Preparation
Hair loss has long been a chief complaint among women, especially as they age. It affects some 30 million women in the United States alone, according to the Cleveland Clinic, and will significantly impact more than 50% of women during their lifetime, says Deanne Mraz Robinson, MD, FAAD, the co-founder of Modern Dermatology and the assistant clinical professor of dermatology at Yale New Haven Hospital. Many aspects play a role, particularly lifestyle, genetics, aging, medical conditions, and hormones.
Luckily, we’ve come a long way in terms of treating hair loss. “In more recent years, clinically tested topical and oral products, such as Minoxidil and Propecia, have become available, as well as procedures like PRP (platelet rich plasma therapy) and hair transplants,” shares Anabel Kingsley, consultant trichologist and brand president for Philip Kingsley.
She finds a holistic, personalized approach to be the most effective way to treat any form of hair loss. “Since there is no ‘one size fits all,’ you want to optimize all possible factors that can affect the hair growth cycle, such as general health, nutrition, and stress levels, as well as the condition of your hair and scalp,” she says. But there are some other new-age options to consider, as well.
Ultimately, there’s a difference between losing more hair when you shampoo because you need a trim and seeing clumps come out in your brush. Hair loss in women—while common—can be scary, and if it’s happening to you, you’re probably wondering why. The cause varies for everyone, but these are the most common culprits.
Can you blame your genetic code for hair loss? Sometimes, says Reid Maclellan, MD, the director of Proactive Dermatology Group and the founder of Cortina. He explains that some of us are just more susceptible to these conditions due to our genetic makeup. “Hereditary hair loss usually comes with aging, and starts when you reach middle age,” he continues. “You will most likely first notice your hair thinning [at the crown] and the part of your hair widening over time.”
Here’s another reason to skip that fad diet: You might experience hair loss, Dr. Maclellan says. “The body is very in tune and sensitive to major changes,” he says. “If you often go on crash diets and cut out certain food groups, your body will need nutrients it is no longer receiving—and this may cause hair loss.” And there isn’t a timeline: Restrictive diets, at any stage of your life, can cause hair loss. “Getting all the nutrients, you need is key to staying healthy.”
While this can happen at any age, most women will experience hair loss tied to nutritional deficiencies between the age of 18 and 30, says William Gaunitz, FWTS, a certified trichologist and founder of Advanced Trichology. “During this time, women are most often dealing with nutritional hair loss related to lower ferritin and zinc levels because of menstruation and a lower intake of animal protein leading to a deficiency of one or both,” he says. “This can easily reduce the overall volume of hair and reduce the length.”
Over the course of a woman’s life, she may experience normal hormonal shifts that impact or cause hair loss.
Ages 18 to 30: Women are often diagnosed with hormonal conditions like polycystic ovarian syndrome, otherwise known as PCOS, between 18 and 30, as well, explains Gaunitz; this condition can result in hair loss. Women in this age group—and those in their 30s—also experience significant hormonal shifts postpartum, about four months after birth, when estrogen levels wane. This can also lead to hair loss.Ages 39 to 51: The next hormonal-related hair loss period is perimenopause, which occurs between the ages of 39 and 51. “During this time, hormonal-related loss is often a culprit because the overall levels of estrogen are declining against the volume of testosterone and DHT, leading to androgenetic alopecia,” Gaunitz says.Ages 50 and up: The last bracket is after menopause, when a female produces nearly no estrogen; this allows dihydrotestosterone to influence the hair follicle without interruption. “At this point, hair loss is most extreme on the top of the scalp and requires some type of hormonal buffer both internally and topically to correct the growth cycle,” Gaunitz says.
If you can’t pinpoint a reason for your hair loss, Dr. Robinson recommends working with your doctor to rule out thyroid disease. Hair loss, she explains, may develop slowly for patients experiencing both hypothyroidism and hyperthyroidism. Shedding may also be associated with autoimmune thyroid disorders, such as Hashimoto’s and Graves’ disease. There’s good news: Hair loss typically stabilizes once the thyroid hormone levels are normalized.
From prescriptions and off-label medications to diet and lifestyle changes, there are many ways to treat hair loss in women. Before considering or starting any of the treatments outlined below, make sure to book an appointment with a trusted physician or dermatologist to assess your unique needs.
