Nutritional Endocrinology Practitioner Training (NEPT)
Clinical Pearl
June 5th, 2016 

 

Aromatase, 5 Alpha Reductase, and Hair Loss

Maybe these words seem like gibberish to you now, but they will be clear as you progress through the course work.

I had an interesting situation come up recently and would love to share. It’s a work in progress so I can keep you posted.

A client with a history of thyroidectomy due to cancer complains of episodic periods of hair loss (among many other complaints; just this one hits women where it hurts most, LOL).

She notes that it happens when her iron gets low. Makes sense. I find that she has a terrible T4 to T3 ratio – poor conversion. She’s been in Synthroid only and has been reluctant to consider T3 until recently.

Both T3 and iron deficiencies can lead to hair loss. But she wants me to solve the hair loss dilemma without having to take T3 (urg… how?).

Well, back in February, she started an episode that’s continued (with a few ebbs and flows), and she is very concerned. Of course, we play detective to see what else has changed (besides long history of stress due to special needs kids and an abuse as a child).

Back then, she started acupuncture and chaste tree, along with some B-vitamins, so she is suspicious of all of these. She told me that when she stopped chaste tree, her hair loss situation improved; when she started chaste tree, it got worse. I was intrigued by this.

Chaste tree helps to improve estrogen progesterone ratio by stimulating progesterone and inhibiting aramotase, the enzyme that converts testosterone to estrogen. Hmmmm… most chaste tree research reports chaste tree improves hair loss, so because I am curious (key word, and one you need to value — get curious when things don’t line up), I decided to do some research.

In rare cases, the aromatase inhibitors backfire and the extra testosterone gets converted to DHT, a “dangerous in excess” testosterone metabolite. DHT is the type of testosterone responsible for triggering male pattern baldness in susceptible men. Ahhh… getting

somewhere.

 

So, if this is what’s happening, why? (Get curious again.) The enzyme that converts testosterone to DHT is 5 alpha reductase; that enzyme is inhibited by zinc, saw palmetto, GLA, and other things.

Now it’s making sense.

Her alkaline phosphatase has been very low for a long time. She is taking zinc, but not enough (due to fear of excess!!)

So I convinced her to increase her zinc, and we are going to do a DUTCH test to see what is going on before trying other approaches.

The point of this story is that you are being given the tools to understand the biochemistry and physiology well enough to ask curious questions then explore and find novel solutions to complex problems.