Nutritional Disorders of the Hair and Their Management
January 2020
Research cited in this study
106 / 106 resultsresearch Biotin: Overview of the Treatment of Diseases of Cutaneous Appendages and Hyperseborrhea
This review highlights the potential benefits of biotin in treating skin disorders related to biotin deficiency but reports no new clinical results.
research Pellagra and Anorexia Nervosa: A Case Report
This case report illustrates that pellagra can develop in patients with anorexia nervosa without typical signs of severe malnutrition, responding rapidly to nicotinamide and tryptophan therapy.
research Telogen Effluvium With Dysesthesia Has Lower B12 Levels and May Respond to B12 Supplementation
This study identifies a specific subtype of Telogen Effluvium associated with scalp dysesthesia, such as itch or burning, in the absence of any inflammatory scalp disorder or medication association.
research Dissecting Folliculitis (Dissecting Cellulitis) of the Scalp: A 66-Patient Case Series and Proposal of Classification
This study found that dissecting folliculitis is more common than previously thought in Taiwan, with obesity possibly linked to higher severity of this condition, but smoking not associated.
research Endocrine Therapy-Induced Alopecia in Patients With Breast Cancer
This study found that endocrine therapy for breast cancer is associated with a pattern of hair loss similar to androgenetic alopecia, negatively impacting quality of life despite mild severity.
research Minoxidil for Endocrine Therapy–Induced Alopecia in Women With Breast Cancer—Saint Agatha’s Blessing?
This abstract provided no research findings as it contains only website navigation and service information.
research Life Before and Beyond Blistering: The Role of Collagen XVII in Epidermal Physiology
This review explores the physiological roles of collagen XVII in the epidermis, its involvement in stem cell maintenance, and its connections with signaling pathways, but it reports no new results.
research Association of Epidemiological and Biochemical Factors with Premature Graying of Hair: A Case-Control Study
This study observed that individuals with premature hair graying had lower levels of certain serum nutrients and lifestyle factors like stress and smoking may contribute; hair oiling appeared protective.
research New-Onset Androgenic Alopecia Following Human Chorionic Gonadotropic Diet and Testosterone Pellet Implantation
This report presents a case of new-onset androgenic alopecia in a patient following the use of the hCG diet combined with testosterone pellet implantation.
research Efficacy and Safety of a Topical Botanical in Female Androgenetic Alopecia: A Randomized, Single-Blinded, Vehicle-Controlled Study
This study found that a new topical botanical lotion significantly increased hair density and improved quality of life in women with androgenetic alopecia over 24 weeks.
research Functional Analyses of a Novel Missense and Other Mutations of the Vitamin D Receptor in Association with Alopecia
This study found that a novel missense mutation in the vitamin D receptor caused hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia by disrupting protein function, highlighting the importance of DNA binding in hair development.
research Serum Vitamin D Level Is Related to Disease Severity in Pediatric Alopecia Areata
This study found that while vitamin D deficiency is not the sole cause of alopecia areata, it may worsen the disease, suggesting supplementation could help in pediatric cases.
research Demographic Characteristics and Association of Serum Vitamin B12, Ferritin, and Thyroid Function with Premature Canities in Indian Patients from an Urban Skin Clinic of North India: A Retrospective Analysis of 71 Cases
This study found that premature hair graying is strongly associated with a family history, Vitamin B12 deficiency, and hypothyroidism, with onset as early as 5 years in patients in Gurugram, India.
research A Review of the Use of Biotin for Hair Loss
This review discusses the use of biotin for hair and nail growth, noting clinical improvement in cases with existing pathologies, but concludes there is insufficient evidence supporting its benefits for healthy individuals.
research Polyglandular Autoimmune Syndrome Type III with a Prevalence of Cutaneous Features
This case report describes a 52-year-old woman with multiple autoimmune conditions suggesting a diagnosis of PAS IIIC, characterized by prominent skin-related symptoms.
research Vitamin and Mineral Deficiencies in Patients With Telogen Effluvium: A Retrospective Cross-Sectional Study
This study found that vitamin D, ferritin, and zinc deficiencies are prevalent among patients with telogen effluvium in the greater Pittsburgh area, suggesting these should be included in initial evaluations.
