Women’s health articles
Hair loss in women
On the causes of female hair loss, the human hair growth cycle, and safe, natural
options for women to help stop thinning hair and reverse hair loss
By Marcy Holmes, NP
One of the most emotionally devastating concerns I hear about from my patients is
thinning hair and hair loss. At Women's Health Network, we understand that a woman’s
head of hair is her crowning glory — and losing too much hair can be a serious
and frightening blow to her self-esteem.
Reacting so strongly to the physical state of your hair may seem like vanity, but
it’s not. Your hair is one of the first areas, along with skin and nails,
to manifest signs of hormonal imbalance, poor nutrition, or illness. Understanding
how hair regenerates and paying attention to any changes in your hair growth and
appearance are important parts of taking care of yourself.
The truth is, a certain amount of hair loss is normal, but excessive hair loss and
hair thinning indicate that something is not right. Unfortunately, many conventional
doctors downplay hair loss as an inevitable part of aging for both sexes, treating
it with topical products like Rogaine that enhance existing hair but offer no real
solution to the causes of hair loss, and therefore no prevention of continued hair
thinning. This leads many women — especially those in
menopause — to think that there is nothing they can do to stop their
hair loss. The good news is that we’ve seen many cases resolve over time with
a holistic approach.
While we wouldn’t claim to know the ultimate cure for hair loss (don’t
believe anyone who says they do!), we don’t think a balding woman should resign
herself to shopping for hair thickeners or wigs when there are so many other natural
choices she can make to support natural hair growth where it counts — at the
Your hair up close
A strand of hair is made up of extruded, compacted dead cells. It grows from living
follicles in the skin of the scalp. At the shaft, or root of the hair, all of your
major systems are at work, including your circulatory, endocrine, and nervous systems.
That’s why it hurts when someone pulls your hair!
Every hair follicle has four distinct phases it cycles through on a regular basis:
growth or anagen, transition or catagen, resting or telogen,
and returning growth or mesanagen (see figure below). A full cycle can
last anywhere from two to five years per follicle. Unusual hair loss and thinning
occur when a follicle is stuck in the telogen or resting phase. Bald spots occur
when a large group of follicles turn off in one place. Most of the time this happens
slowly, but in some severe cases it can happen all at once, causing a clump of hair
to fall out.
© 2006 Women's Health Network
Do you have unusual hair loss? Take our “pull test”
Human beings lose hair every day, typically 50–100 strands a day. You can test hair
loss with the “pull test.” Take about 60 hairs between your fingers
and pull gently but firmly. Normally about 5–8 hairs will come out — reflecting
the average 10% of hair follicles that are transitioning towards the resting phase
at any one time. More than 15 hairs may indicate a more unusual period of hair loss
called telogen effluvium.
Telogen effluvium is sudden and uncharacteristic loss of hair that is usually not
localized. More follicles than average are shocked or move into the resting state.
When this happens, you may notice more hair than usual in your hairbrush or on the
bathroom floor. But I’ve also had patients suddenly lose a clump of hair or
their eyebrows after shock. Keep in mind that the darker and thicker your hair is,
the more noticeable it will be against the shower floor or sink. You may think you
are losing more hair than you actually are.
Causes of hair loss in women
Why do certain hair follicles break their normal cycle and switch into a resting
or “off” position — temporarily or permanently? And why do some
women experience thinning hair on their head and darker thicker hair on other parts
of their bodies? My grandmother was always very proud of her hair, which remained
on her head with only minimal graying or hair loss until she died at age 95. Why
was she so lucky? Probably some good Scandinavian genes and healthy living (which
included a daily helping of native Maine blueberries). She had her battles, too,
suffering thyroid disease and a thyroidectomy, osteoporosis, and high blood pressure.
On the plus side, she managed stress well, did not drink or smoke, and kept a regular
sleep schedule. Somehow in the individual give-and-take of her body’s needs,
her hair was able to maintain its resilience.
