What Causes the Fallout
I had thyroid imbalance hair loss in my 20s, postpartum thinning twice in my 30s, big-time strand shedding after the death of my father in my early 40s, and now, at 47, visible thinning three months after suffering a fever of 104. No actual scalp peeking through as of this morning, thank god, just stringy gobs of lifeless blond in the comb.
So when New York City dermatologist David Orentreich, MD, tells me that nearly 50 percent of women will experience hair loss by age 50, I am unsurprised — and utterly empathetic. While a man’s baldness can symbolize power, success, and virility (note such chrome domes as athlete-mogul Michael Jordan, actor Bruce Willis, billionaire investor Ron Perelman, and short, rich Harry Goldenblatt, Charlotte’s second husband on Sex and the City), women’s sexual attractiveness has always sprung — historically, anthropologically, and culturally — from gorgeous, shiny, plentiful hair.
So where did it all go, that mass of thick, hormonally hopped-up high school hair? At puberty — decades before we can appreciate it or have the money and good taste to properly deal with it — we are blessed with the fullest mane of our entire lives. Then, inexorably, the strands begin to diminish, not just in number but also in diameter and in their ability to grow long. Ever see a 90-year-old woman with wonderful eyes and a magical smile? Sure. With great hair? Not so much. But don’t get depressed. Even though slightly thinning hair is a fact of nature for women in their 40s and 50s, there’s a lot we can do to fight back and look good.
First, Assess Your Losses
Before deciding on a battle plan, you need to determine whether your hair loss is excessive or just gradual and normal. According to Orentreich, the classic definition of abnormal is when you lose more than 80 to 100 strands a day — or if you wash your hair only once or twice a week and have excessive shedding on those days (as in upward of 400 strands). Some cases are clear, but if you’re uncertain, a good, quick test is to run your hands through your hair: If you come away with eight or more full-length strands in your fingers with tiny root bulbs attached, then you’re an excessive case.
If you conclude that your loss is annoying but normal, check out "Feigning Fatter Strands" and "How I Scored More Strands in an Hour" for helpful tips. But if you’re shedding excessively, the next step is to find out why, and there are four likely possibilities.
1. You make it happen. Most receding hairlines are actually lifestyle induced. So if you’ve spent years pulling your hair back into taut ponytails, wearing a riding helmet that rubs at your forehead, or having hair extensions woven in at the root, don’t be surprised if the hair around your face is thinning out. But cheer up: The converse is also true, and altering these habits will allow your hair to grow back within three to six months.
2. Your past made it happen. If your lifestyle isn’t causing the hair loss, or if it isn’t limited to just your hairline, think back to what went on three months ago in your life: A new drug or a change in dosage? A crash diet? Childbirth? Blood loss? Anesthesia? High fever? Traumatic life event? "Your hair tells all," says Kim Vo, a Los Angeles colorist and stylist who tends the tresses of Goldie Hawn and Teri Hatcher. "Even if a client doesn’t mention anything specific, I can always tell something happened just by looking at her hair." If you did go through something fairly trying 12 weeks ago, but it’s over now, the loss you’re experiencing will be temporary and your hair should grow back. However, if the shedding is tied to something that started then but continues to this day — say, a new medication — you may want to talk to your doctor about your options.
3. Your body makes it happen. If your hair loss doesn’t seem to be due to a lifelong habit or a notable recent event, it’s time to ask your doctor to test your thyroid and iron levels. An estimated 10 to 20 percent of American women have thyroid dysfunction. For most of them, the thyroid slows down; for a small number, it speeds up. Either way, hair loss is a symptom. If your test results are positive for thyroid dysfunction, you’ll be given a regulating medication and your hair should grow back within six months. If it turns out an iron deficiency is your issue, most doctors recommend boosting your level with foods rich in the mineral, such as beef, beans, lentils, beets, and spinach. When anemia is severe (or you just can’t stomach an iron-rich diet), popping a supplement can also help. I am anemic and averse to most of the foods that could help, so my doctor put me on Slow Fe supplements. I take them once a day and they gradually release iron into the bloodstream, which helps to minimize the digestive gumming-up for which this nutrient is notorious.
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.
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.
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.
How I Scored More Strands in an Hour
Hair extensions thicken the manes of many over-40 celebs (thought their lush locks were natural? Ha!), so I set out to see what they’d do for my sparse strands. To find a stylist near me to attach them, I went on hairuwear.com, which lists salons that use Great Lengths extensions (a brand I’d heard of). My pick: Marc Mena at New York’s Warren-Tricomi Salon.
"Extensions are better than Botox," says Mena, as he selects from bundles of human hair, each of which contains about 25 strands held together at one end with keratin protein. He then glues the bundles to the roots of my hair, using a bonding machine. (I’m told the extensions last four months, at which point I’ll return to the salon and get them removed with a solution that dissolves the keratin.)
It takes Mena an hour to attach 60 bundles, boosting my hair’s density by about 30 percent. (Although they’re called extensions, on me, it’s more like supplementation.) Mena trims the pieces to match the length of my own locks and gives me rules to follow for two days: No combing, no washing, no products containing silicone. All day, I swing my new superthick strands. I’m addicted.
However, like many potential addicts, I’m saved by the price of the fix: My extensions cost $1,500. Replacing them every four months would cost me $4,500 a year. I may splurge again for a special occasion — or I might try a temporary (and more affordable) approach. My friend swears by Hairdo (also at hairuwear.com), a line of clip-in hairpieces from celeb stylist Ken Paves. Prices start at $95.
Feigning Fatter Strands
Whether your hair loss is normal (but still annoying) or extreme, you can benefit from these expert-endorsed styling tricks.
To achieve faux fullness, try trimming your tresses. "Shorter is better when you’re losing hair," says Sally Hershberger, a New York City-based stylist who counts Meg Ryan and Jane Fonda among her clients. "But don’t layer too much; that can make your hair look even thinner," she warns. The ideal? A slightly layered bob, so you have both movement and the illusion of volume.
Color can also play a part. If thinning has exposed your scalp, play down the contrast between your skin and hair shades, Hershberger suggests. In other words, if your skin is fair, lighten your locks; for darker skin, deepen their tone.
Treat your hair with products that target the problem. Start by using stylers that boost density, usually by causing the hair shaft to swell slightly. Two to try: Oribe’s Volumista Spray, $29, oribe.com; and Fekkai More Density Styling Whip, $25, beauty.com.
Then focus on scalp stimulation, which keeps hair follicles healthy. Pros swear by Leonor Greyl Complexe Energisant, $79, www.leonorgreyl-usa.com.
Finally, check out anything that enhances shine without weighing hair down. Volumizing products are notorious for dulling strands (the plumping action can rough up the hair’s outer layer), so this step is a must. One we love: Nioxin Glossing Color Shield, $20; nioxin.com for salons.
Originally published in MORE magazine, April 2009.