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Alison Richards first noticed that her long blonde hair was starting to thin and fall out in her 20s. “One day I was in the shower and I lost hundreds of hairs, like handfuls,” Richards recalls. “It was a very frightening experience,” she says.
According to some estimates, half of all women will experience hair loss in their lifetime. And if you’ve ever searched for content on that topic, you may soon be bombarded with ads and influencers promoting treatments. Richards, who lives in New York City, said it can be a painful experience in an online environment where celebrities have unrealistic expectations about how much hair a woman should have, even though in real life celebrities often wear wigs and extensions.
Although there are several science-based hair loss solutions, not all treatments work for everyone or for all types of hair loss. If you are facing this issue, here are some keys to understanding the problem and seeking help.
Hair has a cycle of growth and hair loss.
“Understanding hair loss begins with understanding hair growth,” says Dr. Carolyn Go, a clinical professor of dermatology at the University of California, Los Angeles. First, hair doesn’t stay on your head forever. Each strand goes through cycles of growth, migration, and rest. Hair falls out at the end of its lifespan because new hair grows and pushes it out, Go says.
Hair usually falls out in staggered patterns. After you take a shower, you may find some lumps left in your drains, but that doesn’t mean you need to worry about going bald. However, in some cases, stress such as childbirth or COVID-19 can cause the hair cycle to become synchronized, leading to increased hair loss.
“You can see all your hair falling out. It’s a big change and it seems like the world is coming to an end,” Go says. However, in most cases, hair loss in women is temporary and hair often regrows on its own, says Goh.
When hair stops growing naturally
The most common cause of permanent hair loss is androgenetic alopecia, known as androgenetic alopecia in men and female pattern alopecia in women. Symptoms progress with age in both men and women. In women, it usually begins at the top or crown of the head. (Parting your hair may widen the area and expose more of your scalp).
Less common types of hair loss include alopecia areata, an autoimmune disease in which the immune system attacks the hair follicles, often manifesting as one or more patches of hair loss. Goh said there is also cicatricial alopecia, which also causes patches of hair loss that are often itchy, tender and red, and in some cases can lead to acne on the scalp.
Why diagnosis is important
Thea Chacin, who suffers from alopecia areata and runs the non-profit support and advocacy group Bald Girls Do Lunch, says it’s important to see a doctor for diagnosis because it’s not always clear what type of hair loss you’re experiencing, and each type has different treatments. But that’s easier said than done. It can take months to get an appointment with a dermatologist, and some GPs are negative about hair removal.
Chacin says she calls back every day if she needs to see a dermatologist and can’t get an appointment right away. “Sometimes I ask ahead of time. When do I call people to let them know about their appointments? So I kind of have an idea of the window of time they’ll get cancellation notices. And every day I ask, ‘Has anyone canceled?'” she says.
Telemedicine companies like Hers offer an alternative option. You can answer a few simple questions online and talk or message your provider. You will then receive a prescription for your medication and it will be mailed to your home.
Please note – Hers primarily prescribes medications for male pattern baldness and pattern baldness. Thea Chacin says she won’t rely on telemedicine providers to diagnose less common conditions like alopecia areata or fungal diseases. So if you’re not sure what type of hair loss you’re dealing with, an in-person visit may be your best bet, at least initially.
Bald Girls Do Lunch founder Thea Chassin (right) and group member Carrie Stern.
Sonia Moskowitz/Thea Chacin
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Sonia Moskowitz/Thea Chacin
Old standbys and new treatments
Topical minoxidil, also known as Rogaine, is an over-the-counter foam that extends the growth phase of the hair cycle and holds more hair at a time. Mr Goh says this is effective for pattern hair loss, but “many people find it troublesome and difficult”. It is also not safe for use by people who are pregnant or breastfeeding.
Minoxidil also exists in tablet form. Alison Richards takes it along with spironolactone, which some doctors prescribe to treat pattern hair loss.
Richards’ dermatologist prescribes both drugs off-label. This means that these drugs are not approved by the Food and Drug Administration to treat hair loss. Richards said the combination worked for her and she feels lucky to have a doctor who asked lots of questions and monitored her for side effects.
New drugs called JAK inhibitors have been approved in recent years to treat alopecia areata. This drug targets the part of the immune system that becomes overactive and attacks hair follicles. A recent review of several studies published in the medical journal JAMA Network Open found that patients showed more hair regrowth compared to a placebo.
Hair removal is not “game over”
Diagnosed decades ago, Thea Chacin was treated with steroid injections for alopecia areata, which resulted in her hair growing back.
Ten years later, she started losing her hair again and is now completely bald. “And there are ways to live this beautifully,” Chacin says.
“I’m not saying everyone should reach a point where they feel comfortable removing hair,” she says. But she believes it’s an option that “should be as normal for women as it is for men, if they want to.” Sometimes she leaves the house with her head bare, other times she wears a scarf or a hat.
Richards says she found support and community with other women with hair loss, including hair loss influencers, on online forums like Reddit.
“There’s always someone to hold your hand and cheer you on. And if you feel like your beauty is being compromised, beauty will be redefined,” she says.
