Hair Loss for Women: How to Navigate Your Journey

You might be standing there, staring at a rack of half-empty hair products, wondering again why your hair is thin.One product might alter the way your hair feels. Another might hide a wide part. But neither will help you understand what’s going on underneath.You can want answers and also want to keep looking like you, in the meantime. And you can do both. Describe what’s changed to your dermatologist, have the cause evaluated, and find a regimen that works for you.

Before buying another treatment, look at the pattern of hair loss

There are several reasons why a woman might say “I’m losing hair.” Maybe she sees more hair when she washes it. Her part might have grown wider. It might break off in small chunks. A dermatologist has to determine whether the patient is shedding, thinning or experiencing hair shaft damage, as these require different treatments.

A wider part can point to female pattern hair loss

One common cause of hair loss in women is female pattern hair loss, which presents as gradual thinning across the top of the head. It’s also called female pattern baldness or hereditary hair loss. The hair follicles shrink and the resulting hair is thinner, and eventually, some of them stop growing hair. That’s why you may notice that your ponytail feels smaller when you haven’t shed a lot of hair.Mention any family history of hair loss. Tell your dermatologist about any thinning you’ve noticed since perimenopause or menopause, or alongside irregular periods or a thyroid problem. Hormones are one of several things that can disrupt the hair growth cycle, and the practice offers hair loss hormone testing that looks at androgens, thyroid function, estrogen and cortisol when the cause isn’t clear from the exam. The Miami Center for Dermatology has information about female pattern baldness, including how important it is to have a proper diagnosis.

A recent change may have an older trigger

After childbirth, illness, fever, surgery or a severe stressor, hair shedding may be excessive. It usually starts months after the triggering event. It is known as telogen effluvium, and it is shedding rather than true hair loss: the follicles are still working, they have just let go of more hair than usual at once.When you’re scheduling your appointment, look back further than the week you first noticed hair in your shower drain. Did you get sick earlier this year? Did you lose or gain significant weight? Are you taking any medications that could be causing this problem? If you do think a medication is responsible, don’t stop taking it until you talk with your prescribing doctor.Excessive shedding can also happen on top of another cause. Postpartum hormonal changes, for example, can trigger shedding in a woman who already has early pattern thinning.

When your scalp needs attention sooner

An appointment for hair thinning can help your doctor pinpoint the cause and discuss treatment options early.Hair loss that is sudden or patchy should be evaluated sooner rather than later, particularly if there is pain on the scalp, burning, severe itching, scaling or sores. There are other conditions, such as alopecia areata or a scalp infection, that can cause patchy hair loss. It’s important to let the doctor know if your eyebrows or eyelashes are falling out.Tell the scheduler what symptoms you’re experiencing when you call. Saying, “My hair is thinner,” will provide a different response than “I’ve developed a new bald patch that burns.”If the hair loss symptoms are severe or progressing rapidly, seek urgent medical evaluation instead of waiting for a routine cosmetic appointment. Some conditions can permanently destroy a hair follicle. In these instances, preserving the hair that remains is more important than waiting to see if a cosmetic product will work. Whether the hair grows back depends on the underlying cause.

Bring a timeline, even if the dates are approximate

It doesn’t have to be long, but include when you first noticed the change, where the loss is happening, and if your scalp seems different. Mention any recent illness, childbirth, diet, or weight changes. Include medications, including supplements (a photo of the label is easier to review than trying to recall what’s in that “hair vitamin”), recent treatments, and hair color or chemical services and styles. Extensions that pull tightly can cause some hair loss, and the hairstyles you typically wear can give clues. Providing this information helps your doctor figure out possible causes rather than assuming that all women who lose hair have the same issue.If you have older photos, these can also show a difference you’re having trouble describing. Pick one or two that show your part or hairline. If you want to take new photos, make sure you use the same part, camera distance, and lighting so that they are comparable. It isn’t necessary to take daily photos for this discussion.During the appointment, the doctor will discuss your medical history and examine your hair and scalp. Depending on those results, blood work or a scalp biopsy might be recommended. If a hormonal cause is suspected, that blood work may include hormone testing for thyroid function, androgens such as testosterone and DHT, estrogen and progesterone, and cortisol, along with nutritional markers.When you leave, make sure you know the answers to the following questions:

• What is the most likely diagnosis, and are there any lingering uncertainties?
• What should you do until your next appointment?
• What changes should prompt you to contact your doctor sooner?

