“Every type of hair loss that happens to a man can happen to a woman,” says dermatologist Dr. Renée Beach. “The difference is who cares—and what I mean by that is who shows up to the doctor.”
In her experience, Dr. Beach—who is head of the alopecia clinic at Women’s College Hospital in Toronto—says women are more likely to seek medical attention for hair loss, which she attributes to “societal pressures that say women have to have full rich hair to be beautiful.” And, while hair loss is often associated with men, an estimated 40 percent of women will experience hair thinning by age 50.
Actor Jada Pinkett Smith described her personal experience with hair loss as “terrifying.” Last year, Sports Illustrated featured model Christie Valdiserri, who has alopecia areata, which can make hair fall out in patches. She spoke out about how we aren’t “born believing hair makes you pretty, but society has led us to believe that.” And in a recent interview with the Los Angeles Times, Ricki Lake shared that she’s been struggling with hair loss for nearly three decades. “It has been debilitating, embarrassing, painful, scary, depressing, lonely, all the things,” she said.
According to the Canadian Dermatology Association, we shed an average of 50 to 100 hairs per day. Research indicates that men and women have between 80,000 and 12,000 hairs on our heads, however that number can vary greatly person to person.
Dr. Beach sees women of all hair types and ages in her practice, and notes that there are easily 50 different types of hair loss that can impact both men and women. One of the most common indicators of a problem? Noticing more hair in the shower drain, stuck to your pillow or in a brush. Quite simply, hair loss occurs when the amount of hair fall is greater than hair growth.
Dr. Beach has also heard her fair share of misconceptions about how to address hair loss. One of the most common is the belief that shaving the head will make hair grow back faster. Another is that biotin, or vitamin B7, can help hair growth—misinformation that can actually be dangerous since the supplement has been linked to distorting tests for other conditions.
As with any type of change to your health, if you’re concerned about hair loss, the best thing to do is speak with your doctor. As a starting point, here are the most common reasons that women experience hair loss, plus some treatments that can help:
Shock or changes to your body
Experiencing major surgery, increased anxiety or traumatic life events can result in increased hair fall—which, let’s be honest, doesn’t help stress levels. This type of hair loss, Dr. Beach explains, is classified as telogen effluvium, a category that encompasses everything from postpartum hair loss, thyroid function abnormalities or iron insufficiency to emotional or physical stressors like job loss, a divorce or financial woes. Telogen effluvium is often seen as thinning all over the head, rather than in specific spots, and it typically does not result in a complete loss of hair.
Recently, multiple coronavirus patients, including actor Alyssa Milano, reported experiencing hair loss months after recovering from the virus. Though experts are still gathering information about these patients and the virus, some attribute the hair loss to telogen effluvium.
“It’s happening about seven to 12 weeks after infection and the time course seems to be consistent with telogen effluvium,” says Dr. Jeff Donovan, president of the Canadian Hair Loss Foundation. The hair loss specialist, who’s based in Whistler, B.C., has seen multiple recovered COVID-19 patients who started experiencing shedding around June and July.
The pandemic is also causing hair loss concerns for those who haven’t contracted the virus. “There’s a significant increase in concerns about hair loss right now like we’ve never seen before,” says Dr. Donovan, citing the combination of financial stress, the stress of social isolation and other concerns that were not present pre-COVID-19. He says there’s “no doubt” that hair loss issues have increased during this time.
Typically, most of the hairs on our head are in one of three phases: anagen phase, when hair is growing, the catagen phase, when the hair is resting, and the telogen phase, when the hair sheds to make way for new strands. This cycle is normal and the reason why we regularly lose hairs throughout the day. However, a shock to the system—like say, the sudden onset of a pandemic—can force the hairs into the telogen phase. Two to four months later, people will then notice a dramatic increase in the amount of hair they’re shedding.
