Lose The Hair Loss
Here's why some women's hair thins and what can be done to slow the process

By Radha Marcum

Beth Andrews thought it was amusing when her younger brother, Dan, began to go bald in his mid-30s. He continually grumbled about his lost youth, but when it came down to it, Dan felt that his receding hairline was just part of being a guy. When Beth entered perimenopause in her early 40s, though, and started finding larger and larger clumps of hair filling her shower drain each day, she didn't find it so amusing. The thought of losing her hair was horrifying. Was something wrong with her? After checking out a number of websites on the topic, Beth was even more confused. She lost no time in calling her doctor.

"Although men stress about their pattern baldness, they don't typically go to the doctor about it," says women's health specialist Jana Nalbandian, ND, of the Bastyr Center for Natural Health in Seattle. "Women get very distraught over what they perceive as a large amount of hair loss, and so they go to the doctor"—sometimes with bags of their precious hair in hand. The truth is, losing up to a hundred hairs a day is considered normal, says Nalbandian, but when that number increases, hair loss becomes a matter of concern.

Despite the prevalent attitude that women don't (and shouldn't) lose hair, it is more common than many of us think. According to the American Academy of Dermatology, androgenetic alopecia, or hereditary hair loss—the most common type—affects approximately 30 million women (and 50 million men) in the United States. Contrary to popular belief, you can inherit a tendency to lose hair from your father, your mother, or both parents. But for women the diagnosis isn't always so simple. Hormonal shifts, nutritional deficiencies, certain medications, stress, and major illnesses can also be the culprits.

Finding The Cause
"When a woman comes into the clinic with significant hair loss, the first thing I look at is hormonal shifts," says Nalbandian. "Has she just had a baby? Is she perimenopausal? Has she recently started taking birth control pills?" Because shifts in levels of estrogen, progesterone, and testosterone affect hair growth, anything that upsets the balance of those hormones can trigger this fallout.

In fact, the primary instigators in hereditary hair loss are hormones. Between the ages of 12 and 40, an increased sensitivity to androgens, a family of hormones that includes testosterone, begins to cause hair follicles to shrink and deteriorate. Hair grows in thinner and eventually stops growing altogether. For women, the loss isn't usually as great as it is in men because women produce less testosterone.

If hormones don't explain the shedding, Nalbandian asks if the patient has had any surgeries or major illnesses or if she's been crash dieting. "When the body is under significant stress, the hair shifts into a resting phase to help conserve resources. The metabolism slows down, the hair starts to fall out, and it doesn't grow back as quickly." Even something as simple as a high fever or a severe bout of the flu can trigger the resting phase, and some people may even notice hair loss as long as three months after such an event.

A Different Pattern
If some 30 million American women experience hair loss—compared with 50 million men—how come we don't often see women with bald spots or receding hairlines? Women usually experience a diffuse thinning of hair rather than a loss in one particular spot, which may explain why women's hair loss isn't as visible. Even women who feel they have reasonably healthy diets sometimes face nutrition-related hair loss. "Inadequate protein is a really common [factor]," says Nalbandian. "I see many women who have shunned meats but don't know what other proteins are out there for them to eat." They often pass up protein sources such as nuts and cheese because of the high calorie content. As a result, these women become dependent on carbohydrates, Nalbandian explains. Women who suffer from protein-related hair loss often experience other symptoms, such as lowered immunity, fatigue, and blood sugar imbalances.

In rare cases, a hair-loss problem is more elusive and possibly more serious. Hypothyroidism and hyperthyroidism, iron deficiency, diabetes, and lupus can all trigger hair loss, so Nalbandian typically runs lab tests. She also asks if the patient is taking any medications. Most women aren't aware that more than 290 drugs are known to cause or contribute to hair loss, including some antidepressants, blood-thinning agents, amphetamines, birth control pills, and drugs that treat hypertension. One natural supplement—vitamin A—also contributes to hair loss, but only when taken at ten times or more the recommended dietary allowance (RDA) for an extended period of time. "People are always taking one supplement and then another, and they don't know that the cumulative effect can actually cause problems," Nalbandian warns.

Treating Hair Loss
Nalbandian prescribes a number of natural therapies to address the underlying causes of hair loss. Diet is where she starts, stressing that it "should contain adequate amounts of protein, which for a moderately active female would be 4 to 6 ounces of protein-rich foods per meal." She recommends fish, poultry, and vegetable sources rather than beef and pork because of the latter's saturated-fat content. She also recommends taking essential-fatty-acid supplements, such as flaxseed, evening primrose, or cod-liver oil.

Particular vitamins and minerals can also stimulate hair growth and help treat the underlying causes of hair loss, such as stress, so Nalbandian suggests a good multivitamin, underscoring the importance of the B vitamins biotin, B6, and B12; zinc; and selenium. Because the levels of these vitamins and minerals in multivitamins are sometimes inadequate, Nalbandian often recommends additional supplements to achieve the following daily amounts: 10 mg biotin, 50 to 150 mg B6, 1,000 mcg B12, and 30 to 60 mg zinc, along with 2 to 4 mg copper and 200 mcg selenium. These doses are high, she warns. Do not maintain them long term, and make sure a qualified health care practitioner monitors the doses.

If the underlying cause is hormonal, Nalbandian may prescribe phytoestrogens, progesterone-stimulating herbs, or herbs that help regulate the menstrual cycle. Some herbs, such as horsetail (Equisetum arvense), which contains silica, may also help hair growth, and nerve tonics, such as oats (Avena sativa) and passion flower (Passiflora incarnata), can help quell the anxiety or underlying stress pattern associated with hair loss.

Because certain hairstyles and styling products can damage hair, Nalbandian recommends avoiding perming, dyeing, wearing tight hats, and pulling hair too tight over the scalp (in clips or elastic bands). Use hypoallergenic hair products to avoid irritating ingredients.

For Beth Andrews, whose hair loss was related to perimenopausal hormonal shifts, the biggest fear was that she would continue to find piles of hair in the drain and that it would never grow back. Nalbandian encourages women to have patience. She has confidence that when a patient such as Beth addresses the underlying cause, it's likely her hair will return—if not in full, then at least to some degree. It may take as little as four weeks or as long as six months to see regrowth—and hair may have a different texture when it grows back after menopausal shifts—but Nalbandian says it will grow back.

Radha Marcum is a poet, a freelance health writer, and the daughter of one of the original San Francisco cast members of the musical Hair.