Hair loss and hair thinning can be scary and frustrating. In my dermatology practice I see many female patients whose hair is thinning. But what causes hair loss in women? When the scalp itself appears normal (meaning there is no visible specific finding that would be lead us to the diagnosis of a physical condition that can cause hair loss, such as fungal infection, lupus, etc.), we are left with sorting through the causes of general hair thinning in the hopes that we can find a cause, especially one that is reversible. This information applies to both men and women.
What are the most common causes of hair thinning and hair loss in women when the scalp skin appears normal?
- Genetic, called female patterned baldness or androgenic alopecia or androgenetic alopecia. (In men, this is also called male patterned baldness.) Typically this hair loss is worse over the crown of the scalp than the hair line on the forehead. Woman at the greatest risk are those with a family history of balding in either female or male relatives.
- Hair loss from medicines. Many commonly used medicines cause hair thinning. Some of the more common families of drugs that cause hair loss include some antidepressants, beta blockers (used for blood pressure management), cholesterol-lowering drugs, hormones, anti-inflammatory drugs (used to treat pain), and stomach-acid-inhibiting drugs. A good dermatologist can evaluate your list of medicines to determine if you are on a medicine that might be contributing to hair loss.
- Telogen effluvium. This condition occurs when your body is under such great stress that it starts to shut down optional processes, such as hair growth. It’s a survival mechanism to help ensure that vital resources are not squandered during times of grave physical stress. When the body feels the danger has passed, it starts making hair again. However, it unfortunately throws out the old hairs and new ones start growing in the follicles. This is associated with an alarming hair shedding. The good news is that in a month the presence of new “sprouts” of short hairs will visibly emerge from the follicles. Events that can cause telogen effluvium include having a baby, having a surgical procedure, a serious illness (such as pneumonia), radical changes in weight (especially weight loss), and even severe emotional stress like being in a car accident or the death of a loved one.
- Hair loss from internal medical conditions. This list includes the more common causes such as thyroid problems and anemia. It also includes other more vague conditions such as underlying blood cancers like leukemia, complex endocrine problems, etc. When I am evaluating a woman for hair loss and the explanation does not seem to be one of the first three causes, and her thyroid tests and blood count are normal then I consider having her evaluated by her primary care physician for a complete physical aimed at detecting an underlying internal disease. I have patient stories where this was lifesaving and the first symptom of the problem was unexplained hair thinning.
What can you do if you and your dermatologist have not been able to find a specific cause for your hair loss or hair thinning?These are the general recommendations that I give to my patients. The general concept applies to both men and women.
3 Tips to Stop Hair Thinning or Hair Loss in Women
- Stop any medicines that are contributing to hair loss. If the medicines are prescription, this needs to be done with your prescribing doctor’s supervision.
- Stabilize your hormones. Going on and off hormones (including birth control pills, menopausal hormone supplementation, and thyroid medicines) will throw you into bouts of telogen effluvium and/or medication-induced hair loss that may go on until your hormone levels are stable.
- Stabilize your weight, health, and emotional well-being. Again, telogen effluvium will be triggered by significant swings in your physical condition and it is possible to have repeated episodes of telogen effluvium that add up to significant thinning. I would add to this the recommendation to consistently get a good night’s rest and eat a health promoting well-balanced diet.