Adrienne O’Connell, DO, the medical director and president of Laguna Beach Aesthetics, explains that the only FDA-approved treatment for female pattern hair loss is Minoxidil; it’s available over-the-counter as Rogaine (oral iterations exist, as well, but require a prescription). It works by prolonging the growth phase of hair follicles, and the recommended dose is 2 percent, since higher doses can cause unwanted facial hair growth.
According to Dr. O’Connell, this treatment slows down or stops hair loss for most women, and for up to a quarter of women who use it, it can encourage new hair growth, too. “The sooner you start to use it, the better results you’ll have,” she says. “Although Minoxidil is easy to apply to the scalp, you do have to apply it twice a day, which can be an inconvenience.”
And it’s not cheap: It runs about $30 for 2 ounces. It’s also important to note that Minoxidil does need to be used indefinitely, as the results will go away if stopped. Dr. O’Connell recommends using it for at least four to six months, which is how long it takes to see results.
A handful of medications, like birth control pills, aren’t technically prescribed for hair loss, but they can help combat some of the underlying reasons why women might experience shedding. Jodi LoGerfo, DNP, APRN, FNP-BC, DCNP, explains the most common off-label options.
Birth control pills: Because female contraceptives decrease the production of male hormones in the ovaries, LoGerfo says doctors will use them to treat women’s androgenetic alopecia. “There are birth control pills that are considered ’low androgen index,’ and these are better at treating hair loss than others,” she says.Spironolactone: This diuretic was originally developed for high blood pressure, but also serves as an androgen (male hormone) blocker. This not only fights hormonal acne in women, but hair loss, too.Finasteride and Dutasteride: LoGerfo explains these are 5-alpha-reductase inhibitors that are often used in treating androgenetic alopecia in males, but are also used off-label for women. “Both inhibit the conversion of testosterone to DHT, decreasing 5-alpha-reductase and lessening the effects DHT has on the hair follicles,” she says. Women who are pregnant or are trying to become pregnant should avoid this treatment.
Like men, women can also utilize low-level laser light therapy (LLLT) to battle hair loss. Usually, this is in the form of a comb or a cap that you wear for periods of time. “It has been touted to improve hair density, but more research is needed and ongoing. The mechanism of how it is effective is unclear,” LoGerfo says.
This treatment has gained momentum for both women and men alike, and according to LoGerfo, involves drawing a patient’s blood, processing it via centrifuge, and then injecting the plasma—which comes to the top when spun—into the scalp.
“PRP contains lots of growth factors that may trigger hair growth and increase the density and thickness of hair,” she says. “At this moment, there are several different methods for doing the procedure and activating the platelets, which produce varying concentrations of platelets and growth factors. Unfortunately, there is no single protocol.”
Like with any new treatment, the problem remains that there is no exact concentration, dose, or data on the depth of injection; professionals also aren’t sure how frequently the procedure should be done and how many treatments are needed to see the best results. “From experience, more is better, and consistency is crucial,” LoGerfo says. “I usually recommend patients have a treatment every four to six weeks for at least six to 12 months—and possibly beyond.”
Another option is a hair transplant—but this is only possible if adequate donor hair is available. “Hair transplantation is a surgical intervention used in men and women and is used in addition to medical therapy, when a patient does not achieve an acceptable response to medications,” says LoGerfo. “Hair transplants are performed by transplanting the hairs from the back of the scalp to the affected areas—like the frontal hairline, vertex, and crown—and yields cosmetically desirable results.”
It’s important to note that some people are not candidates for hair transplantation, including those with diffuse hair loss or insufficient hair density in the donor area.
Dr. Robinson says most hormonal fluctuations in hair loss are temporary and can be supported with over-the-counter products and systems (like the aforementioned Rogaine). She recommends ISDIN Lambdapil Hair Density Kit, a comprehensive solution that has both short and long-term benefits for women with thinning hair.
“The systemic supplement capsules deliver amino acids and proteins to support healthy hair growth from the inside out,” she continues. “The topical lotion nourishes hair strands to improve resiliency, preventing breakage, while the shampoo delivers volume that instantly improves the appearance of thinning strands while supporting a healthy scalp longer term.”
If you are only experiencing mild hair loss, Dr. Maclellan says to audit your diet. “Making sure you are getting all the vitamins and nutrients your body needs is a good first step if you’re experiencing hair loss,” he says. “The body is sensitive to changes and needs a balance of vitamins. Biotin can also be taken daily and worked into your lifestyle—it is great for hair growth.”
