Does Low Vitamin D Cause Hair Loss?

Written by Rali Bozhinova, Superintendent Trichologist, The Belgravia Centre

As winter is approaching, the days are becoming shorter. You start work early and by the time you finish, the sun has set. We all try to spend more time indoors and cuddle up in a warm blanket. But don’t forget that with less daylight, there’s less vitamin D, too. The sunshine vitamin that we desperately need brings many benefits to your health, and when it is depleted, this is often reflected in your hair. It is one of those things that you may not notice when everything is fine, but you may want to check it when there is a problem with your hair.

What is vitamin D?

Vitamin D is an important fat-soluble vitamin that can also behave like a hormone. Vitamin D receptors are found in many cells across your body, including your hair follicles. The role of vitamin D includes:

 

• It helps you regulate the calcium and phosphate in your body
• It keeps your bones, teeth, and muscles healthy
• It supports the health of your immune system
• It has a role in the process of cell growth and division
• Influences how the cells in your skin and hair follicles grow
• It regulates approximately 3% of the human genome and influences the expression of many genes

You can make vitamin D in your body provided that you spend time outdoors. Your skin has two main layers – a deeper inner layer called the dermis, and a thinner outer layer called the epidermis. When your skin is exposed to UVB light, such as that from sunlight or tanning beds, vitamin D3 is made in the lower layers of the epidermis called stratum basale and stratum spinosum. However, when you are exposed to sunlight through a window, most of the UVB rays will be blocked by the glass and you won’t make much vitamin D.

In the UK there is a limited amount of sunlight and therefore the UK government advises everyone to consider taking vitamin D supplements, especially during the autumn and winter months. As far as the summer goes, you may be able to make enough vitamin D from the sunlight. However, as much as we like the sun, it is always best to obtain most vitamin D from diet or supplements due to the many risks associated with sun exposure, including skin cancer. Other ways of obtaining vitamin D include some foods and supplements. Whichever way you obtain your vitamin D, it is then activated in the liver and kidneys in its active form called calcitriol. Sources of vitamin D include:

 

• Sunlight
• Oily fish such as salmon, mackerel, tuna, herring, sardines
• Some mushrooms
• Egg yolks
• Some meat such as red meat and liver
• Fortified foods such as breakfast cereals, plant-based milk, and some fat spreads
• Supplements such as Hair Vitalics, a hair growth supplement designed by The Belgravia Centre’s experts, containing 800iu, or 20mcg vitamin D, per tablet

At The Belgravia Centre, we often see people with vitamin D deficiency. It may not be the sole reason for their hair loss, but we notice that it can sometimes slow down their hair growth or aggravate a pre-existing hair loss condition. 

Symptoms Of Low Vitamin D

If you have vitamin D deficiency, you may not have any symptoms at all. If you are suspecting low vitamin D, you can check this by doing a blood test. In the UK, usually, vitamin D reading below 30 nmol/L is considered deficient, between 30-50 nmol/L insufficient, and above 50 nmol/L sufficient. Vitamin D toxicity is extremely rare. Occasionally, some symptoms have been associated with vitamin D deficiency and these include:

• Frequent lower respiratory tract infections – after all, vitamin D supports your immune system
• Tiredness and fatigue
• Aches and pains including lower back pain, muscle pain, and joint pain in those with arthritis
• Mood changes including depression and anxiety
• Low bone mineral density and bone loss 
• Hair loss including telogen effluvium, male and female pattern hair loss, and alopecia areata

Are You At Risk Of Having Vitamin D Deficiency?

Low vitamin D is very common and it is important to be treated so you can stay in optimal health. Several risk factors will make you more likely to have low vitamin D so if you fall into one of the below categories, you should be checking your vitamin D regularly:

• You spend most of your time indoors
• You live in a country with little sunlight
• You wear clothes that cover up most of your skin when you are outdoors
• You have dark skin
• You have reduced nutrient absorption such as that from inflammatory bowel disease
• You use medication that affects vitamin D metabolism such as statins

Vitamin D And Hair Loss

Although there is not enough evidence that vitamin D deficiency alone can be the reason for any hair loss condition, low vitamin D levels have been associated with some types of hair loss.

