Female Hair Loss

Female Hair Loss FAQ

Am I Losing My Hair?

Your Questions about Female Hair Loss Answered

While women rarely "go bald," they can experience significant hair loss. In fact, hair loss happens as frequently in women as it does in men. According to the American Academy of Dermatology, 30 million women in the United States experience hereditary hair loss, the most common type. Hormonal changes, pregnancy and extreme stress can also cause thinning. For many, this can be an embarrassing problem and one that is difficult to treat. Doris J. Day, MD, dermatologist and clinical assistant professor of dermatology at New York University Medical Center, tells us when we should be worried and offers advice for dealing with our concerns over this troubling condition.

Q: Does taking the birth control pill increase the likelihood of a woman losing her hair?

A. It depends which one you take. You really need to consult your doctor. Some pills are more or less "androgenic." This relates to the amount and type of hormone called progestins in the Pill. The more androgenic the progestin, the more likely you are to suffer from acne and hair loss as side effects.

Q: How does menopause affect the likelihood of female hair loss?

A. Hormones definitely play a role in hair loss. For certain women, there can be an increase in hair loss during menopause. For some, their hair-loss problem gets better. During menopause, you basically stop making estrogen. Your skin can get dry. You can have hair loss. You still have some progestin, but the progestins are now unopposed. Now there is a tilt toward the side that makes the hair fall out, since the side that was blocking it is now gone (the estrogens).

Q: What would you say to a woman who comes to you with hair loss?

A. There is so much work-up when it comes to hair loss. You have to be patient. You have to eliminate a whole list of problems, but at the end, you are limited. It can be very frustrating. This is a difficult problem for women and I don't minimize the problem.

I do suggest over-the-counter topicals that can slow the hair loss while you look for some other solutions. It depends on the type of hair loss. There are two types of hair loss in women: patterned (androgenic) and non-patterned. With patterned, you lose it up top, but maintain a lot in the back. If you have this problem, then you have a good resource to take hair from the back for a hair transplant. With non-patterned, the hair loss is diffused all over the scalp. Women don't go bald, but with this, they are basically bald. There is no place to take hair to do a transplant. These women are poor candidates for a transplant.

Q: What are some of the best treatments available for women? Is this a problem that can only be solved with drugs?

A. The most important first step is to find out the underlying cause. This can help direct treatments. There are more treatments on the way for women. Rogaine has a women's-strength treatment, which does help a significant proportion of women. Some oral contraceptives are helpful, along with other drugs, like Aldactone [a diuretic usually used to treat hypertension, which works by blocking the action of androgens, the male hormones that contribute to hair loss]. Hair transplants are also an excellent treatment option for the right candidates, but they can be expensive. Hairpieces have come a long way, too. Many of my patients have sprays or powders that cover up the area. These last from one shampoo to the next and look very natural.

Q: How about nutrition? Are there foods we can eat that will affect our hair? Could what we eat cause or stop female baldness?

A. Having a healthy balanced diet with enough protein is very important. Biotin and zinc sulfate, taken as supplements, are good for the hair. Anemia [a condition caused by a deficiency of iron] can also lead to hair loss.

Q: What ways have you seen women covering up their hair loss? What is the most effective way?

A: Fortunately, the most common patterns of hair loss in women are different from those in men. Women do not "go bald." Usually it starts as a widening of the part and then loss of the frontal area behind the frontal hairline. This gives us room to get creative with the way we part our hair to cover up the thinning areas. Also, if your hair is lighter, closer to the color of your scalp, the thinning is less noticeable. Hairpieces are also coming back into fashion.

Unfortunately, this problem is as common in women as it is in men, but it's less socially acceptable. But wigs for women look better than toupees for men. And they are more socially acceptable. A wig is an accessory. I have friends who have a ton of hair, but they wear wigs because it's fun. Wigs have come a long way and they are not as damaging to the underlying hair -- but not everyone tolerates them. I have a problem with hair extensions and braids. These are usually traumatic to the hair. They can cause a problem called traction alopecia, where the constant pulling of the hair leads to hair loss.

