Close to half of all women will experience noticeable hair loss in their lifetime. So why is there still such a stigma about it?
Finer hair at the temples, a widening part, more scalp visible under bright lights…women’s hair loss is nuanced, making it harder to discuss. Image by Freepik.
It usually starts off small.
A hint of a widening part, glimpses of scalp under bright lights you didn’t think were so visible. There’s undeniably still hair there. It’s not like a classic receding hairline or bald patches...
But it looks different. The hair you thought you knew so well isn’t behaving as it used to, so much so, you wonder if perhaps you never knew it at all.
Your behaviour changes too. You avoid the bright lights, style your hair to mask the sparseness. Perhaps you seek out medical hair loss therapy or opt for extensions, a topper, fibre cosmetics, or even a wig.
As many as 50% of women will experience this or a similar scenario over the course of their lifetime. So why do so many insist on treating the existence of female hair loss like a dirty little secret?
Hair as a Measure of Womanhood
Society treats women’s hair loss differently than men’s which can lead to confusion and misdiagnosis. Photo by Towfiqu barbhuiya
All hair loss carries a social stigma, but where women are concerned, it is more pronounced. Women aren’t supposed to lose their hair, not like men, at any rate. As a result, there’s a lack of visibility in modern media. While it's not uncommon to see bald male actors on TV and in film, think of the last time you saw a female actor or model with hair loss.
Lack of visibility leads to something more insidious. While society normalizes male hair loss and more openly discusses the many treatments available to them (if they choose), women don’t get the same grace or opportunity to learn about the biological processes driving their own shedding, often resulting in inaccurate information on the causes and what can be done.
A Problematic Cultural Script
Ashamed, silenced, dismissed. When things aren’t discussed in the open, it can be hard to find therapies and treatments that actually work. Image by Freepik.
Long, thick hair has long been a symbol of youthful, feminine beauty in many global cultures. Especially in the western world, centuries of indoctrination layer additional pressures on how even modern hair texture should look and feel. Wigs, toppers, extensions, and fibre paints are often used to deftly mask hair loss and give women confidence. And no wonder, as women’s hair loss is often portrayed as a reflection of health, or a spectacle.
A great example of this is the show ‘America’s Next Top Model’ from the 2000s. Contestant Jeana Turner from season 24 (2018) had little control over how her alopecia areata (the same autoimmune type of hair loss Dr. Linkov has) was revealed to the audience. There’s been a lot of recent discussion online about how forcing Jeanna to remove her wig on national television (without consent) added to the stigma of female hair loss.
Extensions, wigs, and fibre paint are used globally to mask female hair loss, often with incredible results. Photo by Mohamed B. on Unsplash
The Most Common Causes of Hair Loss in Women
There are many different causes of hair loss in women, some more common than others. Below, I’ve summarized the most common causes and what treatments are available.
1. Androgenetic Alopecia – AKA Female Patterned Hair Loss.
This is the same genetic condition that causes male-patterned hair loss in men and is the most common cause of hair loss globally. Though it manifests differently for women — widening part and thinning all over the crown — many of the treatments are the same.
Androgenetic alopecia is both genetic and hormonal. Dihydrotestosterone (DHT) is a metabolite of the androgen testosterone (which both men and women need, though in differing levels), which binds to the androgen receptor at the hair follicle. The result in sensitized individuals is gradual miniaturization and eventual hair loss. Both perimenopause and menopause can make this condition more apparent as hormones shift, as can conditions that elevate androgens, such as polycystic ovary syndrome.
Treatments: Finasteride has long been used to inhibit the production of DHT in men and can be used by women as well (there are serious pregnancy risks). Minoxidil is another medication that is just as useful for women experiencing hair loss to stimulate growth and reverse miniaturization. Spironolactone is another option only for women. It is a more global antiandrogen used to combat acne.
2. Telogen Effluvium (stress-triggered shedding)
Telogen effluvium is diffuse shedding caused by a sudden stress trigger that pushes many hair follicles into the resting phase prematurely. The shedding itself occurs 1- 4 months afterwards making it tricky to track the exact source. Unlike some other forms of hair loss, this one is usually temporary.
Triggers: Illness, surgery, childbirth, post-partum hormonal shifts, crash dieting, GLP-1 inhibitors (Ozempic hair), major emotional stress, and certain medications.
Treatments: Because hair follicles are ‘shocked’ out of the growth phase, not damaged, they mostly need time to cycle back. Beyond patience? Minoxidil, PRP, microneedling, exosomes, and red-light therapy can potentially help speed things along. Using products formulated to support hair follicle health, like our Feel Confident Haircare line, can also really help encourage regrowth.
3. Thyroid dysfunction (hypo/hyperthyroidism)
Thyroid dysfunction disrupts the hair growth cycle by altering follicle metabolism through the thyroid hormones T3 and T4. An overactive thyroid can speed up cycling, leading to breakage, while an underactive thyroid can lead to prolonged telogen and shedding. Though it can affect both men and women, autoimmune thyroid issues are 5-10x more common in women due to estrogen fluctuations.
Treatment: Treating the thyroid issue (hormone regulation) can lead to improved hair growth in 3-6 months.
4. Autoimmune
Alopecia areata causes patchy, non-scarring hair loss from autoimmune attack on follicles; it often reverses spontaneously or with treatment. In comparison, scarring alopecia destroys follicles via inflammation, leading to permanent bald patches if not caught early.
Why is there a higher prevalence in women? Estrogen modulates the immune system by enhancing B-cell activity and autoantibody formation. Estrogen fluctuations (menstrual cycle and pregnancy) can amplify the immune attacks on follicles.
Treatments: Alopecia areata can be treated with corticosteroid injections, Jak inhibitors and minoxidil (though these don’t always work in a predictable fashion). Scarring alopecia can be treated with anti-inflammatories, but early intervention is key to preserve hair follicles.
5. Traction Alopecia
Braids, extensions, ponytails, buns, and all other types of tight styling have the potential to cause traction alopecia. Prolonged mechanical force loosens the hair shaft from the dermal papilla, inflames the follicle, and has the potential to halt the growth cycle. This leads to thinning along hairlines or temples, progressing to scarring if left unchecked.
Treatment: The best way to prevent traction alopecia is to be aware that it can happen. Reducing tension, giving hair a break from traction styles, and seeing a stylist who specializes in traction styles can all help.
Imagine a world where thinning hair was no more remarkable than a woman wearing reading glasses. Photo by Rendy Novantino on Unsplash
For anyone who thinks they’re experiencing hair loss, you’re not alone, and the first step should be to seek out a proper diagnosis. Knowing and understanding exactly what you’re seeing (and getting medical acknowledgement) is an important step, as treatments depend on the underlying cause. Arming yourself with knowledge? It’s always a confident move.
To keep your follicles in great shape at home, consider a well-rounded haircare routine like Feel Confident (https://feelconfident.com/collections/hair). Our products are packed with ingredients that make an impact on the health of your hair in a formula that’s clinically proven to improve the look and feel of your hair.
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.