Telogen Effluvium

Telogen effluvium (TE) is a type of hair loss that is often experienced following severe stress, weight loss, severe systemic infections, some medications, as well as dietary deficiencies such as low vitamin D. It is a disturbance in the normal hair growth cycle where many actively growing follicles are pushed prematurely to the end of their cycle. This means that the affected follicles lose their hair quickly and you may notice significantly reduced hair density. Signs of TE include:

 

• Increased hair shedding from all over your scalp
• Quickly losing hair density
• The onset of the hair loss is approximately 2-3 months after the trigger event
• Many short tapered hairs across the entire scalp – these are newly growing hairs
• You may feel like your hair doesn’t grow in length

Fortunately, this type of hair loss has the potential to recover on its own within 3-6 months as long as the trigger event has been eliminated. For example, if you had COVID-19 infection in January, but you recovered from it, and then you experienced increased hair shedding in March-April, this may be due to acute telogen effluvium. As long as there were no other reasons for it, the hair can then recover by the late summer – early autumn. However, if the hair shedding then continues for longer than 6 months, the TE is considered chronic, there may be other factors keeping the TE going and treatment may be required at this point. Topical minoxidil, a licensed medication for androgenic alopecia, can be beneficial in cases of chronic telogen effluvium, alongside any other medical intervention that you may require, such as treating any dietary deficiencies.

Vitamin D receptors are found in the skin and hair follicles. It is thought that vitamin D receptors increase during the anagen, or growing phase of the hair cycle and therefore the progression of the hair cycle may be associated with vitamin D receptors. Many studies have found a link between low vitamin D levels and women with chronic TE. At The Belgravia Centre, we always advise that you have a thorough blood test so you can see if there are any contributing factors to hair loss, including vitamin D levels. Hair loss is often multi-factorial and vitamin D is just one of the relevant factors that can be easily tested and treated if needed.

Androgenic Alopecia

Androgenic alopecia includes both male pattern hair loss and female pattern hair loss. This is a genetic type of hair loss that can start at any age after puberty. Testosterone converts into a more potent androgen called dihydrotestosterone (DHT). This is a male sex hormone that is present in both men and women. DHT makes the affected follicles to become smaller and weaker over time. As a result, you may notice your hair growing thinner and shorter with every following cycle, until the follicles are lost and the hair stops growing. Signs of androgenic alopecia include:

 

• Receding hairline
• Thinning of the hair on top of the scalp
• Thinner hair on the crown
• The hair remains thicker at the back
• Gradual hair loss in a similar pattern to other family members
• Seeing your scalp more easily through your hair on the top

Apart from genetic factors, environmental factors also influence the severity of androgenic alopecia and these can include dietary deficiencies such as low vitamin D.  Vitamin D is stimulates hair growth and the anagen (growing) phase of the hair growth cycle. Any changes in the vitamin D levels or the function of vitamin D receptors can affect the cells of the hair follicle as well as gene expression of hair follicle cycling. Several studies have reported low vitamin D levels in men and women with androgenic alopecia. Although low vitamin D is not the reason for developing androgenic alopecia, screening it and treating it can help improve the results.

The International Journal of Trichology published a study in 2016 evaluating the vitamin D level in women with female pattern hair loss. The study was done in Iran where vitamin D deficiency is common. They compared 45 women with female pattern hair loss to 45 women without any hair loss condition. They were matched by age, location, time spent under the sun and other health factors. The women’s vitamin D was measured by a blood test that was carried out in autumn to prevent the seasonal variations of sunlight exposure and vitamin D synthesis. The researchers found that although most women had low vitamin D, those with female pattern hair loss had lower vitamin D levels compared to those without hair loss.

 

The Journal of Cosmetic Dermatology also published a study in 2016 evaluating the vitamin D level in androgenic alopecia and alopecia areata. They recruited 20 people with androgenic alopecia, 20 with alopecia areata, and 20 without hair loss. Their vitamin D was measured by a blood test, and vitamin D receptors were evaluated from biopsies. Those with androgenic alopecia and alopecia areata had fewer vitamin D receptors compared to those without hair loss.

