Hair Loss Advice


Hair Loss in Women - Why Does It Happen


Did you know that 1 out of every 4 women in the United States will experience hereditary hair thinning? And that hair loss affects over 30 million women in the United States alone? Hair loss takes most women by surprise, and for some, the effects can be embarrassing and depressing. Join our panel of experts as they explain the causes and warning signs of hair loss in women.

LISA CLARK: Did you know that 1 in 4 women in the United States experience hereditary hair loss? And that hair loss affects over 30 million women in the United States alone. It takes most women by surprise. For some, the effects can be embarrassing and depressing. Here to explain the causes and warning signs of hair loss are two experts in the field.

hair loss

We welcome Dr. Marty Sawaya, Adjunct Professor at the University of Miami School of Medicine, and Dr. Michael Reed, Assistant Professor of Clinical Dermatology at the New York University School of Medicine, and also in private practice here in Manhattan. Thanks to both of you for joining us.

Now in our appearance conscious society, hair is a huge issue. It is something that women stake a lot of their looks and a lot of their self-esteem in. And when they start to lose it, it can be extremely devastating. Tell me a little bit about the reaction that some of the people you've dealt with have had.

MARTY SAWAYA, MD: Women have a very hard time coping with it. They get very anxious. Their family notices that there's something wrong with them, in the way that they're coping with the fact that they're noticing a lot of hair shedding. Their hair isn't as thick as it used to be. It's not as manageable. They're noticing the changes, and it's going on and on for months into years, and it can go on for quite a long time.

They seek a lot of medical help, but not always the right answers. Our sources of information leading to women trying to find the right answers is very confusing for most women, and it can be very devastating, and a path that just seems to be endless.

LISA CLARK: Dr. Reed, the statistic, one in four women in the US will experience this, is astonishing. You don't ever hear about this. And I guess there's a tendency for women who start to experience this problem to feel very isolated and very alone. How do you help them understand the prevalence of this, and the treatability?

MICHAEL L. REED, MD: I think they may first feel isolated, but then they share their feelings with everyone around them, starting in their family. Because hair loss makes women absolutely crazy. It's a catastrophe. Women have to have hair. And so they share it, day and night, every moment of the day and night, with their loved ones, until finally they and their loved ones find a doctor, someone to see, whether it's an expert or someone who claims to be an expert, and they do seek help.

Whether or not women are seeking help more because there's more things to help them, or whether they've always had the problem but didn't know. Whether it's a sign of the modern woman that she makes more male hormone like the guys, and she has hair like the guys, I don't know. It's probably all those things. But women have to have hair, and it's an absolute nightmare for them, beyond belief. It really is essentially what we call cosmetic death for them, and they won't tolerate it.

LISA CLARK: Well, you grow up, even in fairy tales: Goldilocks, Rapunzel, it's all about hair, at a very early level, and I think it's, as you say, a cosmetic death is not overstating the case for some women.

Now, apart from the incorrect belief that this is a rare situation for women until they experience it for themselves, let's talk about a few of the myths that people might be concerned about when they first start to experience hair loss, and they think: Am I washing my hair too often. Is that a common thing that you hear?

MARTY SAWAYA, MD: That's a common thing that people are misinformed. They think the more they wash their hair, the more their hair is going to fall out. If anything, when patients come to see me, we have them shampoo daily, to really get an estimate of how much hair they're really shedding per day. We know that there's about 50-100 hairs that we normally lose per day, and the only way you're going to accurately assess that is if you shampoo daily. So shampooing often does not cause hair loss.

LISA CLARK: One of the other big myths is that hair loss only happens to women after they reach a certain age. That is not true, is it?

MICHAEL L. REED, MD: Hair loss can begin any time after puberty in women. Although it's more common as they get older, especially around the time of menopause, when the male hormones have more of an effect on their scalp. But we see many, many young women nowadays who have very noticeable hair loss, and they need treatment and they need help early. They're not going to wait.

LISA CLARK: Are hair loss patterns the same for men as for women?

