For women, thinning hair can be downright devastating.
According to the American Hair Loss Association, women make up about 40 percent of American hair loss sufferers. While hair loss (also known as alopecia) isn’t easy for anyone, women face an especially heavy social stigma when dealing with this difficult—and complex—problem.
“This is one of those subjects that’s really complicated,” Sharon Keene, MD, president and medical director of Physician’s Hair Institute, tells HealthyWay. “There is not one diagnosis that fits all.”
We spoke with Keene to find out what women should know about alopecia. For starters…
Don’t assume that your hair is thinning “naturally.”
As your hair starts to thin or your hairline begins to change, you might assume that there’s nothing you can do about it. After all, to some extent, hair loss is a normal part of aging, right?
To a degree, yes, but Keene says that can be a dangerous assumption.
“It’s a complex diagnosis, because hair loss can occur due to metabolic disturbances, thyroid disease, parathyroid disease, polycystic ovary syndrome, hyperandrogenism, malnutrition, or for other reasons,” Keene says.
Some of those conditions are potentially dangerous. Polycystic ovary syndrome has long-term complications that include type 2 diabetes and heart disease.
“If we can identify [women with polycystic ovary syndrome] earlier, that’s very helpful to them,” Keene says.
When nutritional deficiencies cause hair loss, treatment is vital since the deficiencies can prevent the body from functioning normally. However, there’s rarely a simple solution; physicians need to take a complete patient history and perform clinical tests before offering treatment options.
“I’ll ask questions, like: Is the hair loss sudden? …Has it been happening over time? Is there a family history?” Keene says. “There is not one diagnosis that fits all. Typically, when women come into my office, we have them fill out a medical history form, and we do a physical examination, because all of the variables that go into hair loss can make it complicated to get the correct diagnosis.”
First things first: Get rid of stress.
Stress can push hair follicles into their “resting” phase, temporarily preventing new hairs from growing over certain parts of the scalp. It can also cause trichotillomania, the “irresistible urge to pull out hair from your scalp, eyebrows, or other areas of your body.”
“Anything that causes either physical or emotional stress on the body can contribute to hair loss,” Keene says. “That type of hair loss would be self-limited and will usually correct itself.”
Fortunately, treatment for stress-induced hair loss is fairly straightforward: Learn to handle emotional stress with techniques like meditation, and if possible, remove the stressors from your life.
Physical stressors can also cause alopecia. Although hormonal changes during pregnancy sometimes result in shinier, healthier-looking hair, women often experience some thinning after delivery, according to the American Pregnancy Association. “During pregnancy,” they wrote, “an increased number of hairs go into the resting phase …”
Certain hair care habits can also prompt or exacerbate hair loss.
“Tight ponytails, braids, or cornrows can damage the scalp over a long enough period of time,” Keene says, noting that some women can wear tight ponytails for decades without any ill effects.
“But anyone who’s doing that needs to be aware of it. We never know how sensitive their hair could be.”
If your diet is badly imbalanced, get it back on track.
Various nutritional deficiencies can cause or contribute to alopecia. Zinc, iron, niacin, selenium, fatty acids, folic acid, amino acids, biotin, protein, and vitamins D, A, and E all play a role in your hair’s health.
That’s quite a list. If your doctor finds a deficiency with one or more of the nutrients listed above, correcting your diet might reverse the hair loss.
“Women with heavy menstrual cycles are especially likely to have iron deficiencies,” Keene says. “Vegans are also at risk. There’s also an interesting thing about tea drinkers—tea will help to prevent iron absorption, so women have to be careful about drinking too much, especially if they’re already prone to iron deficiency.”
Research in Critical Reviews in Food Science and Nutrition suggests that tea’s hindering of iron absorption can be counteracted by ingesting sufficient amounts of “iron absorption enhancers” like ascorbic acid, meat, fish, and poultry.
Vitamin D deficiency is common in women, and while it’s usually easy to treat—the human body naturally produces vitamin D when exposed to sunlight—some patients run into an unusual problem.
“A lot of patients use sunscreen, so they’re not absorbing those rays that convert to vitamin D and cause the normal reaction that allows us to absorb vitamin D,” Keene says.
