Your Hair Loss Isn’t About Your Shampoo: What Your Body Is Actually Telling You

Your hair is thinning. Maybe it’s collecting in the shower drain, or your ponytail feels thinner than it used to. You’ve tried new shampoos, expensive serums, biotin supplements. Nothing seems to work. I’ve been there and understand this isn’t a problem of vanity, hair loss is a big deal emotionally and it’s a big deal in terms of something being off potentially in your physiology.

Here’s what nobody is telling you: your hair loss isn’t a hair problem, it’s a metabolic problem masquerading as a cosmetic one.

The Statistics Nobody Wants to Talk About

Thirty percent of women in their thirties experience hair loss. By age fifty, that number climbs to fifty percent. Half of all women will watch their hair thin, their volume disappear, their texture change.

Most will be told it’s stress. Or genetics. Or aging. Most will be dismissed.

What’s Actually Happening

Hair loss in women has three primary drivers, and your doctor probably isn’t testing for any of them:

Low iron stores. Not anemia. Low ferritin. The most sensitive marker of iron status, and the one most physicians ignore. When ferritin drops below 70 ng/mL, your hair follicles start to suffer. The standard lab range calls anything above 15 normal. That range was not designed with optimal female physiology in mind.

Insulin resistance. This develops years before your fasting glucose becomes abnormal. By the time your glucose is elevated, you’ve already been insulin resistant for potentially a decade. And during that time, your hair has been thinning because elevated insulin drives androgen production, which shrinks hair follicles.

Hormonal fluctuations. Estradiol supports the growth phase of hair. Progesterone balances the effects of testosterone. Thyroid hormones regulate the entire hair growth cycle. Cortisol, when chronically elevated, disrupts everything. Standard hormone panels miss the nuance. They test for disease, not optimization.

Why Standard Testing Fails Women

Your doctor runs a CBC and tells you your hemoglobin is fine, so you’re not anemic. That’s not the same as having optimal iron stores for hair growth.

Your fasting glucose comes back at 95 mg/dL and you’re told everything looks good. But your fasting insulin, which wasn’t tested, is sitting at 12 μIU/mL, indicating early insulin resistance.

Your TSH is 2.5 mIU/L, within normal range. But your free T3 is low, your reverse T3 is elevated, and your thyroid antibodies were never checked. You’re told your thyroid is fine when it’s compensating, not thriving.

This is the gap between normal and optimal. Normal keeps you out of the emergency room. Optimal allows your body to function at its highest capacity.

What Your Hair Is Actually Telling You

Hair doesn’t lie. It reflects the internal state of your hormones with precision.

Thinning at the crown? Check your ferritin and complete iron panel.

Shedding in clumps? Check thyroid antibodies, free T3, reverse T3.

Changes in texture, going from thick to fine? Check estradiol, progesterone, and testosterone.

Increased facial hair alongside scalp thinning? Check fasting insulin, total and free testosterone, DHEA-S.

Your hair is not betraying you. It’s communicating. The question is whether anyone is listening.

The Root Cause Approach

Addressing hair loss requires treating the body as an integrated system, not isolating symptoms.

Optimize iron. Eat red meat three times per week. Grass-fed, grass-finished beef. Wild game like bison, venison, elk. Pair it with vitamin C for enhanced absorption. If you’re plant-based, liquid iron supplements like Floradix can work, but absorption is lower. Target ferritin above 70 ng/mL, ideally closer to 100 ng/mL.

Address insulin resistance early. Strength training should comprise two-thirds of your exercise protocol. Resistance training improves insulin sensitivity more effectively than cardio alone. Reduce processed carbohydrates. Prioritize protein and fiber at every meal. Consider a continuous glucose monitor to see how your body responds to different foods in real time.

Support hormonal balance. If you’re perimenopausal, declining estradiol and progesterone are affecting your hair. Bioidentical hormone therapy, when appropriate, can restore what’s been lost. If your thyroid is suboptimal, treating it properly changes everything. This means looking beyond TSH and optimizing free T3.