Causes for hair loss are highly individual, but can include any combination of the
- Stress (emotional and physical)
- Hormonal imbalance, specifically androgen sensitivity
- Change in hormonal birth control
- Immune system irregularities
- Yeast overgrowth or fungi
- Thyroid disorders
- Crash or liquid protein diets leading to sudden dramatic weight loss
- Nutritional deficiencies (especially vitamin D, vitamin A, iron, and protein)
- Cosmetics (allergies and harsh treatments)
- Dental treatment
- Blood loss
- Medications (including anticoagulants, anticonvulsants, antithyroid medication,
and hormone therapy)
- Severe psychological distress or life-threatening situations
- vitamins B, C, D, and E
- calcium, magnesium, copper, zinc, and iron
- fish oil with essential fatty acids
Some women experience periods of noticeable hair loss (or growth) at different phases
of their menstrual cycle, or even seasonally. If this is your experience, be assured
that it is very common and tends to resolve itself naturally.
The thing to emphasize about the resting or telogen phase is that it is designed
to be temporary. Hair follicles can be shocked into the resting phase by many stressors
and just as suddenly switch back “on” once stress is reduced. Hair appears
to be amazingly adaptive, which is why so many scientists believe that a cure for
hair loss is right around the corner. But the lack of a remedy now doesn’t
mean you should give up hope. A majority of women with moderate hair loss will notice
big improvements just by paying more attention to their stress levels and nutrition.
If you are currently under a lot of stress, providing your body with a little more
support through nutritional supplements and TLC can really boost your hair growth.
For this reason, I always tell my patients who report surprising hair loss to follow
our Nutritional and Lifestyle Guidelines for three to six months, including hair–specific
vitamins and supplements. But I also screen women carefully for symptoms of underlying
health concerns before proceeding to more intrusive diagnostic or treatment methods.
Testing for more severe hair loss
Most mild to moderate hair loss will improve with some basic stress reduction and
positive lifestyle changes. Hair loss that is more dramatic or persists warrants
a closer look. Testing for insulin resistance, testosterone levels, and thyroid
or other metabolic dysfunction can point to androgen sensitivity, thyroid dysfunction,
or another endocrinologic disturbance as a possible cause for a woman’s thinning
hair. Some women will experience male pattern baldness if their bodies have high
testosterone or become sensitive to normal circulating levels of androgens.
Here are the tests I’d recommend discussing with your practitioner:
- hormone panel (testing specifically both free and total testosterone levels)
- thyroid testing
- fasting insulin
- metabolic panel (for kidney and liver function)
- ferritin stores (for iron deficiency)
- CBC (complete blood count) with differential
- allergy testing
It’s important to understand that conventional doctors have a wide range of
test results that they consider “normal”; specifics vary by the type
of test, but for argument’s sake, let’s say it’s 1–100. If your
number falls near the edge of this range but still within it (say 2 or 99), you
are still considered normal. Look for test results that fall at the midline. Anything
well below or above needs a hard look at. In our opinion, clinging to the edge of
normal is not conducive to good health.
Hormones and hair loss — menopause, PCOS, and male pattern baldness
What about drugs for hair loss?
New testosterone–blocking drugs like flutamide have been only minimally
effective in reversing hair loss in women and should not be taken by women of childbearing
age — they are generally only appropriate for men and could even exacerbate
hormonal disorders in women.
Keep in mind, these drugs only take aim at the surface of the problem; they can’t
rebalance the body from the inside out like a more natural approach can.
Many women experience more dramatic, localized hair thinning, even a noticeable
bald spot. This condition is called male pattern baldness, or androgenetic alopecia
(AGA), and it is the most common form of hair loss in both men and women.
It almost always occurs on the top and sides of the head and above the forehead,
and may also involve excessive hair growth on the face and other areas on the body,
though the range of severity is wide.
While hair loss in women is different from that in men, there are some similarities
in the way in which hormones affect hair growth. Like your body’s own version
of Miracle-Gro, androgens (testosterone and DHEA) are naturally converted into a
substance called DHT (dihydrotestosterone) that stimulates blood flow to the hair
follicle, promoting hair growth. Problems arise when the follicle’s receptors
become oversensitive to androgens and shut down — like locking a door. This
can happen when one or more of the following three conditions prevail: a genetic
proclivity, abnormally high levels of free testosterone, or a change in sensitivity
to normal levels of circulating androgens.
Hormonal imbalance due to PCOS (polycystic ovarian syndrome) or perimenopause is
the primary cause of male pattern baldness in women. Because so many women with
PCOS have high levels
of circulating androgens and are also
insulin resistant, a growing number of practitioners are looking at the
connection between insulin resistance, testosterone, and hair loss. It’s possible
that receptor resistance to insulin and sensitivity to androgens go hand in hand.
