Hair Loss: Not Just A Male Problem
Grab about eight to ten hairs and give a light tug. Get some? If it’s just a strand or two, you can stop worrying that you’re losing your hair. If you came away with four or more, you have reason to be concerned. Twenty-five percent of women begin to experience some degree of hair loss by age 40; by menopause, the percentage rises to 60. The good news is
that the growing acknowledgment of female hair loss has prompted the development of highly effective solutions for women with thinning ponytails and widening parts–both early signs of the problem.
Up until the 1980’s, hair loss in women was assumed by most dermatologists to have an underlying medical cause. But now it’s widely known that, like men, women experience hereditary hair loss. The one upside is that women are generally better-equipped than men to deal with it. Comfortable navigating the world of cosmetics, women research and initiate treatment sooner and more thoroughly. In addition, most solutions–including illusion styling, Rogaine, and hair additions–work better on women.
Nineteen million American women experience some form of thinning hair. The vast majority are affected by androgenetic alopecia, or hereditary hair loss, which can begin anytime after puberty but–in as many as a quarter of cases–starts before the age of 40. How extensive the loss may be is up to the law of averages: If Dad is a carrier, there’s a one-in-three chance his daughter will see its effects.
Unlike men, who experience androgenetic alopecia as a recession of the frontal hairline and hair loss on the crown of the head, women see diffuse loss, mainly over the top of the head. “The gene for androgenetic alopecia is inherited equally in men and women,” says Jerome L. Shupack, M.D., professor of clinical dermatology at the New York University School of Medicine, “but you need the presence of DHT [dihydrotestosterone], a male hormone [or androgen], for the gene to express itself.” In women, where the balance between female and male hormones is more fragile, even a slight shift can signal the hair follicles to shrink and begin producing shorter, thinner hairs. Fortunately for many women, estrogen suppresses male-hormone production, delaying hair loss. When menopause approaches and estrogen levels drop, however, the protective effect is lost, although estrogen-replacement therapy appears to help.
The Stress Factor
The second most common form of thinning hair, telogen defluvium, is stress-induced and causes sudden, temporary clumplike shedding. Here, 10 to 15 percent of hair follicles abruptly enter a resting stage. “This type of loss is the result of a transient but significant hormonal shift caused by a traumatic event,” says Dr. Shupack, “like delivering a child, going on or off the Pill, or anorexia nervosa.” Can a single shake-up like a marital spat or a botched meeting cause such stress? It’s not likely. “Emotional stress seems to cause hair loss usually when it translates into physical stress, like severe weight loss or sleep deprivation,” says Dr. Shupack. Unless the condition is chronic telogen defluvium (which can last up to seven years), growth returns to normal within about nine months.
Telogen defluvium and androgenetic alopecia account for 90 percent of hair loss cases. Other causes range from medical disorders (including an underactive thyroid or an iron deficiency) to yo-yo dieting and improper hair care (e.g., excessive bleaching, coloring, or perming, or overly tight cornrows or braids that cause hair breakage). Because the underlying cause is the one to treat–and more than your hair may be at stake–all significant loss should be reported to a physician. With a correct diagnosis, you’re likely to get many recommendations.
How to Treat
Here’s the lowdown on what works–and which option is best for whom:
How they work: Hair-thickening shampoos are formulated without heavy conditioning ingredients that can weigh hair down: they make hair a little stiffer, so it appears fuller and fluffier. Thickening conditioners, mousses, and gels coat and plump up the hair shaft.
Cost: $2 to $20, depending on whether you buy them at a drugstore or salon.
Best for: Women with minimal hair loss.
What to expect: In a Good Housekeeping Institute study of thickening shampoos, all panelists and independent observers noticed that hair had more fullness and body after use. The effect of conditioners and styling products is similar to putting mascara on eyelashes. (Because a too heavy application of such thickeners can produce the opposite effect, use them sparingly and distribute evenly through hair.)
Snags: Despite claims, neither these products nor the hair-care “systems” that promote various magic-bullet ingredients, can arrest hair loss.
How it works: Hair is cut, colored, or permed to create the illusion of more hair. “The key to making hair look thicker is to keep it condensed,” says Cosmo DiSchino, owner of Cosmo & Company’s Salon of Aesthetics, in West Palm Beach, FL. “Cut it short–chin-length or above; zigzag the part; add more bangs, especially if loss is heavy at the hairline.” To maximize volume while styling, scrunch hair with hands while blow-drying on medium heat (overdrying makes hair limp). If your scalp is visible, you may want to dye your hair a color that minimizes the contrast–for example, going lighter if hair is dark, or blond if it’s gray. “Coloring also swells the hair shaft, making hair appear thicker,” notes Damien Miano, co-owner of New York City’s Miano Viel Salon. And because curly hair bends back on itself, thereby appearing denser, perming is another good option.
Cost: $9 and up.
