Alopecia has a significant effect on the quality of life. There are three general types of non-cicatricial alopecia: androgenetic alopecia, telogen effluvium, and alopecia areata. Androgenetic alopecia is the most common type of hair loss triggered by the effect of dihydrotestosterone on hair follicles, leading to failure of hair growth.
Telogen effluvium occurs when many hair follicles enter a resting phase of the hair growth cycle affecting women aged 30-60 years, resulting in hair loss without new hair growing. Micronutrients (minerals and vitamins) and hormones, namely ferritin, folate, zinc, thyroid hormone, vitamin B12, and vitamin D, are considered the main components in hair follicle growth.
Diffuse hair loss is known to be one of the symptoms associated with iron deficiency anemia. It has been noted that psychological stress and iron deficiency are the most common causative factors for telogen effluvium. The serum ferritin levels in the telogen effluvium patients were significantly lower than in the control group and inversely related to disease severity. Thyroid dysfunction was evaluated in alopecia areata patients, and it was found that thyroid antibodies were elevated in women with progressive disease duration. Serum zinc levels were also significantly lower in patients with hair loss compared to the healthy control group.
In male patients with androgenetic alopecia, zinc and copper levels were significantly lower than in the healthy control group. In patients with alopecia areata and vitiligo, serum zinc levels were significantly lower than in the healthy control group. A study on vitamin B12 also concluded that low vitamin B12 levels might be the leading cause of diffuse hair loss in older people. A significant correlation was found between vitamin D deficiency and the early onset of androgenetic alopecia. Vitamin D affects normal hair follicles, increases immune response, and inhibits cell proliferation in alopecia areata (ages 25-45).
A retrospective study examined the relationship between levels of ferritin, hemoglobin (Hb), stimulating thyroid hormone (TSH), zinc, vitamin B12, and vitamin D with chronic diffuse hair loss in 300 women (ages 17-61 years) and 70 healthy female controls ( ages 20-57 years). Hair loss patients (n = 300) were divided into three groups based on age; 17-32 years (n = 166), 33-48 years (n = 73), and 49-61 years (n = 61). They classified the control group according to age, similar to the hair loss patient group. The normal ranges of the parameters studied were as follows: ferritin (10-120 ng / ml), zinc (90-154 µg / dl), TSH (0.4–4.0 mIU / l), Hb (12-15, 5g / l), vitamin B12 (200–900 ng / ml), vitamin D (20-50 ng / ml).
From these studies, levels of ferritin, TSH, and Hb were found to be significantly reduced (p <0.05) in female patients aged 17 to 32 years relative to the control group. In women aged 33-48 years, TSH was found to be significantly decreased (p <0.05), along with a significant decrease in vitamin B12. Substantial reductions in TSH (p <0.05), vitamin B12 (P <0.05), and vitamin D (p <0.05) were observed in the older age group (49–61 years) relative to the control group. This study showed an association between ferritin, TSH, Hb, vitamin B12, and vitamin D levels among women in different age groups and hair loss.
Because many women with hyperandrogenism also experience hair loss, a team of experts from the Androgen Excess and PCOS (AE-PCOS) Society also recommends taking androgen hormone measurements, including total testosterone and free testosterone measurements for hair loss. In addition, measurement of serum levels of iron, vitamin D, zinc, thyroid profile, and prolactin may be helpful to exclude and treat other conditions that may be contributing to hair loss.
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Reference:
- Farah HS, Hajleh MNA, Shalan N, Assi GA, Alqaisi T. The association between the levels of Ferritin, TSH, Zinc, Hb, vitamin B12, vitamin D and the hair loss among different age groups of women: A retrospective study. IJPR. 2021; 13 (2): 143-8.
- Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, et al. Female pattern hair loss and androgen excess: A report from the multidisciplinary androgen excess and PCOS committee. J Clin Endocrinol Metab. 2019; 104 (7): 2875–91.
