According to ancient literature, women’s hair symbolizes strength,  physical attraction, health, femininity, and even social status. Then as now, hair is a symbol of self, and our hairstyles are a powerful form of self-expression.

When a woman experiences excessive hair loss, it can ravage her sense of self and be so distressing as to cause depression, crippling anxiety, and withdrawal.

For most women with excessive shedding, the issue is one of genetics and hormonal imbalances. For these women, the hair-loss pattern is generally diffuse and there is thinning all over the head (telogen effluvium, or TE) or there is hair loss at the crown and the temples  (androgenic — also called androgenetic — alopecia, more commonly known as “female pattern baldness”).

Less commonly, the hair loss is due to an autoimmune condition (but trust me, that doesn’t tell the whole story) and tends to fall into these categories:

• Alopecia areata: patchy baldness on scalp
• Alopecia totalis: total loss of scalp hair
• Alopecia universalis: total loss, head to toe
• Alopecia ophiasis: a band of loss above the ears, wrapping around the neckline
• Alopecia diffusa: diffuse thinning

The American Hair Loss Association states that women comprise 40  percent of the estimated 6.6 million Americans who suffer hair loss.  And we’re much more likely than men to search for answers. In my  mid-40s, after suffering from mild alopecia areata off and on for 30  years, I graduated to the alopecia ophiasis pattern and became one-third bald.

In most cases, hair follicles can be signaled — even if you’ve struggled for years and even if you’re bald. (Possible exceptions  include cicatricial alopecia, a rare condition where follicles are  covered with scar tissue, and frontal alopecia, a form of lichen  planopilaris characterized by receding hairline and sometimes scarring.)

Whether your hair loss is largely genetic and hormonal or autoimmune,  many of the same strategies work for reversing loss and promoting growth. Indeed, I searched far and wide — and far outside the conventional, multibillion-dollar hair-loss industry — and have had my hair back for two years. I’m confident that nearly anyone experiencing the anguish of hair loss can turn things around.

Below is a list of hair-loss factors, many of which overlap, and suggestions for what you can do if these are your root cause(s).

1. Heredity
Genetics can lead to female pattern hair loss (androgenic alopecia), but it’s important to remember that our genes aren’t our destiny. As they  say, “Genetics load the gun, but environment pulls the trigger.” While our family history and genetic code play a role, the science of epigenetics shows us that addressing many of the factors outlined in this article can positively affect our genetic expression.

2. Autoimmunity
Patchy hair loss and total hair loss are thought to be due to an autoimmune condition, of which there can also be a genetic component, most notably when there’s celiac disease, type 1 diabetes, or rheumatoid arthritis in the bloodline.

Many do well with an immune modulatory protocol for their alopecia, no matter what the pattern. The 100+ manifestations of autoimmunity are, after all, one disease. As an added benefit, treating alopecia as the autoimmune condition it often is can significantly reduce the possibility of a “kaleidoscope of autoimmunity” or MAS — Multiple Autoimmune Syndrome.

Without immune modulation, treatments such as cortisone and steroid injections, creams, pills, supplements, and immunosuppressants aren’t likely to signal the follicles to regenerate hair in any lasting way. In fact, some of these strategies are degenerative, not regenerative, and can contribute to more immune dysregulation, making alopecia worse in the long term.

The first step in reversing an autoimmune condition is to heal the gut, where 70 to 80 percent of our immune system resides. Indeed, most people with autoimmunity have digestive complaints. An elimination/provocation diet is a life-changing experiment that can help sleuth out food sensitivities — one of the most significant contributors to immune dysregulation.

Other gut issues to consider are yeast, or candida, overgrowth and hypochloridia (low hydrochloric acid), both strongly associated with hair loss. Also check for SIBO (small intestine bacterial overgrowth) and other infections, such as H. pylori.

It’s impossible to outline an entire immune modulatory protocol in this article, so I recommend the book The Immune System Recovery Plan, by Susan Blum, MD.

3. Nutrient deficiencies
There are several nutrient deficiencies and nutritional issues associated with unhealthy follicles and hair loss:

• Minerals, most notably iron, manganese, selenium, and zinc
• Ferritin, an iron-storage protein (often associated with anemia, which is strongly correlated with hair loss)
• Vitamins, most notably A, the B spectrum, C, and E
• Arginine, an amino acid
• Protein malabsorption
• Essential-fatty-acid malabsorption

Low ferritin is considered a deal breaker — if it’s low, it will be difficult to slow loss and grow new hair. Some experts say ferritin levels should be at 80–90 ng/mL or higher. One of the best ways to raise ferritin is to take encapsulated liver.

Healing the gut will help with absorption of these nutrients, although supplementation may still be needed. Work with a qualified healthcare provider for specific dosing, since more isn’t more here, especially given risks with overdosing. For example, excess vitamin A supplementation is associated with alopecia and excess biotin (vitamin B7), a popular “hair-loss supplement,” can mimic Graves’ disease on labs, greatly skewing a thyroid treatment plan.