Best for: Illusion styling is the most popular treatment for women with hereditary or temporary hair loss.
What to expect: Though purely cosmetic, strategic styling makes the most of the hair you have left.
Snags: If loss is due to hair being damaged, chemical processing-which can further weaken vulnerable tresses–isn’t recommended.
How it works: Minoxidil is thought to work by stimulating the hair follicle to grow for a longer period of time. It must be applied to the scalp twice daily.
Cost: $20 to $30 for a one-month over-the-counter supply of Rogaine, Upjohn’s brand name for products with minoxidil. Generic versions cost $10 to $15.
Best for: The only Federal Drug Administration (FDA)-approved treatment for slowing hair loss, minoxidil is the second most popular choice among women for good reason–it appears to work best on them. “The more coverage you start with, the more you’ll end up with; the sooner you start, the better,” says Arthur P. Bertolino, M.D., Ph.D., director of the hair consultation unit at New York University.
What to expect: Clinical studies found that minoxidil impeded hair loss in 60 percent of women; 19 percent experienced “moderate” regrowth, though new hair is rarely as thick or dark as it had been.
Snags: The greatest drawback is that minoxidil must be used for as long as you want its effects; all regrowth is lost about three months after stopping application. It can take four to nine months before you even know if it will work for you. Additionally, minoxidil doesn’t seem to be helpful if loss is already pronounced. It shouldn’t be used while a woman is attempting pregnancy, is pregnant, or is breast-feeding.
How they work: The female counterpart to The Hairclub for Men, additions provide fullness and coverage to your existing hair on a long-term basis. The new hair can be cut, permed, and styled. There are several options: Weaves (pieces of real or synthetic hair) are attached to small braids of your own hair. “Integration” pieces, which resemble hair nets woven with strands of hair, are custom-made to fit larger areas of loss–say, the entire crown. For severe thinning, there’s a three-quarter piece, which is practically a whole wig, but through which natural hair can be pulled for blending.
Cost: A high-quality “top-piece” can cost $500. This includes enough real hair pieces to fill out the crown of the head, application, blending with real hair, and styling. Additional charges include $40 for tightening every four to six weeks, and $75 to $150 for quarterly reapplication. More involved additions can run $750 to $1,000.
Best for: Anyone with noticeable loss–whether it’s allover thinning or one small spot, says Linda Stanojevic, owner of Shears To You, a salon in Oak Lawn, IL, specializing in hair additions.
What to expect: Immediate and full coverage. Stanojevic claims that some are so inconspicuous women can wear a part or pull their hair straight back. But all types are noticeable to the touch.
Snags: Dermatologists warn that additions can damage already fragile hair and are difficult to clean, though newer styles are designed for easier and more thorough shampooing. Finding a salon that specializes in hair additions may be difficult. Some that do: Gilbert Hair Illusions in Miami (305-461-0077); the Hair Doctor Salon in Boise, ID (800442-1291); Jeffrey Paul Salon in Cleveland (800-883-7667); Kimberly Sullivan Micro Systems flair Replacement Studio in San Ramon, CA (510-8381522); Shears To You (708-802-0984). Or call the American Hair Loss Council at 312-321-5128.
How it works: A two- to three-hour surgical procedure in which hair–roots and all–is harvested from a dense area that rarely thins (often the back of the head) and inserted into slits between existing hairs in thinning areas. Hair transplantation has evolved from the days when “plugs” of hair were grafted into the scalp, leaving tufts that resembled doll’s hair, notes Walter Unger, M.D., a Toronto-based dermatologic surgeon, and author of Hair Transplatation (Marcel Dekker, 1995). Now, micro- or mini-grafts (tufts of one to three hairs) are inserted into slits with a hypodermic needle or small scalpel. The procedure is done under local anesthesia, and no stitches are needed. Although the area is covered with scabs for several days, hair can be shampooed the next day. The transplanted hair falls out after two to four weeks, and new hair grows in about three months later.
Cost: $5 to $20 per graft. Because a typical session involves at least 500 grafts, it can cost between $2,500 and $10,000.
Best for: Hair transplanting is the one treatment better suited to men than to women because of the latter’s more diffuse hair loss. “In order for transplants to work, you need an area of significant density to harvest hair,” says Dr. Unger. But don’t count yourself out: “If there is at least one tenth of an inch of space between hairs’ micro- (one hair) and mini(two to four hairs) grafting is possible,” says Dr. Bertolino.
What to expect: Done correctly, the results are permanent.
Snags: Inserting hair into an area that’s already populated is a tricky business. Choose your surgeon with care. For information and referrals, call the International Society of Hair Restoration Surgery (800-444-2737), or the American Academy of Dermatology (847330-0230)
How it works: A low dosage of Proscar, a medication prescribed to men to prevent and retard enlargement of the prostate gland, Propecia thwarts the conversion of testosterone into hair-loss-provoking DHT. Both Propecia and Proscar are Merck & Co. brand names for the drug finasteride.