research Estimated Serum Vitamin D Status, Vitamin D Intake, and Risk of Incident Alopecia Areata Among US Women
This study found no significant association between vitamin D intake or estimated vitamin D status and the risk of developing alopecia areata among women.
research Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management
This review summarizes hair growth aspects, treatment options, and management strategies for hirsutism in women with polycystic ovary syndrome, without presenting new clinical findings.
research Assessment of Vitamin D Receptors in Alopecia Areata and Androgenetic Alopecia
This study suggests that lower serum and tissue vitamin D receptor levels in alopecia areata and androgenetic alopecia patients may play a role in the pathogenesis of these hair diseases.
research Efficacy and Safety of Minoxidil 5% Foam in Combination With a Botanical Hair Solution in Men With Androgenic Alopecia
This study found that a twice-daily regimen of 5% minoxidil foam combined with a botanical hair solution significantly improved hair growth and appearance in men with mild to moderate androgenic alopecia over 12 weeks.
research Efficacy and Safety of Minoxidil 2% Solution in Combination With a Botanical Hair Solution in Women With Female Pattern Hair Loss/Androgenic Alopecia
This study found that a 12-week regimen of 2% minoxidil combined with a botanical hair solution improved hair growth and patient satisfaction for female pattern hair loss, aiding treatment adherence.
research Hair Follicle Aging Is Driven by Transepidermal Elimination of Stem Cells via COL17A1 Proteolysis
This research found that Foxc1 transcription factor and COL17A1 are critical in regulating quiescence and hair thinning in hair follicle stem cells, with aging-related DNA damage leading to hair loss.
research Traditional Anticoagulants and Hair Loss: A Role for Direct Oral Anticoagulants? A Review of the Literature
This review discusses the potential link between direct oral anticoagulants and hair loss, suggesting DOACs may not be a suitable alternative for patients with alopecia from traditional anticoagulants; however, no clinical results are reported.
research Serum Vitamin D3 Levels and Diffuse Hair Fall Among the Student Population in South India: A Case-Control Study
This study found that female students experiencing diffuse hair fall had significantly lower Vitamin D3 levels compared to healthy controls.
research Serum Biotin Levels in Women Complaining of Hair Loss
This study found that 38% of women with hair loss had a biotin deficiency, suggesting oral biotin supplementation should be based on confirmed biotin deficiency rather than as a general treatment.
research Serum Vitamin D3 Level in Patients with Female Pattern Hair Loss
This study found that women with female pattern hair loss had significantly lower serum Vitamin D3 levels compared to healthy controls.
research Perifollicular Hemorrhage With Corkscrew Hair Due to Scurvy
This case study illustrates the classic dermatological signs of scurvy in a man with unusual dietary habits, showcasing the importance of recognizing and treating vitamin C deficiency in marginalized populations.
research Effect of a Nutritional Supplement on Hair Loss in Women
This study found that a 6-month supplementation with omega 3, omega 6, and antioxidants significantly improved hair density and reduced hair loss in women with female pattern hair loss.
research Semiquantitative Assessment of Hirsutism in 850 Patients with Polycystic Ovary Syndrome and 2,988 Control Women in China
This study found that hirsutism is more prevalent in Chinese women with PCOS compared to the general population, and the Ferriman-Gallwey score is a good predictor for diagnosing PCOS in this group.
research The Impact of Obesity on the Folliculosebaceous Unit
Obesity may worsen hair loss in men and increase hirsutism in overweight or obese individuals, with weight loss recommended for treatment.
research Vitamin D Deficiency in Alopecia Areata
In this study, patients with alopecia areata were found to have significantly lower serum vitamin D levels compared to those with vitiligo and healthy individuals, with lower levels correlating with increased disease severity.
research Higher Body Mass Index Is Associated With Greater Severity of Alopecia in Men With Male-Pattern Androgenetic Alopecia in Taiwan: A Cross-Sectional Study
This study found that higher BMI was significantly associated with more severe hair loss in men with male-pattern and early-onset androgenetic alopecia.
research Microarray Analysis of Androgenetic and Senescent Alopecia: Comparison of Gene Expression Shows Two Distinct Profiles
The conclusion is that androgenetic alopecia and senescent alopecia have unique gene changes, suggesting different causes and potential treatments for these hair loss types.
