Discover why hair loss happens and how functional medicine identifies underlying health factors—from hormones to gut balance.
Table of Contents
Add a header to begin generating the table of contents
Scroll to Top
By Lynda Sherland, CRNP, FNP-C, IFMCP
Dr. Jennifer Patterson, DO, MMH, CHt, IFMCP
Dr. Georgia Tetlow, MD, ABOIM, ABPMR, IFMCP, Founder & CEO, Philadelphia Integrative Medicine
Medically Reviewed by Dr. Georgia Tetlow on July 28, 2026
Finding a clump of hair in your brush, seeing strands collect in the shower drain, or noticing a widening part in the mirror can be an alarming experience. For many people, hair is closely tied to identity, confidence, and how they see themselves—and when it begins to thin, it can feel deeply personal.
The standard approach to hair loss often focuses on common explanations such as genetics, aging, or stress. While these factors can play a role, they may not always tell the complete story.
At Philadelphia Integrative Medicine, we look deeper. Hair is often a reflection of what is happening throughout the body. When the body experiences changes in hormones, nutrient availability, inflammation, metabolism, sleep, or stress physiology, hair follicles may be among the first places those shifts become visible.
Hair loss is often a symptom—not the entire story. Your hair may be one of the first places your body tells you that it needs support.
When the body experiences ongoing physiological strain—whether from nutrient insufficiency, hormonal transitions, chronic inflammation, disrupted sleep, metabolic changes, or prolonged stress—processes involved in growth and repair may be affected. Because hair growth requires significant energy, nutrients, and healthy signaling pathways, these changes can influence the hair growth cycle.
How Much Hair Shedding is Too Much?
Everyone loses hair daily as part of the normal hair growth cycle. Hair follicles naturally move through phases of growth, transition, rest, and shedding.
However, noticeable increases in shedding, visible thinning, patchy loss, or changes in hair density may indicate that further evaluation is needed.
A commonly used guideline is shedding beyond approximately 100–125 hairs per day, especially when accompanied by visible thinning.
The pattern of hair loss often provides important clues.
Androgenetic Alopecia (Pattern Hair Loss)
This is the most common form of hair loss in both men and women. It typically develops gradually and may appear as:
- A receding hairline or crown thinning in men
- A widening part or diffuse thinning across the top of the scalp in women
Genetics play an important role, but follicle sensitivity to hormones, including dihydrotestosterone (DHT), can also influence how hair follicles respond over time.
Telogen Effluvium (Diffuse Excessive Shedding)
Telogen effluvium occurs when a larger-than-normal number of hair follicles prematurely enter the resting (telogen) phase of the growth cycle.
Because shedding often occurs two to three months after a trigger, many people do not immediately connect current hair loss with a previous event (Malkud, 2015).
Common triggers may include:
- Significant physical or emotional stress
- Childbirth and postpartum hormone changes
- Major surgery, illness, or high fever
- Rapid weight loss or restrictive dieting
- Changes in birth control or hormone therapy
Alopecia Areata (Autoimmune Patchy Hair Loss)
Alopecia areata occurs when the immune system mistakenly targets hair follicles, causing distinct round or patchy areas of hair loss.
Because immune-related hair loss may involve broader systemic factors, understanding the contributing factors behind immune imbalance can be an important part of evaluation.
Recognizing your pattern of hair loss is an important first step. However, topical treatments and cosmetic solutions often focus only on the visible symptom.
A root-cause approach asks a different question:
Why has your body changed the way it supports hair growth in the first place?
The Myth of “It’s Just Genetics” or “It’s Just Aging”
Genetics and aging influence hair health—but they are rarely the only factors involved.
Genetics may influence susceptibility, while internal factors such as hormonal changes, nutrient status, inflammation, metabolic health, and stress physiology may influence when and how hair changes appear.
This applies to both women and men.
