Hair has long been a symbol of femininity and beauty for women. Long hair, in particular, has been associated with health, fertility, and youth. People have used these symbols of hair to punish women, from cutting off Rapunzel’s protracted locks to shaving the heads of French women who slept with German soldiers during World War II.
Hair has also been used by women as a tool for protest, rebellion, and asserting power. History is chock full of examples, including the legend of Lady Godiva riding naked —covered only in her long hair— through Coventry to protest taxes and women bobbing their hair during the 1920s to signify their equality to men. Women have famously shaved their heads for movie roles, a la Demi Moore and Kristen Stewart. Grace Jones shaved hers to look more powerful and abstract. Sinead O’Connor famously shaved her head after recording executives told her she needed to look more feminine.
Hair, at whatever length, is an integral part of most women’s identity. Many women spend considerable time and resources on having the hair they want but not necessarily the hair they have. Cut, color, curl, or lack thereof can be changed in an hour or two. In total, women spend hundreds of dollars every year to care for and transform their tresses.
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But what happens if you start losing your hair? You may be surprised to hear that hair loss is actually very common for women (it’s not just common for men!) In fact, a recent study found that more than 52% of postmenopausal women suffer from female pattern hair loss. That doesn’t even account for the number of women who lose their hair temporarily or permanently for other reasons throughout their lives.
So how do you know the difference between normal hair shedding, temporary hair loss, and female pattern hair loss? Read on to learn more.
What Does Hair Loss Look Like in Women?
Perhaps the best place to begin learning about hair loss in women is to understand how hair grows. After all, some degree of hair loss is simply a stage of the life of a hair. Finding some in the drain trap or in your hairbrush is nothing to worry about. Various sources estimate normal daily hair loss from the head ranges from 50 to 150 hairs.
Blood vessels feed the papilla, located at the bottom of the hair bulb in the deepest layer of skin. The papilla supplies blood to the hair bulb, which is where new hair growth begins. The follicle forms a shaft from the top of the bulb, upward to the surface of the skin, sheathing the root. Near the epidermis, a sebaceous gland feeds the hair with oils that keep the shaft, the hair visible above the follicle, from being dry and brittle.
The length of your hair grows for as long as new cells are produced in the bulb, pushing more of the root out of the follicle. This is the growth, or “anagen,” phase. For most people, roughly 90% of their hair is in this phase at any given moment. Moreover, this phase may last for years for head hair, compared to up to five months for other body hairs. That is why the hair on your head gets longer than, for example, your eyelashes.
The next phase, the “catagen phase,” is transitional. The root starts separating from the papilla, so it begins losing its blood supply. When that supply is cut off, the hair enters the resting or “telogen” stage where it remains until it is pushed out of the follicle and becomes one of those hairs you find in your sink or on your pillow.
Normally, new hair cells would begin to fill the empty bulb and the process repeats itself. But if the hair root is damaged during the growth phase or you have a significant number of hairs simultaneously in the resting phase, hair loss will be noticeable. If no hair is emerging from the follicle for a period, the opening will close up. It’s not unlike when you stop putting an earring in a pierced ear. On your head, such closures become bald spots, referred to as alopecia.
Does Women’s Hair Loss Look the Same as Men’s?
Common pattern baldness in women and men is called “androgenic alopecia,” referring to baldness that occurs when androgens, hormones related to testosterone, cut the growing phase short. A surplus of androgens has been identified as the cause of male pattern baldness, but the jury is still out on how androgens affect female pattern hair loss. Although some may have excessive androgens, it is believed that in women with pattern baldness, a genetic propensity may allow normal androgens to affect the hair cells in the follicles.
How pattern baldness presents itself also differs between women and men. In men, the gradual hair thinning begins with a receding hairline in the front of the scalp and thinning on the crown. This usually leads to more complete balding of the scalp in men compared to women.
In women, the hair loss usually begins on the crown in the center part. As the hair thins, the scalp that shows in the center part can widen and look a bit like a Christmas tree. Unlike in men, the front hairline often remains intact, although it may recede some as part of the normal aging process.
In women, the balding is generally far more diffuse and rarely leads to complete baldness. In other words, the distance between follicles with no growth and those with small or normal hair growth is spaced out enough to prevent total balding.
Hair loss takes an emotional toll on both men and women. However, studies show that women with alopecia experience significantly more distress related to the condition than men do. It’s not surprising. A woman’s body image is inexorably linked to the quality and quantity of her hair. History, tradition, and society are all to blame for that connection. If you see a bald man, you probably don’t really think about his baldness. If you see a woman who is bald or has thinning hair, your instinct likely will be to look twice.
What Causes Hair Loss in Women?
Women’s hair loss may be permanent or temporary, and there are many causes linked to both. Here are some of the prevalent causes:
Heredity and Genetics
Women are the “stuff” of their genes. Although studies have shown a strong link between women with female pattern hair loss and a family history of it, particularly on the maternal side, the reason for it remains elusive.
