Are you waking up to find your pillow covered in hair or your bathroom trash filled with strands? Does the thought of showering or brushing your hair make you anxious, anticipating the hair loss? In this article we’ll discuss common causes of hair loss in women, like high testosterone, autoimmune conditions, medications, and what to do about them.
If so, you're not alone. Hair loss, also known as alopecia, is common among both men and women. About 50% of women experience thinning hair1 at some point in their lives, and about 80% by the age of 80.
Losing your hair is undeniably concerning, whether it's just begun or has been ongoing. Clinically I have found that hair loss often signals deeper imbalances, including hormonal issues such as PCOS or low nutrient levels. Left untreated, it can also potentially lead to other symptoms or prevent the return of your once lush locks.
Below, we'll explore potential causes of hair loss, recommended lab tests to uncover root causes of thinning hair, and effective approaches to help promote regrowth.
Different Types of Hair Loss Patterns to Look For
Do you notice any of the hair loss patterns described below? If so, consider if any of these root causes may be the culprit:
- Gradual Thinning of Part that Progresses to Diffuse Thinning: Androgenic alopecia caused by elevated levels of dihydrotestosterone (DHT).
- Patches of hair loss: You may have a cortisol imbalance (such as from high-stress levels), a deficiency in B vitamins or zinc, heavy metal exposure, or an autoimmune hair loss condition.
- Thinning hair all over: You may have a hormonal imbalance, such as thyroid disease.
- Hair loss at the top of the head only: Testosterone, progesterone, cortisol, or estrogen may be out of balance. This might signal PCOS, for example, in which androgens are elevated, which can also cause abnormal hair growth on the face and the body (called hirsutism).
- Total body hair loss: DHEA, blood sugar regulation, autoimmune disease or poor circulation may be at play.
Balding all over: You may be experiencing poor circulation or a deficiency in protein, essential fatty acids, B vitamins, silicon, or zinc.
How to Stop Hair Loss & Regrow Your Hair
Fortunately, female hair loss can often be treated and, in some cases, reversed with appropriate treatments. Treatment approaches vary depending on the underlying cause and severity of the hair loss.
Here are some common hair loss treatment options to stop hair thinning and help regrow hair:
1. Topical Treatments
Minoxidil (Rogaine) is an FDA-approved topical medication that can help promote hair regrowth by increasing blood flow to the hair follicles. It's applied directly to the scalp and is effective for many women with Female Pattern Hair Loss (FPHL).
Initially, you will lose hair. And while minoxidil is often a go to by many providers, you can’t take it if you are pregnant, trying to conceive or breastfeeding.
Topical treatments are the most common and can lead to hair growth in other areas if exposed. Oral minoxidil is less common, but can be a good option for people who want to simplify. The typical dose is 5 mg orally.
Ask your dermatologist if it's a good option for you, especially if you have sensitive skin or are unsure of what's causing your hair thinning to begin with. As always, you should have a thorough work-up to explore the cause of hair loss.
2. Nutritional Supplements
Supplements such as iron, vitamin D, biotin, and omega-3 fatty acids may help support healthy hair growth and address underlying deficiencies that can contribute to hair loss. Additionally, there are herbs that have been shown to support the hormones behind hair loss.
Saw Palmetto
The most common cause of hair loss in women is androgenic alopecia. In this condition there are elevations of dihydrotestosterone (DHT), which causes irreversible hair loss on the scalp. Saw Palmetto is an herb that balances the enzyme that produces DHT, helping dampen the impact on the hair.
We've combined saw palmetto with nettle root, zinc, vitamin B6, and vitamin D in my Saw Palmetto Plus supplement that helps to support healthy testosterone levels and hair growth.
Iron
If you have low ferritin (<50) or iron deficiency anemia, you may need more iron in your diet.
Iron-rich foods include:
- grass-fed meats
- organ meats
- leafy greens
- eggs
- lentils
Iron supplementation may also be necessary to support new hair growth. I typically utilize a quality prenatal in cases of hair loss because it also provides other nutrients important for hair regrowth like B vitamins, vitamin A, zinc, and biotin.
Ferritin levels, the blood marker for iron stores, generally need to reach 70 before hair growth begins.
B Complex
B vitamins, including biotin, are involved in numerous metabolic pathways in our bodies, including those that support hair growth. If you're feeling stressed, it may be beneficial to supplement with a high-quality B complex (such as my B-Active Plus formula) containing methylcobalamin (B12) and methyltetrahydrofolate (folate).