For many women, hair changes become noticeable during hormonal transitions such as postpartum hair loss, perimenopause-related thinning, and menopause-related changes. These shifts can influence hormone balance, nutrient needs, and the hair growth cycle. Men experiencing early thinning—especially in their 20s and 30s—may also seek a broader evaluation of factors that influence hair health before deciding on long-term treatment approaches.
The same symptom—hair loss—can have very different underlying contributors.
That is why understanding the full picture matters.
Looking Beyond the Scalp: 6 Interconnected Systems That Influence Hair Health
Healthy hair growth depends on an intricate network of systems working together. When one or more of these systems become disrupted, hair follicles may respond by slowing growth, producing finer strands, or entering shedding phases earlier than expected.
At Philadelphia Integrative Medicine, we look beyond the scalp to understand the internal factors that may influence the hair growth cycle.
| Body System | Areas We May Evaluate | How It Relates to Hair Health |
| 1. Hormones & HPA-Thyroid-Gonadal Axis | Thyroid markers such as TSH, Free T3, Free T4, thyroid antibodies, Reverse T3 and additional thyroid markers when clinically appropriate; sex hormone patterns and DHEA-S when indicated | Hormones act as communication signals throughout the body and influence hair follicle activity, growth cycles, and how follicles respond to internal changes. |
| 2. Nutrient Stores & Cellular Building Blocks | Ferritin (iron stores), RBC Zinc, B12 markers including MMA (methylmalonic acid), Vitamin D, and other nutritional markers when clinically appropriate | Hair follicles are highly metabolically active and require adequate nutrients to support protein production, cell division, and healthy growth cycles. |
| 3. Gut Health & Nutrient Absorption | Digestive function, microbiome balance, inflammation markers, and specialized stool testing such as the RSM Total GI Stool Test (top GI stool study, not widely known, adopted or expertly interpreted) when appropriate | Proper digestion and absorption help ensure the body receives and utilizes the nutrients required for healthy hair production. |
| 4. Immune Function & Inflammation | Inflammatory markers, thyroid antibodies, autoimmune-related markers, and other immune factors based on individual symptoms | Immune imbalance and chronic inflammation may influence follicle function and contribute to certain forms of hair loss. |
| 5. Stress Physiology & Nervous System Balance | Sleep patterns, stress response, lifestyle factors, cortisol patterns when clinically appropriate, and nervous system regulation | Physical and emotional stress can influence hormone signaling, recovery processes, and the timing of shedding cycles. |
| 6. Metabolic Health & Cellular Energy | Blood sugar regulation, metabolic markers, circulation factors, and oxidative stress markers when clinically appropriate | Hair growth requires significant cellular energy, nutrient delivery, and metabolic support to maintain healthy follicle function. |
Understanding the 6 Systems
1. Hormones & Thyroid Function
Hormones act as the body’s communication network, helping regulate metabolism, growth, reproduction, stress response, and tissue repair.
Changes in thyroid function, stress hormones, or sex hormone balance may influence the hair growth cycle.
Many patients are told their thyroid is “normal” because a basic screening marker falls within a standard laboratory range. While routine thyroid testing provides important information, it may not always explain ongoing symptoms such as hair thinning, fatigue, or changes in energy.
Depending on the individual’s symptoms and health history, a more comprehensive evaluation may include additional thyroid markers such as:
-
- TSH
- Free T3
- Free T4
- Reverse T3
- Thyroid antibodies, including TPO antibodies and anti-thyroglobulin antibodies
- Additional thyroid-related markers when clinically appropriate, including Thyroid Stimulating Immunoglobulin or TSI
Thyroid hormone signaling plays an important role in hair follicle biology, including follicle stem cell activity (Contreras-Jurado et al., 2015). A broader evaluation can provide additional context when symptoms continue despite routine testing.
Hormonal transitions can also influence hair health. Changes during perimenopause, menopause, postpartum recovery, PCOS, or age-related hormonal shifts may affect the balance of estrogen, progesterone, and androgens. When appropriate, hormone metabolism testing may provide additional insight into how the body processes these hormones.