Hormones play a role in hair loss, as is true with so many other issues women face. As women age, estrogen and progesterone production drops and androgen production rises. During menopause and postmenopause, when this transition occurs, it is common for a woman’s hair to become thinner and finer as increased androgens hamper growth of new hair cells.
The hormonal relationship is also why some women suffer hair loss while using hormonal birth control. This usually occurs when a woman first begins using hormonal birth control or when they stop using it. In most cases, the issue is temporary or even unnoticeable. But if you want to avoid it, you may try a low-androgen hormonal birth control, such as desogestrel-ethinyl estradiol, or a non-hormonal form of birth control. Medical Conditions
You have likely read that some autoimmune diseases can cause hair loss. The nature of autoimmune diseases, like lupus, thyroid conditions, and others, is that your body attacks itself, including the normal function of hair follicles and new cell creation.
Syphilis can cause hair loss and is often the most outward sign of the disease. Hair loss can result in a “moth-eaten” appearance on the scalp.
Dysfunctions of the thyroid commonly cause hair loss because hyperthyroidism and hypothyroidism interfere with the hormone production necessary for the development of new hair cells. Hair loss is a side effect for people suffering from Grave’s Disease and Hashimoto’s Disease, which both affect the thyroid.
Nutrition deficiencies, particularly of iron and protein, can cause hair loss, especially in women who have heavy menstrual cycles and/or may be anemic. Iron supplements and dietary changes can often help eliminate related hair thinning and loss.
Weight Loss and Excessive Stress
Significant weight loss over a short period of time, as seen with “crash diets” or weight loss surgery, causes sudden stress on the body. So does childbirth. Both conditions can cause telogen effluvium (TE), which is temporary hair loss characterized by excessive shedding.
If you remember, “telogen” is the resting stage of hair growth. “Effluvium” is an excessive discharge, so you see where the name of this condition comes from.
The stressors that can cause TE include virtually anything that stresses the body, including severe psychological stress, infections and fevers, surgery, diets lacking nutrients, and medications discussed in the following paragraph.
Medications and Supplements
The types of medications and supplements that might have hair loss as a side effect are common.
Retinoids, derivatives of vitamin A, are often prescribed or purchased over the counter to improve immunity and skin health. Although oral retinoids have been linked to hair loss, topical retinoids do not appear to have that side effect.
Beta blockers, used to control high blood pressure; statins, used to lower high cholesterol; and anticoagulants, used to prevent blood clots, may cause TE while you are taking them. However, some formulations of these medications do not appear to cause hair loss.
For example, angiotensin-converting enzyme (ACE) inhibitors used to treat high blood pressure may cause hair loss while angiotensin receptor blockers (ARBs) may not. Hair growth resumes back to normal once the medication is discontinued, although you should never stop taking medications prescribed to treat such medical conditions without consulting a medical professional. Talk to your healthcare provider about side effects of medications to see if you can find one that does the job it is supposed to do without the hair-loss side effects.
Vitamin and nutritional supplements may help hair grow if you are consuming insufficient amounts in your normal diet. That said, too much of a supplement may have the opposite effect, causing hair loss.
Chemotherapy may cause hair loss, although there are new formulations that do not appear to have that side effect. Hair loss from chemo is temporary, with new hair growing once you have finished treatment. However, your hair may change color or texture as regrowth appears.
Radiation therapy to the head region may also cause hair loss. In some cases, hair may begin to grow back within three to six months after you complete this therapy. However, if you receive high doses of radiation, your hair may grow back much thinner or not at all.
Hairstyles and Treatments
If you pull your hair up tightly in braids, cornrows, buns, or tails, or if you frequently wear hair extensions or weaves, you may suffer hair loss called “traction alopecia.” It makes sense that frequent pulling of your hair in these ways will cause breakage and damage over time.
The solution is to loosen up and change your hairstyle. Consider loose hairstyles with claw clips, bandanas, or scrunchies, or wear your hair down. And give your heat styling tools a break while you’re at it. The hair damage is usually temporary when the tight pulling is stopped Scalp Infection
Folliculitis decalvans is an infection that leads to chronic inflammation of the follicles. The type of infection is uncertain, although staph is the likely culprit.
The damage can cause permanent scarring and permanent hair loss. Before it does, multiple hair shafts may push out of the same follicle at the same time in “tufts.” Once those fall out, the follicle won’t produce new hairs.
Smoking compromises the immune system, which can then affect healthy hair production and growth. Moreover, weaknesses in your immune system can lead to illnesses that may cause hair loss as well as scalp infections, which can affect hair health.
Who Is at Risk for Hair Loss?
Risk factors for hair loss include all the causes of hair loss addressed previously in this article. Overall, less is known about the cause of alopecia in women than in men.
What Tests Can Diagnose Female Hair Loss?
Hair loss is often visually obvious, but occasionally certain tests may be required to find out if an underlying issue may be causing yours. While Nurx medical providers currently don’t offer most tests requiring lab work, there are a variety of tests you should be aware of, including:
A simple blood draw analyzed for the right issues may indicate why you are suffering hair loss. If your doctor suspects an underlying health condition may be contributing to yours, your blood can rule in or rule out certain possibilities.