Zinc
Zinc supports hair tissue growth and repair while also supporting immune function and wound healing.
Food rich in zinc include:
- Beef
- Oysters
- Pumpkin seeds
You'll find zinc and other essential minerals in my Saw Palmetto Plus, Women's Twice Daily multivitamin and Prenatal Plus Vitamin.
Vitamin D
Low vitamin D levels have been linked to hair loss. Supplementing with vitamin D may help stimulate hair follicles and promote hair growth.
It is important to always take vitamin D3 along with K2 to ensure it provides the most benefit.
We synthesize vitamin D from the sun. If you’re low in vitamin D, be sure that you are getting enough sunlight exposure daily.
Adaptogenic Herbs
These herbs help regulate cortisol (the primary stress hormone) and balance overall hormone levels. Some of the most well studied adaptogens include Rhodiola, Ashwagandha, and Shatavari.
Cortisol and stress2 in general can interrupt the hair growth cycle and lead to hair loss. In addition to stress reduction practices, leveraging herbs, like Ashwagandha may also be helpful.
You'll find beneficial herbs and other key nutrients in my Balance- Women's Hormone Support formula.
Omega-3s
Omega-3s, found in fish like salmon and supplements such as fish oil and my Omega Plus capsules, support hair growth by nourishing hair follicles and promoting scalp health. They reduce inflammation, enhance circulation to the scalp, and contribute to the production of oils that keep hair hydrated and shiny.
If you have PCOS and are looking for help choosing supplements, you can refer to this article: 10 Best Supplements for PCOS
3. Nutrient-rich, Balanced Diet
Make sure you're consuming enough calories in general to meet your body's needs since this supports healthy thyroid function, and aim for a balance of complex carbs with fiber, quality proteins, and healthy fats such as olive, nuts, seeds, oily fish, and avocado.
You can grab my free recipe guide for hormone optimizing nutrition.
Some specific foods and ingredients that can be helpful for hair growth include:
- Foods with iron, zinc, and B vitamins: red meat (beef, lamb), poultry (chicken, turkey), fish (salmon, tuna), shellfish (oysters, clams), beans and legumes (lentils, chickpeas), tofu, spinach and other leafy greens, eggs, dairy products (cheese, milk, yogurt), nuts and seeds (pumpkin seeds, cashews), whole grains (wheat germ, quinoa)
- Apple cider vinegar: Taking 1-2 teaspoons before meals can improve stomach acid and support healthy blood glucose levels while improving the absorption of vitamins and minerals.
- Pumpkin seeds: Rich in zinc, these seeds can help prevent testosterone from converting to DHT, which is responsible for female pattern baldness.
- Essential fatty acids: Consuming salmon or sardines weekly boosts omega-3 levels. Chia seeds and walnuts are also excellent sources of omega-3 fatty acids. Other essential fats, such as mono and polyunsaturated fats, can be found in nuts, seeds, olive oil, and avocado.
- Fresh ground flax seeds: I recommend two tablespoons daily for healthy fats and essential minerals. Ensure it's freshly ground, as pre-ground flaxseed can become rancid quickly. Ground flaxseed also increases SHBG, which binds to excess hormones.
4. Exercise and Stress Management
Hair loss can have a profound psychosocial impact on women, affecting self-esteem, body image, and quality of life. Many women report feelings of embarrassment, anxiety, and reduced confidence due to changes in their appearance tied to aging, including thinning hair.
Managing stressors can help you keep your cortisol levels optimal. You can learn more about stress reduction practices here.
Exercise regularly to help increase overall circulation, reduce stress, and stabilize blood sugar levels. The best type of exercise varies depending on your current health, but yoga and pilates often benefit those under stress, while strength training, brisk walking, or cycling can often help with blood sugar or hormonal imbalances.
Getting enough sleep (seven to nine hours per night) and working on improving your mental health, such as with help from therapy, meditation, journaling, and reading, can also help to support hormonal balance and, therefore, hair health.
5. Hormonal Therapy
In cases where hormonal imbalances are significant, hormonal therapy may be prescribed to help regulate androgen levels. Birth control pills containing estrogen and progestin or anti-androgen medications like spironolactone can be effective.
In the case of menopause hair loss, different treatments may be recommended, which you can learn about here.
6. Platelet-Rich Plasma (PRP) Therapy
PRP involves injecting a concentration of a patient's own platelets3 into the scalp to stimulate hair growth. This treatment is believed to promote hair follicle health and increase hair thickness, although it can be expensive and isn't always recommended as a first-line approach.
