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When Hair Loss Strikes, a Doctor Is a Girl’s Best Friend


Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic, examining a woman’s scalp. Americans spent an estimated $176 million on hair loss products last year. CreditDavid Ahntholz for The New York Times

A COUPLE of years ago my hair started falling out. Not in clumps, but I noticed more hairs than usual in my comb and in the bath drain.

I went to a trichologist (a hair specialist, not an M.D.) who tested my blood (all fine), told me some thinning was natural for a woman in her mid-40s and sent me home with expensive shampoo and a serum to use on my scalp. I used the potions. I took vitamins. I stopped brushing my hair.

I was a wreck. If someone had told me there was a cure in a remote village in the mountains of Bhutan, I would have put on my hiking boots and boarded a plane.

No one wants to lose their hair, but for women it is especially traumatic. Men can shave their heads and look hip, even sexy. Most women don’t want to be bald. Though it is more common — and visible — in men, many women lose their hair. According to the American Academy of Dermatology, 30 million women in this country have hereditary hair loss, compared with 50 million men. But many additional women experience thinning hair that results from menopause or health problems.

If your hair is coming out, be advised that of the multitude of treatments on the market for women, few are worth your money, says Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic.Continue reading the main story


Americans spent an estimated $176 million on hair loss products last year, and chances are some of that money was not well spent. Don’t let charming salon owners, seductive ads or fancy gimmicks convince you otherwise.

So why did my hair fall out? After doing some research on my own, I decided it was either a bad bout of stress or the antidepressant I was taking at the time to treat the stress.

I’ll never know for sure, because both stress and certain antidepressants can cause hair loss. But after a couple of months, my hair stopped coming out and my life was back to normal.

In this column, I’ll explain what generally causes hair loss among women and what treatments tend to work. Please post your own experiences online, so other women can learn from them.

Each day you lose about 50 to 100 hairs but, when all is well with your body, an equal number is growing back. Lifestyle upsets, including severe stress (death in the family, divorce, job loss) and changes in your diet (crash programs, lack of protein), can cause your hair to shed more rapidly than normal.

Besides antidepressants, beta blockers and anti-acne prescriptions can also temporarily disrupt the growth cycle of your hair. And take note: medications with testosterone, which women may take to increase their sex drive, can also cause hair loss. (Ask any balding man and he’ll be sure to tell you that his abundance of testosterone is to blame.)

Certain medical issues can also impair hair growth. An overactive or underactive thyroid gland can cause hair loss. So can iron deficiency. When women go through menopause and their estrogen levels fall, their hair often begins to thin. Many women also lose some hair a few months after giving birth because of the hormonal changes the body experiences.

That’s the background. Now for some guidance:

BE PROACTIVE If your hair is thinning, see a dermatologist who specializes in hair loss right away. No matter what the cause, the sooner you address the problem the better for you and your hair.

The dermatologist will take your medical history, run blood tests and may even do a scalp biopsy (don’t worry, it takes about five minutes).

“A scalp biopsy is the gold standard for diagnosing hair loss,” said Dr. Marc Avram, a dermatologist in private practice with offices in Manhattan and Brooklyn. “The test examines the follicles themselves and can help determine whether the hair loss is genetic, inflammatory, infectious or due to an unusual physical or emotional shock to the system.”

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If the blood test reveals that you have low iron, for instance, your doctor will put you on a supplement. If your hair loss seems to be the result of menopause, you and your doctor can discuss whether hormone replacement therapy would be a good idea.

“Low estrogen causes the hair density to decrease and the hair strands to become smaller. Estrogen makes the hair thicker and longer,” Dr. Piliang said.

The dermatologists I spoke with estimated that about half of the women they saw for hair loss had an identifiable trigger that could be addressed with medication, hormones or better nutrition.

THE TREATMENTS If no trigger is present, it’s likely you have androgenetic alopecia, a hereditary condition that causes the hair follicles to get progressively thinner over the years. The most effective topical medication for the condition is minoxidil (brand name Rogaine), the only treatment for hair loss in women that has been approved by the Food and Drug Administration.

You can buy minoxidil over the counter, for about $25 for a three-month supply. But you’ll also need to invest some patience. Minoxidil can take six months or even a year to work. Dr. Avram estimates that the drug, which must be applied twice a day, stops hair loss in 80 percent of the women who use it properly and it can actually stimulate hair regrowth in about half the users.

Your doctor might also suggest the prescription pill finasteride, sold under the brand name Propecia and also in generic versions. Although the drug is not federally approved for use in female patients, some doctors have observed good results in postmenopausal women. But women who are planning to have children should not take this drug because it can cause birth defects.

Some of Dr. Avram’s patients report success with laser combs, devices that are intended to stimulate hair follicles. The combs cost $300 to $500 and are available online. Only one such comb, the Laser Comb brand, has been approved by the Food and Drug Administration, and only for male pattern hair loss.

“Theoretically, light could thicken hair follicles,” Dr. Avram said, “but there are no independent, long-term studies that show laser combs work or don’t work.”

If treatments are not helping and your scalp is more visible than you’d like it to be, you might consider hair transplantation. The latest procedures work well and produce natural-looking results (gone are the days of hair plugs). But the transplants can cost $8,000 to $12,000 and are not reimbursed by most insurance companies.

BEWARE THE GIMMICKS Lots of over-the-counter products claim to promote hair growth, but probably only those with minoxidil do. Shampoos and vitamins might make your hair look and feel healthier, but they won’t put more hairs on your head.

“There are no specific vitamins that grow hair,” said Dr. Zoe Diana Draelos, a consulting professor of dermatology at the Duke University School of Medicine. Unless you are nutritionally deficient, you probably don’t need a vitamin supplement and if you do, a simple multivitamin is enough.

The saw palmetto plant is often said to help hair growth, but there is little clinical evidence concerning its efficacy.

Finally, be skeptical of any hair expert who claims to be able to determine the cause of your hair loss simply by analyzing your strands. “You can’t figure out someone’s overall health from their hair,” Dr. Draelos said.

Fads and gimmicks probably won’t hurt you, but they will waste time and money. When it comes to hair loss, a prompt medical consultation is the key.

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