A woman’s hair is often viewed as part of her signature identity, and women typically take great pride in the locks they were born with. Because of this, the experience of thinning hair or hair loss can be depressing at best.
This article takes a look at the emotional effects of hair thinning and hair loss for women, when and why it’s experienced, reasons for these conditions, as well as several treatments that doctors recommend.
We’ve interviewed top experts on this topic, including Dr. Anthony Oro, a hair loss specialist at Stanford Health Care. Dr. Temitayo Ogunleye, Assistant Professor of Clinical Dermatology at Penn Medicine, a world-renowned academic medical center.
Dr. Deanne Mraz Robinson, Assistant Clinical Professor of Dermatology at Yale New Haven Hospital and Co-Founder of Modern Dermatology of Connecticut and Pure BioDerm.
And Dr. Paul Yamauchi, Ph.D, who’s in private practice at the Dermatology Institute and Skin Care Center in Santa Monica, California.
Hair is culturally something we associate with youth, beauty, and good health. Hair loss – also known as alopecia – or thinning hair can greatly impact self-esteem and cause depression, anxiety, and other emotional issues, Dr. Robinson said.
“In our culture, hair defines our appearance and distinguishes us,” Dr. Yamauchi noted. “For women who had a full set of hair and start to experience hair loss, this can be devastating. Women will feel less attractive and self-esteem and confidence decrease. Stress sets in as the hair loss progresses and quality of life diminishes.”
Dr. Robinson noted that according to the American Academy of Dermatologists, it’s normal to lose anywhere from 50 to 100 strands of hair per day.
Relative to the 100,000 (or more) follicles of hair on our heads, this shouldn't make a noticeable difference in how your hair appears. However, “if you're seeing a difference in your appearance then you are likely experiencing something pathological.”
Dr. Yamauchi agreed it is normal to lose about 50 to 100 hairs per day. “Women oftentimes report more hair left behind on the hairbrush or in the shower drain. They notice that their full head of hair diminishes becoming less dense. In general, hair loss has no symptoms such as itching or pain.”
When it comes to hair loss with women, female pattern baldness is the most common. “That’s when women get thinning on the top of the crown of the scalp,” Dr. Ogunleye said. “You might see some women will have a comb-over; that’s what most women complain about.”
Women who are going through perimenopause or post menopause may experience hair thinning or hair loss, and it may gradually get worse as the woman grows older, Dr. Ogunleye noted.
Perimenopause usually starts when a woman is in her 40s, but can start as early as her 30s. “However we do see it in women in their 20s so it can start pretty early.”
When it comes to hair growth, Dr. Oro uses the analogy of a garden.
“There are stem cells that allow the hair to grow and those are like the seeds, and the surrounding part of the stem cell helps those seeds grow, so it’s like a soil,” Dr. Oro explained. “For optimal growth, you need the seeds to be healthy and the soil to be healthy.”
There’s a genetic map of the scalp, and when you’re born, these “seeds” are given a genetic warranty, he said.
“Those seeds are genetically programmed, and sometimes they’re programmed with a short warranty, so some people start to experience thinning hair at age 20 – and we’ve even seen it happen with teenagers,” Dr. Oro said.
However, women with a longer “warranty” might have thick hair well into her golden years.
“It’s just a longer warranty, as the difference between buying a Yugo versus a Mercedes,” Dr. Oro said.
Genetics is often a factor when it comes to thinning hair or hair loss, Dr. Ogunleye said. For instance, if a mother has a history of hair loss or thinning hair, it could be passed down to her daughter. But if genetics is the cause, the daughter might not begin to lose her hair at the same age as her mother did.
“It doesn’t necessarily happen at the same age as the parent when the woman might start losing her hair, and we don’t know why that is,” Dr. Ogunleye said.
2. Thyroid Levels
An underlying medical condition such as thyroid disease and anemia can result in hair loss, said Dr. Yamauchi, adding that treating the condition can result in reversal in hair loss.
As we age our thyroid may become less, but low or high levels can affect hair growth, Dr. Ogunleye said. “I recommend that women have that checked with their doctor.”
The hair depends on the thyroid hormone, Dr. Oro added. “The thyroid gland gives out over time, so you want to make sure that’s okay,” he said.
3. Harsh Chemicals
There are also “inflammatory” types of hair loss that can be caused by “scarring” the scalp, said Dr. Ogunleye, noting examples of traumatic dyeing and relaxers. “The main issue people have with dyeing is it’s harmful to the scalp but also the hair. So you can have a lot of hair breakage and damage, and that can lead to thinning and damaged hair.”
