Causes, Prevention & Regrowth Treatment Options

Also known as androgenetic alopecia, female pattern hair loss (FPHL) will affect 40 percent of women by age 50, according to Journal of the American Academy of Dermatology. This chronic and slow type of hair loss can be characterized by a receding hairline, a wider part, and a more visible scalp, says Dr. Piliang.

Causes such as age and genetics are at play, but hormonal shifts are the biggie. “Your levels of androgens, male hormones such as testosterone, tend to increase around menopause and are converted into DHT, a hormone that targets the hair follicles,” says Paradi Mirmirani, MD, a board-certified dermatologist specializing in hair disorders. “This alters the normal hair cycle, shortening the growth phase, and miniaturizing the hair, making the diameter continuously smaller.” While FPHL shows up as you get older, it can happen at any point, especially if you have a genetic predisposition.

Telogen effluvium

Telogen effluvium (TE) is defined by a sudden, dramatic shedding that seemingly comes out of nowhere. TE most often occurs after an event that causes emotional stress (a break-up, the death of a loved one) or physical stress (surgery, extreme illness), says Dr. Green. More specifically, the shedding will start three months after the event. The reason why it happens is unclear, but it’s suspected that high levels of cortisol, a stress hormone, shortens the growth phase, pushing a greater amount of hair into the shedding phase, adds Green.

That said, if you’re dealing with this type of hair loss, know that it’s temporary and will resolve on its own so long as there are no other contributing factors at play and the stress isn’t chronic. One of the most common examples of telogen effluvium? Postpartum hair loss, which occurs a few months after giving birth—a major physical and emotional stressor.

Alopecia areata

Alopecia areata occurs when your immune system attacks the hair follicle. “We don’t know exactly why it occurs, but genetics likely play a role,” says Dr. Mirmirani. Still, when the hair follicles are under attack, they go into a hibernation mode. They aren’t permanently damaged or destroyed, meaning the hair can grow back—it’s just unclear when.

The autoimmune disease is unpredictable and can come and go, seemingly without reason, says Dr. Piliang. It manifests as smooth, bald areas in dime to silver dollar-sized patches on the scalp or body. People who are battling alopecia areata tend to notice big clumps and chunks of hair falling out.

Traction alopecia

Traction alopecia occurs in women whose hair styles or practices consistently put a lot of pressure on the hair (think: tight braids and ponytails or extensions). Tension or strain on the hair damages the follicle, impacting the ability for blood flow and nutrients to reach it and can result in permanent hair loss, says Dr. Mirmirani.

Sporting a tight updo for one event isn’t problematic, but doing it on a regular basis is when it becomes an issue, Dr. Mirmirani says. Common symptoms include thinning on the edges of the scalp, patches of thinning in areas where there’s repeatedly a clip or a roller, and scalp tenderness. “If your scalp hurts, that’s a great indicator that you need to switch up your style,” says Dr. Mirmirani.

You can’t do much to change your genetics, age, or hormone levels. But that doesn’t mean that things are entirely out of your control.

• Switch up your style: When it comes to traction alopecia specifically, simply changing up your hairstyle so that you’re not putting too much tension on your roots can be hugely helpful, says Dr. Mirmirani. Similarly, you also want to be mindful about consistent chemical damage to your hair via dye, perms, or relaxers, Dr. Green adds. These can compromise the strength of your hair, making it more susceptible to damage from tight styles.

• Shampoo regularly: It’s trendy advice these days to wash your hair as infrequently as possible, but this may not be the right approach if you’re battling hair loss. When allowed to build up on your scalp, oil, dirt, and pollutants can clog hair follicles and impact hair growth, says Dr. Piliang. So, make sure you’re cleansing regularly with a gentle non-drying shampoo. She adds being judicious with heat styling to the list of other smart preventative strategies.