2. Cellular Nutrient Stores: Why “Normal” May Not Always Mean Optimal
Hair follicles are among the most metabolically active tissues in the body. Because they require continuous energy and nutrient support to produce new hair strands, even subtle nutritional imbalances may influence the hair growth cycle.
Standard laboratory reference ranges are designed primarily to identify significant deficiency or disease. When evaluating symptoms such as hair thinning or excessive shedding, clinicians may also consider whether nutrient levels are appropriate in the context of the individual’s symptoms, goals, and overall health picture.
| Nutrient | Why It Matters for Hair |
| Ferritin (Iron Stores) | Iron stores support the energy-intensive process of hair follicle growth. Some clinicians evaluating hair shedding consider ferritin levels above approximately 50 ng/mL as part of a broader assessment of iron status and hair health. |
| Zinc | Supports protein synthesis, tissue repair, and healthy follicle function. RBC Zinc may provide additional insight into cellular zinc status. |
| Vitamin B12 / MMA | Methylmalonic acid (MMA) can provide additional information about functional B12 status beyond serum B12 alone. |
| Vitamin D | Plays a role in immune regulation and hair follicle cycling. |
At PIM, we begin with the appropriate level of evaluation for each individual. Foundational markers such as ferritin, zinc, B12 status, and vitamin D are commonly assessed through routine laboratory testing, which may be covered by insurance depending on medical necessity and individual coverage.
3. Gut Health, Microbiome Balance & Nutrient Absorption
You are not only what you eat—you are also what you absorb.
A nutrient-rich diet is one part of supporting healthy hair. Digestive function and nutrient absorption also influence whether the body has access to the building blocks required for hair production.
Digestive factors that may influence nutrient availability include:
- Gut microbiome imbalance
- Digestive dysfunction
- Small intestinal bacterial overgrowth (SIBO)
- Intestinal inflammation
- Challenges with nutrient absorption
Emerging research suggests that changes in gut microbiome balance may influence immune signaling and inflammatory pathways that could affect hair follicle function (Sánchez-Pellicer et al., 2022; Hayashi et al., 2017).
Why Gut Testing Deserves Special Attention at PIM
At Philadelphia Integrative Medicine, we believe the quality and clinical usefulness of testing matter as much as the results themselves. Rather than selecting a testing platform based only on availability, our clinical team spent nearly a year evaluating different functional stool testing platforms, comparing factors such as consistency, depth of information, clinical usefulness and how effectively results could help guide individualized care. This process helped guide our decision to incorporate the RSM Diagnostics Total GI Stool Test in appropriate clinical situations.
This testing may provide insight into areas such as:
- Digestive function
- Microbiome balance
- Intestinal inflammation
- Pancreatic function
- Markers associated with intestinal barrier health
The goal is not simply to collect more data. The goal is to gather meaningful information that can help create a personalized care plan.
4. Immune Function & Inflammation
The immune system plays an important role in maintaining balance throughout the body. When immune regulation becomes disrupted, inflammatory signals may affect multiple tissues—including the scalp and hair follicles.
Factors that may contribute to immune-related hair concerns include:
- Autoimmune conditions such as alopecia areata or Hashimoto’s thyroiditis
- Chronic inflammatory states
- Gut-related immune triggers
- Environmental and lifestyle factors that influence inflammation
A comprehensive evaluation considers the broader immune picture rather than focusing only on the visible symptom.
5. Stress Physiology & Nervous System Balance
Stress is not only an emotional experience—it creates measurable changes throughout the body.
Periods of prolonged physical or emotional stress may influence:
- Cortisol patterns
- Sleep quality
- Blood sugar regulation
- Inflammatory pathways
- The hair growth cycle
This is why some people notice increased shedding several months after a stressful event, illness, major lifestyle change, or period of exhaustion.