To be clear, Keene isn’t recommending walking around outdoors for hours at a time without sunblock. She’s simply highlighting how a single habit could contribute to a nutritional deficiency.
“For instance, excessive ingestion of raw egg whites can inhibit biotin absorption,” Keene says. “I don’t know who would want to do that, but people do it.”
Supplements can help—but they can also do a lot of damage.
Let’s say that you’re fairly sure you’ve got one or more of the vitamin deficiencies we just listed. You should start taking a supplement, right?
“It’s really important not to take supplements you don’t need. Especially minerals and micronutrients,” Keene explains. “Patients have to be careful that they’re not self-treating without diagnosis. …Supplements can contribute to toxicity that can actually cause hair loss.”
Here’s the problem: Supplements are unregulated, and many contain massive amounts of nutrients. That sounds like a good thing, but when those nutrients build up, they can actually harm your body. A 2017 paper published in the journal Dermatological Practical & Conceptual found that supplement research is limited, at best, and that “some supplements carry the risk of worsening hair loss or the risk of toxicity.”
What about biotin, the B vitamin most commonly associated with hair and nail health? Keene says it can be a useful supplement for some patients, and because B vitamins are water-soluble, women can safely take them without risking side effects due to toxicity (in other words, if you take too much biotin, the excess amount will pass harmlessly out of your body through your urine).
However, Keene says that while biotin supplements won’t hurt, they probably won’t help.
“What biotin can do is prolong the hair’s growth cycle,” she says. “What it can’t do is prevent androgen-mediated hair loss, or prevent hair loss from any of the other causes … and most patients aren’t biotin deficient.”
Don’t immediately rush toward surgery.
While hair loss surgery has come a long way, it’s a last resort, not a first measure. Unfortunately, Keene says that many not-so-reputable clinics promote transplant surgeries to every client, regardless of circumstances.
“There are a lot of people who bought a machine and they’re offering surgery, but they don’t really know about the various causes and the methods of evaluating it,” Keene says. “You don’t want someone who isn’t qualified, someone who promotes surgery as a first course of action. After all, when all you have is a hammer, everything is a nail.”
“A lot of female patients are not good candidates for surgery, or they’d benefit from medical treatment before being considered for surgery,” she says.
Another reason to seek out a real hair specialist: Physicians who don’t study hair loss might not understand the gravity of the issue.
“If they don’t have an interest in hair, they may not be very attentive to a patient who’s full of anxiety because they’re losing their hair,” Keene says. “A lot of physicians think it’s just a superficial thing. For the patient, it’s quite serious. It can affect your quality of life.”
Know when to see a physician.
If you noticed hair loss after a major life event or if you’ve been battling nutritional issues, you may be able to address the problem on your own. However, a physician can make the process much easier—and in some cases, medical intervention is downright necessary.
“One of the things I’d really like to make a point about for your readers is that I do think that unless your hair loss came [to be due to] a specific event, it’s time to see a hair loss specialist,” Keene says.
Your specialist can look at your family history, perform a physical examination, and look at other factors that may be contributing to the problem. Even if your alopecia has a clear genetic component, you’ll have plenty of treatment options. Minoxidil, the active ingredient in Rogaine and other over-the-counter hair loss treatments, can be very effective.
“[Minoxidil] won’t work for everybody,” Keene says, “but it’s effective for some women. You have to have enough of a certain enzyme, which allows your body to convert minoxidil into minoxidil sulfate.”
Keene says that various other medications can make a difference, and for some patients, treatment is a matter of finding and eliminating triggers. She also says that recent medical breakthroughs could change alopecia treatment over the next decade or so. Oral minoxidil treatments, for instance, might be more effective than topical treatments, according to recent research.
In order to take advantage of those treatments, however, women need to take the first step, even if the idea of treating hair loss brings on feelings of anxiety.
“I have female hair loss in my own family,” Keene says. “Luckily, I haven’t had to deal too much with it, but every time I go through a shedding phase, I get anxious. …Sometimes, seeking treatment is about getting reassurance. Find out about the options—there’s no reason to ignore it. It’s not a purely cosmetic issue.”