Cost: Probably $60 to $100 for a month’s supply of pills.
Best for: Propecia may soon be an excellent option for menopausal women, but it’s not suggested for women of childbearing age due to the risk of birth defects.
What to expect: “Propecia has the effect of growing back more hair than minoxidil,” says Dr. Unger.
Snags: Propecia has not been approved by the FDA for the treatment of hair loss in either men or women. However, it’s been widely tested for men and is being studied for use in women at eight clinics nationwide. The drug is expected to be available to women by prescription within a year.
RELATED ARTICLE: Hair Today, Gone Tomorrow
I can recall the moment with perfect clarity, like every other calamitous event in my life. I was at the beauty parlor, freshly washed and waiting to be cut, when I first noticed I was losing my hair. I stared at my reflection in the mirror. There, right on the front of my scalp, was a bare patch about the size of a dime that seemed to have popped up overnight.
“Oh, don’t worry about that,” my stylist said, waving away my anxiety like an annoying mosquito. “A lot of women experience a little thinning on top when they hit forty. It will stop.”
Five years later, the dime has turned into a half dollar, and I have no reason to believe the inflation won’t continue. My stylist no longer lies to me; both of us know the truth.
Instead, he has become my coconspirator, my partner in artifice–blowing, teasing, moussing, perming, and coaxing each precious wisp to do the work of two. With each visit, he gradually moves my part lower and lower, until it almost touches my ear.
I never had a svelte figure or flawless complexion. But my hair was one of my best features. Now, the evidence of my loss is all around me–dangling from my comb, wrapped around the drain, floating onto my shoulders. Why is this happening to me? I continue to wonder. How did I go from having a bad-hair day to a no-hair day?
Once, I ever so gingerly brought up the subject to my husband, who reassuringly declared that he married me–not my hair. But will he still feel this way a few years from now when, I fear, I’ll be even more follicularly challenged?
Good brassieres can help neutralize the effects of gravity; opaque hose can hide spidery veins. But of all the indignities of aging, hair loss is one of the hardest to camouflage. Which is why it’s such a blow to the self-esteem.
“I went through a real depression,” says Marsha Knight Dubois, a Tinley Park, IL, nurse who started losing her hair in her mid-30s. “To a woman, her hair is very important because it’s the frame for her face.”
Dubois, 51, confronted the problem by getting a wig, but she hated the way it looked and felt. “The day it blew off and a man helped me chase it around the parking lot was, quite possibly, the most humiliating day of my life.” Complicating the emotional landscape was the fact that Dubois was contemplating a divorce. “After twenty-nine years of marriage, dating was petrifying enough, but to do it without hair would’ve been a nightmare.”
Desperate, Dubois heard about a local stylist who did hair weaves, and could combine her own strands with artificial hair. At the time, the price tag was prohibitive for her, so Dubois volunteered to be the model while her stylist taught the technique to disciples.
“When it was done, I felt like a little kid; I just kept shaking my head and touching my new hair. It was as if someone gave me my life back. I stayed [in my marriage] so long because I didn’t think anyone would want me. But my new hair gave me the confidence to be on my own.”
She wasn’t on her own for long. A coworker fixed her up with a friend, and 14 months later, in February 1997, Dubois married her husband, Don.
Tracy Pattin, 40, was also desperate enough to be a guinea pig. In 1986 she participated in clinical trials for Rogaine. “It was my only hope,” says Pattin, who lives in San Francisco and had battled hair loss since she was 17. “I was so fragile. All it took was one comment–especially from a man–to absolutely flatten me.”
Hair loss had even affected her work. Trained as an actress, Pattin found herself taking voice-over roles so she could be invisible. But after several months of Rogaine treatments, she started noticing that some of the sparse spots were getting I fuller. “I can’t describe the feeling… like I was normal again.”
Eleven years later, Pattin still faithfully applies the liquid twice a day–and will be perfectly happy to do so for the rest of her life. Her experiences prompted her to start a hair-loss support group–which still meets in the Bay Area–and become a spokesperson, which led to an appearance on the Today show. “It was ironic-l had spent years covering myself up with scarves and hats, terrified someone would find out about my hair. And here I was, talking about it on national TV!”
The response was overwhelming. Pattin received some 1,500 letters from women, a few so poignant she wept when she read them. “In this day and age, when people talk about everything, hair loss is still in the closet,” she maintains. “Women need to swap information, lend support. And know they’re not alone in this. A lot of us are going through it.”
Pattin is now cowriting a book called Please Come Back, which sums up the mourning that often accompanies hair loss. “But it doesn’t have to be that way,” she insists. “Whatever you do, do something. There are just too many choices today to let this ruin your life.”
As for me, I’m keeping one eye on the mirror and the other on the latest scientific research–and, for now, using enough mousse to slice a hole in the ozone.