research Patchy Hair Loss on the Pubis: A Case Study
This case report details a 17-year-old female with anorexia nervosa who presented with a large, irregular area of pubic hair loss exhibiting various hair and skin abnormalities.
research Efficacy and Tolerability of Two Scalp Cooling Systems for the Prevention of Alopecia Associated with Docetaxel Treatment
Scalp cooling significantly reduces hair loss in chemotherapy patients.
research Reduced Level of 25-Hydroxyvitamin D in Chronic/Relapsing Alopecia Areata
In this study, researchers observed vitamin D insufficiency in many patients with Alopecia Areata, suggesting its potential role in managing this autoimmune condition.
research CG210 Enables Finasteride 1mg Users to Further Improve Hair Pattern: A Randomized, Double-Blind, Placebo-Controlled Pilot Study
This study reported that adding the topical product CG210 to oral finasteride 1mg significantly increased hair diameter more than finasteride alone in male androgenetic alopecia patients already stabilized on finasteride treatment.
research Premature Graying of Hair: Causes, Associations, and Treatments
This review examines the pathogenesis of premature hair graying and potential treatment avenues, but reports no new experimental outcomes, highlighting ongoing research challenges and hopes for drug development.
research Serum Ferritin and Vitamin D in Female Hair Loss: Do They Play a Role?
This study found that low serum ferritin and vitamin D2 levels are associated with hair loss in females with chronic telogen effluvium and female pattern hair loss, suggesting potential benefits of screening and supplementation.
research Scalp Hair Loss After Transsphenoidal Adenomectomy in Patients With Acromegaly
This study found that over half of the patients experienced varying degrees of hair loss after acromegaly surgery, with female patients and those with severe postoperative growth hormone deficiency more commonly affected.
research Permanent Scalp Alopecia Related to Breast Cancer Chemotherapy by Sequential Fluorouracil/Epirubicin/Cyclophosphamide (FEC) and Docetaxel: A Prospective Study of 20 Patients
This study reports that permanent and severe alopecia is a newly identified complication of the FEC 100–docetaxel regimen used for adjuvant breast cancer treatment.
research What Women Want: Quantifying the Perception of Hair Amount - An Analysis of Hair Diameter and Density Changes with Age in Caucasian Women
This study analyzed changes in hair diameter and density with age in Caucasian women, highlighting variations in perception of hair amount over time.
research Oral Zinc Therapy for Zinc Deficiency-Related Telogen Effluvium
In this study, all five patients with zinc deficiency-related hair loss experienced improvement or recovery of their condition after receiving oral zinc treatment.
research Vitamin D Concentrations Are Decreased in Patients with Alopecia Areata
This study found significantly lower serum vitamin D concentrations in patients with alopecia areata compared to healthy controls, suggesting that vitamin D deficiency may be a risk factor for this autoimmune hair loss disease.
research Aging Processes Influence Keratin and KAP Expression in Human Hair Follicles
This study found that hair follicles undergo significant molecular changes with age, notably a decline in keratins and keratin-associated proteins, which may contribute to age-related hair alterations.
research Permanent Alopecia After Systemic Chemotherapy: A Clinicopathological Study of 10 Cases
This study found that permanent alopecia can occur after certain chemotherapy treatments and presents as nonscarring hair loss similar to androgenetic alopecia, with specific histological features that could be misdiagnosed without proper clinicopathological correlation.
research How Real Is Senescent Alopecia? A Histopathologic Approach
In this study, old age was concluded not to be a significant cause of hair loss, with most cases in the elderly appearing to be androgen-driven.
research Iron Deficiency in Female Pattern Hair Loss, Chronic Telogen Effluvium, and Control Groups
This study concluded that iron deficiency is common among women but not more prevalent in those with female pattern hair loss or chronic telogen effluvium compared to control subjects without hair loss.
research Iron Deficiency and Diffuse Nonscarring Scalp Alopecia in Women: More Pieces to the Puzzle
This review examines the debated link between iron deficiency and nonscarring scalp alopecia in women, offering no new clinical results but emphasizing the need for further research and well-designed trials.
research Androgenetic Alopecia and Cardiovascular Risk Factors in Men and Women: A Comparative Study
Hair loss linked to higher heart disease risk in both men and women.
