Gaining Weight And Hair Loss: Clues To Diagnosis

Gaining weight and hair loss can be a co-incidence or the result of an underlying medical problem.

The most common medical problems causing weight gain and hair loss simultaneously include:

PCOS (polycystic ovarian syndrome)
Cushing’s syndrome
Hypothyroidism
Virilization syndrome
Medications
Stress

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How to Identify the Cause of Your Weight Gain and Hair Loss?

It is always fruitful to identify any underlying cause for your unwanted weight gain and hair loss. Identifying the cause can increase your chances of reversing your condition.

Here are some clues to the underlying medical conditions causing weight gain and hair loss:

Weight gain, hair loss, and irregular periods:

A few conditions can cause weight gain and hair loss along with abnormal or irregular periods. These include PCOS, Cushing’s syndrome, and Hypothyroidism.

However, first think of PCOS if your periods are irregular, along with weight gain and hair loss

PCOS (polycystic ovarian syndrome):
- This is the most common cause of weight gain and hair loss in women.
- The three cardinal signs of PCOS are irregular periods, signs of androgen excess (such as facial hair, hoarse and deep voice, frontal balding, and masculine body), and multiple cysts in the ovaries on ultrasound.

What to do if you have PCOS?
- Get an ultrasound of your ovaries (or pelvis) done to look for cysts in your ovaries.
- Check your hormones: Testosterone (will be elevated), LH and FSH (LH is higher than FSH in PCOS), SHBG (sex hormone binding globulin is low), and OGTT (oral glucose tolerance test to look for insulin resistance.
- Consult an endocrinologist.
- You may be advised one or all of the following along with a low-calorie diet and exercise to lose weight:
  - Finasteride
  - Spironolactone
  - Oral contraceptives like Diane 35.
  - Metformin

Weight gain, hair loss, muscle weakness, diabetes, and hypertension:

This is the classic presentation of a person with high cortisol levels or Cushing’s syndrome.

Cusings Syndrome:
- Cushing’s syndrome is commonly caused by exogenous glucocorticoid intake.
- Common conditions in which your doctor may be prescribing you glucocorticoids include:
  - Arthritis (rheumatoid arthritis, ankylosing spondylitis, SLE (lupus), reactive arthritis, and psoriatic arthritis.
  - Asthma and chronic bronchitis
  - Autoimmune conditions
  - Cancers
- The classic symptoms and signs of Cushing’s syndrome are:
  - Disproportionate weight gain (central obesity, buffalo hump, and thin limbs)
  - Hair loss or balding
  - Moon like face
  - Purplish abdominal striae (Stretch marks)
  - Limb weakness (proximal muscle weakness)
  - Hypertension
  - Diabetes
  - Osteoporosis, and
  - Low immunity manifests as frequent and recurrent infections

What to do if you have Cuching’s syndrome?
- Consult your endocrinologist or primary doctor before making any decision to stop taking glucocorticoids.
- Your doctor may advise you the following tests:
  - Cortisol levels (morning and evening)
  - Overnight dexamethasone suppression test
  - ACTH
  - Ultrasound or CT Scan of the adrenal gland
  - MR of the pituitary gland
  - OGTT, blood sugars, HbA1C, Dexa scan, and electrolyte panel.
- If you have an adrenal tumor or a pituitary tumor, your doctor may prescribe surgical removal of the tumor.
- You may be asked to reduce your glucocorticoid dose if you are taking any.
- You may be given medications for diabetes, and hypertension, calcium supplements, and vitamin D.

Weight gain, hair loss, and fatigue:

Fatigue is a non-specific symptom. However, if it’s the main symptom a person complains about, always think about hypothyroidism.

Hypothyroidism or an underactive thyroid is a treatable and easily diagnosed condition. Diagnosis should not be delayed in such cases.