One Finnish study of women in their 60’s showed a definitive correlation between
insulin resistance and increased risk of hair thinning, particularly when a subject
had a paternal history of hair loss.
Some women carry a genetic predisposition to male pattern baldness, but the process
occurs in every woman to some degree as she ages and estrogen levels fall. Decreasing
estrogen levels may allow the body to convert more available testosterone without
opposition. The good news is that some cases of AGA resolve or limit themselves
once internal balance has been restored.
Immunological and infectious factors in hair loss
If hair loss worsens over time, or if hair falls out in great clumps, creating patchy
bald spots all over the head, it may indicate a more serious autoimmune condition
called alopecia areata, or an infection-induced alopecia called cicatricial
These hair concerns go beyond the scope of this article and must be diagnosed by
a punch biopsy, in which a minute section of the scalp is removed and tested. As
of this point, there is no cure for alopecia areata, only topical solutions and
injectable steroids. But we believe our holistic approach can help boost immune
function and help stem progression of symptoms.
Occasionally an overgrowth of fungus or yeast can trigger severe follicular inflammation
that results in hair loss. This can be diagnosed by a dermatologist after a thorough
scalp examination. Treatments vary depending on the practitioner, but usually involve
some kind of topical anti-fungal shampoo or solution.
New inroads into hair transplants, laser stimulation, and topical products are a
great reason not to despair if you’ve been diagnosed with alopecia areata
or another troublesome scalp condition. A new type of minimally-invasive hair transplant
procedure called follicular unit extraction (FUE) or “NeoGraft”
is offering promising results, though it is costly and not yet widely available.
You may not have the head of hair you were born with, but some of these developments
may provide the next best thing.
Natural hair loss solutions
Conventional topical solutions for hair loss like minoxidil (Rogaine) enhance
and thicken existing hair — they do not generate new growth. This may be useful
for some women who can deal with a small bald spot or expanding part line by changing
their hairstyle, but these products do nothing to restore natural hormonal balance
or metabolic function — the factors that are causing the excessive hair loss
in the first place.
If your hair loss is mild to moderate, the most important thing to do is weigh the
immediate stressors in your life against how much support you’re giving your
body. Start with an honest inventory of your healthy and not-so-healthy habits.
Then take some steps toward shifting the balance to the support side. Here’s
what we recommend:
Eliminate dietary causes of hair loss. Eat a balanced
diet comprised of whole, protein-rich foods — organic, if possible. Avoid
or limit refined sugar and other simple carbohydrates to ameliorate insulin resistance.
Read how in our Nutritional and Lifestyle Guidelines.
Address vitamin deficiency hair loss. Take a rich multivitamin
like the one we offer in our Hormonal Health Package that includes hair-healthy
vitamins such as B, C, D and E. Other important nutrients are calcium, magnesium,
copper, zinc, and iron. A fish oil supplement containing vitamin D and essential
fatty acids will help boost immunity and soothe inflammation.
Balance your hormones. If you are going through menopause
or are beginning to notice hormonal changes, consider gentle endocrine support like
to help naturally rebalance your hormones.
Consider alternative approaches. Scalp massage and acupuncture
can be helpful in stimulating blood flow to the scalp and supporting normal follicle
function. Kelp-derived supplements add iodine to the diet, which assists in the
manufacture of thyroid hormones. Ginkgo biloba increases blood flow to
the scalp (without androgens).
Examine your emotional health. If you are under severe
psychological stress, your hair loss could be a result and should improve a few
months after the stress is relieved. Finding healthy ways to express your feelings
can go a long way toward reducing stress, as can gentle meditative exercises and
If your hair loss does not improve with these measures after six months, talk to
your practitioner. He or she may recommend undergoing the tests outlined above.
Ask to see the results and where they fall in the range of normal. If you notice
any irregularities, discuss supplements or treatment targeted toward hair growth
with your practitioner.
New growth in every way
Remember that the condition of your hair mirrors what’s going on inside your
body. It only makes sense to consider natural options that nurture your whole health
before spending a lot of money on expensive shampoos, conditioners, and hair-thickening
products. While some of these products may enhance the appearance of your existing
hair, they don’t generate new hair. Nurturing your health from the inside
out, including your emotional health, should improve the quality and quantity of
your hair, as well as your overall quality of life!
Related to this article:
References & further reading
on female hair loss
Last Modified Date: 04/19/2011
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician