Diabetes/Insulin

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How does it affect my hair?

The increasing number of women experiencing hair loss has become a growing concern for me as a professional. When treating these issues as a specialist, I was never convinced that it was an inherited condition.

Almost two decades in the field of trichology, I have come across many practitioners who still regard all hair loss issues as a single issue. At the very least, its usually divided into two categories: alopecia and genetic hair loss.

This approach is not always effective due to the complexity of the body’s complex mechanisms. In fact, it is very common for practitioners to mistakenly believe that a single treatment will cure all hair loss issues. Recently, a group of entrepreneurs started marketing a line of pills that combine the two most common blood pressure drugs: Minoxidil and Spironolactone.

The increasing number of women experiencing hair loss has become a growing concern for me as a professional. When I started treating these issues as a specialist, I was never convinced that it was an inherited condition.

Over the years, I have come across many practitioners who still regard all hair loss issues as a single problem. At the very least, it’s usually divided into two categories: alopecia and genetic hair loss.

This approach is not always effective due to the complexity of the body’s complex mechanisms. The body is constantly changing and adapting to its needs. This is why it is very common for practitioners to mistakenly believe that a single treatment will cure all hair loss issues. Recently, a group of entrepreneurs started marketing a line of pills that combine the two most common blood pressure drugs: Minoxidil and Spironolactone.

The Australian Therapeutic Goods Administration (TGA) defines the use of certain medicines, such as Minoxidil and Spironolactone, outside of their intended use as “Off-label.” This means that the doctor is only authorized to use the medicine if he or she has informed the patient.

Informed consent is a requirement that patients be informed about the risks and benefits of taking an off-label treatment compared to the other available treatments. It should be noted that women do not suffer from an anti-androgen deficiency. They may experience hormonal-metabolic-autoimmune imbalance or nutritional deficiency.

Following the recommendations of leading medical researchers, I believed that most hair loss cases in women are caused by a complex hormonal-metabolic disturbance. This issue, which can be triggered by a combination of factors, can lead to elevated Testosterone levels.

The pathology results of my patients’ cases were the basis of my “acquired pattern hair loss” diagnosis. It is now widely accepted that obesity and hyperinsulinaemia are also contributing factors to the increasing number of hair loss cases.

This condition can lead to various health problems, such as diabetes, high blood pressure, heart disease, and orthopaedic issues. One of the most insidious effects of this issue is elevated insulin levels.

High blood glucose and insulin levels are the main symptoms of a type of metabolic syndrome. This condition can lead to the loss of body cells’ ability to respond to Insulin, which is required for the production of energy.

The stress response can also affect the activity of insulin. For instance, prolonged exposure to cortisol can trigger functional insulin resistance. Another issue that can cause this issue is the disruption of the effects of synthetic hormone therapy.

Although it’s not yet clear if obesity and hyperinsulinaemia are related, it’s widely believed that high sugar diets and refined carbohydrates are the causes of both conditions. Since the 1970s, the rise of obesity has been attributed to the introduction of Fructose, which is a cheap and sweet ingredient used in soft drinks and refined food products.

Studies in the US have shown that Fructose acts as a suppressive agent on the action of Leptin, which results in the immediate storage of fat instead of being utilized as energy for the body. In younger women, hyperinsulinaemia is also associated with a higher risk of developing polycystic ovarian syndrome.

A study conducted in 1995 revealed that obese women with polycystic ovarian syndrome (PCOS) had similar levels of Testosterone compared to those with normal levels. The results of the study showed that the higher levels of Free Testosterone, as well as the thinning of the scalp, could lead to hirsuteness and hair loss. The effects of hyperinsulinaemia and obesity on the body’s sex hormone binding protein, known as SHBG, were also studied.

The effects of SHBG on the availability of Oestrogen and Testosterone can be controlled by manipulating its levels. This substance is produced in the liver and is a 2nd tier carrier for both Testosterone and Oestrogen.

The levels of SHBG and the hormones that it carries are influenced by various factors. Some of these include the diet, lifestyle, age, sexual and physical activity, and hormonal therapy. These factors can affect the availability of Oestrogen-Testosterone.

Overuse of synthetic oestrogens, which are found in various HRT and contraceptive products, can lead to elevated SHBG. Other factors such as liver disease and diabetes can also affect the development of this condition.

When SHBG levels are elevated during pregnancy, it can trigger low thyroid function. This condition is caused by how the SHBG partially binds to the thyroid hormone T4. Some of the factors that can increase this condition include the age of the thyroid hormone, the consumption of high fibre, and the low protein diet. On the other hand, those who are experiencing a period of menopausal transition may experience low P4 levels.

The effects of insulin on the production and control of Testosterone and other hormones can be studied. However, the physiology of this process is not explained in this article.

The interested reader should refer to Peter Baratosy’s excellent book entitled “You and Your Hormones.” The precise way and where TT is produced and stimulated varies between men and women. In females, about 50% of the substance is produced by the Adrenal glands, while the rest is taken up by the ovaries.

In females, the production of adrenal androgens is not regulated by the Luteinizing and Follicular Stimulating Hormones. Instead, they are produced by the Follicular Stimulating Hormone (FSH) and the Luteinizing Hormone (LH). In most cases, the aromatase activity is converted back to Oestrogen after the release of FSH and LH. It is important to note that in insulin-sensitive individuals, the high blood insulin concentrations do not activate aromatase. This is because hyperinsulinemia, which is found in PCOS, can suppress aromatase activity.

In hyperinsulinaemia, the levels of insulin resistance are varying. The target to minimize inflammation is around 6-7 mU/L. This condition is caused by how the negative feedback loop of the brain is disrupted, which is related to the activity of FSH and LH. In response to low Oestrogen levels, FSH stimulates the production of ovarian TT. However, the aromatase activity is not activated, and the levels of TT continue to rise.