If you're interested in PRP or another professional treatment, such as low-level LED laser therapy, talk to your dermatologist about whether you're a good candidate.
While PRP may be promising, it will not be as effective if you do not address the underlying cause of hair loss.
How Common Is Hair Loss in Women?
Hair loss among women, medically termed female pattern hair loss (FPHL) or androgenetic alopecia, describes thinning hair primarily on the top and crown4 of the scalp near the part.
Unlike male pattern baldness, which typically results in a receding hairline and bald patches, female hair loss tends to cause thinning without significant receding of the hairline5. It's usually noticeable around the part first before spreading to other areas.
Hair loss in women can begin at various ages, but it commonly starts around the onset of menopause, typically between the ages of 40 and 50. However, it can also occur earlier, especially in women with a family history of early hair loss or those experiencing hormonal fluctuations, such as due to conditions like polycystic ovary syndrome (PCOS) or thyroid disorders.
In terms of its prevalence, up to 40% of women6 experience some degree of noticeable hair loss by age 50. By age 70, at least half of women experience female-pattern baldness, and rates of thinning hair only go up from there with increased age.
Even before menopause, hair loss can be common due to hormonal fluctuations. For example, over 90% of women report7 experiencing postpartum hair loss. Among women with hypothyroidism, about 33% report losing hair8, while about 50% of those with hyperthyroidism report dealing with hair loss.
What Causes Hair Loss?
Hair loss usually progresses over decades as it becomes more noticeable. It's considered “normal” for women to lose up to 100 strands of hair each day, but as hair starts to thin, up to 300 or more strands start to fall out as fewer follicles grow new hair.
There are many potential underlying causes of hair loss in women, with hormonal changes and genetics being two primary causes.
Common causes of hair loss include:
- Hormonal shifts, including from menopause or childbirth
- Hormonal imbalances, such as PCOS, in which there's an imbalance between androgens (male hormones like testosterone) and estrogen
- Genetics and family history of hair loss
- Infections and autoimmune disorders that impair normal immune function
- Skin disorders like psoriasis and seborrheic dermatitis that affect the scalp
- Hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid), which can result from factors like chronic stress, being underweight or overweight, crash dieting, genetics, and other factors
- Nutrient deficiencies, such as in iron, zinc, B vitamins like biotin, or vitamin D
- High amounts of stress, depression, or anxiety
- Certain medications, such as chemotherapy drugs, anticoagulants, retinoids, beta-blockers, and some antidepressants
- Medical treatments such as chemotherapy or radiation
Types of Hair Loss in Women
The most common type of hair loss in women is androgenic alopecia, often referred to as female pattern hair loss. But there are other types of hair loss to be aware of:
Androgenic Alopecia
The most common type of hair loss in women, the hair follicles miniaturize and the hair shaft gradually becomes thinner and thinner. Unlike men, the hair line does not typically recede, but the part does appear wider over time.
Telogen Effluvium
During this type of hair loss, a large amount of hair enters the telogen phase (the resting phase) of hair growth and there is a delay in the growth phase beginning. The result is that as many as 500 hairs can be lost daily without regrowth.
This pattern of hair loss typically begins 3 months following a medical event.
Alopecia Areata
This irreversible form of hair loss is caused by an autoimmune condition in which the immune system attacks hair. Hair loss can be seen on the head and body, including the eyelashes.
Anagen Effluvium
Rapid hair loss due to chemotherapy drugs. The hair typically grows back once treatment has been stopped.
Cicatricial Alopecia
This rare hair loss condition is caused by inflammation destroying the hair follicle and scaring of the scalp. Red and white lesions that burn, itch, or swell can be seen on the scalp.
Tinea Capitis
Hair loss is caused by fungal infection commonly referred to as ringworm. The hair typically falls out in circular patches.