You might add, “This shedding is the most concerning thing to me,” or “I’d like to focus on the pain or itching before anything else.” What concerns you most might not be evident from looking at your scalp.

Make caring for thinning hair less complicated

What are the areas of your routine that are placing excessive stress on your delicate strands? Wash your hair with a mild shampoo, apply conditioner and be patient when combing through your locks. Limit the use of hot styling tools and set your blow dryer on a lower temperature. These are some of the American Academy of Dermatology’s suggestions for caring for thinning hair.Notice what a hairstyle does to your hair. Braids, buns, ponytails and extensions that pull your hair tightly can lead to hair loss known as traction alopecia. If you feel pain or stinging from wearing a certain style, don’t wait to have it fixed at your next appointment. With repeated tugging, this type of hair loss can become permanent.Having an easy-to-follow regimen helps you to explain it to your doctor. If you’ve started using five different products and notice scalp irritation, give your dermatologist all five product names instead of having to figure out which one is to blame.Watch out for supplements that promise faster, thicker hair growth. Sometimes there really is a nutrient deficiency that needs addressing, but taking nutrients without a medical reason can have adverse effects. In fact, too much of some vitamins and minerals can also cause hair loss. Before you order yet another bottle, ask if testing or a diet adjustment would be more appropriate.

Decide what your hair loss treatment should achieve

To answer the question “Will it work?”, you need to first know what success looks like. Is the aim to prevent further hair loss, stimulate hair growth, reduce scalp inflammation or monitor recovery after a shedding episode? How will you and your doctor measure success? If there is less shedding or new hair, those will be different signs of improvement.With female pattern hair loss, your dermatologist may recommend topical minoxidil. It can take several months to evaluate efficacy and ongoing use is required to keep its effects going. Ask about side effects, early shedding and how to apply. Tell your dermatologist if you’re pregnant, planning a pregnancy or breastfeeding before using any hair loss medication. The AAD specifically advises avoiding minoxidil in those circumstances.Hair transplantation may be another option for some women with pattern hair thinning. To be eligible, you must have adequate donor hair and a healthy recipient area that can support growth. Ask your dermatologist whether you have enough healthy donor hair to be a candidate.If testing shows a hormonal imbalance, the plan may look different. Treating a thyroid problem, managing PCOS or addressing a menopause-related shift can be part of the hair loss plan, sometimes alongside topical treatment rather than instead of it. Ask what the test results actually showed and how the proposed treatment addresses them.According to the Miami Center for Dermatology’s hair loss treatments information page, platelet-rich plasma (PRP) therapy entails drawing your blood, separating the blood and injecting the platelet rich portion into the scalp. The practice advises scheduling a consultation to determine which treatment is right for you based on your goals and health history.Should PRP be recommended, ask why it was selected for your condition, what level of improvement can realistically be expected, the potential side effects and the number of sessions you will likely require. Find out how much it will cost for the full proposed treatment plan including follow-ups rather than considering one session alone.

Make room for your appearance and your peace of mind

It’s also okay to change your part or opt for a bob, or try a wig or hairpiece, even before you see hair regrowth. It isn’t necessary to cover up sparse areas. The NHS advice about managing hair loss recognizes both possibilities. When considering a hairpiece, find out how it’s fixed in place, how it should be washed and whether you can trial the fit. Make sure clips aren’t tugging at delicate areas. Scarves and wigs should be comfortable rather than restrictive. If you use a topical medication on your scalp, ask how to integrate wearing a covering into your regular regimen.You can employ the same simple technique for deflecting unsolicited opinions: ‘I have an appointment and I’d rather not talk about it’ works fine. With relatives or acquaintances you might say, ‘I don’t need more treatment links, but I’d appreciate some company at my appointment.’If your sleep, work or relationships are affected by anxiety, let your doctor know. Psychotherapy or a support group may be appropriate, but ensure you’re in an environment where you feel free to raise your anxieties without being pushed towards purchasing a product or endorsing another person’s treatment of choice.

Leave yourself a clear next step

Treatment for hair loss in women may not show results for several months. Agree on when to follow up and how you will evaluate progress, such as comparing photographs taken with similar lighting and camera angles at different times. Make sure you know what steps to take if the medication causes irritation, is too expensive, or doesn’t work. These are signs that it’s time to reassess the treatment.You can request a consultation with Miami Center for Dermatology to discuss your observations. Come prepared with your timeline and the question you’re most anxious to have answered. The first visit should identify issues that must be dealt with immediately and those that you can wait on to check again later.