• Take care of yourself. Aside from those specifics, the best things you can do to set yourself up for tress success are general health and wellness tips that aren’t particularly groundbreaking. The high-level summary: What’s good for your overall well-being is good for your hair, too. “Exercising and managing stress as best you can ensures you have the best hair possible and maximizes your genetic predisposition and age,” Dr. Piliang says. Keeping stress in check, in particular, prevents cortisol levels from spiking, helping to potentially avoid telogen effluvium. While it’s understandably easier said than done, finding stress management techniques that work well for you—whether that’s exercising, meditation, yoga, or journaling—is paramount. There’s no current research demonstrating a direct correlation with hair loss, but it’s well-known that these practices do help to reduce stress. (Take this study, which showed that people who regularly practiced yoga had lower cortisol levels.)

• Pay attention to nutrition. While there’s a lot of talk on the Internet about which vitamin deficiency causes hair loss, the answer isn’t exactly cut-and-dry. Vitamin deficiencies (specifically vitamin D, iron, and zinc) can certainly play a supporting role in contributing to hair loss, but they’re unlikely to be the sole reason for dramatic hair loss since the average U.S. diet covers most of our nutritional needs, says Dr. Green. That being said, a vitamin deficiency definitely won’t help matters if you’re already predisposed to FPHL or experiencing any type of hair loss, which is why the experts we spoke with point out that it’s a good idea for anyone dealing with hair loss issues to have their bloodwork checked, eat a balanced diet, and take a multi-vitamin.

Tech-y looking tools may look wacky—but there’s real science behind their effectiveness.

As mentioned above, it’s important to seek the professional help of a board-certified dermatologist if you’re battling hair loss. Only she can pinpoint what’s behind your shedding—and come up with an effective treatment plan. These are some of the most effective over-the-counter and in-office options.

At-Home Treatments

Effective hair loss solutions are just a click away.

1. Topical minoxidil: This is as close to a silver bullet as you could ask for. “Minoxidil is the only FDA-approved topical hair loss treatment, but even today we still don’t know exactly how it works,” says Dr. Mirmirani. “We do know it’s a vasodilator, because it was originally given as an oral medication to treat high blood pressure and hair growth was a side effect,” adds Green, noting that increased blood flow to the follicle may be at play. It’s available topically without a prescription in 2 percent and 5 precent concentrations (the docs we talked to say 5 percent tends to be more effective). It may take a few months to work, so patience and consistency are key, and if you stop using it, that new hair growth will stop, too. Find it in: hers Hair Regrowth Foam Treatment 5% Minoxidil.

2. Laser Devices: Most of these at-home devices rely on red light and there is some data indicating that they can help with female pattern hair loss. Again, we don’t understand exactly why, but one theory is that they may combat the oxidative stress that plays a role in hair loss, adds Dr. Piliang. (Just like we know that free radical damage is no good for your skin, it also doesn’t do your scalp any favors, damaging the hair follicle and negatively impacting healthy hair growth.) They’re generally safe, but they can be expensive, and research suggests they’ll work even better when paired with topical minoxidil. Try the Hairmax LaserBand 82 ComfortFlex (photographed for this story) or the LaserCap SD, which Dr. Green recommends to her patients. Use it every other day for 30 minutes.

3. Supplements: Again, start with a good multi-vitamin. “My biggest issue with hair-specific supplements is that they’re pricey,” says Dr. Mirmirani. “There’s likely no harm in taking them, but you’ll also probably do just fine with an over-the-counter multivitamin.” She suggests starting there and, if after six months you don’t see a difference—and you have the money to spend—consider moving onto something more expensive.

One to try is Nutrafol Women. Dr. Green was skeptical about the hype surrounding this popular supplement…until she started taking it herself and was impressed with the results. “I do think there’s a place for it for most patients. It’s good for overall hair follicle health, which is important for any type of hair loss,” she says. Just keep in mind that it’s not cheap, it takes three to six months to see results, and requires a regimen of four pills daily.

