Hormonal Status and Post-Surgical Hair Loss in Female Bariatric Patients

Ami Rao-Zawadzki, Timothy M Farrell, MD, David W Overby, MD. UNC School of Medicine

Introduction: Hair loss is a common complaint among women post-bariatric surgery; the degree and etiology are not well-studied. With previously reported data showing increased serum FSH, LH, SHBG, and decreased estradiol, testosterone, and DHEA-S after bariatric surgery [1], we hypothesized that a temporary hypo-estrogenized state is present after surgery, and that questionnaire proxies for estrogen fluctuations (rate of weight loss, vaginal lubrication, sudden resumption of menstruation) would be positively correlated with severity of post-surgical hair loss.

Methods: Questionnaires were mailed to 253 female patients age 18-60 who received gastric bypass, sleeve gastrectomy, or gastric banding at UNC between 01/01/2010 to 01/01/2014. Eligible patients were identified by retrospective chart review, with exclusion criteria of previous bariatric surgery or post-operative complication causing re-admission/surgical intervention. Hierarchical multiple regression analysis [SPSS] controlled for pre-surgical hair loss, procedure type, family history of hair loss, and vitamin/protein deficiency. Final sample size was n=53 (23% response rate).

Results: Hair loss after bariatric surgery affected 77% of surveyed women. Weight loss in the first year post-surgery independently correlated with increased hair loss (p = 0.004), after controlling for protein deficiency (p = 0.005). Vaginal lubrication (p = 0.046) and sudden resumption of menstruation (p = 0.001) also positively correlated. No correlation was detected with age at surgery; that analysis may have been impacted by the high rate of hysterectomy before age 55 (n=13, 25%).

Conclusions: Significant correlations of weight loss rate, increased vaginal lubrication and resumption of menstruation support the role of estrogen fluctuations, as estimated by questionnaire proxies, in bariatric post-surgical hair loss. We believe this is a novel insight, and propose future studies using direct serum markers for further analysis.

[1] Sarwer et al. (2014) Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surgery, 149:26-33