The Truth About Hair Loss in Women

women's hair loss“Every month I receive a referral from a colleague or cosmetologist regarding a patient struggling with hair loss. Very few patient complaints are as emotionally charged as those from women dealing with hair loss—an issue that will affect up to 60 percent of women at one point in their lives.”  – Dr Williams


When is hair loss usually temporary?

  • If your thinning is triggered by a specific event such as childbirth, a medical condition or a period of intense stress:
  • It will probably manifest as excessive (more than 100 hairs a day), and sudden, allover shedding.
  • Once the trauma passes, your hair will grow back within a few months.
  • If your thinning is triggered by a medical condition such as thyroid imbalance, endocrine disorder (like polycystic ovarian syndrome), dietary deficiency, or a specific medication
  • Your hair will most likely return to its former glory once the underlying issue is addressed and managed

When hair loss is considered chronic?

  • The most common cause of female hair loss is androgenetic alopecia
  • A genetic condition in which new hair shafts grow in progressively thinner.
  • Women usually notice a wider part and gradual reduction in overall volume
  • Often with a concentrated thinning at the crown.
  • The condition can begin any time after puberty but often becomes noticeable during and after menopause, when it’s compounded by hormonal shifts.

Treatment options:

Minoxidil: (brand name: Rogaine).

  • The only FDA-approved medication for female hair loss.
  • Applied topically, minoxidil prolongs the hair’s growth phase.
  • Available over-the-counter in 2 and 5 percent formulas.
  • Only the lower dose is approved for women, but many doctors recommend using the higher dose (though it carries a risk of increased facial hair growth).
  • Massage minoxidil into the scalp twice daily
  • Regrowth should appear in about six months
  • Three-month supply costs around $50.
  • If you stop treatment, hair density returns to what it would be if you had never used the medicine.

Finasteride: (brand names: Propecia and Proscar).

  • Prescription-only pill is
  • Not FDA approved for women, but some doctors prescribe it off-label to postmenopausal patients.
  • The higher dose (in Proscar) is usually more effective in women, and usually slows hair loss in 75 percent of her postmenopausal patients.
  • Finasteride is taken daily and works only as long as you’re using it.
  • A one-month supply costs about $70

Dutasteride: (brand name: Avodart)

  • Approved in 2002 by the FDA for the treatment of non-cancerous prostate gland enlargement
  • This oral medication has also been shown to be effective in treating Male Pattern Baldness
  • Works by interfering with enzymes that cause the breakdown of testosterone.
  • Appears to be more effective than Finasteride because it inhibits two types of enzymes, as opposed to just one, in the case of Finasteride.
  • Shown to be up to 30 percent more effective.
  • Currently, Finasteride is the only oral medication approved by the FDA to treat hair loss, but a doctor can prescribe Dutasteride / Avodart to men seeking treatment for Male Pattern Baldness.
  • Not FDA approved in women but off label indications may apply in cases which are resistant to other forms of treatment
  • Generic versions of Dutasteride are available under the brand names of Dutas, Duprost, and Dutagen.
  • The recommended dosage of Dutasteride / Avodart for treating Male Pattern Baldness is 2.5 mg per day
  • Will increase the number of scalp hairs and delay additional hair loss.
  • Month’s supply of the medication can cost US$100 to $150.
  • Most health insurance plans do not cover the costs associated with hair loss treatment.

Lasers

  • There are no large independent trials proving the efficacy of light sources in treating hair loss.
  • For patients who have not had success with minoxidil or finasteride, some doctors suggest the HairMax Laser Comb ($495).
  • Of several OTC handheld lasers marketed for hair growth, it’s the only one with FDA approval.
  • Glide it over your scalp for ten to 15 minutes three times a week.
  • After about six months it can grow some hair in about 25 percent of cases

Hair transplant

A possibility if your hair loss is concentrated in specific areas. Hair follicles (in groups of up to four) are surgically removed from an area on your scalp where growth is dense and then implanted in the thinning patches. Since female hair loss is often diffuse, only about 20 percent of female patients with thinning hair are candidates.