4. Anti-Dandruff Shampoo: Even if you think you don’t have dandruff or see any visible flakes, you can have it and not know it. A formula like this is effective for keeping yeast and inflammation in check, which may help keep hair loss at bay. In fact, one study showed that men with male pattern hair loss experienced an improvement in hair growth after using an anti-dandruff shampoo. Try Head & Shoulders Classic Clean Anti-Dandruff, which contains a 1 percent concentration of pyrithione zinc, the studied ingredient.

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Hairmax Ultima 12 LaserComb

Research shoes that laser light can reverse hair loss. Run this comb through your hair three times a week for eleven minutes to get results.

Nutrafol Women’s Hair Growth Supplements

A blend of vitamins, zinc, selenium, marine collagen and more that target the major causes of hair loss, including stress and nutrition.

Head & Shoulders Classic Clean Daily-Use Anti-Dandruff Shampoo

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Dandruff shampoo helps to quell inflammation and scalp yeast at bay—and may help improve hair loss too.

Suffering from loss? You’ve got plenty of at-home options.

In-Office Treatments

When you need a bit more help, talk to your doc about these.

1. Prescription oral medications: Oral meds are often a first-line treatment, with low-dose oral minoxidil (which is used off-label) being the most popular. “It offers an improved result for many patients because topical minoxidil needs to be converted by an enzyme to work—and many people have low levels of this enzyme, says Dr. Mirmirani. Oral finasteride, which is FDA-approved to treat hair loss in men but not in women, is another off-label option. Again, we don’t know the exact mechanism of action, but we do know that it blocks an enzyme that’s necessary to convert testosterone into DHT, explains Green. (As a reminder, increased DHT is associated with female pattern hair loss.) Spironolactone is yet another common oral medication used for its hormonal effects, as are birth control pills.

2. PRP Injections and/or microneedling: Platelet-rich plasma is often talked about in skincare, but it can be good for the scalp, too. “The idea here is that the growth factors in the PRP help stimulate hair growth,” says Green. It can either be injected directly into the scalp or delivered via microneedling, a treatment during which thousands of tiny needles create miniscule holes in the skin (the theory is that the micro-injuries trigger a wound-healing response that can also help with hair re-growth, says Dr. Mirmirani).

The dermatologists we talked to agree that PRP injections tend to yield better results. Dr. Green says she typically treats patients with four monthly treatments followed by yearly or bi-yearly injections thereafter depending on the results. Still, this remains best used as an add-on to oral meds or topical minoxidil. “I’ll always start with minoxidil plus a good oral medical regimen, then add this in as an adjunct treatment,” says Dr. Mirmirani.

3. Hair transplant surgery: This is the most permanent solution of the bunch, but it’s not as cut and dry as it may seem, or often is for men. For a hair transplant to be successful you need to have enough donor hair. “Men typically only have thinning on top and denser hair in the back so they have more hair that can be transplanted while women often experience thinning all over so there’s less hair to harvest,” says Dr. Piliang. However, in the right candidate who does have severe enough thinning to warrant a transplant and also has enough thick donor hair to move, it can be a successful option.

Hair loss is complicated, with no shortage of causes and potential factors at plan. And it’s an undeniably tricky condition to treat. Part one of your plan is to figure out what’s behind your shedding—nine times out of 10 that involves seeing your dermatologist. By doing a complete assessment, evaluating your hair loss, checking labs, and considering your medical and family history, she can help you get to the root of the issue as quickly as possible. Once that’s figured that out, they’ll help you determine the most effective treatment path to take, be that a mix of prescription meds, at-home products, or in-office procedures.

So yes, hair loss is extremely stressful and emotionally taxing. But don’t despair—you do have options.

Meet our experts: Melissa Piliang, MD, a board-certified dermatologist at the Cleveland Clinic, Michele Green, MD, a board-certified dermatologist in New York City, Paradi Mirmirani, MD, a board-certified dermatologist with Kaiser Permanente in San Francisco specializing in hair disorders