Ever heard of a trichologist? It’s a specialist who treats hair loss and scalp problems (yes, such a thing exists), and it’s what I do for a living. Now if I asked you to picture my typical patient, would you immediately imagine a man or a woman? It might surprise you to hear that at my clinic, I actually see more women than men.

When it comes to hair loss in women, it must be emphasized that there are many different types of hair loss and many factors that can contribute to it – genetics, hormones, diet, autoimmune problems, medications and stress, to name a few.

Stress can play a large role in hair loss, with many women juggling work and raising a family, caring for elderly parents, experiencing childbirth, not to mention the stress we’ve all experienced managing life throughout a pandemic. Higher estrogen levels also mean that women are more prone to autoimmune conditions than men, which can in turn affect scalp hair. The loss of blood with periods also makes women more prone to iron deficiency, which is yet another cause of hair loss – so really, there are a multitude of possible causes.

Genetic Hair Loss in Women (Female Pattern Hair Loss)

Genetic hair loss in women is characterized by a gradual thinning of hair in the top and/or front areas of the scalp. Many genes contribute to female pattern hair loss, and it is possible for the daughter of two parents with full heads of hair to still experience genetic hair thinning.

Sex hormone levels can also contribute to genetic hair loss. In simple terms, estrogen is good for the hair, while testosterone can cause hair loss. Both men and women produce both types of hormones, but to different degrees, and their balance can change over time. This is why some women with a genetic predisposition can experience hair thinning at the time of menopause, when estrogen levels are reducing and male hormones have more relative influence on the hair. Also, oral contraceptives that contain levonorgestrel or norethisterone can have an overall ‘male hormonal’ effect on the hair, triggering or aggravating genetic hair thinning.

It should be noted that stopping oral contraceptives can cause diffuse-type hair loss, but this is temporary and self-correcting, and distinct from female pattern hair loss.

Iron Deficiency

General excessive hair loss (called diffuse hair loss or telogen effluvium) is a sign that either an imbalance exists in the body or the body has experienced a severe shock. The causes of such hair loss always affect the hair via blood circulation, which is why the hair loss is experienced all over the scalp rather than in patches.

Women lose iron with the blood loss experienced during their periods. If this is coupled with a diet that contains little iron, then anemia, fatigue and diffuse hair loss can result. Iron is an essential nutrient – it is part of hemoglobin, which carries oxygen around the body to be used to produce energy. Trichologists emphasize that it is iron storage (indicated by ferritin in a blood test) that affects the hair more than low iron levels per se, with hair loss correlating with low ferritin.

Good food sources of iron include tofu, lentils, peas, beans, spinach, nuts, eggs and red meat. If you’re taking an iron supplement, take it every second day rather than every day. Vegetarians especially must ensure their diet supplies enough iron, as well as vitamin B12 and essential amino acids, to maintain their hair and keep themselves healthy and full of energy.

Dietary Changes

Dramatic changes in diet or crash dieting can cause diffuse hair loss after about three months, as the shock to the body causes growing hairs to pass prematurely to the resting phase of the hair cycle. Hairs are in this resting phase for about three months before they fall from the scalp, which is why there is a lag between the dietary change and experiencing hair shedding. Fortunately, this type of hair loss is temporary and reversible unless nutritional deficiencies develop as a result of the new diet.

Autoimmune Conditions

Autoimmune conditions, in which our white blood cells attacks our own body cells, can lead to patches of hair loss on the scalp. There are several different autoimmune problems that can affect scalp hair, some of which can cause permanent destruction of the hair follicles.

An autoimmune issue we are seeing increasingly in post-menopausal women affects their eyebrows and hair along the hairline at the front and sides. If not caught early, this can lead to destruction of hair follicles. An essential part of therapy for this problem is supplementation with vitamin D, because of its role in regulating immunity and protecting hair follicles from autoimmune attack. Generally, people who suffer different types of hair loss have lower vitamin D levels than people who do not suffer hair loss.

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