Once or twice a week a 40 year old woman comes in to my office asking me this question. Hair loss is very distressing but your primary care doctor can help you sort out the cause. The first question I ask my patients is this: is your hair breaking or falling out? Do you notice short broken pieces of your hair or do you wake up in the morning with long hairs on your pillow. You may also even be able to tug on your hair and see if you can easily pull out a hair (follicle and all). And you may notice increased amounts in the brush after a shower.

I won't discuss broken hairs which are usually an issue of brittle, dry hair from hair products, bleaching, coloring, etc. Increased hair loss from the scalp is a different issue. Let's walk through it.

What are the reversible medical causes of hair loss in women?

• An under or overactive thyroid


• iron deficiency anemia


• Autoimmune diseases like Lupus, Rheumatoid arthritis


• Polycystic Ovarian Syndrome (PCOS) or other disorders that cause too much systemic male hormone (which should be accompanied by abnormal periods, acne, among other things).


• Medications with some common culprits being beta blockers, antidepressants, anticoagulants, and chemotherapy


• The postpartum period is characterized by hair loss and can persist up to 15 months after delivery


• Some skin conditions can do it so your scalp should be examined to make sure there isn't a dermatologic cause contributing to the hair loss.


• A family history of similar hair loss is suggestive of androgenetic alopecia, or genetic hair loss, which I will discuss below.

If your primary care doctor has ruled those out then the answer to your hair loss is likely genetic. Here's the deal. Androgenetic alopecia is the most common type of hair loss, affecting approximately 30 to 40 percent of adult men and women. This will shock you but the incidence is the same among women as men although it may be camouflaged better in women. While it often affects women prior to the age of 40, the incidence increases around the time of menopause.

Why is this happening? Well hair loss in androgenetic alopecia is due to a genetically determined production of a shorter, thinner hair shaft. With normal hair growth each day up to 75 hairs are shed from the scalp and about the same number of follicles enter. Simply put with genetic hair loss the hair growth cycle continues, but new growth becomes thinner and shorter as follicles are miniaturized.

What will the hair loss look like in women? Unlike in men it is typically more diffuse and rarely complete in women. The front hair line is normal, with diffuse thinning typically just behind the frontal hairline or midscalp area to the vertex. The affected part is usually widened and more obvious. The presence of uneven lengths and texture is a classic sign of androgenetic alopecia.

What are my options for treatment? Once your hair loss has been determined to be genetic and not related to one of the above listed causes there are some options but not many. Oral finasteride (Propecia) and topical solutions of minoxidil (Rogaine) are the only drugs approved by the United States Food and Drug Administration for treatment of androgenetic alopecia in men. Only minoxidil is approved in women. There is some evidence that using Aldactone (spironolactone) at a dose of 100-200 mg a day showed benefit in women who haven't responded to the use of topical minoxidil and is worth asking about. As a last resort a referral to a dermatologist or plastic surgeon may be appropriate and though they are expensive available procedures include hair transplantation or flaps, and scalp reduction.

Last but not least, the psychological effects of this should not be underestimated. Reach out to others in your position and check out some additional resources that may be helpful: American Hair Loss Council (www.ahlc.org) and the American Academy of Dermatology (www.aad.org).

Dr O.

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