One of the best ways to support protein absorption is to ensure  sufficient hydrochloric-acid status; to support essential-fatty-acid  absorption, ensure sufficient gallbladder function.

4. Systemic inflammation
Chronic follicular inflammation may lead to hair loss. Autoimmunity and inflammation are kissing cousins, so an immune-modulatory protocol is certain to reduce inflammation, but other anti-inflammatory measures include keeping your blood sugar as stable as possible, eating a low-glycemic diet, and essential-fatty-acid and turmeric supplementation.

5. Medication-induced loss
Many medications have been associated with excessive shedding, including amphetamines, hypolipidemic drugs, antidepressants, blood thinners, the birth control pill, and thyroid hormone replacement.

Diffuse loss is one of the hallmark symptoms of hypothyroidism and   Hashimoto’s, but the cosmic joke is that thyroid-hormone replacement causes hair loss for many. (Read the fine print on your drug insert, and  you’ll see “hair loss” listed as a possible side effect.)

6. Stress, trauma and the resultant telogen effluvium
An intensely stressful or traumatic event is thought to be the primary cause of telogen effluvium (TE), which forces follicles into a resting phase, after which new hair should grow. But many doctors don’t recognize the difference between TE and alopecia diffusa or TE and androgenic alopecia; each has specific considerations for treatment.

The stress associated with TE typically takes place one to six months prior to shedding. The loss should be temporary, lasting six months or less.

If the diffuse loss is chronic, unresolved, and unassociated with a stressful event, it could be alopecia diffusa, which responds well to an immune modulatory protocol (see above).

If it’s truly TE, supporting a healthy stress response by focusing on adrenal health can help to slow shedding and promote growth.

7. Hypothyroidism and Hashimoto’s
Over 90 percent of those with hypothyroidism have Hashimoto’s autoimmune hypothyroidism), making the cause of hair loss often three-fold:

1. Hair loss is a primary symptom of hypothyroidism.
2. With any autoimmunity, follicles are often “low-hanging fruit”  because we don’t need hair for survival. Thus, there’s often concomitant shedding or alopecia associated with other autoimmune conditions.
3. Hair loss is often a side effect of thyroid hormone replacement.

Optimizing thyroid function is important, but it’s important to determine if your thyroid drugs are causing hair loss. Go here for a functional thyroid panel.

8. Androgenic hormone imbalance
Both elevated and deficient androgens (“male” hormones like testosterone and DHEA) can cause hair loss. Even if you don’t have the classic androgenic-alopecia pattern (a wide part and temporal loss), it’s important to test these hormones: total testosterone, free testosterone, DHEA-S (-S includes sulfate molecule), DHT, and also 5-alpha reductase enzyme (5α-R). These hormones are best tested via saliva or urine.

9. Premenopause and menopause
During premenopause, when estrogen drops, our hair follicles come under the influence of testosterone as a result of reversal of the estrogen–testosterone ratio, which can cause hair loss. The loss can continue well into menopause and beyond.

10. Histamine intolerance and overload
After having gone through immune modulation to reverse my Hashimoto’s years before I  became one-third bald, I finally found my missing link — histamines. For many, there’s a strong association between histamine intolerance or overload and alopecia.

Histamines are the immune system’s first responders. They are neurotransmitters that are released when there’s any whiff of a threat,  like a pathogen, bacteria, or otherwise benign food or other substance that the body has mistaken for an enemy.

Histamine intolerance and overload is a little-known and hard-to-diagnose condition that can masquerade as many other conditions,  including allergies.

Over-the-counter antihistamines come with some risk. In addition to a  low-histamine diet, natural antihistamines including butterbur,  nettles, vitamin C, and black-seed oil (nigella sativa) can offer support.

11. Heavy metals
Hair loss is also a common symptom of heavy-metal exposure,  including arsenic, aluminum, cadmium, lead, mercury, and/or thallium.  Work with your physician to uncover if this may be one of your root causes and to determine if a medically supervised heavy-metal detox is in order.

There’s no quick fix
Many experiencing hair loss, especially those with patchy loss or baldness, have lost hope.  They’ve “tried everything,” having invested thousands in drugs,  potions, creams, shots, and empty promises. While these conventional treatments may sometimes promote short-term hair growth, there are risks and they don’t prevent future loss.

There’s no silver bullet in slowing excessive loss and regrowth. But with a multifactorial approach of targeted nutritional and digestive improvements, lifestyle changes, and hormone balancing, it’s possible for those suffering from hair loss — even autoimmune-related hair loss —  to see new growth in a matter of about three months.

And the benefits to the mind–body are so far-reaching. Take it from me, it’s a life-changing journey.

This article was originally posted on Experience Life.

Jill Grunewald is a Functional Medicine Certified Health Coach, founder of Healthful Elements, coauthor of The Essential Thyroid Cookbook,  and an alopecia and hair-loss expert. She has suffered from alopecia,  off and on, since the age of 13, and after quickly becoming one-third  bald in her mid-40s with no growth in sight for over two years, has kept her newfound, full head of hair. Her online program for the alopecia community, Reversing Alopecia, launches again this April.