Traction Alopecia
Certain hairstyles, like braids and tight ponytails can pull on the hair shaft resulting in loss of hair and damage to the hair.
| Type of Hair Loss | Cause | Solution |
| Androgenic Alopecia | Elevated androgens | Spironolactone Saw Palmetto Zinc Minoxidil 2% Oral contraceptive pills Ketoconazol Estrogen/ Progesterone HRT Topical Rosemary Oil |
| Telogen Effluvium | Iron deficiency Postpartum Starting/Stopping Birth Control Hypothyroidism Blood thinners Illness Surgery | Nutrient Dense Diet Multivitamin or Prenatal Scalp massage Stress management Gentle brushing & styling |
| Alopecia Areata | Autoimmune disease | Steroids Immunosuppressants Minoxidil Anti-Inflammatory Diet |
| Anagen Effluvium | Chemotherapy | Nutrient Dense Diet Discuss treatment option with provider |
| Cicatricial Alopecia | Inflammatory condition | Topical antibiotics Anti-inflammatory meds |
| Tinea Capitis | Fungal infection | Anti-fungal medication |
| Traction Alopecia | Tight hair style creating tension on the hair | Change hair style and release tension on the hair |
Helpful Lab Tests & What They Reveal
If you're unsure of why you're experiencing hair loss, certain tests can be very helpful for identifying a cause and coming up with an effective treatment plan. I suggest having the following tests done to identify factors contributing to your hair thinning or loss:
- CBC & Ferritin: Both screens for iron deficiency anemia. When iron dips low, hair loss can occur. If your ferritin is <50, inadequate iron may be the cause of your hair loss. Read more about iron deficiency anemia and hormones here.
- Complete thyroid panel (TSH, free T3, free T4, anti-TPO, anti-thyroglobulin, RT3): If these tests reveal unusual levels, then your thyroid may be to blame for your hair loss.
- ANA & RF: Both of these are makers for autoimmunity. There are many autoimmune conditions that can reveal themselves with hair loss.
- CRP & ESR: These check for inflammation, which is a sign that you may be at risk of developing other symptoms or a certain underlying disease affecting your immune system.
- Testosterone, free testosterone, dihydrotestosterone (DHT): Testosterone is most commonly associated with male pattern baldness, but it can also be the cause of a woman's hair loss. High testosterone may be due to hormonal imbalances, including PCOS.
- FSH, LH, Estrogen, Progesterone: Imbalances in these hormones can cause hair loss, along with PMS, or irregular or heavy periods.
- Sex Hormone Binding Globulin (SHBG): This protein grabs onto excess hormones, so if it's low and your free testosterone is high, your hair loss treatment should include both increasing SHBG and lowering testosterone by balancing all hormones.
- Cortisol, DHEA-S, 17-hydroxyprogesterone: Think of cortisol as an aging hormone in addition to a “stress hormone.” If these hormones are out of balance, you will visibly age quicker, which includes hair loss.
- Prolactin: Elevated prolactin will result in higher testosterone and other androgens, which affects hair growth and loss.
- CMP: This is a good baseline test to check liver and kidney function, as well as the balance of your electrolytes, which can affect blood sugar regulation and therefore hormonal balance.
- Fasting Insulin, Fasting blood glucose, Hemoglobin A1C: These are screening labs for diabetes. Improper blood sugar regulation can create imbalances in your hormones and impede circulation to your scalp.
- Heavy metal testing: Are you an artist or a welder who has a lot of silver fillings and eats a lot of rice or non-organic foods? You may have higher than normal levels of heavy metals in your body, which can affect hair patterns.
An important reminder: you are more than just your lab results! If your doctor has told you that all of your labs are normal, but your hair loss persists (especially if you experience other symptoms), I recommend seeking a second opinion.
Key Takeaways on Hair Loss and How to Stop It
- While female hair loss can be distressing, it's common, affecting around half of women, especially those with a family history of hair loss, thyroid issues, or PCOS.
- Early diagnosis of underlying causes, such as hormonal shifts, nutrient deficiencies, hypothyroidism, or autoimmune conditions, can often help to halt hair thinning and promote regrowth.
- Options for treating hair loss include use of supplements like iron, B vitamins, herbs, and omega-3s, a balanced diet, stress management, and treatments like topical creams, hormone therapy, or PRP.
- Consult with a healthcare provider or a dermatologist specializing in hair disorders to help determine the underlying cause of your hair loss and to develop a personalized treatment plan to address your needs.
References
- https://my.clevelandclinic.org/health/diseases/16921-hair-loss-in-women ↩︎
- https://www.nia.nih.gov/news/how-stress-causes-hair-loss ↩︎
- https://www.health.harvard.edu/blog/thinning-hair-in-women-why-it-happens-and-what-helps-2020032719267 ↩︎
- https://www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss ↩︎
- https://www.nhs.uk/conditions/hair-loss/coping-tips-for-women/ ↩︎
- https://www.uclahealth.org/news/article/what-causes-female-hair-loss ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846762/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492440/ ↩︎
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