May2015

ADVERTORIAL
A Case of
Hair Loss
BY KENNETH N. WOLINER, M.D., A.B.F.M., A.B.O.I.M.
“People just don’t understand.”Marisa definitely had hair,
but that didn’t stop her from being devastated. “I’m afraid to wash my hair. I’m
shedding worse than a German Shepherd in spring [1].”
I’ve learned how important it is to listen to all of what my patients have to
say; and this is especially true when doing consultations about hair loss. After
a good five minutes of venting, I was able to start asking some questions.
“Anything else?”
“Besides my pony tail not being as thick as it used to be? I’m so worried I
won’t have any hair left that my stomach is tied up in knots. I wear St. Agnes of
Rome around my neck hoping my prayers will be heard soon [2]. Until then, I
have to take Pepcid with my coffee.”
“Other than prayer, have you tried anything else?”
“I’ve seen every type of doctor you can imagine. My primary scolded me for
doing the hCG diet and made me start eating again [3]. My GYN said I’m not yet
in menopause so she referred me to an Endo. My thyroid tests were ‘in range’
so he sent me to the dermatologist. I’m not a candidate for steroid injections so
I then went to the hair transplant surgeon for a consult. I left him with Viviscal
vitamins and shampoo, prescriptions for spironolactone, Propecia, and Rogaine,
but still, no hair.”
“Hmmm …” As Marisa was speaking, I was simultaneously reviewing her
old records. “I don’t see where they ever checked you for estrogen dominance,
thyroid antibodies, insulin resistance, or adrenal fatigue [4].”
“
“Dr. Woliner, that’s why I’m here. You’re known all over the Internet as
someone who looks at everything.”
“My practice is named ‘Holistic Family Medicine’ because I take a holistic
approach. After our 80-minute consultation today, I’ll check for things that
weren’t looked at yet to find the cause(s) of your hair loss. Then, we’ll put
together a comprehensive plan of behavior changes, diet, exercise, vitamins,
OTC meds, and even prescriptions, as necessary.”
Marisa came back ten days later to go over her labs. “I have bad news and
good news. It’s not just one thing; you have twelve different findings that are
abnormal. I break them down into ‘things you’re missing that you need to get’,
‘things you got that you need to get rid of’, and ‘hormone balancing’ [5].”
“What’s the good news?”
“They’re all treatable! Instead of using the same cookie-cutter approach to
everybody, I can tailor my therapies directly to the specific problems you have.”
“Like what?”
“For starters, you might not be anemic, but you’re really low in iron [6].”
“I can’t take iron pills. I’m nauseated already.”
“That’s okay; we can give iron to you by injection here in the office. Quite a
few of my patients periodically tank up their body’s iron stores that way.”
“What else did you find?
“When I see a slightly low WBC (white cell) count; that’s a sign of excessive
stress [7]. Your coffee isn’t the culprit, but it’s your half-fast way of selfmedicating
this problem. Herbs and other supplements that support your
adrenals are a better answer.”
“And you said something about hormones?”
“Thyroid hormones (not just T4 but also T3), are necessary to keep your hair
in anagen, or the ‘growing phase’, as well as to keep its coloring [8]. Without
thyroid your hair loses its luster and becomes dull, dry, and grey. Your TSH
might be normal, but you tested positive for Reverse T3 and Hashimoto’s
Thyroiditis, both of which cause thyroid hormone resistance [9].”
Over the next 40 minutes, I went over the rest of Marisa’s labs and the
game plan to regrow her hair and rejuvenate her body. “You’ll first notice less
shedding, but since hair grows only at a rate of one-half inch per month, it
might take a year and a half to regain the length you used to have [10].”
Six months later, Marisa gave me an update. “Dr. Woliner, my hairdresser
thinks St. Agnes answered my prayers, but between you and me, I think you had
something to do with it too.”
Without thyroid your hair loses
its luster and becomes dull,
dry, and grey.
“
References:
[1] Reid EE, et al. Clinical severity does not reliably predict quality of life in
women with alopecia areata, telogen effluvium, or androgenic alopecia.
J Am Acad Dermatol. 2011 May 24.
[2] Trüeb RM. St. Agnes of Rome: patron saint for women with hair loss? Dermatology.
2009; 219(2):97-8.
[3] Trozak DJ. Letter: Hair loss after therapy with chorionic gonadotropin.
Arch Dermatol. 1976 Jul; 112(7):1035.
[4] Mirmirani P. Hormonal changes in menopause: do they contribute to a
‘midlife hair crisis’ in women? Br J Dermatol. 2011 Dec; 165 Suppl 3:7-11.
[5] Baker SM. What is Biomedical? Presentation to the National Autism Association.
April 7, 2011.
[6] Deloche C, et al. Low iron stores: a risk factor for excessive hair loss in
non-menopausal women. Eur J Dermatol. 2007 Nov-Dec; 17(6):507-12.
Epub 2007 Oct 19.
[7] Dhabhar FS, et al. Diurnal and acute stress-induced changes in distribution
of peripheral blood leukocyte subpopulations. Brain Behav Immun.
1994 Mar; 8(1):66-79.
[8] Van Beek N, et al. Thyroid hormones directly alter human hair follicle
functions: anagen prolongation and stimulation of both hair matrix keratinocyte
proliferation and hair pigmentation. J Clin Endocrinol Metab.
2008 Nov; 93(11):4381-8.
[9] Guran T, et al. Alopecia: association with resistance to thyroid hormones.
J Pediatr Endocrinol Metab. 2009 Nov; 22(11):1075-81.
[10] Sinclair R, et al. Hair loss in women: medical and cosmetic
approaches to increase scalp hair fullness. Br J Dermatol.
2011 Dec; 165: Suppl 3:12-8.
Dr. Kenneth Woliner is a board-certified family physician in
private practice in Boca Raton. He can be reached at 9325
Glades Road, #104, Boca Raton, FL, 33434 • 561-314-0950
knw6@cornell.edu; www.holisticfamilymed.com