6. Metabolic Health & Cellular Energy
Hair growth requires significant cellular energy. Healthy circulation, metabolic balance, and mitochondrial function all contribute to the environment needed for strong hair production.
Factors that may influence hair health include:
- Blood sugar regulation
- Insulin sensitivity
- Oxidative stress
- Nutrient delivery to tissues
Rather than viewing hair loss as an isolated scalp issue, we consider how overall metabolic health may influence follicle function and the body’s ability to support growth and repair.
Standard Labs vs. The PIM Comprehensive Approach
Many patients ask:
“If my annual bloodwork was normal, why am I still losing hair?”
The answer is that standard medical testing is designed primarily to identify disease or significant abnormalities. While these tests are important, they may not always capture the broader patterns that contribute to symptoms.
At Philadelphia Integrative Medicine, our fellowship-trained practitioners combine conventional medical evaluation with a deeper assessment of functional health patterns.
Our team brings more than 95 years of combined clinical experience, along with advanced training through the Institute for Functional Medicine.
The goal is not to replace conventional medicine—it is to expand the evaluation when patients are seeking a more complete understanding of their health.
| Area Evaluated | Standard Evaluation | Expanded Functional Evaluation |
| Thyroid Function | Often begins with basic thyroid screening | Additional thyroid markers may be considered when clinically appropriate |
| Nutrient Status | Primarily identifies significant deficiencies | Evaluates nutrient status alongside symptoms, history, and health goals |
| Hormone Balance | May rely on individual hormone measurements | May explore broader hormone patterns and metabolism when indicated |
| Gut Health & Digestion | Often evaluated through symptoms and standard testing | May include specialized testing to explore digestion, absorption, inflammation, and microbiome balance |
| Overall Goal | Identify disease or major abnormalities | Understand contributing factors and create a personalized care plan |
Understanding the “why” behind hair loss can be the first step toward creating a more targeted approach.
What to Expect: A Personalized Roadmap to Healthier Hair
Many factors that contribute to hair changes may be modifiable. While genetics and age influence hair health, they rarely tell the entire story.
Every person’s experience with hair loss is different. Someone experiencing postpartum shedding may need a different approach than someone dealing with thyroid concerns, nutrient depletion, autoimmune-related hair loss, menopause-related changes, or metabolic concerns.
At PIM, our goal is not to apply a one-size-fits-all solution.
We take time to understand your health history, symptoms, lifestyle, and laboratory findings to identify factors that may be contributing to your hair changes.
Rather than simply asking:
“How do we stop hair loss?”
we ask:
“What does your body need to support healthier hair growth?”
While no healthcare provider can guarantee a specific outcome or timeline, many patients first notice changes such as reduced shedding before seeing visible regrowth.
Because hair grows slowly—typically around half an inch per month—meaningful improvement requires patience, consistency, and addressing contributing factors over time.
Your Personalized Plan May Include:
Targeted Nutrient Support
Hair follicles require a steady supply of nutrients to support growth and repair.
Depending on your individual needs, your plan may focus on:
- Iron and ferritin stores
- Zinc
- Vitamin D
- B vitamins
- Essential fatty acids
- Protein and amino acid intake
Rather than recommending the same supplement for everyone, we use your health history and testing results to determine what support may be appropriate.
Gut Health & Microbiome Support
If testing suggests digestive dysfunction, microbiome imbalance, inflammation, or challenges with nutrient absorption, treatment may focus on improving the internal environment that supports overall health.
This may include:
- Nutrition strategies
- Digestive support
- Targeted supplements
- Lifestyle changes
- Microbiome-focused interventions when appropriate
Supporting gut health is not only about digestion—it may also influence how effectively your body absorbs and utilizes nutrients needed for healthy hair production.
Hormone & Endocrine Support
Hormonal changes are a common concern among people experiencing hair thinning, particularly during:
- Perimenopause
- Menopause
- Postpartum changes
- PCOS
- Thyroid-related concerns
- Age-related hormonal shifts
Depending on your situation, support may include lifestyle strategies, nutritional interventions, botanical medicine, thyroid optimization, or hormone therapy when clinically appropriate.
