Iron deficiency is the most common vitamin deficiency globally & has been associated with some forms of hair loss including telogen effluvium (TE) & chronic telogen effluvium.

A controversial paper by an Australian dermatologist demonstrated that iron deficiency is not related to telogen effluvium, however this view is not shared by the wider dermatological community. Few studies have suggested that supplementation can improve clinical outcomes in the context of TE. It is widely accepted that low ferritin levels are not associated with androgenetic alopecia, namely male/female pattern hair loss.

My viewpoint: discuss with your physician / dermatologist the value of iron supplementation based upon ferritin levels & the diagnosis of your hair loss pattern. TE & CTE can be diagnosed clinically & confirmed microscopically.

Disclaimer: I do not treat hair loss with medical measures, for a diagnosis, please consult a general dermatologist.

Vitamin A consists of retinol, retinoic acid, & retinyl esters. It is one of the most important vitamins for skin, nail & hair. This fat soluble vitamin is primarily sourced for a well balanced diet. This vitamin is important in vision, collagen production, immune surveillance & cellular differentiation.

The recommended daily intake of vitamin A ranges from 5,000 to 10,000 International Units. The vast majority of the population will not require supplementation as this vitamin is readily available via animal & plant sources. Excessive vitamin A beyond the RDI can theoretically increase the risk of hair loss. 

There are 8 forms of vitamin B complexes, of which riboflavin, biotin, folate, and vitamin B12 deficiencies have been associated with hair loss. The vast majority of the population will not be deficient in these complexes. Over supplementation has no clinical benefit .

The RDI of vitamin B can be obtained via a well balanced diet, apart from biotin which is made by the body. In healthy individuals, vitamin B does not need to be supplemented. 

Biotin deficiencies can be genetic or acquired. Acquired biotin deficiency can occur with excessive consumption of raw eggs, malabsorption & alcoholism. Biotin assays can detect deficiencies. Clinical findings include brittle nails & non-specific rashes. This vitamin is commonly found in multivitamins. There is no evidence to support hair regrowth in individuals with normal biotin levels.

Vitamin B12 & folate deficiencies can be associated with some forms of hair loss, in particular autoimmune disorders. These include alopecia areata (diffuse type can be tricky to diagnose), as well as lupus associated hair loss. The latter can manifest as scarring alopecia (discoid), lupus hair, telogen effluvium or associated autoimmune conditions such as thyroid disease.

Medical dermatologists can provide some input regarding autoimmune related hair loss & may carry out basic screening blood tests.

Vitamin C or ascorbic acid is a water-soluble essential vitamin. Ascorbic acid can affect hair growth in two ways-

1. Vitamin C affects chelation & reduction of iron from the gastrointestinal tract- hence plays an important role in iron absorption. Supplementation of C should be considered in patients with low serum ferritin.
2. Vitamin C deficiencies, though extremely rare, can lead to reduced tensile strength of skin, & hair as this vitamin plays a crucial role in collagen synthesis. Deficiencies can lead to scurvy ( I have only seen two cases in my 20 year career as a dermatologist). Vitamin C assays can be useful, in addition to clinical finding of cork screw hair, follicular hyperkeratosis, alopecia & easy bruising.

My recommendation: If you are iron deficient you probably will get enough vitamin C from your diet. If in doubt, supplement with a multivitamin.

Vitamin D is a fat-soluble vitamin formed in the upper layers of skin (epidermis). UVB is required for synthesis. The role of vitamin D in the context of hair growth is conflicting. 

Papers indicated that there may be a correlation between autoimmune disorders & low levels of D (not deficiencies). This includes alopecia areata, vitiligo & lupus. The argument is that of cause & effect as vitiligo & lupus patients will naturally get less UVB, and hence lower levels of this vitamin.

In the context of telogen effluvium & female pattern hair loss, results are once again conflicting. My recommendation is to supplement vitamin D. Besides, if you follow photoprotection to reduce photoaging, most people will have a lower level of vitamin D. No big deal, just supplement.

Vitamin E is a fat-soluble vitamin which has an important role in immunity. Along with ascorbic & ferulic acid, it is part of the family of antioxidants that protect against free radicals caused by UVR & pollutants.

There are conflicting studies that demonstrate lower levels in autoimmune conditions such as alopecia areata. 