Since telogen effluvium can be caused by a variety of issues, ranging from stress to hormone levels, the treatments depend on the cause, explains Dr. Beach, so it’s a good idea to start by talking with your doctor. A patient with a B12 deficiency may need to take supplements, but a patient with a thyroid disorder will need to be seen and assessed by their family doctor, and possibly referred to an endocrinologist, for treatment and monitoring.
Beyond meeting with a medical expert to find out the potential cause of telogen effluvium, Dr. Beach also recommends patience. Once the trigger has been addressed, it typically takes three to six months for hair loss to stabilize and another three to six months to—hopefully—see hair levels recover.
Heavy extensions and tight braiding or ponytails may look great, but over time these hairstyling practices can lead to what is known as traction alopecia, hair loss that is caused by continuous force and pulling on the hair roots. Black women are particularly at risk for this type of hair loss, due to tight braids, weaves or wigs. Head coverings like turbans or hijabs can also lead to traction alopecia, says Dr. Beach.
“The short answer is the less forces that are applied to the hair and for a shorter period of time, the less severe the traction alopecia will be,” says Dr. Donovan. That means halting hairstyles from slicked-back ballerina buns to heavy weaves.
For those wearing religious head coverings, such as a hijab or turban, Dr. Donovan says to be wary of a tingling or burning sensation on the scalp, which is an indication that the hair is pulled too tight. When possible, such as at home or at night, he recommends leaving hair down or in a loose ponytail. “It really comes down to: The longer the hair is tied, and the tighter it’s tied, the higher the likelihood of developing hair loss,” he says.
Other options include using minoxidil 5% foam, commonly known by the brand name Rogaine, which can be purchased over the counter. There is a men’s version and a women’s version, the latter of which is (infuriatingly) more expensive. Both contain the same active ingredient, says Dr. Beach, the only difference is in the additives, making the women’s product “theoretically less irritating.” (Minoxidil was initially developed to treat hypertension, however, it became a popular off-label hair loss treatment because it has been shown to decrease hair “death” (i.e. shedding) and improve hair growth.)
If traction alopecia is caught in its early stages, Dr. Beach says that improvements may be seen in three to six months.
Female pattern hair loss
You may have heard of male pattern baldness, which commonly presents as a receding hairline or a widening bald spot at the back of the head, but did you know that female pattern hair loss is also common?
This type of hair loss, also known as androgenetic alopecia, can present in multiple different ways. Some women will notice their centre part gradually widening. Others may notice that hair coverage on top of their head is less dense overall, perhaps leading to more sunburns on their scalp.
For most women, female pattern hair loss does not usually lead to bald spots or complete baldness, like it does in men, but rather a thinning of the hair in different areas.
Though this is still an ongoing area of research and discovery, according to Dr. Beach, genetics and hormonal activity are believed to contribute to female pattern hair loss.
This type of hair loss “is something that really requires assessment with a dermatologist,” says Dr. Beach. Treatments like injections of platelet rich plasma (PRP), which helps stimulate the development of new hair follicles and growth, hormone medications like spironolactone, and hair transplants are viable options for medically supervised treatment of androgenetic alopecia, depending on the individual.
In some cases, over-the-counter options like minoxidil may also be recommended. Like all hair treatments, Dr. Beach notes that patients using minoxidil must continue to do so regularly in order to maintain results. “There isn’t a permanent fix for hair loss. Even a lot of the people who have undergone transplants are still recommended to have a particular therapeutic regimen on an ongoing basis,” she says.
When thinking about our hair, Dr. Beach reminds patients that it is normal not to have the same size ponytail you had as a teen. As we age, it’s natural for hair to thin, also known as senescent alopecia, particularly after age 50. “Think about your whole body, what do you have that was like it was when you were a teen? Why would your hair be any different?”
That said, hair loss can be incredibly worrying. That’s why, in addition to encouraging women to have patience because it can take months to see noticeable gains with the available treatments, Dr. Beach prescribes the following mantra: “Remember that you are more than your hair.”