Androgenic follicle miniaturization and the inability to aromatase back to Oestrogen can result in the development of facial and body hair loss. This condition can also affect the skin’s pores.

One of the most important factors that can contribute to the development of this condition is the level of Testosterone-DHT ratio. This is because the amount of this substance that is produced by the hair follicles and the male reproductive and adrenal glands is greater than that of total Testosterone.

Although these two hormones have potential problems, they play a vital role in the development of sex-specific characteristics for men. It’s important for males to maintain their levels of aromatase activity and retain their TT.

Hair Loss after Covid19

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There are a variety of symptoms and signs that can persist or develop long after the SARS-COV-2 virus has left the body. When symptoms or complications are present more than 4 weeks after the onset of symptoms of COVID 19 this is revered to as “Post-acute COVID 19 syndrome.” Many people who have such long lasting symptoms after COVID 19 refer to themselves as “long haulers.” Other names such as “long COVID” and post-acute COVID syndrome (PACS) have been applied to this situation as well.

It is common to have symptoms in the weeks and months after being diagnosed with COVID 19. Carfi and colleagues showed in their publication in JAMA that most people still have one or more symptoms at day 60 of recovery. specifically, the authors of this study showed that 87.4 % of patients had at least one symptom and fatigue and shortness of breath were the top symptoms. 

Patients with post-acute COVID 19 syndrome can experience a wide array of persisting symptoms. These include fatigue, chest pain, shortness of breath, heart rhythm problems, brain fog, headaches, poor sleep, loss of smell, anxiety, depression, joint pains. Quality of life is reduced in many people even after the infection has cleared the body. Patients with post-acute COVID 19 syndrome may have lung issues, kidney issues, hematologic issues, blood clotting issues, cardiovascular issues, endocrine, psychiatric and neurological issues and therefore may be referred to a variety of different medical specialists. 

Hair Loss in COVID Survivors

Hair loss is one of the most common dermatologic issues that develops in patients who recover from COVID 19. It has been estimated that about 1 in 5 patients (20 %) of hospitalized who survive COVID 19 will have hair loss. We don’t know exactly what the numbers are patients with milder forms but it could be slightly less. Hair loss typically happens 8-12 weeks after infection and can even happen in those without any symptoms of COVID 19 at all. Let’s take a look at some of the important studies. 

The Huang Study, 2021

Huang and colleagues studied patients with confirmed COVID-19 who had been discharged from a hospital in China between Jan 7, 2020, and May 29, 2020. In total, 1733 patients completed questionnaires about their health status after leaving the hospital. Hair loss was reported in approximately 22 % of patients. Interestingly, the incidence of hair loss did not seem to differ in patients with greater degrees of illness compared to patients with less degrees of illness. For example, 22- 24 % of patients who required oxygen or mechanical ventilation during their hospital stay had hair loss compared to 22 % of patients that did not require oxygen.

The Garrigues Study, 2020

Garrigues and colleagues from Paris France examined health status of patients with COVID 19 after being discharged from hospital. They included 120 patients in their study, of which 96 were admitted to a hospital ward and 24 were more ill and needed to be admitted to the intensive care unit. Hair loss was reported in 20 % of patients overall. Further analysis showed that hair loss occurred in 25 % of ICU patients and 18.8 % of hospital ward patients. In this small study, these differences did not meet statistical significance indicating that hair loss is not seem to matter much according to how ill the patient was. 

The Akama-Garren Study, 2021

Akama-Garren and colleagues used the electronic health records from Mayo Clinic to examine whether certain terms were more common in patients before they were diagnosed with COVID 19 or more common after they were diagnosed with COVID 19. The authors showed that the term “hair loss” was much more commonly found in charts in patients after diagnosis with COVID 19 than before COVID 19 (OR 2.44, 95% CI 2.15-2.76, p=8.45×10-3). Other terms that also appeared more frequently were those related to kidney disease and coagulopathies. Hair loss seemed to be much more of a concern unique to females in this study rather than males. In addition, concerned about hair loss spiked dramatically at around day 100 after a diagnosis of COVID 19 which is what we would expect in a telogen effluvium.

The Miyazato Study, 2020

Miyazato and colleagues from Japan interviewed patients following discharge from hospital. 58 patients were asked about hair loss. Fourteen (24.1%) of 58 patients reported hair loss. . Of the 14 patients, 5 were women and 9 were men. Hair loss developed approximately 58.6 days ( 8 weeks) on average after symptoms of COVID 19 firsts began. Of the 14 patients, there were only 5 patients who had been studied long enough to get a good sense of how long hair loss lasted. Nevertheless, of these 5 patients, hair loss lasted on average 76.4 days ( 10 weeks). 

The Morenes-Arrones Study, 2020

I’ve talked about the Morenes-Arrones study before This was a study of 214 patients with proven SarsCOV2 infection. 13. 6% were asymptomatic, 77% needed medical treatment and 21 % needed hospitalization. Hair shedding occurred after an average of 57.1 days ( 8 weeks) similar to the results from the Miyazato study reviewed above. 

Conclusion and Summary 

Thanks again for the great question. If you were hospitalized for your COVID 19 infection, we can say that there is approximately a 20 % chance you’ll get hair loss. we don’t know with great confidence that chances of hair loss in patients with more mild symptoms of COVID19 but there is a chance that the chances of hair loss are under 20 %. The only good data we have so far is in patients who were released hospitalized. 

Overall, the data together indicate that there is a much better chance that you won’t get hair loss than you will get hair loss. But if you do get hair loss, it will occur most likely around week 8 to week 12 after your COVID symptoms first started. Shedding will last about 10 weeks before the stopping. Complete hair regrowth would be expected in a large proportion of patients. .