Manage cortisol. Chronic stress elevates cortisol, which disrupts the hair growth cycle and contributes to telogen effluvium, a condition where hair prematurely enters the shedding phase. Stress management isn’t optional. It’s medical intervention.

Get the right testing. The tests you need: complete blood count, ferritin, thyroid panel including TSH, free T3, reverse T3, and thyroid antibodies. Fasting insulin and glucose. Total and free testosterone. Sex hormone binding globulin. Cortisol. Antinuclear antibody if autoimmunity is suspected.

These tests give you data. Data tells you what’s actually happening inside your body. Without it, you’re guessing.

A Case From My Files

Joan came to me at forty-four. Her sleep had deteriorated over the past year. She was exhausted, irritable, barely interested in sex. Her periods were heavy, bordering on hemorrhagic. Her hair was falling out.

Her ferritin was low because of the blood loss every month. Her progesterone had tanked. She wasn’t sleeping because progesterone is somnolent, and without it, deep sleep becomes nearly impossible.

I prescribed micronized progesterone, 100 mg nightly from Day 12 through Day 26 of her cycle. Within days, she was sleeping through the night. Her periods lightened. Her ferritin climbed back to normal. Her hair loss stopped.

This wasn’t a hair problem. It was a hormone problem that showed up in her hair.

Beyond Symptom Management

Minoxidil works. It promotes hair growth. But it doesn’t address why you’re losing hair in the first place. Stop using it, and the hair loss returns.

The same is true for most topical treatments. They manage symptoms without treating root causes.

I’m not opposed to topical therapies. I’ve seen good results with Nutrafol, Hers, and laser therapy. Personally, I recommend Harklinikken for patients who want a comprehensive topical approach. But topicals work best when combined with metabolic and hormonal optimization.

You can’t out-serum insulin resistance. You can’t out-supplement a failing thyroid.

The Bigger Picture

Hair loss is not vanity. It’s a signal that something deeper is off. It’s your body asking for attention, for better data, for precision.

Women are told their hair loss is cosmetic. That it’s part of aging. That they should accept it. But accepting it without investigating why is a failure of medicine, not a failure of your body.

Your hair deserves better. You deserve better.

Ready to take action?

I’ve created a complete guide on hair loss assessment and treatment for women. It includes the exact blood tests to order, optimal ranges for female physiology, treatment protocols, and what to do with your results.

Get the guide here: https://saraszalmd.com/hair/

References

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Kil, Moon Soo, et al. “Analysis of Serum Zinc and Copper Concentrations in Hair Loss.” Annals of Dermatology 25, no. 4 (November 2013): 405–9. https://doi.org/10.5021/ad.2013.25.4.405.

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Sharma, Anubha, et al. “Hair Loss in Women: An Update.” Journal of the American Academy of Dermatology 87, no. 6 (December 2022): 1271–84. https://doi.org/10.1016/j.jaad.2022.06.1171.

Trost, Laura B., et al. “The Diagnosis and Treatment of Iron Deficiency and Its Potential Relationship to Hair Loss.” Journal of the American Academy of Dermatology 54, no. 5 (May 2006): 824–44. https://doi.org/10.1016/j.jaad.2005.11.1104.

Urysiak-Czubatka, Izabela, et al. “Assessment of the Usefulness of Dihydrotestosterone in the Diagnostics of Patients with Androgenetic Alopecia.” Advances in Dermatology and Allergology 31, no. 4 (August 2014): 207–15. https://doi.org/10.5114/pdia.2014.43183.

Woessner, Anne Marie, et al. “Female Pattern Hair Loss and Metabolic Syndrome: A Retrospective Cohort Study.” International Journal of Women’s Dermatology 8, no. 2 (June 2022): e014. https://doi.org/10.1097/JW9.0000000000000014.

Zeng, Rui, et al. “Insulin Resistance and Its Relationship with Androgenetic Alopecia in Young Men.” Dermatology 238, no. 3 (2022): 437–43. https://doi.org/10.1159/000518968.