Abstract: Female hair loss affects approximately 50% of women by the age 50 and management can be challenging, frustrating and devastating. Alopecia is the main term for autoimmune hair loss among different types including areata, androgenetic, and universalis. With over 30 known causes of hair loss – nutrient deficiencies, hormonal imbalances and inflammation rank as the top three. Studies confirm a healthy microbiome is vital for healthy hair, even for cases of alopecia. Hair is built from nutrients the body can efficiently digest and absorb and autoimmune hair loss can be a result of unresolved, chronic inflammation. Autoimmune diseases including alopecia have a common link to gut health. An imbalanced gut microbiome starts the process of permeability leading to leaky gut, a compromised gut barrier that facilitates inflammation. Chronic inflammation is a trigger, yet leaky gut itself creates inflammation. This bi-directional relationship is central to understanding the role that leaky gut plays in the onset of autoimmunity, hence chronic inflammatory diseases. The loss of immune privilege that leads to the autoimmune attack of the hair follicles, is considered a predominant cause of alopecia. This phenomenon has led researchers to describe alopecia hair follicles as “leaky”. Dysbiosis, inflammation, and immune dysregulation that begin in the gut do not stay in the gut, the effects are systemic. There is a known association between gut dysbiosis, inflammatory bowel disease, and hair loss. In 4 published clinical trials, where men and women with alopecia received a fecal transplant, all were able to regrow hair afterwards proving that a healthy microbiome plays a major role in hair growth and reversal of hair loss. Given how much the gut and our immune system collaborate and overlap, the presence of immune system dysregulation and autoimmunity means that we need to take a closer look at the gut and investigate the root causes that have led to dysbiosis, nutrient deficiencies, hormonal imbalances, inflammation and inevitably hair loss.