What causes hair loss in women?


My daughter is only in her 30s and she’s starting to lose her hair. What can she do?


About one-third of women experience hair loss at some time in their lives. Most of the time it happens after menopause.

There are many potential causes of hair loss, including medical conditions, medications and physical or emotional stress. I recommend that your daughter see her doctor to rule out more serious causes.

Most likely, though, her hair loss is due to female-pattern hair loss. The medical name for this is androgenetic alopecia. This condition begins with gradual thinning at the part line. Then comes diffuse hair loss, starting with hairs that come out of the top of the head. Female-pattern hair loss is not like male-pattern balding: A woman’s hairline rarely recedes, and women rarely become bald.

Each hair on our head grows out of a little pit in the skin called a hair follicle. A hair grows longer and longer, over several years; then it’s shed. Shedding is a normal part of hair’s life cycle. After a few months, a new hair starts to grow in the follicle. For the average person, about 75 hairs are shed from the scalp every day, and 75 new hairs start to grow. (On my head, unfortunately, the ones that are being shed seem to be a lot more than 75, and the new ones a lot less!)

With female-pattern hair loss, it starts to take longer for hair to grow back after it is shed. Also, thicker, pigmented, longer-lived hairs are replaced by shorter, thinner, non-pigmented hairs. Over time, not only is there less hair, but the hair also becomes less colored, and eventually comes in gray or white.

Medications are the most common treatment for female-pattern hair loss. In my opinion, only one of them (minoxidil) works. They include:

  • Minoxidil (Rogaine, generic versions): Minoxidil can produce new growth of fine hair in some women, but it can’t restore the full density of lost hair. Also, you need to keep using it to maintain the results. If you stop, you’ll start to lose hair again.
  • Anti-androgens: Androgen receptor–blocking drugs such as spironolactone (Aldactone) and finasteride (Propecia) are not approved to treat female-pattern hair loss. There is little evidence that they are effective.
  • Iron supplements: Iron deficiency can cause hair loss, but there’s no reliable evidence that iron supplementation helps hair to grow back.

Hair transplantation is another treatment option. In the most commonly used technique, surgeons remove a narrow strip of scalp that still has hair and divide it into hundreds of tiny grafts, each containing just a few hairs. Each graft is planted in a slit in the scalp in the area of missing hair. Hair grows naturally this way, in small clusters. As a result, the graft looks better than the larger “plugs” associated with hair transplants of yesteryear.

In my experience, minoxidil often helps, and can be obtained without a prescription. If your daughter wants to consult a doctor, a dermatologist has the best training to help.