My recommendations? Follow the RDI, supplement with the usual biotin, zinc, iron, & vitamin D. The main concern with vitamin E in higher doses can thin the blood- especially important in skin surgery to cease for one week prior.

Alopecia or hair loss is a well-known side effect of zinc deficiency. This usually manifests in infancy, however acquired causes include bypass surgery, anorexia, inflammatory bowel disease and malnutrition.

Supplementation of zinc has not shown to be effective for male & female pattern hair loss. There are a few studies suggesting that supplementation with zinc gluconate 50 mg od can improve the outcomes of alopecia areata. 

Given the level of evidence, & balancing the risk benefit ratio of vitamins, I do believe that zinc coupled with iron, & biotin supplementation is sensible. Besides, placebo can be a good thing!

At the time of writing (2021), new research has shown the efficacy of topical caffeine to increase hair counts in cases of androgenetic alopecia. Preliminary results have shown efficacy ‘just as good as’, if not better than topical minoxidil.

No, not unless you are seriously deficient. Selenium deficiency has been reported to cause hair depigmentation in patients with ridiculously low levels (chemotherapy, total parenteral nutrition). A normal diet of vegetables, meats, nuts, cereals etc. will ensure your RDI is met.

Ideally supplements should be incorporated with medical and surgical treatments. The ideal treatment will depend on the cause of alopecia. Examples include-

Androgenetic alopecia (male/female pattern hair loss): Minoxidil, anti-androgens such as finasteride, dutasteride, cyproterone acetate, spironolactone. Low level laser therapy, thulium 1927 lasers, PRP, FUE hair transplantation.

Alopecia areata: Intralesional steroids, pulsed CS, Jak inhibitors, DCP therapy.

FFA frontal fibrosing alopecia: CS injections, hydroxychloroquine, immune modifiers

For medical treatments, please consult your dermatologist.

There are several medical studies of value. Firstly, it has been shown that if patients are low in iron & suffer from hair loss conditions (in particular androgenic alopecia/female pattern baldness with telogen effluvium), supplementation with iron, & in some cases vitamin C is advisable.

A good study has shown that saw palmetto combined with topical minoxidil grows more hair compared to saw palmetto alone.

For patients with autoimmune hair loss, in particular alopecia areata, supplementation with vitamin D is recommended (if levels are low). The same recommendations apply for patients who suffer from vitiligo. In the context of AA, supplementation may not change the course of the disorder, however has implications regarding bone health. Discuss this with your dermatologist/ endocrinologist.

Side effects are extremely rare with supplements. There have been reports of GI upset, nausea & abdominal pain.

Be mindful of excessive intake of some vitamins as paradoxical hair loss may occur. This applies to vitamin A supplements. These are fat soluble vitamins including retinol, retinoic acid, retinyl palmitate & esters. The RDI is between 5,000 to 10,000 IU. Do not exceed the upper levels as hair loss can be a side effect of over supplementation.

There is a theoretical risk of loss of libido with saw palmetto. 

In the majority of cases people, amino acids, vitamins & minerals are adequate for hair growth. Supplements, as the name suggests augment deficiency in diet. If you suspect you may be deficient, it is important to find the cause. Your family physician can run a series of tests to look for iron, vitamin B12, zinc, & vitamin D deficiencies. 

Supplementation can be obtained through pharmacies & health food shops. Naturopaths can sensibly add to the investigations & safely supplement your intake if required.

A firm diagnosis of your hair loss pattern is important. It not only gives prognosis, but will dictate a clear & precise management plan. With medical management, including supplementation where indicated, alopecia (hair loss) can in some cases be reversed without the need for drugs, lasers or surgery. This especially applies to self-limiting causes of hair loss, including telogen effluvium & chronic telogen effluvium.

Autoimmune hair loss disorders including lupus, & alopecia areata are commonly associated with vitamin B12 & folate deficiency. Simple screening blood tests conducted by your physician can check these levels.

FUE is indicated for male & female pattern hair loss. Other indications include scarring forms of alopecia including lichen planopilaris, frontal fibrosing alopecia, discoid lupus as well as traumatic alopecia. In the context of scarring alopecia, most dermatological surgeons would want a period at least 18 months of quiescence prior to transplantation.

My viewpoint is to consider test patches of transplantation for scarring alopecia. Additionally, your condition should be evaluated & closely monitored by your medical dermatologist to ensure graft uptake.