It is important to note that androgenic alopecia is not caused by vitamin D deficiency alone. It is a genetic condition and if you have androgenic alopecia, you likely have inherited genes that make you more predisposed to this type of patterned hair loss. However, ignoring other factors such as having low vitamin D, can only make the problem worse. It is therefore important to keep in good health and treat any dietary deficiencies while you are also using a hair loss treatment. Future studies should further investigate the exact role of vitamin D and vitamin D receptors in androgenic alopecia.  There are only two medically proven treatments for androgenic alopecia – minoxidil - used in men and women, as well as finasteride – prescribed for men only.

Alopecia Areata

Alopecia areata (AA) is an autoimmune type of hair loss. Your white blood cells that normally protect you from foreign bodies like bacteria and viruses, are attacking cells in your hair follicles in error. As a result, you may notice patchy hair loss and little stubbles of broken hair, called exclamation mark hairs. It can affect any hair on your body but is most commonly found on the scalp. When the follicles lose their hair, they may remain empty for a while. Although this type of hair loss can be difficult to treat and completely unpredictable, the affected follicles have the potential to regrow their hair. In some cases, alopecia areata recovers spontaneously, but sometimes treatment is required. Signs of alopecia areata include:

• Sudden patchy hair loss – this can be on the scalp, face, and body
• Sudden increased hair shedding
• Some people lose the back hairline in a band-like pattern – this is called alopecia areata ophiasis
• Some people may lose all hair on their head – alopecia areata totalis
• In rare cases all hair can be lost from the head and body – alopecia areata universalis
• Small broken stubble-like hairs called exclamation mark hairs
• The new hair growth may be white
• You may notice your nails pitting and breaking

It is difficult to know why some people develop AA and others don’t. Often there are multiple triggers involved. For example, you may have genetic predisposition to autoimmunity, especially if other members of your family have autoimmune conditions such as systemic lupus, inflammatory bowel disease, vitiligo, and psoriasis. Additionally, any environmental or lifestyle factor that influences your immune system could contribute to the onset of alopecia areata – this may include severe illness, systemic infection, and severe vitamin D deficiency. Vitamin D is essential for healthy hair growth cycle and initiation of the anagen phase of the cycle. There have been many studies demonstrating a correlation between low vitamin D and severity of alopecia areata, and at The Belgravia Centre we also often see patients with AA and vitamin D deficiency

In 2012 the Department of Dermatology at Chung-Ang University College of Medicine in Seoul, Korea published a case study describing a 7-year-old boy with 2-month history of alopecia areata. Topical minoxidil 5% and hydrocortisone 1% cream were used for 3 months with no success. A biopsy of the AA patch was then carried out and it demonstrated that the affected follicles were lacking vitamin D receptor expression. The treatment was then changed to topical calcipotriol solution (a type of vitamin D). Six weeks into the new treatment some hair grew back, and three months into the treatment complete regrowth was seen. Another biopsy was then carried out and this time vitamin D receptor expression was detected in the hair follicles.

 

This is of course only a single case study and it is important to keep in mind that AA sometimes recovers spontaneously. However, such case studies provide an interesting question to be explored in future research. Many other patients successfully treat alopecia areata with high-strength topical minoxidil or steroid-based treatments. Such examples demonstrate that AA can have multiple factors contributing to its severity and stubbornness, and vitamin D may be one of them.  

Similarly to other types of hair loss, vitamin D deficiency is not the sole reason for the onset of alopecia areata however, it still plays a vital role in the hair cycling and is important that it is not ignored.  

Trichotillomania

Trichotillomania is hair loss caused by pulling your own hair. It is a behavioural disorder that can start from young age and can be part of obsessive-compulsive disorder. The habit of pulling your own hair can be difficult to break, and can be triggered by stress, anxiety, depression, or personality disorders. Signs of trichotillomania include:

 

• Patches with hair breakage and hair loss
• Pulling your own hair or twisting it around your finger until it breaks
• Playing with the pulled hair, rubbing it across your lips or eating it
• A sense of tension before pulling or if you try to resist pulling
• A sense of pleasure or relief after the hair is pulled

Vitamin D not only supports healthy hair growth cycle, but it also assists with improved nutritional status and is thought to assist with healthy neuronal functioning and improvement of mental health status. Researchers from the College of Pharmacy at The California Northstate University published a case report in 2020 exploring the possible link between vitamin D and trichotillomania.

