HRT hair loss, don't know what to do next!

[Pinkseashells]

Sorry this is long but hoping someone can help! Started peri about 5 years ago at 47, had night sweats, immense rage but for the first time since i was a teenager my hair was amazing, thick and long and healthy which i attributed to a new diet and increased protein consumption. Went on HRT in May 2022 as rages were out of hand and sleep was awful. Had been a year without a period at that point so doc thought full menopause. The HRT helped other symptoms but i had very heavy bleeding which was unmanageable even when dose changed (started on 50mg evorel patch and 200mg of utrogestan tablet 14 days monthly, which doc reduced to 25mg of oestrogel to try and manage bleeding and same dose of utrogestan).
However HRT completely ruined my hair. It started as shedding which i didnt take much notice of as still had a lot of hair, but then got so thin and straggly. By March 23 others were noticing including my hairdresser that it was shedding really badly, and looks like Tef E when i have researched. Also after reading hormone repair manual i wonder if the new hair growth i had in peri could have been due to oestrogen dominance and not protein as i had thought.
Read threads on here of others experiencing hair loss on HRT and came off it as was terrified. Its not shedding as badly as it was now but still lose more than i used to when washing hair and it is thin around temples and any new growth is like candy floss and all fluffy and thin, and now poor sleep and rage back and i dont know what to do. Terrified to go back on HRT and lose more hair and wondered if anyone has had similar experience and if they retried HRT and/or managed to reverse hair thinning. Am trying rosemary oil, georgiemane and collagen but cant see a huge difference yet and wonder if that was the last hurrah for my hair. I have also read others say that oestrogen helps hair growth so wonder was it the progesterone that was causing and was my dose too high once my oestrogen dose was changed? Thanks for reading and any advice!

If you were experiencing heavy bleeding for a while, have you had your bloods checked? Low ferritin, even if you are not anaemic (low haemoglobin) can cause hair loss.
Many GPs will tell you a ferritin level of 10 or more is 'normal' but I think you need to aim to get it over 70 for good regrowth of hair and a level over 100 is optimal.
You might find this website useful
https://theironprotocol.com/

Agreeing with @helleborus that it’s more likely to be low iron than HRT.

I experienced similar on the same HRT although my hair always been fine, at one point I could see my scalp and I did panic a bit then as my go to hair style has been to put it up with a clip.

I have had a lot of success using minoxidil and my hair has improved massively. I have gone back on to patches now and fingers crossed my hair seems to be ok.

My doctor did bloods and said all was ok, but i didnt actually find out specific levels so hadn’t thought it could be iron. Thank you i will go back and ask what the actual results were!
nottaotter i thought about minoxidil but some of the reviews said it can get worse before it gets better and i was too scared to risk losing anymore! Did you wait until it had restored it a bit before going back on the patches?

Easy easy - oral minoxidil and finasteride are your friends. Get on them asap - remember there's a dread shed at the beginning so don't be scared

You can buy the pills yourself online but you need to say you're a man (get your partner/brother to order). 1.25mg of minoxidil a day and 2.5mg of finasteride. Good luck

Thank you thats so helpful, will have a look into those.x

Following (sorry have to leave for work so don't have time to comment!)

@heartbroken40 @Pinkseashells please do not take oral minoxidil without a doctors check and prescription it can be dangerous and cause heart problems also its a big no if you have high blood pressure.
There's a reason you can't buy the oral one over the counter but you can the topical.

@nottaotter yes i wouldnt take any oral meds without prescription. I had been considering topical minoxdil but know it can get worse before it gets better which is what has put me off so far.

Ferritin x 1000!! You can have normal HB (so not aneamic) and still have low ferritin. You WILL get fobbed off by your GP. I use the one recommended on here from Amazon and the result was transformative within a month. It’s FerroDyn by nutriadvanced. You must take it correctly. Empty stomach, no dairy or tannins(tea…) so i take it first thing with a cup of herbal tea and wait a couple of hours before I eat or drink anything. Every second day. My ferritin was 6.

