Why Hair Loss Happens & What To Do About It

Illustrated by Ini Neumann.

From getting a professional cut or the occasional salon blowout to all of the hours spent in the morning washing, drying and styling, women often spend a lot of time (and money) getting a perfectly coiffed
head of hair. But then, if you suddenly discover that you're losing hair — be it strands or chunks — it can be a scary and confusing thing. Because hair loss or alopecia, as it's medically termed, is
traditionally thought to only affect men, many women are shocked when they learn they are prone to this condition. As a dermatologist who's had experience working with patients who have this affliction, I'm here to break down the different types of hair loss in women and the medical and cosmetic options to consider.

Female Pattern Hair Loss
The most common types of
alopecia in women are female pattern hair loss (FPHL), also known as androgenetic alopecia (AGA) — or hereditary hair loss. AGA is the type of hair loss most commonly
associated with men but, in fact, approximately 50% of women develop it
during their lifetime. 

Genetic and inherited from either the
maternal or paternal side of the family, AGA may occur all over the scalp and not in a concentrated area. Washing your hair frequently,
dying your hair, or using a hairdryer or any other hair styling tool daily are not causes of this hair loss. I've had patients come to me concerned about losing hair because of their own hair-care behaviors, but I always assure them that it's not anything they're doing — or not doing. Rather, hair loss occurs when, over time, the
hair follicles get smaller or miniaturized. Once the hair strand sheds, it is replaced
by a thinner, finer strand.

Telogen Effluvium
While FPHL is the most common type of hair loss in women, Telogen Effluvium (TE) exists as well. Many women experience this kind of hair loss after giving birth, but in fact, there are a number of other potential triggers of TE, including trauma, major surgery, thyroid disease, crash diets, extreme stress and even some medications. On average, TE occurs three months after the precipitating event. The trigger causes an increased number of hairs to transition from the anagen (growing) phase to the telogen (resting) phase. These telogen hairs are the hairs that we normally shed, but in TE, there is a significantly increased amount of shedding because the percent of hairs in telogen has increased. At its peak, women may find that handfuls or whole clumps of hair are coming out.  Because TE generally resolves itself on its own or after an underlying trigger, such as nutritional deficiency, is corrected, I don't typically recommend medical treatment for this type of hair loss.  

Medical Treatments
The primary
treatment for FPHL is minoxidil, which is an over-the-counter topical medication, so you
don't need a prescription from your doctor. Both the 2% solution and 5%
foam are FDA-approved for use in women. It can take at least 4-6
months to begin to see results, though I typically recommend that my patients try it for a year. I always caution my patients that initially, there can be a temporary increase
in shedding for the first few weeks or even months. As counterintuitive as it sounds, this shedding is a sign that the
minoxidil is working. Because AGA is lifelong
and progressive, minoxidil should really be used indefinitely.

Other treatments include oral medications, low-level laser
therapy, and platelet rich plasma (PRP). Oral medications, such as
spironolactone work through altering
hormones. This type of medication is effective in some women, but as it is not
FDA-approved for hair loss, it should be used with
caution and only under the supervision of your doctor.

Low-level laser therapy has been found to
reverse miniaturization and stimulate hair growth in some women with AGA, but
the exact mechanism by which it promotes hair growth is not fully understood.
Platelet rich plasma is one of the newest treatments available. This treatment
harnesses growth factors in your own platelets to stimulate the hair follicles
to produce hairs.  

Lastly, surgical treatment with hair transplant is an
option in some women with AGA. You may be a
candidate for this treatment if your hair loss is quite localized or resembles
more of a man’s hair loss pattern with thinning in the front or top of the scalp. During
the procedure, hair follicles are removed from the back of the scalp and moved to the areas where hair is thinning.  Therefore, hair transplant cannot be used to
treat thinning all over the scalp, since the hair used in the transplant can only be taken from areas of healthy hair growth. Another caveat: Since this procedure is considered cosmetic, it's generally not
covered by insurance. 

Cosmetic Treatments
Besides medical treatments, some women utilize camouflaging techniques
to conceal areas of hair loss. Cosmetic
coverups, which are kind of like a makeup for your scalp, are a popular option. Most women choose a powder or “fiber” form
that coats the hair and the scalp to give the illusion of thicker hair and
cover any visible scalp. A relatively new camouflaging approach, scalpmicropigmentation (SMP), is a permanent cosmetic tattoo that is matched to the hair color.  Although it is a tattoo, it is important that if this option is chosen, you go to a doctor familiar with the technique and not a tattoo artist, who is likely less versed in this type of tattooing.

Wigs or hairpieces also provide good coverage,
especially if the thinning is diffuse (all over the scalp). Hairpieces or extensions that are glued or
sewn into the hair should not be used, as these can cause more hair loss due to
pulling or traction on the hair. Some women even opt for fashion and use
scarves, turbans, or hats.

think it's important to stress that hair loss isn't something to be ashamed of. Wigs, scarves, and medical treatments can be great ways to deal with this issue, but women do not need to hide their hair loss. The reason women are so afraid to talk about hair loss is because as a society, we
don't recognize hair loss in women as normal the way we do with men. But, it is, and a consultation with your doctor should clear up any questions or concerns you may have. 

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