Your blood may be tested for serum iron and serum ferritin. Serum iron indicates the amount of iron in your blood. Serum ferritin is the protein that indicates how much iron your body is storing. Too little iron can cause hair loss. The condition is common among women who are menstruating, consume a diet low in iron, or are anemic. The sample can also be tested for levels of calcium and phosphorus, two other elements of healthy hair.
Blood may also be tested for hormone levels, such as high levels of androgen known to contribute to androgenic alopecia. Blood tests are also a way doctors diagnose overactive or underactive thyroid conditions. The test can reveal levels of the thyroid-stimulating hormone (TSH), indicative of thyroid disease.
The venereal disease research laboratory test (VDRL) and rapid plasma reagin (RPR) test are performed by testing your blood. You can order a home sexually transmitted infections (STIs) test kit that allows you to collect your own throat swab and blood samples. Among the STIs these samples are used to diagnose is syphilis, another condition that results in hair loss if left untreated.
Hair Pull Test
Your provider may pull gently on your hair in various places on your scalp to see how many come out. If more than three hairs from a small section of hairs come out, you are likely suffering from excessive hair loss.
Strands of hair shafts trimmed from the scalp may be examined under a lighted microscope. The light and magnification reveal the structure of the hair, which could indicate possible disorders of the hair shaft.
Samples scraped from the scalp are examined under a microscope to look for signs of infection, including folliculitis decalvans.
Any healthcare provider should ask you a variety of questions related to potential causes for hair loss, such as how you style your hair, use of dye, straighteners, and other chemicals, and products you use on it. They will ask about your diet, medications and supplements you take, and your family history related to hair loss. Finally, they will ask about your observations regarding your hair loss, such as when you began to notice it and if it is ongoing or cyclical.
How Can You Prevent Hair Loss?
Hair loss due to genetics or heredity cannot be prevented, but it can be treated. The same applies to temporary hair loss that results from childbirth, cancer treatment, or hormonal fluctuations throughout a woman’s life cycle. Hair loss caused by factors such as hair styling and hair products, smoking, nutritional deficits, supplements and medications, and untreated scalp infections or syphilis can be avoided or mitigated by following various preventative measures.
What Do Dermatologists Recommend for Hair Loss Treatment?
The type of treatment dermatologists recommend for female hair loss of course depends on the cause of the hair loss. For example, hair loss caused by childbirth will be temporary, and in other cases, changes in hair styling, diet, and lifestyle can help restore hair health.
Because less is known about the causes of female pattern hair loss, there are fewer treatment options than those approved for use by men. But there are some treatments dermatologists may recommend for women suffering from alopecia.
Minoxidil was originally formulated as an oral medication to treat severe hypertension. When new hair growth was observed on men taking the drug, a topical formula was introduced for treating androgenetic alopecia in men, which was then later approved for women. Minoxidil 5% is now one of the most widely used treatments for this type of hair loss.
The topical solution comes in liquid or foam form and is applied directly to the clean scalp using an applicator. The solution must be allowed to dry thoroughly for a period of hours, during which time you must avoid hair styling and other hair-related contact.
Common side effects include scalp irritation, itching, contact dermatitis, and temporary hair shedding before beginning to spur growth. Minoxidil is not safe for use by pregnant or breastfeeding women.
Anti-Androgens require a prescription. They include spironolactone and oral birth control containing estrogen. Although spironolactone is not FDA-approved for treating hair loss, it is frequently prescribed off-label by healthcare providers to treat female androgenetic alopecia. This medication and estrogen birth control pills both reduce the production of testosterone-related androgens, which is why they may be prescribed to treat androgenetic alopecia.
Side effects of oral birth control are nausea, headaches, cramping, breast tenderness, and weight loss or gain, although many of these go away once you begin taking them. They are contraindicated for women who smoke due to increased risk of stroke.
Side effects of spironolactone include headache, nausea, vomiting, breast tenderness and enlargement, dizziness, increased urinary frequency, and irregular periods.
Iron supplements may be recommended if blood tests indicate a lack of iron or anemia. Even though these are dietary supplements, they still have some potential notable side effects. Nausea, vomiting, diarrhea, constipation, gas, and a metallic taste in the mouth are among them.
Hair transplantation may also offer a solution to hair loss, particularly in women who have more diffuse balding patterns and less hair loss on the back of their scalps. During this procedure, small sections of the scalp with hair on the back of the head are transplanted to the balding areas. Infection of the scalp or follicles may rarely occur with this procedure.
When Should You Consult a Doctor About Hair Loss?
You should talk to a healthcare provider about hair loss as soon as you notice it, even if you think it may be temporary. As with most treatments, early intervention is key to stopping, slowing, or reversing hair loss.
How Do I Get Started?
If you think you are losing more than a normal amount of hair, get started on finding out why and treating hair loss right away with a consultation by one of our Nurx Dermatology providers. As science learns more about women’s hair loss, prevention and treatment will improve. In the meantime, start getting to the root of your hair loss today.