Thickening treatments

  • African-American women with thinning hair might think it’s a genetic issue, but they may in fact be dealing with a more common reason for hair loss: central centrifugal cicatricial alopecia.
  • Exact causes are unknown, but if the condition is left untreated, bald patches can form.
  • Both topical and injected steroids can help stop the progression.

The Cause

The major hormone involved in hair loss is called dihydrotestosterone (DHT) which is the result of testosterone being in contact with an enzyme, which is found in the skin and scalp. When DHT is present, it interacts with the hair follicles and disrupts the process of hair growth. This process is called androgen alopecia and is caused by excessive androgenic hormones coupled with high levels of oxidative stress.

Several researchers have reported a correlation between excessive sebum (oil) in the scalp and hair loss. Excessive sebum often accompanying thinning hair is attributed to systemic inflammatory conditions in the body and an enlargement of the sebaceous gland. The researchers believed excessive inflammation into the sebum causes a high level of enzymes which clogs pores and further increases inflammatory processes.

Several factors are critical for reducing inflammatory conditions in the hair follicle. The first step is to inhibit the excessive androgenic (male) hormone formation.

  • Saw Palmetto is a very effective anti-androgen that blocks the cells from absorbing high levels of DHT. This helps balance hormones in the body.
  • Other DHT inhibiting nutrients include green tea extract.

The second step is to enhance intracellular anti-oxidant stores with glutathione boosting sources. Boosting glutathione within the cell protects the scalp and follicle mitochondria from oxidative stress. Low glutathione increases a molecule called Protein Kinase C which accelerates the loss of hair follicles.

Major anti-oxidant sources that boost glutathione include:

  • N-Acetyle Cysteine
  • Inositol
  • Lutein
  • Quercetin
  • Resveratrol
  • Grape Seed Extract
  • Zeaxanthin.

There are certain enzymes that regulate different inflammatory processes. One particular pro-inflammatory enzymes is TNF-a. When TNF-a is over-secreted in the sebaceous gland and hair follicles, it causes rapid inflammation and hair loss. Low vitamin-D and improper Omega 6:3 ratios within the cell can lead to increased TNF-a and elevated inflammatory pathways.

Nutrients that inhibit the TNF-a pathway include:

  • Curcumin
  • Ginkgo Biloba Extract
  • Stinging Nettle Extract
  • Green Tea Extract
  • Fish Oil
  • Evening Primrose Oil

If you have been losing hair, you should immediately begin implementing:

  • An anti-oxidant rich diet and utilize high doses of anti-inflammatory based herbs (Turmeric, Ginger. Dandelion).
  • Regular exercise
  • Maintain low stress levels.
  • Reduce or eliminate sugar and grain consumption.

Test your testosterone, DHT, thyroid hormones, and cortisol to help you determine if your hair loss is hormonal or genetic.

If hormone and/or nutritional levels are imbalanced, natural bioidentical hormone replacement therapy paired with a customized nutrition, fitness and supplement program can bring the levels back to optimal balance.

Hair Loss in Women

Hair loss in women affects millions of women worldwide and tends to come in two distinct forms.

Female pattern hair loss

  • 95% of women’s hair loss
  • Predominantly due to estrogen decline
  • Estrogen helps to counter-act the effects of the (male) hormone testosterone
  • Less estrogen results in less effect on DHT production (which promotes hair loss)
  • Less estrogen to block DHT causes more hair loss
  • More DHT effect leads to the thinning of hair around the crown and forehead areas.
  • The life cycle of the hair follicles in these areas becomes shorter, and shedding of hair becomes more frequent.
  • Markedly increased once women reach the age of 40
  • Natural thinning process that many women experience as they grow older whereby the hair gets noticeably thinner around the crown and forehead areas.
  • Common occurrence in women once the onset of menopause

Chronic hair loss.