Why is My Hair Falling Out?

The answer might surprise you...

Welcome to the Gut Honest Truth blog where a Certified Functional Medicine Practitioner gives you digestible information to tackle your chronic health concerns.

That’s me, Katie Morra; and in this blog I am going to talk about the six most common causes of hair shedding and loss, what triggers each and how to start supporting your healing journey.

And as always, working one-on-one for your specific needs is always our top recommendation, check out our appointment options to get started with one of our licensed health care professionals today.

Are you struggling with hair loss or thinning hair?

If it feels like no matter what you try, you just keep losing hair — you're not alone. Hair thinning and excessive shedding are one of the top complaints I see in my practice. And I want you to know: we hear you, and we've been there.

We also have a podcast episode on this exact topic — Episode 33: Can't Stop Losing Hair: SOS! — available on Apple Podcasts and Spotify if you prefer to listen.

First, some reassuring context: we are born with 100,000-150,000 hair follicles, and it is completely normal to lose about 100 strands per day. Finding hair in your brush, your shower, or on your pillow is often just the normal hair cycle at work.

The 3 Stages of the Hair Cycle:

1. Anagen phase — The active growth phase, where the hair bulb pushes new hair out of the follicle. This can last years.

2. Telogen phase — The resting phase. No new growth occurs, and this stage can last several months.

3. Exogen phase — The shedding phase. The old hair falls out to make room for a new strand to begin growing. This is the phase that tends to alarm people — but it's a normal part of the cycle.

Understanding this cycle matters because many types of hair loss are actually disruptions to this process, not permanent damage to the follicle itself. Which means they're often addressable when you find the root cause.

The 6 Most Common Causes of Hair Loss:

1. Telogen Effluvium (TE)

Telogen effluvium is diffuse, all-over shedding — not patchy — that happens when a significant stressor pushes a large number of follicles into the resting and shedding phase at the same time.

Common triggers:

• Pregnancy, childbirth, and lactation

• Acute or chronic stress (emotional, physical, or perceived)

• Acute or chronic illness

• Hypothyroidism

• Nutrient deficiencies (iron, protein, zinc, B vitamins, vitamin C)

• Scalp inflammation

• Medications

• Eating disorders or disordered eating

• Sudden weight loss or major dietary shifts

• Surgery

There are a few deeper themes worth understanding here:

Gut health — Are you producing enough stomach acid and digestive enzymes to actually break down and absorb your food? You can be eating all the right things and still be deficient if digestive output is low or if a gut infection is competing for your nutrients. A GI-MAP stool test and SIBO evaluation can give you a much clearer picture of what's going on internally.

Nutrition — Hair is essentially made of protein. Without enough of the right building blocks, the body will deprioritize hair growth. Key nutrients:

• Protein/Cysteine — Needed to produce keratin. Prioritize meat, eggs, beans, and sunflower seeds.

• Omega-3s — Support scalp health and reduce dryness and flaking that contribute to breakage. Aim for at least 2g/day if supplementing.

• Zinc — Acts as a 5-alpha-reductase inhibitor, helping block DHT conversion (more on that below). Aim for 15-30mg/day if supplementing.

• Iron/Ferritin — Essential for carrying oxygen to hair follicle cells. Low ferritin in particular is one of the most commonly missed drivers of hair loss. Always check ferritin and serum iron before supplementing.

• B Vitamins (Biotin, B6, B12, Folate) — Needed for red blood cell production and cellular energy. Take a B complex rather than mega-dosing biotin alone.

• Vitamin C — Aids iron absorption and collagen production. If supplementing, 1,000mg 2-3x/day as tolerated is a good starting point.

Stress — Did your hair loss begin after a stressful period, or have you been running on chronic stress for years? Stress elevates cortisol, suppresses stomach acid, and can push large numbers of follicles into the shedding phase simultaneously. A DUTCH Complete or DUTCH Adrenal test can show how your stress hormones are affecting your overall physiology.

Inflammation — Chronic inflammation from gut infections, poor diet, or intestinal

permeability can contribute to immune confusion that sometimes leads the body to attack its own hair follicles. Addressing gut health is often the most impactful starting point.

2. Alopecia Areata and Alopecia Totalis

Alopecia areata is an autoimmune condition where the immune system attacks the hair follicles — presenting as patchy hair loss. Alopecia totalis refers to complete scalp hair loss.

In functional medicine, we understand that autoimmunity generally requires three things: a genetic predisposition, intestinal permeability (leaky gut), and a trigger. The diagnosis tells us what is happening — our job is to figure out why the immune system lit the match and work to put that fire out.

Leaky gut allows bacteria, food particles, and other antigens to escape into the bloodstream. Through a process called molecular mimicry, the immune system can confuse these particles with the body's own tissues — including hair follicles — and mount an attack against them.

When we identify and address those triggers, support gut barrier integrity, and reduce the overall inflammatory load, the immune system often becomes significantly less reactive over time.

3. Androgenic Alopecia

Also known as male or female pattern baldness, androgenic alopecia is driven by elevated androgens — particularly DHT (dihydrotestosterone), produced from testosterone by an enzyme called 5-alpha reductase.

What many people don't realize is that DHT can also be produced within the hair follicle itself — meaning systemic hormone labs may look normal while the follicle is still being locally affected. When DHT binds to hair receptors, it shortens the growth phase and eventually stops it altogether.

Main drivers of elevated 5-alpha reductase and DHT:

• Genetics

• Scalp inflammation

• High insulin and blood sugar dysregulation

• PCOS

• Obesity

• High triglycerides

Addressing insulin sensitivity, inflammation, and underlying hormonal imbalances is often the most effective long-term approach here.

4. Tinea Capitis

This is scalp ringworm — a fungal infection that can resemble eczema on the scalp and cause patchy hair loss in the affected area. It's transmissible through shared hairbrushes, hats, or close contact. Treatment is typically straightforward with antifungal medication. If you suspect this is your situation, work with your primary care provider or dermatologist.

5. Trichorrhexis Nodosa

This is hair breakage — and it's incredibly common. The most frequent culprits are excessive heat styling, tight hairstyles, and harsh chemical treatments. Reducing wash and style frequency, lowering heat settings, and switching to gentler products are the most impactful changes. The EWG Skin Deep database is an excellent resource for finding cleaner hair care options.

6. Trichotillomania

Trichotillomania is a hair-pulling disorder, often tied to anxiety, stress, or OCD — and the person may not always be consciously aware they're doing it. If you think this might apply to you, working with your primary care provider alongside a psychologist or psychiatrist who specializes in this area is the right path forward. It's very treatable with the right support team.

Tips for Hair Health

Regardless of type, these foundational supports can help:

• Scalp massage and blood flow — Regular scalp massage, red light therapy, and acupuncture all support circulation to the follicle and can stimulate growth.

• Topical oils — Peppermint, lavender, or rosemary oil mixed with a carrier oil has solid research behind it for supporting hair growth. Use as a mask or add to shampoo.

• Castor oil — Anti-inflammatory and a natural vasodilator that increases blood flow to the scalp. Queen of Thrones is a high-quality option.

• Collagen supplementation — Provides peptides that support keratin production, scalp elasticity, and hydration.

• Address the gut first — If digestive output is low or a gut infection is present, no amount of topical support will fully compensate for what's happening internally.

Hair loss is rarely just a hair problem. It's almost always a signal that something deeper needs attention — whether that's gut function, hormone balance, nutrient status, stress, or immune health.

The good news is that with proper testing and a targeted approach, most types of hair loss are very addressable.

Ready to get to the root of it? Schedule a free discovery call with our team here.