Hypothyroidism:
- Hypothyroidism is a condition when your thyroid is underactive.
- Thyroxine is required for almost every body function.
- An underactive thyroid can cause all your metabolic functions to slow down resulting in the following clinical features:
  - Weight gain
  - Feeling chilly
  - Fatigue and muscle weakness
  - Getting tired easily
  - Slow mentation
  - Thinning of hair
  - Body swelling
  - Constipation

What to do if you have an underactive thyroid (hypothyroidism)?
- Consult your doctors, who may ask you to do the following tests:
  - Thyroid functions (TSH, Free T4, and Free T3)
  - Blood Complete Picture (for anemia)
  - Lipid Profile (Ddyslipidemia)
  - Ultrasound neck (for thyroid enlargement and lymph nodes)
  - Anti-TPO Antibodies (thyroid peroxidase antibodies) for Hashimotos thyroiditis
  - ECG (for bradycardia)
  - Blood sugars
- Treatment is with levothyroxine along with calcium supplementations.
- Levothyroxine is usually given for life.

Weight gain, hair loss, deep voice, acne, oily skin, and aggression:

Weight gain, deep voice, masculine features, acne, and oily skin are all pointing to a hyperandrogenic state.

A hyperandrogenic state is characterized by high testosterone in your blood.

Testosterone is a male hormone. It is found in a small quantity in women as well.

Hyperandrogenic state:
- Androgens are male hormones.
- Some patients (including women) may have high levels of male hormones.
- Common reasons to have high androgens in your body include:
  - Exogenous intake (such as to boost performance as in athletes)
  - PCOS (polycystic ovarian syndrome) in women
  - Congenital adrenal hyperplasia (CAH)
  - Adrenal tumors
- High testosterone levels can cause hair loss (frontal balding), acne, oily skin, deep voice, and masculine body.

How to lower your testosterone levels?
- Identifying the underlying cause is important.
- Your doctor may ask you to do the following tests:
  - Early morning serum testosterone levels
  - DHEA and DHEA-S (dehydroepiandrosterone sulfate)
  - Ultrasound or CT scan of the adrenal gland and ovaries
- Treatment is directed at treating the underlying cause.
- In addition, anti-androgens may be used including:
  - Finasteride,
  - Flutamide,
  - Enzalutamide and apalutamide,
  - Bicalutamide,
  - Cyproterone acetate,
  - GnRH analogs, and
  - Spironolactone

Weight gain, hair loss, fatigue, and low mood:

A low mood is the hallmark of depression. Depression is commonly associated with weight gain as patients become less active than normal.

In addition, depression may be linked to abnormal eating behaviors. Antidepressant medications can also cause weight gain and hair loss.

Stress, Anxiety, or Depression:
- Stress, anxiety, and major depression can all cause hair loss, and weight gain, along with a low mood, panic attacks, binge eating, abnormal eating behaviors, and a vitamin-deficient diet.
- Psychological disorders are clinically diagnosed after excluding organic medical problems.

How to manage Depression?
- Regular exercise, meditation, a good night-time sleep, and solving underlying social, financial, or personal issues are the only sustainable lifestyle interventions that can treat depression and anxiety.
- Antidepressant medications and anxiolytics only help you temporarily to get out of the situation you are in.
- If you are started on an antidepressant, try to taper it off after 3 to 6 months.
- Don’t get used to it.
- During these three months, get active and social, start exercising, and meditate.

In addition, medications are common culprits causing weight gain and hair loss. Some notorious medications include:

Corticosteroids
Testosterone replacement
Muscle-boosting supplements (may also contain testosterone)
Antipsychotics (Zyprexa and Seroquel)
Antidepressants (Seroxat)

Weight gain, hair loss, and normal blood tests:

You can have hair loss, weight gain, and normal blood tests. So, is weight gain leading to hair loss?

Weight gain does not have a direct impact on hair loss, it can be an indirect cause, though.

For instance, some factors like hormonal imbalance, stress, and nutritional deficiencies are common to both hair loss and weight gain.

According to one study, Obesity-related stress targets Hair Follicle Stem Cells (HFSCs) and accelerates hair thinning.

The study also suggested that high-fat diets induce lipid droplets within HFSCs, which lead to abnormal differentiation of hair cells and eventually cause hair loss. [Ref]

Apart from this, insulin resistance, which is caused by obesity and weight gain, is also linked to excessive hair loss.

According to one study, women with high insulin resistance-associated parameters had extensive hair loss as compared to normal participants. [Ref]

Furthermore, hormonal changes caused by weight gain, especially in women, might be a risk factor for PCOS. High levels of androgens in women with PCOS might result in hair loss.