Dr. Yamauchi agreed that the type of hairstyle and the products used can result in hair loss. Frequent bleaching or permanents, regular or improper use of dyes, gels, relaxers, and hair sprays, excessive use of blow dryers, flat irons, and other devices can cause hair breakage.
As a woman grows older, her hair’s protective coating becomes thinner, so harsh chemicals have greater potential to cause hair damage, Dr. Oro said. While hair dyes are quite common, some dyes have components that cause allergy or inflammation on the scalp – and should be avoided.
“As you get older you should consider using less harsh chemicals,” Dr. Oro advised. “There are different product lines that don’t have p-Phenylenediamine – PPD – which is the thing that causes the allergies in hair dyes.”
Instead, he recommends natural dyes like henna. “Also, choose dyes that are ammonia-free, because ammonia is very harsh on the hair,” Dr. Oro said.
With dyeing, it’s not so much about the frequency – it’s about how light a woman wants to dye her hair, Dr. Ogunleye said.
“If they’re going lighter, those dyes tend to be more damaging because you have to strip the hair color beforehand to go lighter,” she said. “However, going darker can make the hair feel thicker because it has to coat the hair with that dye color. So darker color tends to be less damaging than going lighter.”
4. Sun Exposure
As the hair ages, it tends to be more sensitive to the sun and can become more dry and brittle, Dr. Oro said.
“So you want to put moisture back in the hair, and don’t expose it to damaging chemicals because they can make the hair easier to break,” he noted.
If you’re going out in the sun, Dr. Oro recommends wearing a protective hat, because UV light can cause more damage to the hair when it starts to lose its protective coating as you age.
“They even have shampoos with sunscreens,” said Dr. Oro, further noting he doesn’t recommend such products because they tend to be expensive. “Just wear a hat or stay out of the sun.”
5. Vitamin Deficiency
Some women may have a vitamin deficiency that can be contributed to thinning hair or hair loss, Dr. Ogunleye said.
“Iron can be helpful if those levels are low, and Vitamin B has been recorded to be helpful for hair growth,” Dr. Ogunleye said. “And zinc is another mineral that may help.”
However, before buying any of these vitamins, be sure to talk to your doctor first to find out if you have a vitamin deficiency, or if the hair loss is being caused by other factors.
“As far as vitamins out there, I’m not a huge proponent for them,” Dr. Ogunleye noted. “But most of them aren’t harmful so women can try them if they would like.”
There are some things which the hair really depends on for growth, like iron, biotin, and protein, Dr. Oro noted, as well as Vitamin D and zinc.
“For most people, if you have a healthy diet, you get plenty of all those,” Dr. Oro said. “If you want to take a one-a-day vitamin, that would be great. However, I don’t recommend hair supplements unless you have some sort of an illness where you’re not eating as well.”
Stress can also be a contributor to hair thinning and hair loss, Dr. Oro said. “The stress hormone can be sensed by the nervous system which wraps around the hair follicle stem cells and causes the hair to respond differently,” he explained.
A college student, for instance, might experience hair loss during final exams, “and in the summer, when there’s no school, their hair grows well,” Dr. Oro hypothesized. “It’s very clearly emotionally connected.”
This is also known as Telogen effluvium, a temporary hair loss where physical or mental stress can result in hair loss, Dr. Yamauchi said. “A severe illness, surgery under general anesthesia, sudden job loss can result in this condition.”
The hair follicle is a biosensor for everything going on in our body.
“It’s wired up to your brain, it’s surrounded by blood vessels, it senses all the hormones – it knows your stress levels,” Dr. Oro said. “Make sure all your nutrients and emotional state and hormonal state are in balance – that’s number one and it’s the easiest thing to do.”
7. Hormone Levels
According to Dr. Robinson, hormonal changes are the most common trigger for hair loss (androgenetic alopecia), and is most noticeable during hormonal life events such as having a baby or menopause.
“There is also a self-induced form of alopecia called traction alopecia which is hair loss caused by how a woman is styling her hair, so ditch the tight pony tail and change up where you part your hair from time to time,” Dr. Robinson advised. “Beyond these factors, there are also autoimmune diseases and conditions of the thyroid and anemia that can cause hair loss.”
8. Non-Scarring and Scarring
Dermatologists define hair loss as non-scarring and scarring, Dr. Yamauchi said. Scarring hair loss is associated with medical conditions such as lupus and other autoimmune conditions where the hair follicles become burned out and scarring occurs. “Once this happens, the hair loss is permanent.”
