Hormones and Hair Loss and Excess Skin, Oh My!

We all know bariatric surgery promotes weight loss, but with a change that significant to your internal anatomy there are always going to be other effects on your body. Bariatric surgery may cause hormone fluctuations, hair loss, and excess skin. During the September MUSC Metabolic & Bariatric Surgery Program support group meeting, we discussed some of these effects and how current post-operative patients are managing them.

Hormone Changes

Fat cells, or adipose tissue, produces certain hormones in the body, a big one being estrogen. Bariatric surgery causes weight loss and a decrease in the amount of fat in the body, thus impacting our hormone production. Estrogen is a sex hormone, primarily in females, but it is also found in males. Estrogen plays a strong role in the female reproductive system. With rapid weight loss, many females experience an increase in fertility shortly after surgery, but it is recommended to not get pregnant the first 18 months after your weight loss surgery. Due to this increase in fertility, we recommend long-term reversible contraceptives (like the IUD, the arm implant, or injectable birth control) or 2 forms of other birth control (example: birth control pill and a condom) for 18 months after surgery. After 18 months, it is perfectly safe for a woman to become pregnant, and because of the weight loss associated with bariatric surgery, pregnancy is actually safer for both mom and baby. The baby is more likely to be a normal weight, and the baby has a decreased risk of developing chronic health conditions like obesity. In men, excess estrogen produced by fat cells can cause an imbalance with other sex hormones, like testosterone, and weight loss from bariatric surgery can help improve this balance and often improves erectile dysfunction. 

Another important hormone that is effected by bariatric surgery is ghrelin, or the “hunger hormone.” Ghrelin is a hormone that is produced and released mainly by the stomach. Ghrelin is released when our stomachs are empty and is responsible for the growling noise that our stomachs make. After bariatric surgery, because a large portion of the stomach has been removed, there is less ghrelin produced. Decreased amounts of ghrelin help to decrease appetite and promote weight loss. Bariatric surgery works on a physical and chemical level, changing both the size and structure of the gut anatomy and impacting ghrelin production to increase weight loss.

Hair Loss

Members of the September support group meeting opened up and discussed their hair loss after bariatric surgery. Hair is can be important to a lot of people. Hair may have cultural significance, improve self-esteem, or be a fun hobby, and losing it can be devastating. Hair loss is a side-effect of bariatric surgery the most patients experience, particularly the first 3-6 months after surgery. While we value our hair, on an anatomical level it is not as important as our organs in keeping our bodies healthy, which is why hair loss is common with excessive weight loss or drastic change in diet. The good news is- hair grows back! You may have to be patient because growing back a head full of healthy, luscious locks takes time. To help, you can be sure you are eating enough protein every day. You want to be giving your body enough protein so it can send some up to your head to use for hair growth. After weight loss surgery, if your protein intake drops, it is likely you may start to lose hair once more. It is vital to make sure you are getting adequate amounts of protein daily after bariatric surgery, general recommendations of at least 60 grams of protein daily.

Excess Skin

When you lose a significant amount of weight post bariatric surgery, it is possible that your body may accumulate excess skin. The amount of fat inside your body is decreasing, but sometimes your skin does not shrink with the rest of you and you may be left with portions of loose, hanging skin. Genetics is responsible for whether or not you have excess skin after weight loss. An example given during support group was that some women have a baby and are left with no stretch marks, while another woman may have stretch marks after gaining only 10 pounds. While this excess skin may be unpleasant it is completely up to you if you would like to have it removed.

To qualify for skin removal surgery, you must have a BMI of less than 35 and have lost 50% of excess body weight. Most referrals for skin removal surgery are 12-18 months after bariatric surgery. It is important to wait at least 12-18 months to ensure you have reached a stable weight, so you do not nip, tuck, and tighten skin if you are going to lose weight again. Skin removal surgery does not remove fat, it only removes excess skin from the body. To have skin removal surgery covered by insurance, you must have medical reasons for needing skin removed. Medical reasons may include difficulty keeping these areas clean and moving with the excess skin. Recovery from skin removal surgery is more demanding. You will need up to 6 weeks off from your job if it has any physical component.

Recap

It is important to be aware of the changes mentioned in this post and others that your doctor will discuss with you when deciding if bariatric surgery is right for you, or if you have had surgery so none of these things come as a surprise. Bariatric surgery can have amazing, positive impacts on your health and life overall. There may be some challenges you have to face, but these obstacles for most are well worth the improvements that they see in their lives after surgery.

Audrey Calianos graduated from the University of Massachusetts Amherst and is a current dietetic intern at MUSC. She plans a future career as a registered dietitian.