Nervous System & Lifestyle Support
Hair growth does not happen in isolation from the rest of the body.
A comprehensive plan may include strategies to support:
- Sleep quality
- Stress resilience
- Healthy movement
- Circadian rhythms
- Nervous system regulation
Creating a healthier internal environment allows the body to better support growth, repair, and restoration.
Ongoing Monitoring & Personalized Adjustments
Health is not a one-time event, and neither is creating meaningful change.
As your body responds, we monitor progress, reassess symptoms, and adjust your plan when needed. Follow-up testing may be considered depending on your individual circumstances.
The goal is not simply to address hair shedding.
The goal is to understand what may have contributed to the change and support your long-term health along the way.
Every person’s outcome is different, and not all forms of hair loss can be completely reversed. However, identifying contributing factors early may help:
- Reduce excessive shedding
- Support existing hair growth
- Optimize scalp and follicle health
- Improve overall wellness
Hair regrowth is a marathon, not a sprint. Because hair follicles operate on a slow growth cycle, consistency and patience matter.
Hair Loss Isn’t a Failure—It’s Information
Hair loss can feel emotional, frustrating, and isolating.
Many people quietly worry that their changing hair is something they simply have to accept—that it is just aging, genetics, or a cosmetic concern.
But your body is constantly communicating.
Hair changes may be one of the first visible signs that something beneath the surface deserves attention. They can provide valuable insight into your nutritional status, hormone balance, stress response, immune health, and overall physiology.
Instead of viewing hair loss as a failure, consider it a signal.
A signal to listen more closely.
A signal to understand your body better.
A signal that there may be an opportunity to support your health in a deeper way.
You do not have to guess why your hair is changing.
A comprehensive evaluation can help identify factors that may be contributing to hair thinning and guide the next steps toward a personalized approach.
At Philadelphia Integrative Medicine, we believe the best approach to hair health starts by understanding the whole person—not just the symptom.
Ready to Better Understand What May Be Contributing to Your Hair Loss?
If you are in Philadelphia, the Main Line, or the surrounding region and are looking for answers beyond temporary solutions, our team is here to help.
A comprehensive hair loss evaluation can help uncover factors that may be contributing to hair changes and create a personalized plan based on your unique health story.
Schedule your Free 20-Minute Consultation today
Our team can help you understand your concerns, explore potential contributing factors, and determine what next steps may be appropriate for your health goals.
Join Our Monthly PIM Newsletter for More Functional Health Insights
Haven’t joined our mailing list yet? Stay up to date by receiving our monthly newsletter, and get the latest insights on PIM’s educational resources, programs, and integrative medicine news sent right to your inbox.
References
Contreras-Jurado, C., Lorz, C., García-Serrano, L., Paramio, J. M., & Aranda, A. (2015). Thyroid hormone signaling controls hair follicle stem cell function. Molecular Biology of the Cell, 26(7), 1263–1272.
Hayashi, A., Mikami, Y., Miyamoto, K., Kamada, N., Sato, T., et al. (2017). Intestinal dysbiosis and biotin deprivation induce alopecia through overgrowth of Lactobacillus murinus in mice. Cell Reports, 20(7), 1513–1524.
Malkud, S. (2015). Telogen effluvium: A review. Journal of Clinical and Diagnostic Research, 9(9), WB01–WB03.
Sánchez-Pellicer, P., Navarro-Moratalla, L., Núñez-Delegido, E., Agüera-Santos, J., & Navarro-López, V. (2022). How our microbiome influences the pathogenesis of alopecia areata. Genes, 13(10), 1860.
Disclaimer
This content is for educational purposes only and is not intended to diagnose, treat, cure, or replace formal medical advice. Always consult a qualified healthcare provider regarding your individual health conditions.