Their first case is a 40-year-old woman with trichtollomania and low vitamin D. She was prescribed vitamin D and Clomipramine (a type of antidepressant). Five months into her treatment vitamin D improved, the urge for hair pulling decreased, and the hair growth in the affected area also improved.

The second case is a 25-year-old woman with anxiety disorder, trichotillomania, and her blood test showed severe vitamin D deficiency. She was also prescribed vitamin D and antidepressants and assessed in the following weeks. This case also demonstrated improvement in the vitamin D and hair growth, as well as better management of the hair pulling habit.

Although both patients were given antidepressants, these remained on a low dose and were never increased. The researchers thought that the antidepressants didn’t significantly contribute to the reduction of trichotillomania symptoms because of their low dose. They provided an interesting point of view of the role of vitamin D on hair growth, as well as on mental health.

If you have signs of trichotillomania, it is important that you contact your GP for further advice and treatments. You can also contact the NHS Talking Therapies service (IAPT) who can help you improve your mental health. The Belgravia Centre does not offer treatments for trichotillomania.

Scarring alopecia

Scarring, or cicatricial alopecia is an umbrella-term for several types of hair loss conditions that cause inflammation in the hair follicles. The chronic inflammation gradually destroys the affected follicles, leaving permanent hair loss. Signs of scarring alopecia include:

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• Hair loss patches that look bald and pale
• Tingling, burning or sore sensation
• Changes in the affected skin such as redness or scaling

Scarring types of hair loss are very complex and can be stubborn to treat. Many of them have autoimmune nature but are also influenced by other environmental factors that are not fully understood. Nutritional deficiencies, including vitamin D deficiency, have been associated with lichen planopilaris as well as central centrifugal cicatricial alopecia.

If you have signs of scarring alopecia, it is important that you contact a dermatologist for further advice and treatments. The Belgravia Centre does not treat these types of hair loss.

How To Make Your Hair Grow Back?

As you can see, there are many types of hair loss. If you have noticed any hair thinning, or hair loss, the first thing you should do is contact a specialist. They will go through your medical history, examine your scalp, and discuss a suitable treatment plan for your specific case. The Belgravia Centre advises that you bring a recent blood test to your consultation. This will help you determine whether there are any nutritional factors that could be contributing to your hair loss, including vitamin D.

However, you should also keep in mind that your hair cycle is influenced by many factors simultaneously – genetic predisposition, your health, your diet, your nutrient intake, your stress, and your hair care routine. If your blood test shows that you have vitamin D deficiency, you should certainly address this. However, this may not be the sole reason for your hair loss and this is where a hair loss specialist can be of huge help. Not only they will discuss a treatment plan for you, but they will also monitor you regularly and be ready to answer any questions that you may have 7 days a week.

Conditions such as scarring alopecia and trichotillomania should be discussed and treated by your doctor. Acute telogen effluvium (less than 6 months) has the potential to recover on its own and at this point it is best to focus on improving your health, diet, and stress levels. However, if the telogen effluvium lasts for longer than that, it is considered to be chronic

If you notice any signs of chronic telogen effluvium, mild to moderate patchy alopecia areata on your scalp, male pattern hair loss, or female pattern hair loss, contact The Belgravia Centre where the team of hair loss specialists will be more than happy to help you. The Belgravia Centre’s pharmacy prepares special formulations of minoxidil at different strengths, and with various additives to maximise effectiveness, whilst finasteride can be used orally or topically by those with male pattern hair loss.  We also offer other natural and technological solutions that are combined to provide the optimum solution to prevent hair loss, and an exceptional level of expertise. One of our 20 qualified hair loss specialists will be available to help you any time at our Central London clinic or through a Zoom consultation if you live outside of London.

 

If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. Take a look through our hair regrowth photo gallery – which is the largest gallery of its kind in the world and contains over 1,000 sets of hair growth photos and verified reviews from patients of The Belgravia Centre.