Hair Loss in Women

About the author

Dr. Yvo Sijpkens is an internist at Haaglanden Medical Center in The Hague and medical advisor to Stichting Je Leefstijl Als Medicijn. He specializes in lifestyle medicine and its application to conditions such as diabetes and metabolic dysfunction.

Read more about Yvo Sijpkens →

In brief

• Hair loss in women is often treatable
• Restoring iron status, vitamin D, insulin sensitivity, and stress balance forms the foundation
• Therapeutic carbohydrate restriction, nutritional optimization, and lifestyle interventions are effective first steps
• New hair growth is visible after 3-6 months

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1. Physiology of optimal hair growth

Hair cycle

Hair grows in cycles. Understanding these cycles helps to understand and treat hair loss:

Phase	Duration	Characteristics
Anagen phase (growth phase)	2-6 years	85-90% of hair is in this phase
Catagen phase (transition phase)	~2 weeks	Hair follicle temporarily stops growing
Telogen phase (rest and shedding phase)	2-4 months	Hair falls out, new cycle starts

The anagen phase requires: proteins, iron, vitamin D, zinc, B12, healthy fatty acids, and a stable metabolic status.

Essential conditions for hair growth

Factor	Role
Metabolic energy	Glucose, amino acids, fatty acids, micronutrients. Deficiencies shorten the growth phase.
Hormonal balance	Estrogen extends the growth phase, androgens (DHT) shorten it. Thyroid hormones regulate hair growth.
Immunological rest	Inflammation, autoimmune processes, and elevated cortisol accelerate shedding.

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2. Diagnostics: metabolic and hormonal focus

With hair loss, blood tests are essential to identify underlying causes:

Parameter	Target value	Meaning
Ferritin (iron storage)	>70 ug/L (minimum >50 ug/L)	Low ferritin is a common cause
TSH, free T4	Within reference	Hypothyroidism → diffuse hair loss
Vitamin D	>80 nmol/L	Deficiency affects hair follicles
HbA1c & fasting glucose	HbA1c below 42 mmol/mol	HbA1c above 42 indicates insulin resistance
Vitamin B12 & zinc	Within reference	Needed for keratin production
Androgens	Individual	Free testosterone, DHEAS with suspected PCOS, hirsutism, AGA

Ferritin and hair growth

For optimal hair growth, a ferritin of at least 70 ug/L is needed. This is higher than the lower limit of many laboratories. Discuss this with your doctor.

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3. Differential diagnosis and causes

Telogen effluvium (TE)

Most common form of hair loss in women.

Causes:

• Iron or vitamin D deficiency
• Infection (e.g., COVID-19)
• Stress (physical or emotional)
• Crash diets
• Surgery
• Medication

Recovery: 3-6 months after treating the underlying cause.

Androgenetic alopecia (AGA)

Genetic sensitivity to DHT (dihydrotestosterone). Worsens with:

• Insulin resistance
• PCOS

Lifestyle intervention helps by lowering insulin and androgens.

Alopecia areata (AA)

Autoimmune condition with bald patches. Associated with:

• Inflammation
• Stress
• Episodic course

When to refer

Refer for: bald patches (suspected alopecia areata), suspected hyperandrogenism/PCOS, or severe/progressive course.

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4. Therapeutic approach

A. Nutrition: therapeutic carbohydrate restriction (TKB)

A carbohydrate-conscious eating pattern can help treat hair loss by:

• Stabilizing glucose
• Lowering insulin
• Reducing inflammation

Practical:

• Avoid fast carbohydrates and sugars
• Focus on green vegetables, high-quality proteins, healthy fats
• With PCOS/AGA: TKB normalizes androgens

B. Supplements for deficiencies

Supplementation only with proven deficiencies:

Supplement	Dosage/goal	Note
Iron	Ferrous fumarate or ferrous glycinate, 3-6 months	Aim for ferritin >70 ug/L, combine with vitamin C
Vitamin D	Supplement to >80 nmol/L	Check after 3 months
Zinc & biotin	Only with deficiencies	Don’t supplement by default
Magnesium	Bisglycinate or malate	Supports relaxation

Iron absorption

Take iron supplements with vitamin C (e.g., orange juice) for better absorption. Avoid taking with coffee, tea, or dairy.

C. Lifestyle: exercise, sleep, stress

Factor	Effect	Approach
Exercise	Improves insulin sensitivity, reduces inflammation	Daily movement
Sleep	Sleep deprivation raises cortisol	Optimize sleep hygiene
Stress management	Chronic stress shortens growth phase, causes TE	Breathing, relaxation

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5. Follow-up and referral

Evaluation

• Check ferritin after 3 months of supplementation
• New hair growth visible after 3-6 months
• Communicate this beforehand to set realistic expectations

Refer for

• Bald patches (suspected alopecia areata)
• Suspected hyperandrogenism or PCOS
• Severe or progressive course despite treatment

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Key message

Summary

Hair loss in women is often treatable. The foundation is:

1. Restore iron status (ferritin >70 ug/L)
2. Optimize vitamin D (>80 nmol/L)
3. Improve insulin sensitivity (carbohydrate restriction)
4. Restore stress balance (sleep, relaxation)

Therapeutic carbohydrate restriction, nutritional optimization, and lifestyle interventions are effective and safe first steps.

Veelgestelde vragen

What are the most common causes of hair loss in women?

The most common cause is telogen effluvium (TE), caused by iron or vitamin D deficiency, infection, stress, crash diets, surgery, or medication. Other causes are androgenetic alopecia (AGA, genetic) and alopecia areata (autoimmune).

Which blood values should be checked for hair loss?

Important are: ferritin (iron storage, aim for >70 ug/L), thyroid function (TSH, free T4), vitamin D (aim for >80 nmol/L), HbA1c and fasting glucose, vitamin B12, zinc, and with suspected PCOS also androgens (free testosterone, DHEAS).

How long does it take for hair loss to recover?

With telogen effluvium, recovery is expected after 3-6 months. New hair growth becomes visible after 3-6 months of treatment. It's important to communicate this beforehand so expectations are realistic.

Does nutrition help with hair loss?

Yes, therapeutic carbohydrate restriction (TKB) stabilizes glucose, lowers insulin, and reduces inflammation. Focus on green vegetables, high-quality proteins, and healthy fats. With PCOS/AGA, TKB helps normalize androgens.

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