research Does D Matter? The Role of Vitamin D in Hair Disorders and Hair Follicle Cycling
This article outlines the potential for upregulating the vitamin D receptor in treating hair disorders, emphasizing the need for further studies to evaluate vitamin D's role in the hair cycle.
research Skin Signs in Anorexia Nervosa
This article reviews skin signs in patients with anorexia nervosa and their potential role in early diagnosis but reports no clinical results; it emphasizes the importance of dermatologists in recognizing these signs.
research Chemotherapy-Induced Alopecia: Emotional Distress and Mitigation Strategies
This review covers various strategies to manage chemotherapy-induced alopecia, highlighting that agents like AS101 and minoxidil can reduce its severity but not prevent it, with no new clinical results reported.
research Coenzyme Q10 Has Anti-Aging Effects on Human Hair
In a study using a placebo-controlled design, the researchers found that coenzyme Q10 may enhance gene expression of age-relevant hair keratins in human hair roots, suggesting potential anti-aging benefits for mature hair.
research Senile Hair Graying: H2O2-Mediated Oxidative Stress Affects Human Hair Color by Blunting Methionine Sulfoxide Repair
This study found that hydrogen peroxide accumulation and reduced methionine sulfoxide repair play a significant role in the oxidative damage linked to senile hair graying.
research Iron Status in Diffuse Telogen Hair Loss Among Women
This study found that women with serum ferritin levels below or equal to 30 ng/mL have a strong association with an increased risk of diffuse telogen hair loss.
research The Therapeutic Effect and Changed Serum Zinc Level After Zinc Supplementation in Alopecia Areata Patients with Low Serum Zinc Level
In this study, oral zinc supplementation for twelve weeks increased serum zinc levels in alopecia areata patients with low zinc, showing positive hair regrowth in 66.7% of participants, though this was not statistically significant.
research Characterization of Curved Hair of Japanese Women with Reference to Internal Structures and Amino Acid Composition
This study examined hair curvature in Japanese women, finding that 47% have curved hair, and identified structural differences in hair fiber, which resemble those in wool fibers.
research Low Iron Stores: A Risk Factor for Excessive Hair Loss in Non-Menopausal Women
This study found that low iron stores are a risk factor for excessive hair loss in non-menopausal women.
research Hair Loss and Serum Zinc Values Among Arab Females in Al Ain Region, United Arab Emirates
research No Association Between Serum Ferritin Levels Greater Than 10 μg/l and Hair Loss Activity in Women
This article discusses the controversy over serum ferritin levels in diagnosing iron deficiency in women with hair loss but reports no new findings, emphasizing the need for consistent reference ranges.
research Diffuse Alopecia in a Child Due to Dietary Zinc Deficiency
In this case study, a 4-year-old girl's hair loss stopped after six months of zinc supplementation and dietary changes, suggesting a possible link to low zinc levels.
research Trichotillometry: The Reliability and Practicality of Hair Pluckability as a Method of Nutritional Assessment
This study found that due to variability in measurements, hair pluckability is not a reliable indicator of adult nutritional status, although it may hold potential in certain emergency situations if improved for consistency.
research Obesity and Low-Grade Inflammation Among Young Finnish Men With Early-Onset Alopecia
This study found a correlation between moderate to extensive alopecia and low-grade inflammation, a cardiovascular risk marker, particularly in young men under 35 with central obesity.
research Chemotherapy-Induced Anagen Effluvium: Diffuse or Patterned?
This article discusses the presentation of chemotherapy-induced anagen effluvium as either diffuse or patterned hair loss and reports no new clinical findings.
research Protection Against Chemotherapy-Induced Alopecia
This review discusses advances in protecting against chemotherapy-induced alopecia and reports no new clinical results; calcitriol and cyclosporine A emerged as promising agents in animal models with broader efficacy across multiple chemotherapy drugs.
research Towards A Free Radical Theory Of Graying: Melanocyte Apoptosis In The Aging Human Hair Follicle As An Indicator Of Oxidative Stress Induced Tissue Damage
This study found that oxidative stress in hair follicle melanocytes contributes to premature aging and apoptosis, providing insights into graying as a model for studying aging and testing antiaging therapies.
research The Diagnosis and Treatment of Iron Deficiency and Its Potential Relationship to Hair Loss
This review discusses the complexities of diagnosing and treating iron deficiency related to nutritional anemia and hair loss, concluding that routine screening and supplementation for hair loss are not yet supported by sufficient evidence.
research Premature Androgenic Alopecia and Insulin Resistance: Male Equivalent of Polycystic Ovary Syndrome?