Q: Should a woman be alarmed if she believes she has sudden hair loss? What could this mean?

A. There are bound to be some variations in how much hair we lose on any given day depending on what we do to our hair. You may notice less hair loss if you don't brush your hair one day, or more if you manipulate it more on the next. I think it's reasonable to consult your doctor if this lasts more than a few weeks. Obviously, if you notice big chunks falling out, you need to see your doctor immediately. Thyroid conditions or other hormonal changes, anemia, malnutrition or even lupus can have hair loss as one of the signs of the condition. There is also a condition called alopecia areata, where the hair falls out in patches. Alopecia areata is an autoimmune condition where the body attacks the hair follicle. The hair falls out in discreet circle-shaped patches of hair. You can also get this on the eyebrows or any hair-bearing part of the body. It is usually treated with a series of cortisone injections into the scalp to stop the inflammation and help the hair regrow. But it should be treated early; if you treat it within a couple of weeks to months, there is a better chance of the hair coming back.

Q: If a woman's mother or father has thin hair, does that mean she definitely will? And does it matter who has thin hair, the mother or the father?

A. Family history definitely plays a role in hair loss, but is not a guarantee. It comes from both sides of the family.

Q: Can improper care of one's hair cause hair loss? Like wearing ponytail holders all day, every day?

A. Improper care plays a very large role. Wearing a tight ponytail or braids pulls the hair and makes it fall out prematurely. If you think your hair is falling out and you keep checking to see, then you may also be pulling your hair out. Too much blow-drying or processing can also cause breakage and pull hair out prematurely. This includes coloring and relaxing. Highlighting is less problematic, since this usually doesn't affect the root of the hair or the scalp as much. It's best to do as little as possible to your hair.

Q: What about frequent shampooing?

A. It's not good to rub too much or use a harsh shampoo. There's an ingredient in shampoo -- surfactant -- that makes it lather so nicely. Surfactants can be irritating to the scalp, and that can lead to itching and scratching. By doing this, you can traumatize the area, which can lead to permanent hair loss. It's better to use a gentle shampoo. Or look for a shampoo that's surfactant-free.

Q: Is it true that after a woman has a baby, she may experience hair loss? Why does this happen and how long does it last?

A. This is called "telogen effluvium," and it usually starts about three to four months after any extreme physiologic stress like pregnancy, major surgery or any major life event, such as divorce, death in the family or even major job-related events. What happens is that your hair growth, which until now has been unsynchronized -- 90 percent in anagen, and the rest in catagen or telogen -- goes through a synchronized shift from anagen to telogen. We know that the telogen phase can last up to three to four months, and then ends in the catagen, or falling out, phase, which can be very disconcerting since some women lose up to 40 percent of their hair during this time! The good news is that the hair cycles then unsynchronize themselves again and the hair grows back the way it did before. Telogen effluvium is not a process of going bald; it is simply a shift of hair in an abnormal way from one part of the hair growth cycle to another. Once that shift is over, things usually revert back to normal with regrowth of the hair. [According to the AAD, hair loss from pregnancy can last from one to six months, but completely resolves in most cases.]

Q: What about Propecia? Does it work for women?

A: It doesn't seem to work for women. Plus, if you are in childbearing years, there are issues. The drug affects your hormones. Pregnant women aren't even supposed to touch it, as it may change a boy's genitals. It is sometimes prescribed off label for women who are not in their childbearing years, but the studies seem to indicate that it doesn't work very well for women, and there are side effects. For women, there's Aldactone. And there is hope in the Pill. Taking a Pill like Yasmin may help treat this problem, sometimes in conjunction with Aldactone. A drug called glucophage that is usually used in people with type 2 diabetes is also being used with some success.

Q: What kind of research is being done in the area of hair loss in women?

A: There is a ton of new research going on. And a lot of money is going into this research. The race is on to clone the hair or reverse this process. With the most common forms of baldness, the hair follicle is still there, it just becomes miniaturized. If you find a good way of opening that up, through a gene or by blocking the process that leads to that miniaturization -- something that you can take as a pill or a cream -- it would be an ideal way to control the hair loss.

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