopause, it's due to kind of changes that are affecting that hair follicle at the base. And estrogen replacement therapy would be helpful. So the reason for this is twofold. We know that estrogen and progesterone help the skin blood flow like we talked about when you're pregnant, resulting in less skin dryness and better hair and nail growth. And it also. That's right. Yes. But if you're but you remember, we have that one year, of course, right after that last period where we haven't officially diagnosed you, you know, you need to be a whole year without a period in order to be considered postmenopausal. So if you have that hint that your periods are stopping and you're having hair loss, this is the perfect time to start estrogen replacement therapy. And sometimes when I have people who have really severe hair loss, this is a time when we'll just go ahead and try some low dose estrogen and progesterone in order to see if it makes a difference. So there's a lot of different kinds of increments of estrogen that we might be able to use for in order to help with that. Yeah. Well, yeah. Well, and I just wanted to mention one of the reasons why when we take estrogen replacement therapy, it helps blood flow to the vaginal region. And that's why it helps that vaginal dryness, just like it's helping your skin dryness and your hair dryness. So it's helping that helping you kind of all of that epidermal area, including vaginally. So we'll talk about the vagina. Yes, I think so. And maybe even bring in a specialist because that's an important thing for sure. Your vagina still means something, even postmenopausal. You still need your vagina. Still want that thing working. That's for sure. Yeah. So there's other treatments. So if a woman has a constellation of changes around menopause, which has also weight gain, especially in the abdomen, facial hair, and blood tests that show kind of borderline glucose or prediabetes or higher insulin levels, we might be thinking of like a polycystic ovarian syndrome or a metabolic syndrome for these people. And that tends to be a testosterone excess state. And we'll sometimes use spironolactone in those patients. Yeah. So spironolactone is the medicine. Yep. And it's old medicine that we used to use for blood pressure. Sometimes we use it as a diuretic. But it has an effective blocking testosterone receptors on the hair follicle and in the skin. So it actually ends up helping acne and excessive hair growth on the face. So that's a nice medicine that's a two-for as well. Mm-hmm. Right. Right. So another blood pressure medicine that helps blood flow to the scalp is minoxidil. So that one taken at low doses daily might be very effective for helping hair growth, too. So those are two non-hormonal prescription, regular prescription medicines. So for — yeah, you can eat those as a pill, a low-dose pill. Exactly. Yeah. Yeah. So even for — we talked about different types of hair loss. There's some medicines that'll work for both. One is called Propecia or Finasteride shampoo or foam. You can also take Finasteride orally at one milligram a day. So those are medicines that'll work for hair growth no matter what the cause. It just happens to be a side effect of the medicine. I mean, it's a medicine that we used to use for other reasons. And we found, wow, look at that. People's hair are growing like crazy. So — right. Lateef, which is that — it's kind of a cosmetic topical for eyelashes. Same thing. That was a side effect that they — it was originally for glaucoma. And they said, wait, look at this. Women's eyelashes are so much longer. Let's use it just for that. Yep. So remember, even with these topicals, it might take three months up to a year to notice complete effects. There's some really good vitamins that are helpful for supporting your hair follicle, too. So biotin, vitamin C, vitamin E, and zinc. And all of those are kind of coenzymes in the body's production of collagen, which is a major component of your hair shaft. So that's why they're helpful. Yeah. Yeah, you probably are covered. No, if you are taking a supplement that has that, then that's probably covering you. In fact, there are some subscription vitamin products out there on the market that you might be thinking of. And some of them have ashwagandha, which is an adaptogen herbal. It kind of helps with lots of things, like energy. It's an adaptogen. Saw palmetto, which is one that typically we use for prostate health, that one seems to promote hair growth. And as we talked, a lot of the combinations have the zinc, vitamin C, and vitamin E in them. Sometimes also biotin as well that can be helpful for hair growth. Right. Ashwagandha, saw palmetto, zinc, vitamin C, vitamin E, and biotin. Those seem to be good over-the-counter herbals that might be helpful. If it feels like it's very severe, you can really see patches of hair coming out. You're really losing what looks like handfuls of hair. You may want to see a provider before you do that just to make sure that you get your thyroid checked. Oh, another thing I wanted to mention, besides thyroid, anemia sometimes can cause hair loss too. And we talked about those kind of crime scene periods where women are having really heavy periods. Those crime scene periods can result in anemia, and for some women, that will cause hair loss too. So those blood tests will probably also be important to rule that out as well. Yes. Right. And we were talking about that patchy, different kinds of baldness, the alopecia areata and the alopecia totalis. So if you're noticing your hair loss is patchy or all over and you're getting significant baldness, you may want to see the dermatologist sooner because they're the ones who help evaluate you for that autoimmune-related alopecia. And the sooner they can get you treated, then the better. Sometimes they'll even use steroid injections intradermally in small, small amounts of steroids within the hair of your scalp in order to keep that from happening. Yes. Right. Yeah. There's other kinds of scalp conditions that maybe your GP could handle that can contribute to hair falling out, and that's seborrhea or psoriatic scalp. Generally, that kind of really flaky, dry scalp can cause hair loss by damaging the hair follicle. That you would notice yourself too. You'd have all of that really flaky, dandruffy scalp. So you'd probably notice that as well, but not all the time. Sometimes people don't notice that it's happening. Your GP might be able to handle that one. So that's another condition, though, that can be associated with hair loss. There's another, there's some, there's out there you might find cold laser caps, and they do have some research that shows that they might help hair regrowth with little side effects. They're expensive, though. They can be expensive and take multiple treatments. So that's just something to keep in mind. Mm-hmm. Right. I'm not advocating for it, really. I think there's a lot of things to try before you go that route, for sure. I want to mention my friend, Chinese medicine, that I love so much. Just because I think that with Chinese medicine they have an interesting take. So just using this whole different paradigm, you know, the top of the head and the scalp is, on a person's body is thought to be ruled or governed by the kidney system. And this system, in Chinese medicine, is the creator of all our body chi or energy. So to me it's interesting that as we age, our hair turns gray as our energy decreases, as we kind of lose our chi with aging. So in menopause, our body is very stressed by hormone and body changes and is trying to find a return to homeostasis. So that might be part of, like, the Chinese paradigm of why you might be losing hair. So maybe if you're having hair and scalp issues, it might be useful for you to seek support from your acupuncturist for help balancing these elements and meridians. Yeah. Right. Yeah. I know. Right. Yeah. And it's a good thing to mention to them if you do see them regularly because it's a good symptom in Chinese medicine as well. And then remember, when we're talking about treatments, we mentioned right up at the very beginning that stress might contribute to hair loss after you have a traumatic event or loss of someone close to you might have hair loss. And menopause is a stressful time. So don't forget about that good old stress reduction and protecting your sleep, which will help your hair as well. I won't. I love it. Right. Yeah. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. 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