This study suggests that some men with premature androgenic alopecia may have hormonal profiles similar to women with polycystic ovary syndrome, potentially indicating a male equivalent of the condition.
research Zinc as an Ambivalent but Potent Modulator of Murine Hair Growth In Vivo: Preliminary Observations
This study found that high-dose oral zinc significantly influences hair growth in mice, showing both inhibition and promotion effects depending on the timing and duration of administration.
research The Lack of Significant Changes in Scalp Hair Follicle Density With Advancing Age
This study found that age and follicular miniaturization were extremely weak predictors of total hair count in women with hair loss.
research Selenium as an Element in the Treatment of Ovarian Cancer in Women Receiving Chemotherapy
This study concluded that selenium supplementation for ovarian cancer patients during chemotherapy may have several beneficial effects, such as increased antioxidant enzyme activity, reduced chemotherapy-related symptoms, and higher selenium levels in serum and hair.
research Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS)
This review discusses the evolution of diagnostic criteria for polycystic ovary syndrome and emphasizes its association with various metabolic and cardiovascular risks, but it provides no new research findings.
research Decreased Serum Ferritin and Alopecia in Women
This study found an association between low serum ferritin levels and alopecia in women, suggesting a potential role of iron in hair health and paving the way for further research.
research Decreased Serum Ferritin Is Associated With Alopecia in Women
This study found that women with androgenetic alopecia or alopecia areata have significantly lower serum ferritin levels than those without hair loss, suggesting a potential link between these types of alopecia and decreased iron stores.
research Significance of Iron Status in Hair Loss in Women
This article discusses the association between chronic diffuse telogen hair loss in women and iron deficiency, supporting the view that iron's role is unclear and often overstated, but reports no new clinical results.
research There Is No Clear Association Between Low Serum Ferritin And Chronic Diffuse Telogen Hair Loss
This study found no direct relationship between low serum ferritin and chronic diffuse telogen hair loss in women, questioning the usefulness of serum ferritin measurement and iron supplementation for managing this condition.
research Molecular Mechanisms of Androgenetic Alopecia
This paper discusses key mechanisms of androgen metabolism in androgenetic alopecia and reports the effectiveness of treatments like oral finasteride and topical minoxidil, highlighting the limited success rate due to factors like follicular inflammation.
research Effects of Minoxidil 2% vs. Cyproterone Acetate Treatment on Female Androgenetic Alopecia: A Controlled, 12-Month Randomized Trial
Minoxidil works better for female hair loss, but cyproterone reduces scalp oiliness and causes menstrual issues.
research Lack of the Vitamin D Receptor Is Associated with Reduced Epidermal Differentiation and Hair Follicle Growth
This study observed that vitamin D receptor knockout mice exhibit impaired epidermal differentiation and progressive hair loss, suggesting the importance of the vitamin D receptor in normal skin and hair follicle development.
research Low Serum Biotinidase Activity in Children with Valproic Acid Monotherapy
In this study, valproic acid treatment was associated with reduced biotinidase activity and improved skin lesions after biotin supplementation in children with seizures.
research Hair Density, Hair Diameter, and the Prevalence of Female Pattern Hair Loss
FPHL affects hair density and diameter, causing visible hair loss in older women.
research Permanent Alopecia Following Chemotherapy and Bone Marrow Transplantation
This case study reported a 23-year-old woman with chronic myeloid leukemia who developed permanent hair loss after chemotherapy and did not respond to topical minoxidil treatment.
research Does Tissue Iron Status Have a Role in Female Alopecia?
Iron deficiency is not a significant cause of hair loss in women.
research Failure of Gluten-Free Diet in Celiac Disease-Associated Alopecia Areata
A gluten-free diet does not help hair regrowth in celiac disease patients with alopecia areata.
research Proliferation and Differentiation of Cultured Human Follicular Keratinocytes Are Not Influenced by Biotin
research Obesity and Female Androgenic Alopecia: A Cause and an Effect?