MARTY SAWAYA, MD: Patterns differ in women, and this is something that most women aren't informed about. They think that they have to have the same patterns as men. But women have more of a centralized, diffuse thinning on the top of the scalp, sparing the frontal hairline. So that they have an intact frontal hairline, but they're seeing most of the hair loss in the center part of the scalp, where they're seeing more visible scalp with time, continued time.

They notice, also, that their hair just isn't as thick all over the scalp, but the most prominent area is the top, center part of the scalp.

LISA CLARK: Let's talk about the fact that it is a part of the natural cycle of hair that everyone loses hair daily, on a daily basis. How much is considered in the normal range, before you would say: This is something to worry about?

MICHAEL L. REED, MD: Depending on how often the person washes their hair, it can be up to 100 hairs a day. Although, the typical patient with no hair loss problems probably notices under 50 hairs a day; 20-30 is probably fairly typical. Although once they start to shed hair, then they become almost allergic or hypersensitive. Everything comes out. They notice every hair that comes out, and even though there's not more, it seems like more hair to them.

LISA CLARK: Let's talk about the three major causes of hair loss for women. We'll start with the first. It's called androgenetic alopecia. This is genetically related hair loss. How common is this type, and could you describe how it appears, what it looks like?

MARTY SAWAYA, MD: It's a very common form of hair loss for women, because women inherit the genes for hair loss as men do, so that's why it's called androgenetic. It's a combination of androgens, which are male hormones, and the genes that we inherit from both sides of the family. Not just mother, not just father's side, both sides of the family. And it has a variable degree of how severe it can affect you. So, for some people it may be very mild, for other people it may be very severe. There's a variability on the severity level of what we inherit in androgenetic alopecia.

This can hit a large proportion of women. Usually more prominently in their 20s and 30s. But again, it can also start to exacerbate and have signs noticed in the perimenopausal stages, when male hormones are coming to the foreplay with regards to the ovaries and the changes in the ovaries with menopause coming about. So they will start to see this widened part area. If they part the hair down the center of the scalp, they'll start to see more visible scalp. The part does not look as tight as it used to be. And this becomes very alarming for most women.

MICHAEL L. REED, MD: But the term "male pattern hair loss" and "female pattern hair loss" just refer to the most common patterns, ergo the describer. A male pattern is typically a receding hairline with a bald spot in the back. They meet in the middle and the guy cueballs out maybe sometime in life. The women get see-through hair. They have a hairline; it's maybe not so great.The hairline stays there, but behind it you see mostly scalp and not hair. And that's a disaster.

LISA CLARK: Let me ask you a question. There's a popular conception that you can predict baldness for men by looking at the maternal father. (A) is that true, and (B) are there similar predictors for women as they look at their ancestors and say: Hmm, So-and-so had thinning hair --I'm at risk?

MICHAEL L. REED, MD: I tell my patients who say that there's no family history of hair loss, that that often happens. That sometimes there's no hair loss even in the neighborhood. No one ever came near their whole family. The milkman was never, no one. And still they have this problem in a typical case.

It's a polygenetic type of thing. There may be a gene for onset, for progression, for endpoint, and when that occurs in life. There are many modifying factors. It's much more complicated than people realize. It's not simply through the maternal line, although it seems to me it has a noticeable trend in that direction, but it clearly can come from all over the place.

LISA CLARK: Let's talk about the second type of female hair loss. Telogen effluvium or, as you like to say, defluvium.

MICHAEL L. REED, MD: I was a Latin scholar; I call it "defluvium." But we won't argue the fine points. Most people call it effluvium, which means a flowing out, a coming out of resting hairs, which are called telogen hairs, or club hairs. They're the little hairs that come out when you comb your hair, brush your hair, wash your hair. They have a little white tip on them. It's normal for hairs to grow for three to four years on the scalp, rest for three to four months, and then come out, because they're being replaced by a new hair. That's normal.

LISA CLARK: This form of hair loss is often temporary, but not always. Let's talk about some of the things that might spark a loss of hair in this type of category, telogen effluvium.