Non-scarring hair loss is where the hair follicle becomes dormant and the hair stops growing, and the most common form of non-scarring hair loss is hereditary hair loss.
“This is frequently referred to as female-pattern baldness or androgenetic alopecia – for men, this is called male pattern baldness,” said Dr. Yamauchi, adding about 80 million men and women in the United States have this type of hair loss.
According to Dr. Yamauchi, some medicines can cause hair loss such as blood thinners, high doses of vitamin A, and drugs that treat arthritis, depression, heart problems, and high blood pressure.
Alopecia areata is a common condition where defined patches of hair loss can occur, Dr. Yamauchi said, adding that this can be associated with a thyroid condition or anemia, and the extent of alopecia areata can range from a size of a quarter to the full scalp in severe situations.
“Another kind of alopecia is traction alopecia where if the hair braided too tightly, hair loss can occur from the excessive tension,” Dr. Yamauchi added.
Dr. Ogunleye and Dr. Oro both recommend Rogaine as an over-the-counter solution to thinning hair or hair loss for women.
“The only thing that is FDA approved is Rogaine – it absolutely does work,” Dr. Ogunleye said. “But it doesn’t work for everybody in the same way.
Everyone has different results. Maybe 20 percent of people will get hair re-growth, and another 30 to 40 percent will experience hair stabilization, which is better than continued hair loss.”
She refers to Rogaine as “hair fertilizer.”
“You have to continue to use it, so if you stop using the fertilizer it stops growing – once you start you can’t stop,” Dr. Ogunleye advised.
“You have to continue using it for the positive benefits to be continued. You have to use Rogaine for about three to four months before you’ll see an effect. Some women will try it for a month and not see any growth – it does take some time for that to work.”
Minoxidil is the generic version of Rogaine.
“I recommend getting the generic version and using that once-daily – that can be helpful,” Dr. Ogunleye said. “I recommend getting the 5% version. It comes in a solution and foam. The solution can sometimes be more irritating, so I recommend the foam.”
Rogaine initially designed a 5% version for men and a 2% version for women.
“In the last three years, Rogaine came out with studies to prove the 5% version worked better with women,” Dr. Ogunleye said. “And now they have a patent on Minoxidil. So you want to get the generic for women for 5%. I recommend they get the men’s version because that’s the same thing.”
Dr. Oro noted that Rogaine can be effective because it provides blood flow to the scalp, but Rogaine is not as strong as finasteride, which is an oral prescription medication.
“It blocks the male hormone, which tends to reduce the warranty on the hair follicle stem cells,” he said. “It doesn’t stop the process altogether, but it slows it down.”
Noticeable results may take six months or longer, and effects are not sustained without continued treatment, according to the study, Finasteride for Hair Loss in Women, published by the Drug and Poison Information Centre in British Columbia.
The study evaluated topical finasteride for pattern hair loss in 52 patients. This group included 24 women, ranging from 23 to 38 years old, in a 16-month, single-blind, placebo-controlled trial.
This treatment consisted of topical finasteride applied twice daily to balding areas. While there was no response to treatment in the first three months, by six months, there were statistically significant differences in hair density and hair loss compared to the placebo.
“By the end of the study all treated patients had slight to marked reduction of balding areas and all reported perceived benefit, rating their treatment moderately or highly effective,” according to the study. “Treatment was well-tolerated with no report of local or systemic side effects.”
3. Nioxin Hair Products
Dr. Ogunleye recommends a product line called Nioxin.
“You can buy it online and a lot of hair stores like Sally’s carries it,” she said.
Some of the Nioxin products contain ingredients like vitamins, SPF 15 sunscreen and botanicals, which can help clean follicle-clogging sebum from the scalp.
Another product, Smoothplex, contains silk amino acids, kukui nut oil and protective conditioning agents, which can help reduce hair loss by strengthening the hair against damage and breakage.
“The reason I like Nioxin is that their shampoo and conditioner have hair thickeners that coat the hair shaft to make the hair feel thicker,” Dr. Ogunleye said. “So some people like that because it makes their hair look thicker.”
4. Hair Powders
Hair powders, which are designed to mask the appearance of bald spots or thinning hair, can also be effective.
“Many women don’t like it when you can see their scalp, but there are scalp dyes to color match your hair that you sprinkle on that makes you look like you have hair there, and you really don’t,” Dr. Oro said.
“They’re fill-in powders that can help fill in the space on their scalp and make the hair loss less evident,” Dr. Ogunleye said.
While she doesn’t recommend any particular brand, Dr. Ogunleye said women can research hair powder products easily on the internet to determine what will work best for them.