This report describes a possible case of burn-induced bullous pemphigoid, as the disease was transient and did not recur, suggesting a potential link between burns and the condition.
research Clinical Response of Alopecia, Trichorrhexis Nodosa, and Dry, Scaly Skin to Zinc Supplementation
This study reported that oral zinc therapy improved hair and skin abnormalities in patients with dry brittle hair, alopecia, and other symptoms, regardless of demonstrated zinc deficiency.
research Skin Signs of Nutritional Disorders
This review discusses the clinical manifestations of malnutrition in children, particularly highlighting the overlapping skin changes from various nutrient deficiencies, and reports no new clinical results.
research Biochemical and Trichological Characterization of Diffuse Alopecia in Women
Diffuse alopecia in women may be related to androgens and iron deficiency, and basic hormone and nutrient screening is useful.
research Partial Biotinidase Deficiency: Clinical and Biochemical Features
This study suggests that biotin therapy may be beneficial for individuals with partial biotinidase deficiency, as some developed symptoms later, which resolved with treatment.
research The Comparative Histopathology of Male-Pattern Baldness and Senescent Baldness
This review discusses the histopathology of male-pattern baldness and highlights ongoing disputes over several aspects, including sebaceous gland size and follicle loss, reporting no new clinical findings.
research Hormonal Diagnosis of So-Called Androgenetic Alopecia in Women
In this study, treatment targeting the estrogen-androgen balance reduced hair loss in 74 out of 104 women with androgenetic alopecia, with some experiencing hair regrowth.
research Polarization Microscopy of Hair in Acrodermatitis Enteropathica
In this study, hair anomalies associated with acrodermatitis enteropathica in a young girl improved significantly after two years of zinc therapy.
research Element Concentrations in Serum, Erythrocytes, Hair, and Urine of Alopecia Patients
This study found no differences in trace element concentrations between Finnish alopecia patients and the normal population, but noted significant serum copper variation among different alopecia subtypes.
research Uncombable Hair Syndrome: Observations on Response to Biotin and Occurrence in Siblings with Ectodermal Dysplasia
In this study, oral biotin improved hair growth, strength, and combability in a child with uncombable hair syndrome, while hair in two others slowly improved without biotin.
research Biotin Deficiency Complicating Parenteral Alimentation: Diagnosis, Metabolic Repercussions, and Treatment
This study reported successful treatment of biotin deficiency in three patients receiving total parenteral nutrition, suggesting current biotin supplementation recommendations may be inadequate to maintain normal biotin status.
research Pili Torti in Association with Citrullinemia
This report presents a case of pili torti in a young girl with citrullinemia, a novel association not previously documented.
research Neurotrichosis: Hair-Shaft Abnormalities Associated With Neurological Diseases
The authors reviewed cases of six children with both hair-shaft abnormalities and neurological disorders, noting that such hair defects may indicate neurological conditions, including potentially treatable metabolic errors.
research Hair Changes Due to Zinc Deficiency in a Case of Sucrose Malabsorption
This case study reports that oral zinc therapy improved hair growth and pigmentation in a young girl with sucrase deficiency and low zinc levels.
research Alopecia
The document concludes that correct diagnosis of alopecia types is crucial, scalp biopsies are important, and more research is needed.
research Hair Loss With Rapid Weight Loss
In this study, increased protein intake during modified fasting nearly eliminated hair loss observed in patients with significant weight loss and negative nitrogen balance.
research Morphological and Biochemical Investigations of Hair in Disturbed Amino Acid Metabolism
Metabolic disorders can cause hair structure defects and growth issues, but amino acid levels in hair remain normal.
research Profuse Hair Loss Due to Sudden Weight Loss and Hormonal Injections in Women
This case report discusses two female patients experiencing significant hair loss, potentially linked to a weight loss regimen involving chorionic gonadotropin injections.
research Aminogenic Alopecia: Loss of Hair Associated with Argininosuccinic Aciduria
Argininosuccinic aciduria can cause hair loss.
research On the Vitamin B Complex Content of the Hair of Normal and Pellagrous Subjects
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research Hair Integrity and Health with Dieting
In this abstract, it is highlighted that inadequate nutrition and hormonal imbalances can contribute to hair loss, and individuals experiencing hair loss should be evaluated for nutritional deficiencies, which should be addressed if identified.