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Women and Hair Loss

Women & hair loss. It’s always so devastating to look in the mirror and wonder if (or know that) your hair is thinning. The panic experienced in the shower when you see a bunch of hair in your drain after a routine shampoo is even worse. And yet, it’s so common. Chances are the woman next to you has experienced or will experience hair loss at some point in her life. So, what causes hair loss and what can we do about it? The answer is not simple. 

We go through life in hormonal phases. We are little girls, then hormones kick in and we become teenagers with attitudes. Then the growth spurt stops & we enter early adulthood. Women go through the stress of pregnancy and childbirth, for many women, more than once. We experience some degree of biological “stability” when we are middle-age, only to enter menopause, and later, post-menopause. All of these changes are stressful to the body.  

Then there are major life events that impact us emotionally. The loss of a loved one. Financial instability. A bad car accident. A sick child. Work. Emotional stressors are challenging. Some people manage them well, but most of us probably don’t. If the stress is significant, our body will begin to prioritize function. Hair and nails are secondary. And typically, within 3-5 months after the stressor is first perceived, our hair will begin to shed. If the stressor has resolved (a bad car accident & we’ve recovered), we will shed our hair for 1-2 months and then regrow. If the stressor is ongoing (a bad car accident with months of physical therapy), we will shed our hair for 1-2 months and then continue to shed at a lower rate.  

Then there are true organic stressors. Low vitamin D or low iron. Thyroid problems. Chronic disease states that cause ongoing stress to the body like poorly-controlled diabetes or anemia from a heavy menstrual cycle. Long-term medications for high blood pressure that cause an increase rate of shedding. All of these conditions can and will contribute to hair loss.  

Let’s review a classic example. A woman in her 30s reports hair loss. She’s had one child. She had long, thick beautiful hair in her teens. Now she’s in tears because her hair is thinning. She had hair loss 3 months after her baby’s birth 3 years ago and has not seen regrowth. She’s on medication for blood pressure. She states that she sees a lot of hair in her drain & that she is constantly seeing hair on her sweaters. It is also tax season and she hates her job as an accountant. So, she has several reasons for hair loss: she’s on medication that can cause hair loss; she had hormonal fluctuations pre/post pregnancy; she has emotional stressors related to her hair loss (ironically), finances, and work; and she’s probably not sleeping well. Plus, we haven’t checked her labs for thyroid problems, vitamin D, anemia, and iron stores.  

It’s important to note that most of us will thin out significantly as the years, decades, go by. It’s unusual, though not unheard of, to see a woman in her 80s with a thick head of hair. Think about it. When was the last time you saw one? As we age, we lose hair naturally. To masquerade this, women cut their hair shorter and shorter and color it lighter and lighter. It’s very common to see older women with shorter, lighter hair and younger women with longer, darker hair.

Another example. A woman in her 60s reports hair loss. She has 3 adult children. She remembers beautiful, thick hair in her 20s that started to thin out by her 30s. She has diabetes, high blood pressure, and high cholesterol and is on chronic medications to control these conditions. She worries about her youngest son, who still lives at home, and her oldest son who is having trouble in his marriage. She had her gallbladder removed at age 42 and a hysterectomy at age 48. She decided that she would start taking care of herself about a year ago and has adopted a healthy diet and exercise regimen. She reports that since she has made this change, she has lost 15 pounds. Despite her healthy lifestyle, her hair is thinner than what she would like, and she reports that she can now see her scalp. Again, many reasons to have hair loss over the years, right? She had 3 pregnancies and probably experienced some hair thinning with each one. Then went through surgeries and menopause that likely contributed to further hair thinning. She is now on medications and has emotional stressors that are contributing to ongoing hair shedding. Plus, she recently lost weight, which is a perceived emergency state for the body. Remember? Function over hair & nails. And she still does not know if she has an underlying thyroid problem, vitamin D deficiency, anemia, or low iron stores.

And, of course, there is hair loss due to inflammatory and scarring diseases of the scalp. These are inflammatory disease states that, if left untreated, will result in permanent hair loss with no possibility for regrowth. These conditions may require a biopsy to fully diagnose and require prescription medications to control.  

So, should we all throw up our hands and give up? Will we all lose hair anyways? That is certainly the approach that many women have taken. Many women choose to purchase a wig. Others choose to wear their hair naturally. After all, like stretch marks, hair loss can be perceived as another badge of courage. 

Others have decided to be proactive. Healthy hair habits include practicing the daily routines that we were taught in kindergarten: drink 8 glasses of water a day (dehydration, no matter how mild, can be a perceived stressor), eat a balanced diet (maintain your vitamins & minerals), exercise 30 minutes 5 days a week, and sleep 8 hours a night. We can augment that by taking the hair vitamin, biotin 5000mcg daily. And when that isn’t enough, there’s prescription-strength medications that can slow down hair loss and promote hair regrowth. 

Parting Thought: Life happens. Hair loss happens. If you find yourself in front of the mirror scrutinizing your head, don’t panic. Keep calm and call a dermatologist.

Dr. Sauceda Dr. Ana Trevino Sauceda, M.D., is a top-rated dermatologist serving patients of all ages throughout the San Antonio, TX and surrounding areas.

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