3 shots of liquid protein a day was my most infamous crash diet in high school.  I starved myself drinking only 3 shots of foul smelling liquid protein a day. Sure the weight came off quickly, but so did loads of hair in my starvation mode. When I went off the diet, the pounds quickly returned, but the hair took much longer to grow back.

Hair Loss affects 10% of all women and can start as early as age 12. Unfortunately, after age 65, up to 75% of women will have hair loss.

Some hair loss every day is normal. In fact up to 100 hairs a day is normal. We have about 100,000 hairs on our head that grow about a half-inch per month. An individual hair usually grows for 2-6 years in the growth phase then enters a rest phase for a few months. At any given time 85% of our hair is growing while 15 % is in the rest phase. Finally it will fall out and a new hair grows in its place.  Learn more about the phases of hair growth here.


What are the main causes of hair loss in women?

There are many reasons for hair loss and I will highlight the most common ones.

1. Traction Alopecia

These are bald patches from the hair being basically pulled out from different hairstyles such as:

Tight ponytail

Tight Braids especially if you sleep in them

Curlers

Extensions

The traction or pulling of the hair causes it to fall out.

Take your hair out of traction and you will allow your hair to grow back. You may see permanent scarring as a result of constant pulling if you keep the pulling hair styles.

2. Telogen Effluvium

This is sudden hair loss usually after pregnancy, stress, illness, surgery or crash diets like I had with my shots of liquid protein. I also had this after each one of my pregnancies. These stressors take a lot of hair out of growth phase and put them into rest phase, which lead to hair loss about 3 months later.

This is especially noticeable in pregnancy because hormones of pregnancy cause the hair to grow all at once. They then rest and fall out in what seems like gobs. I’m sure the stress and sleep deprivation that comes with a new baby doesn’t help either. This is a usually temporary hair loss.

All types of hormones can greatly affect hair loss. You can see this type of hair loss with change in birth control pills and menopause too.

3. Female Androgenic Hair Loss

This is more of a permanent hair loss and often genetic. It is associated with higher levels of male hormones and one of the most common causes of hair loss in women.

In some women when testosterone hits the hair cell it is converted to DHT (dihydrotestosterone) that binds to the hair follicle making it weak and shrink. This can affect the growth and rest cycle so that hair falls out or sometimes makes it so the follicle won’t be able to grow new hair.

Many of these women will have other signs of excess male hormone or androgen excess such as facial hair, polycystic ovaries, infertility and even diabetes.

Click here to see a typical androgenic female hair loss pattern

4. Medical Conditions

Fungus, low thyroid and anemia are a few of the medical conditions that can lead to hair loss.

Women with hair loss should have at least a TSH to check thyroid and a CBC to check for anemia. Other tests can be considered especially when there are signs of high male hormones.

Complete Workup:

Complete Blood Count (CBC ), Serum Iron, Serum Ferritin, TIBC (Total Iron Binding capacity) to check for anemia
Thyroid Stimulating Hormone (TSH)

DHEAS

Testosterone

Androstenedione,

Prolactin,

Follicle Stimulating (FSH) and Leutinizing Hormone (LH)

VDRL, Checks for syphllis

Biopsy of scalp and examination of hair

Some women should be checked for other diseases such as diabetes, lupus, liver disease, Lymphoproliferative disorders, and inflammatory bowel disease including Crohn’s, Celiac  disease or gluten allergy.

More medical conditions can be found here.

5. Medications

Chemotherapy or radiations are the first medication that comes to mind. They cause Anagen Effluvium hair loss that is usually only temporary.

There are many medications that can cause hair loss.

Here is a short list of the most common ones.

Allopurinol ( for the treatment of Gout)

Heparin ( blood thinner)

Coumarin (blood thinner)

Gemfibrozil Lopid (Cholesterol lowering drug)

Clofibrate Atromid-S (Cholesterol lowering drug)

Click here for a more comprehensive list.

Treatment

The root cause of hair loss should be addressed immediately. It is easier to prevent hair loss than to regrow it.

The first step is taking good care of the hair that you have. You don’t want to compound hair loss by breaking the hair that you have. Treat your hair gently when it is wet and most susceptible to breakage. Pat, don’t rub your hair dry and use a wide tooth comb instead of a brush to get tangles out. There are many protein-building shampoos and conditioners that will help strengthen hair such as Fekkai Protein Rx.

Daily scalp massage with essential oils may stimulate hair growth.

Nizoral shampoo is an antifungal with anti androgen effects that some recommend for all types of hair loss as it also decreases inflammation.

Supplements such as omega fatty acids found in walnuts and salmon may help with regrowth. Vitamins including Vitamin B6 and B12 have been reported to help with hair loss.

The only FDA approved for women is Minoxidil or Rogaine.  2% used twice a day, on the scalp, although some use the 5%.  This helps hair to actually regrow but must be used continuously. It is not clear how it works but it does seem to increase blood flow to the hair follicle.

Propecia (finasteride) blocks testosterone and while not FDA approved for women, many have found benefit, even postmenopausal women without the increased male hormones.  It can cause birth defects so should not be used in women that can become pregnant.

Saw Palmetto is an herbal supplement that has a similar action to Propecia but is not FDA approved.

There are many other medications that can decrease testosterone in women including certain birth control pills like Yasmin, Yaz that contain Drospirenone and Desogen that contains desogestrel. Women can also decrease androgens through spirolactone and weight loss.

Women that notice hair loss at menopause may see improvement with estrogen replacement.

Other medical treatments are discussed here.

Laser combs such as Hair Max can stimulate hair growth but are very expensive  (460.00 on Amazon) with some mixed reviews. It does take 15 minutes a few times a week but it is FDA approved in that it is safe but does not make claims of effectiveness.

Makeup such as DermMatch may be the cheapest and safest treatment. This is waterproof and greatly enhances how full your hair looks.

Toppik and Couvre’ are other products that disguise hair loss.

Hair is your crowning glory except too much visible crown is not glorious at all. Products to help hair grow and look fuller are not just for men. Women should not be embarrassed but seek the help that they need.

Peace, (and a good hair day)

Dr. Deb