How to Treat Weight Gain-Related Hair Loss?

Fortunately, weight gain is not a direct cause of hair loss. However, the underlying causes of weight gain might somehow lead to hair loss.

Consequently, you can treat weight gain-related hair loss by solving the underlying issue.

Here’s how you can get your hair back in form

Gradual Weight Loss:

When we say weight loss, it never means those strict and restrictive diet plans or any of the false claims of losing 10 kgs in 10 days. Gradual weight loss is what makes an actual difference.

Aim for slow and steady weight loss by clean eating and regular exercise. Never fall for speedy weight loss tricks because they might trigger hair loss rather than reduce it.

Get Sufficient Protein

Try to fulfill your protein requirements of 1-1.5g/kg daily. After all, your hair is made of protein, so giving it the right food makes a big difference.

Although protein is good for hair growth, according to research, exceeding the recommended daily intake has no specific benefit to hair health. [Ref]

Addressing Thyroid Problems

Thyroid hormones regulate the cellular activity of hair cells. T3 and T4 overlook the growth and division of hair cells during the anagen phase.

Low levels of thyroid hormones, as in hypothyroidism, result in reduced growth and increased hair shedding.

Additionally, an overreactive thyroid also leads to hair loss as the hair cells prematurely enter into the telogen phase.

Controlling hyperthyroidism with medications like methimazole and radioactive iodine therapy helps promote hair growth by normalizing the hair growth cycle.

Treat underlying medical problems:

As mentioned previously, treat the underlying medical problems including Cushing’s syndrome, PCOS, and Depression.

Addressing Nutrient Deficiencies

Deficiency of B vitamins, iron, and vitamin D can lead to hair loss. A high BMI doesn’t mean that you cannot have a deficiency.

According to research, obese individuals have high rates of micronutrient deficiencies as compared to lean people. [Ref]

Eat a healthy and balanced diet to avoid any deficiencies.

Manage Stress

Stress is a significant factor in hair loss, and stress combined with increased weight can wreak havoc on your hair health.

Stress can affect your hair in so many ways, like reducing blood supply, disrupting the hair growth cycle, and weakening the immune system.

Manage stress by relaxation techniques or Cognitive Behavioral Therapy (CBT) to help prevent stress-associated hair loss.

Do Hair Supplements Help?

The effect of micronutrient supplements on hair growth is a mixed bag. This is because:

Some studies suggest that supplementation of biotin, zinc, and marine proteins has a potential effect on hair growth [Ref]

Meanwhile, other studies suggest that supplementation may improve hair growth if you actually have a deficiency, but only when that specific micronutrient is targeted. [Ref]

Medications to Treat Hair Loss

Some FDA-approved medications to treat hair loss are listed below. However, it is essential to locate the underlying cause first.

Minoxidil:

A topical medication that comes in liquid or foam formulations. It works by increasing blood flow to the hair cells and increasing the duration of the growth phase.

Finasteride:

This medication is prescribed for the treatment of male pattern baldness. It acts by inhibiting the production of dihydrotestosterone, which contributes to hair loss.

Some off-label medications include Spironolactone, which is sometimes used to treat female pattern baldness associated with hormonal imbalance.

Spironolactone:

Spironolactone is an anti-androgen. It is commonly prescribed to women with PCOS and excessive facial hair and frontal balding.

Hair Transplant

Hair transplant surgery is a permanent fix to your hair loss issues. It works by transplanting hair follicles to the bald area on your scalp.

Hair Transplant involves two main techniques:

Follicular Unit Strip Surgery (FUSS) involves scalp strips of healthy hair follicles from the donor area that are transplanted to small sites on the balding area.
Follicular Unit Extraction (FUE) involves individual extraction of follicular units that are implanted in the recipient sites.

It takes almost 12 to 18 months to achieve full results. The good news is that transplanted hairs are resistant to balding.

Conclusion

The connection between weight gain and hair loss can be indirect, but proper interventions are still required to avoid any permanent hair loss.

On a positive note, weight gain-associated hair loss is mostly temporary and reversible. So, you can treat it with lifestyle changes if no other causes are involved.