One of the most challenging symptoms I deal with in my practice is female hair loss. It is also one of the most common symptoms women report to me. It is challenging for myriad reasons, not the least of which, is how emotional it is for so many women to watch their hair fall out, while feeling helpless to do anything about it.
Female hair loss can be due to a number of different things. The more common causes include:
Stress–this may be physical or emotional and can occur a few months after the stressor. Similarly anesthesia can also lead to hair loss a few months after the procedure.
Changes in estrogen levels–many women know to expect hair loss a few months after giving birth (when baby is a bald, drooling, 4 month-old, Mom is typically at her baldest too), but other hormonal changes can cause hair loss including stopping birth control pills and perimenopause.
Vitamin Deficiencies–B12 and Iron deficiencies are common and easy to fix. Other deficiencies are less common, but possible. This is where hair growth vitamin formulas like Viviscal and Nutrafol can be helpful.
High male hormone levels–also called hyperandrogenism. Men lose their hair due to testosterone’s effects on the hair follicles. When women have high male hormone levels they can also experience male pattern type hair loss. This is often seen in women with Polycystic Ovarian Syndrome.
Underlying medical conditions–Thyroid diseases are notorious for causing hair loss.
Alopecia–there are a number of subtypes that can cause both diffuse and focal hair loss.
And there are many more…
With so many causes of hair loss, what is the best first step to sort out the cause of your hair loss?
First, know what is normal. Everyone is shedding hair all the time, this is normal. It is reasonable to be concerned when there is a change in the amount of shedding or actual thinning. Both stress and changes in hormone levels can cause a significant shedding. For many women this shedding will stop on its own and hair will regrow.
If your hair loss does not seem to be triggered by any of these things or if hair loss is patchy rather than diffuse, your dermatologist is often a good place to start. A dermatologist can not only examine the scalp for patterns and other clues to the type of hair loss, they can also check vitamin levels and hormone levels and even perform a scalp biopsy to help pin down the cause of hair loss.
There are a variety of vitamins and shampoos on the market claiming to stop hair loss and improve regrowth. Vitamins like Viviscal and Nutrafol may be helpful where a specific deficiency is contributing to hair loss. Biotin, a B vitamin often sold in massive doses, does not seem to be helpful for hair in clinical trials. Biotin can however, interfere with certain lab tests, impeding the diagnosis of the cause of hair loss. If you do take biotin, be sure to stop it at least 3 days prior to seeing your doctor if they will be drawing blood work.
DHT blocking shampoos, in theory, block this specific form of testosterone found in the scalp from acting on the hair follicle and causing loss, but there are no clinical trials supporting their use.
Rogaine is one of the few over-the-counter options for hair loss that has been shown to be useful in clinical trials. However, it only works while you use it, and it typically needs to be used daily to see an effect. So you have to be committed to using it properly to see good results. If you do try Rogaine, I always recommend opting for the 5% women’s foam, which has a moussy texture, which limits dripping onto the face where hair growth may be less desirable.
Depending on the cause of hair loss there are a number prescription medications from steroids to birth control pills to testosterone blocking medications which may be quite helpful. So as always be sure to speak to your doctor about the hair loss you are experiencing.
Diagnosing and treating hair loss is often tricky, but working closely with your dermatologist can help you get an accurate diagnosis and the best possible results from treatment.
The Endocrinologist Is In 