MARTY SAWAYA, MD: Very commonly, stress or, as we say, postpartum, after delivering a baby, is very common to see, about two to three months after delivery of a child, that your hair is starting to shed. And this is from the effects of pregnancy, when the hair has grown to such a great hair cycle where you're not seeing much shedding at all. So now after the baby's been delivered, you're seeing the shedding making up for lost time, so to speak.

But there are other causes, such as anemia, blood loss from menstrual cycles. Medications are a very big factor for women, and there's a list of common medications for blood pressure, depression, other types of medications.

LISA CLARK: Beta blockers?

MARTY SAWAYA, MD: Beta blockers especially. They're very prominent. So I always have patients go back six months, a year ago, on new medications they may have started. Oral contraceptives. We categorize them as the good ones and the bad ones, and it really depends on which one they're taking, because some of them can actually exacerbate hair loss and get the cycle started.

And I always describe for each patient the hair cycle, because it's very important for them to realize that no matter what we try to instigate in therapy, it's not going to happen overnight, because the hair cycle, as we talked about earlier, goes through a resting stage of three to four months. And for anything to help, it's going to take four to six months to help turn things around. So understanding that gives people the patience to understand, so that they can stick to whatever treatment or therapy that you're going to outline for them.

So, again, medications are a big factor. Other underlying medical conditions that they may have, like thyroid disease, other autoimmune related factors that they may have going on. Again, all these are very intricate and complicated sets that you have to really unravel, like being a detective, when I have a patient come in. To really understand what is happening in this particular patient. And it's not easy.

LISA CLARK: We have just a couple of seconds left, and I want to address the third type of hair loss. Alopecia areata, and not just areata, but there are varieties of alopecia. Alopecia presents often as a round spot?

MARTY SAWAYA, MD: Round, circular patch in childhood, anywhere to adulthood. I say, with alopecia areata, anything goes. This is an autoimmune related disease which, there are genetic factors to this disease, and they're doing a lot of HLA typing or factors in the family makeup, to try and look at the genetic makeup of this very complicated disease.

You can have circular patches, and you can totally do nothing, and they grow back on their own. Or you can lose all the hair on your body, not just the scalp hair on your scalp. You can lose eyebrows, eyelashes. It's very devastating to children as well as adults.

LISA CLARK: And another form is caused by perhaps too much chemical processing?

MARTY SAWAYA, MD: That's a different entity. As we say, pseudopelade or follicular degeneration, from especially African-American women who do a lot of perming and cosmetic things to their scalp through years of perming and using colorants and harsh chemicals to the scalp. With time it can have an effect on the hair follicle deep in the scalp and cause the hair to scar, and you totally lose the hair follicle. That's a very difficult problem to treat, called scarring alopecia.

LISA CLARK: As we wrap up, I want to ask you: What resources are available for women who are experiencing hair loss? Where should they start, what should they look for?

MICHAEL L. REED, MD: The first thing a woman should do who's losing her hair, or having it come out, is see a board-certified dermatologist. Dermatologists are the experts in medical treatment for hair loss. A lot of them also are good at surgical treatments, but always we use medical treatments first. Dermatologists have treatment that works. See them, and they'll tell you what it is.

LISA CLARK: I'd like to thank both of you for joining us here today. This is a very important issue for a lot of women, a lot more than I realized initially. Thank you both for being here, Dr. Marty Sawaya, and Dr. Michael Reed. And thanks to you for tuning in for our webcast. I'm Lisa Clark.

Further Reading

Rapunzel Envy - Hair Loss in Women

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Medical Treatments for Hair Loss in Women

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Eating Well for Hair Health

"What you eat or do not eat can affect your hair and skin," says Doug Kalman, RD, a nutritionist with Miami Research Associates. This is important for dieters to keep in mind, Kalman says, particularly those who choose diets that severely restrict calories or eliminate groups of food.

Rogaine for Women - A Snapshot

For years, only men were acknowledged when it came to hair thinning and hair loss, but now we know that hereditary hair thinning is almost as common for women. In fact, one in four women in the United States experiences hair thinning.