Why hair plays a disappearing act after 40

Nearly half of women over 40 suffer from hair loss, but take note: It’s not inevitable. Here’s how you can prevent future shedding and even regrow what’s been lost.

By Annemarie Iverson
Photograph: Photo by: Plamen Petkov

4. Hormones make it happen. If your thyroid and iron levels are normal, your next strategy is to find a dermatologist who is an expert in hair and scalp disorders. (A good place to start is aad.org, the Web site for the American Academy of Dermatology; search for a doctor near you who lists hair disorders as a specialty.) Doctors’ approaches vary, but Orentreich, who is a hair and scalp specialist, says one common cause he sees is excessive androgens, male hormones that gain greater influence in women during perimenopause as estrogen decreases. To block androgens and protect new hair growth, Orentreich gives his patients oral antiandrogens and also applies them topically to the scalp. He says this treatment has yielded considerable success. An added benefit: While androgens are hormones, the antiandrogens are not, which pleases patients who would rather not take hormone supplements of any kind. Orentreich says he and many other doctors used to treat hair loss with hormone therapy, but stopped doing so in 2002 after the release of the Women’s Health Initiative study that linked HT to an increase in breast cancer. "At that point, we replaced the HT that we were administering with antiandrogens," he says. "But the fact remains that when you put female hormones into your body, you do lower the level of male hormones. So HT helps counteract hair loss." Most experts now agree that the WHI study was flawed in certain important ways, and that HT is safe for short-term use by women in the first few years after menopause. But there are still risks, so hair loss shouldn’t be your only reason for taking HT. Consult your ob-gyn to weigh the pros and cons.

When You Can’t Find a Cause
What if none of the usual explanations applies to your hair-loss situation? Don’t lose hope. Even if the reason remains a mystery, you should be able to trigger some regrowth (or at least plump up what’s left) with one of the following strategies.
Scalp Treatments
Regrowth begins with a healthy scalp, and for that you should consider consulting a professional licensed in trichology, the branch of medicine that deals with hair and scalp care. Philip Kingsley, a New York-based trichologist (and the unofficial granddaddy of the profession, with such clients as Barbra Streisand and Candice Bergen) offers follicle-stimulating treatments at his clinics in Manhattan and London. His theory: The treatments boost blood flow in your scalp, which brings growth-maximizing nutrients to your roots. For at-home use, he has created a product called Scalp Toning Tonic ($22, philipkingsley.com), which increases blood flow and also exfoliates dead skin cells (which can inhibit growth by clogging up the follicles). To find a trichologist, go to the Trichological Society at hairscientists.org.
Originally prescribed to treat hypertension, Rogaine was discovered to also stimulate hair growth.Experts attribute the beneficial effect to Rogaine’s active ingredient, minoxidil, which they believe increases blood flow to hair follicles (the same thing Kingsley’s tonic aims to do, but with more horsepower). The net effect: Revitalizing shrunken follicles helps them produce thicker strands.
Hair Transplant
Garren, a New York City stylist who coiffs many celebs and socialites, says his over-40 clients who’ve tried everything else for thinning strands — without success — have turned to hair transplanting, a surgical procedure in which hair follicles from an area on your scalp where growth is dense are removed, then surgically implanted in thinning spots. (Hair in the "normal" area does grow back.) Prices can range from $6 to $10 per graft (one hair follicle), and you need several thousand. The bill: $4,000 or more.

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