Hi all,
I've been obsessively researching hair loss, had a bunch of blood work done, been to my dermatologist twice, and went to an endocrinologist. I understand that hair loss is common a few months following surgery but I had GRS April 2014. Has anyone else gone through this after having the big surgery? Here is some data.
I'm going to be as brief as possible but I can provide more detail if needed. Sorry, this is longer than I thought it was going to be.
I notice the most thinning on the sides of my head.
It's my understanding that I can post levels, just not dosages:
- Late December 2014 (8+ months post-op), my total T was 5ng/dL, my free T was <0.2pg/mL, and my DHT was 5ng/dL.
- Mid-May 2015 (1+ year post-op), my total T was <3ng/dL and my DHT was 5.4ng/dL. We didn't test free T.
At this point, I had done a bunch of research on hair loss because I had been convinced that I was having it. Upon my research, I learned that low/no T can cause TE (telogen effluvium) and I had other symptoms of low T, so I got some T cream. However, I feel that it is good to mention that I was briefly on progesterone (not medroxyprogesterone) because after surgery, I lacked a libido. In October 2014 (6 months post-op), I started taking it but at the same time, I stopped taking Finasteride because it didn't seem that I needed it with my levels being so low.....but maybe my follicles are super sensitive to DHT, I don't know. Anyway, after I started with the T, I stopped taking P, which I cycled 12 days a month.
Earlier this month (1 year, 3 months post-op), I went to an endo because I wanted to get a bunch of blood work done that could contribute to hair loss. I got a lot more than this but here are things that are known to contribute to hair loss:
- Testosterone, Serum 10 ng/dL Ref: 8 - 48
- Testosterone,Free 0.11 ng/dL Ref: 0.10 - 0.85
- % Free Testosterone 1.15 % Ref: 0.50 - 2.80
- Cortisol 18.3 ug/dL Ref 2.3 - 19.4 <---taken in the morning
Ref: Cortisol AM 6.2 - 19.4
Ref: Cortisol PM 2.3 - 11.9
- Ferritin, Serum 69 ng/mL Ref: 15 - 150
- Thyroid Peroxidase (TPO) Ab <5 IU/mL Ref: 0 - 34
- TSH 3.680 uIU/mL Ref: 0.450 - 4.500
- Triiodothyronine (T3),Free,Serum 3.2 pg/mL Ref: 2.0 - 4.4
- T4,Free(Direct) 1.30 ng/dL Ref: 0.82 - 1.77
I got a bunch of other stuff taken too so if there is anything I feel I should list, please let me know. I am vitamin D deficient so I started supplementing as well.
You might notice that I don't list E anywhere. Since surgery, I've been playing with dosages and ultimately had to go back on my pre-op dosage using transbuccal (oral just doesn't work for me for some reason). I went back to transbuccal toward the end of 2014:
- Late December 2014, my E was 160.9pg/mL and my estrone was 455pg/mL.
- Late May 2015, my E was 227.9pg/mL and my estrone was 723pg/mL.
Before I went back to transbuccal, my E level was 61.9pg/mL and my estrone was 570pg/mL......same dose, just different administration. I just very recently went to injections.
Now that the numbers are out of the way, I want to mention that while on HRT pre-op (I was on HRT for about 2 years before GRS), I didn't have this problem. I don't know what caused this to start but the things I think of are:
- Low T.
- Too much P (I read that taking too much P can cause hair loss).
- Going off of Finasteride.
Since I cycled P and I stopped over a month ago, I'm not sure if this is a root cause. I thought about it being a reason but I started P at the same time I stopped Finasteride. The fact that I have been convinced of hair thinning since surgery makes me think it's a low T issue but for the past several months, my scalp has been a lot more sensitive than it used to be, meaning that pulling the hair gives more pain than what I'm used to. It looks a little pink too. Although, the severity has seemed to go down over the past month....so again, maybe caused by low T? Scalp sensitivity often indicates hair loss, either from AA, AGA, or TE. My dermatologist did a pull test and said that he didn't see any alopecia scarring, so he thinks it's TE (which is temporary loss, temporary until the root cause is settled). He didn't do a biopsy.
Lastly, my endo (who I'm going to drop for several reasons and find a new one) wants me to take Spiro because my DHEA level was 518ng/dL (reference range 31-701ng/dL). It's not over the range but it "is on the high end". She said that taking Spiro would help with my acne and my hair loss.....I don't have acne. Besides, it's my understanding that Spiro blocks androgen receptors by replacing them with a weaker androgen, thus lowering testosterone. As far as I know, Spiro doesn't do anything to lower DHEA but if I'm wrong, please, someone correct me. DHEA is a precursor to androgens and estrogens and Spiro doesn't lower/block DHEA directly. The fact that my T levels are the way they are on T supplement makes me question her credibility.
I'm sorry for the lengthy post all and if you've made it this far, thank you. I'm obsessing over this and I have been for a long time. I'm planning on getting second opinions from another endo and a different derm but I'm curious to know if anyone else has experienced this and can give me insight.
Should I try the Spiro? If it isn't needed, I'd rather not go back on it, especially because it could drop my already low T even further. What about the Finasteride? Follicle sensitivity is very YMMV but could this 5ng/dL really be having an ill-effect on my hair?
