Women and Hair Loss

Understanding the intricate process of hair growth is akin to envisioning a flourishing garden, where the visible outcome relies heavily on what transpires beneath the surface. “Just like a garden, a normal hair cycle should culminate in the production of hair,” explains Dr. Wendy Roberts, a dermatologist based in Rancho Mirage, CA. “The growth cycles play a vital role because when they go awry, hair loss becomes a prominent issue.”

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Interference with the hair cycle, whether through medications, illnesses, infections, or chemicals, has the potential to disrupt the proper formation of hair. “It’s a highly dynamic process, and anything that disrupts the cycle can cause hair loss,” notes Dr. Roberts.

While hair loss may appear to be more prevalent among individuals assigned male at birth, those assigned female at birth are equally susceptible to experiencing hair loss or thinning. Although most women notice these changes in their 50s or 60s, it can occur at any age due to various reasons.

Hormonal changes resulting from taking hormones can influence hair growth in individuals, particularly those who are transgender or nonbinary. Transgender individuals do not identify with the sex assigned at birth, while nonbinary individuals may not identify strictly as male or female but rather as a combination of genders or none at all.

Hair growth follows three distinct cycles: anagen (growth phase), catagen (transition phase), and telogen (resting phase). Approximately 90% of the hair on the head is in the anagen phase, which lasts from 2 to 8 years. The catagen phase, lasting 2–3 weeks, is a transition period where the hair follicles shrink. The telogen cycle, spanning around 2 to 4 months, is a resting phase for the hair.

Typically, the vast majority of hair on the scalp is in the growth phase, with only about 10% transitioning or resting at any given time. On average, hair grows about 6 inches per year for most individuals.

It is normal to lose between 50 and 100 strands of hair per day, according to the American Academy of Dermatology. However, about one-third of women experience more substantial shedding. Several factors can contribute to increased hair loss, including hormonal fluctuations, medications, stress, and styling habits. On hair-washing days, an individual may lose up to 250 strands, as explained by Dr. Roberts. However, avoiding washing the hair in an attempt to retain it is futile since the hair will eventually fall out regardless.

Detecting hair thinning or excessive loss can be achieved through various visual cues. Dr. Nicole Rogers of Old Metairie Dermatology in Metairie, LA, notes that women may observe a significant amount of hair on their pillow when waking up in the morning or notice an increased quantity of hair left in the comb during gentle combing. Over time, women may also witness thinning on the top third to half of the scalp, with the frontal hairline often remaining intact.

Diagnosing the cause of hair loss involves a combination of approaches. Physicians can typically make a diagnosis based on physical examinations, inquiries into family and medical history, blood tests to detect underlying conditions like low iron or thyroid problems, hair shaft examinations using a light microscope, pull tests to assess the extent of hair loss, scalp examinations for infections or swelling, and, in some cases, biopsies involving gentle scraping of the scalp to analyze skin samples.

While hereditary factors commonly account for female pattern hair loss, other conditions can lead to hair loss as well. Pregnancy, thyroid disorders, anemia, autoimmune diseases, polycystic ovary syndrome (PCOS), and various skin conditions such as psoriasis and seborrheic dermatitis are among the many possible causes. Extreme stress, physical trauma, rapid weight loss, excessive vitamin A intake, certain medications, and specific medical treatments such as radiation and chemotherapy can also trigger hair loss.

Self-inflicted hair loss known as traction alopecia can occur due to hairstyles like cornrows or excessively tight braids. Additionally, certain styling habits, such as using high heat from blow dryers or flat irons, applying harsh chemicals like bleach or perms, or subjecting the hair to excessive tension from clips, bands, or pins, can lead to hair loss. Over-shampooing and excessive brushing or combing, especially when the hair is wet, can also contribute to damage and breakage.

Fortunately, many instances of hair loss can be reversed or treated with appropriate medical interventions. Seeking dermatological advice early on increases the likelihood of successful treatment and hair regrowth. For individuals experiencing traction alopecia, recognizing the signs before the condition becomes permanent is crucial.

Hair loss can also affect transgender and nonbinary individuals, posing additional challenges when it comes to self-expression and aligning hair growth with their affirmed gender. Hormone therapies, such as masculinizing hormone therapy for transgender men (taking testosterone) or feminizing hormone therapy for transgender women (taking estrogen or antiandrogens), can influence hair growth patterns. Survey data indicates that hair loss or thinning is a common concern among transgender and nonbinary individuals, emphasizing the importance of comprehensive care and potential additional treatments beyond hormone therapy.

Hormonal fluctuations related to pregnancy and menopause can also contribute to temporary hair loss. Stressful events or conditions can trigger telogen effluvium, causing a substantial amount of hair to fall out during brushing or washing. Additionally, some individuals may engage in a hair-pulling disorder known as trichotillomania as a means of coping with tension or discomfort.

Dietary factors and nutrition play a role in hair health as well. Significant weight loss, inadequate intake of iron, protein, and other nutrients, excessive consumption of vitamin A, insufficient vitamin D levels, and eating disorders like anorexia or bulimia can contribute to hair loss.

In conclusion, a comprehensive diagnosis of hair loss involves thorough medical assessments and examinations to determine the underlying causes. Prompt medical attention allows for effective treatment and improved chances of restoring hair growth. It is essential to address the unique challenges faced by transgender and nonbinary individuals, offering support and tailored treatments to align their hair growth with their affirmed gender. Ultimately, understanding the various factors that contribute to hair loss empowers individuals to take proactive steps towards maintaining healthy and vibrant hair.

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