Women’s Hair Loss: Where to find the answers

When women have hair loss (i.e. alopecia), the Internet can be a confusing jumble of advice and advertisements.  Finding a diagnosis can be daunting, not to mention doing research on which treatments might be the best.  It seems like someone is always out to sell you something.

Seeing one’s doctor can be frustrating, too.  Unfortunately, physicians can be unwittingly dismissive about a patient’s hair loss concerns (in doctors’ defense they may be trained to focus more on the life-threatening issues of the day – I know I was!).  Nevertheless, I meet with many patients who feel both helpless and hopeless, knowing something is wrong with their hair, but unable to figure out what to do about it.

To that end, I have compiled a list of resources for the female hair loss patient.  Since the first step is always to find a diagnosis, a good place to start is your “hair loss history.”   Is the hair falling out all at once or gradually?  Sudden and significant shedding is almost always termed a “telogen effluvium.”  It can be the body’s reaction to weight gain, weight loss, stressful situations, pregnancy or birth, surgery, illnesses, and medication changes (among others!).

This may seem like a long list of causes but the good news is that it almost always grows back, even though it may take 12-24 months to do so.   In this case, minoxidil (like Rogaine 5% foam) and laser therapy can help speed recovery and re-growth of hair.  Get help from an online support group like the Women’s Hair Loss Project (www.womenshairlossproject.com) and check your progress using weekly hair counts or a HairCheck device that measures hair mass.  And try not to drive yourself crazy with the inevitable anxiety – you will NOT be bald by next week.  (I know it feels like it, though…)

Gradual hair loss in a pattern that preserves a frontal hairline but thins behind and on the sides is usually female pattern hair loss (aka FPHL or Androgenetic Alopecia).  Here the causes are usually hormones and genetics – especially if anyone (even the guys!) in your close family has androgenetic alopecia (pattern hair loss).  Look for PolyCystic Ovarian Syndrome (PCOS) with your regular doctor, especially if you are a younger woman.  Rule out low iron by checking a Ferritin and note that anything at or below 70 is concerning for hair loss.  Then be on the lookout for low B-12, low Vitamin D, and hypothyroidism since these can all worsen underlying FPHL.  Eat more meat protein, too, (whey and soy protein just don’t cut it!) and avoid tight hairstyles, chemical or thermal damage (i.e. straightening, perming, extensions, excessive coloring, etc.) since these can cause breakage on top of already “miniaturized” or weakened hair.  Hair surgery does work to replace some lost hair mass, but you should also slow the native hair loss as much as you can with Rogaine and Laser Hair Loss Therapy as above, and find a doctor with an interest in hair loss to formulate a long term plan for treatment (www.ishrs.org and www.abhrs.org).  Being proactive will help you take control of – and feel better about - what is always going to be a chronic condition.

If your hair loss does not sound like one of the above, or if it is patchy and regrows, you might have alopecia areata or a scarring alopecia (also known as a cicatricial alopecia).  Biopsies are usually needed to diagnose either a scarring alopecia or even alopecia areata, but once you have your diagnosis, there are treatments and some good resources online.  For patchy hair loss, the National Alopecia Areata Foundation (www.naaf.org) is a good place to start.  Less common hair loss patterns can find help from the Cicatricial Alopecia Research Foundation (https://www.carfintl.org/).  For general questions on what works and what doesn’t, the National institute of health’s online database for medical studies will be a tough read, but it will point you in the right direction. You can search it at www.pubmed.org and if you don’t find anything you like, you could use some of the medical articles in there as a sleeping aid…

I am kidding, of course.  I just realize that not everyone gets as excited to read medical studies about hair as I do…

Nevertheless!  The Intenet abounds with bogus medical “studies” so becoming familiar with both PubMed and Medline to do your research will reap rewards in the long run.

Now take a deep breath.  You are not alone.  Your hair loss will not kill you, although for most female patients losing their hair DOES feel a little like dying inside.  I understand.  We can work through this – all of us together – and I want you to resolve when you finish reading this that you will NOT GIVE UP.  Ladies, I hope this article helps you find some answers and some good information.  Good luck and God Bless!

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