5. Wigs, Weaves and Hair Extensions
As far as other disguise techniques are concerned, wigs, weaves and hair extensions are great options to help mimic the look of a full head of hair.
“Wigs are the least damaging option for your hair and they’re really popular right now,” Dr. Ogunleye said.
She recommends weaves tentatively, “because you have to make sure you’re going to the right person and that the person installing the weave doesn’t damage your underlying hair. It’s something that you can do – but you have to do it cautiously.”
Dr. Oro refers to these options as “hair enhancements.”
“Weaves or extensions can look very nice,” he said. “There are plenty of people, public figures, who wear these. And you’d never know because they have this amazing look, but they are actually hair enhancements. Hair extensions, hair weaves and hairpieces – there are all sorts of options for women as their hair configuration changes to improve their appearance.”
6. Hair Implants
Hair implants can be pricey – typically costing from $6,000 to $10,000 – but they do work, Dr. Ogunleye said.
“It’s not a cheap intervention but it definitely can be helpful,” she said.
Dr. Oro noted his garden analogy to explain how hair transplants work.
“There’s the soil and the seeds, and when you do the transplant, you take the soil and seeds together and transplant it to another place,” Dr. Oro said. “So basically you’re not creating more hair. You’re redistributing the number of seeds on your scalp.”
However, “if you have an autoimmune disease – or the soil is not good – then trying to transplant seeds into concrete is not going to work all that well,” he said.
If you decide to get hair implants, it’s important to seek out an expert in the field.
7. Platelet-Rich Fibrin Matrix
Platelet-Rich Fibrin Matrix, or PRFM, when injected into the scalp can trigger natural hair growth, Dr. Robinson said. Here’s how it works:
“We draw the patient's blood from the arm, spin it down in a centrifuge to isolate the platelets and then inject it back into the scalp. The platelets contain hundreds of proteins called growth factors, those are our liquid gold.”
PRP is then converted to PRFM creating a scaffold to protect and persevere the platelets so their release of growth factors can be sustained over a longer period of time when they delivered back into the scalp.
Typically, patients will need monthly injections for 3 consecutive months, and then maintenance treatments every 6-12 months. The injection schedule will depend on your genetics, pattern, and amount of hair loss, age, and hormones.
8. Follicular Unit Extraction (FUE)
According to Dr. Robinson, Follicular Unit Extraction – FUE – is the latest advance in surgical hair transplantation.
During the procedure hair follicles are removed one-by-one from permanent hair-bearing areas of the body and then re-implanted into areas experiencing hair loss. Since each follicle is being removed individually (versus in a strip) the scarring is minimal, typically less than 1mm in diameter.
“I use the NeoGraft Automated Hair Transplantation system, a cutting edge technology for men and women looking to restore their hairline using the Follicular Unit Extraction,” she said.
A pill called spironolactone “has been shown to be beneficial for hereditary hair loss,” Dr. Yamauchi said.
According to the American Osteopathic College of Dermatology, spironolactone pills help many women, especially those whose hair loss begins before menopause, but takes many months to work.
The side effects of spironolactone include postural hypotension, electrolyte disturbances, menstrual irregularities, fatigue, urticaria, breast tenderness, and hematological disturbances, according to the National Institutes of Health.
Hair loss can be emotionally traumatic for women, Dr. Yamauchi said, and despite treatment or avoiding triggering factors, hair loss can continue.
“I have noticed that eventually most women adapt and learn to live with it. For more extensive hair loss, a wig or hair extensions will conceal the hair loss.”
Before spending your money on products that claim to fight hair loss or thinning hair, keep in mind that most things on the market probably won’t work, Dr. Ogunleye said.
“Hair is important and hair is a huge industry in our country, and so there are a lot of products out there that aren’t proven to work,” Dr. Ogunleye said.
“If it’s being offered by only a few places it’s probably not working that well.” Everyone wants to find out a way to grow hair – and the person who figures this out will be rich, she added. “So if something works, you’re not going to find only a few people that are doing it.”
Meanwhile, it’s important to make sure that you treat the hair that you have left as gently as you can, she said. That means avoiding external factors that could be damaging, such as too much heat, or using chemical relaxers.
Currently, there are some very useful products on the market for mature hair, Dr. Oro said, “and there’s a lot of research going on right now in trying to improve growth and health of hair stem cells. There’s a lot of hope and promise in the future.”
Dr. Robinson added: “We have more options now than ever to help patients who are struggling with hair loss. It's best to address it early before the follicle is completely gone and our modalities are limited to FUE.”