@Pinkseashells yes understandable a shed is the last thing you need! However I think its worth it for the results, you might not even have the shedding, I don't think I did or if I did it was not a heavy one.

You mentioned your new diet. Have you been losing weight (a lot/quickly). Hair loss may very well be down to that.

Thank you all so much for the helpful advice its made me feel like there is hope! @Spirallingdownwards the dietary changes were in 2020, it wasnt a crash diet or anything just started watching macros added more protein and lost around 10lbs on 2 months so slow and steady. However about 6 months later my hair was amazing and in a condition it has never been, my hairdresser couldnt get over it and the only thing i had changed was eating more protein so we thought it was that. I have since discovered you can have oestrogen dominance in peri and a huge surge, and i had all of the other symptoms of that too so it was more likely that that made my hair great. I do wonder if the suggestions re iron level is the most likely reason as i was bleeding almost constantly on HRT.

@MrsKwazi how do you find out your exact ferritin level was it with your doctor?

@nottaotter I've been on oral minoxidil for 10 years! I used to buy it from India but in the past two years I buy it from Oxford online pharmacy. The dose for hair loss is minimal - I come from a family of doctors and I asked in passing and they said it's an absolutely small dose (1.25mg). The dose for high blood pressure is 100mg. I did get a dread shed but honestly I have more hair now than 20 years ago- super thick. And also dermatologists who prescribe it don't ask for a heart check I can guarantee you (make an appointment with Dr Wade for example). So thanks for your advice but it's way too late!

@Pinkseashells the gp can check ferritin or you can do it with medichecks (privately). They say it needs to be over 70 for hair growth (mine is 120 and I was shedding like mad then so for me definitely it wasn't that)

Have a read of Dr Donovan blog - he says that ferritin, unless super super low doesn't affect shedding
donovanmedical.com/hair-blog/2015/12/16/ferritin-levels-frantic-or-factual

@heartbroken40 thats really helpful thank you. Going to ring my GP and see if that was on my test results when they did them as would help me rule in or out.

I had a blood test abroad before moving back to the UK. Ask your GP
but they have to specify ferritin.

Just checked my test results and HB was 133 and ferratin 57 when i was tested when the shedding was at its worst while taking the HRT so it might not be that after all. 😕I have read that too much iron can be as bad as too little for hair loss. Its not making me feel like i should start the HRT again anyway.

My ferritin is 3! How high did you manage to get your levels on the FerroDyn?

I haven’t had a repeat blood test yet, due to go mid Jan, but within a month my hair stopped falling out, no more funny heartbeats and no more restless legs!
ferritin was 16 in Oct 2022 medical and 6 in Oct 2023 . Totally diet related as I’m vegetarian (and have been breastfeeding for the last 3 years) so started to supplement religiously.

OP - I believe it needs to be around 70 for hair loss, but that is just what I read on google.

@Pinkseashells with 57 it's definitely not ferritin - (do read the article please), it's probably a mix of TE and AGA. You can ask for referral to a dermatologist but it takes 2 years and the NHS is woefully inadequate when it comes to hair loss. I was scared of the dread shed too but basically that's hair you would lose anyway and you just lose it faster to give way to strong and healthy hair. While AGA is not scarring if you wait too long the follicles actually die and then there's no going back that's why they advise starting as soon as you notice

I lost a lot of weight recently and combined with menopause had a huge hair shed, it's been quite alarming. I've been taking Metatone tonic and using rosemary hair oil and it's really helped and things are finally settling down now.

Have you had any viruses lately? Chicken pox caused a large amount of hair loss in my dd. I had covid quite badly in 2021, lost at least a third of my hair in the 4 months following.

Thanks so much @heartbroken40 i could tell by the article it wasnt likely to be ferritin at those levels. I think im going to look into a private consultation. Just gutted as it was fine before i took the HRT so now i wish i hadnt and feels like too much of a coincidence that the shedding started when i started that 😔