What to know about treatments for female hair loss or alopecia : NPR

Alison Richards first noticed that her long blonde hair was thinning and then falling out when she was 20 years old. “One day in the shower, hundreds of strands fell out, like handfuls of hair,” Richards recalls. “It was a very scary experience,” she says.

It is estimated that half of all women will experience hair loss during their lifetime. And if you've been looking for content on this topic, you may soon be inundated with ads and influencers promoting medications. This can be a painful experience in an online environment where celebrities create unrealistic expectations about how much hair women should have, when in fact celebrities often wear wigs or hair extensions, said Richards, who lives in New York.

While there are some science-backed solutions for hair loss, not every product is suitable for every person or every type of hair loss. If you're facing this problem, here are some keys to understanding it and getting help.

Hair goes through cycles of growth and loss.

Understanding hair loss begins with understanding hair growth, says Dr. Carolyn Guo, clinical professor of dermatology at UCLA. First of all, hair on your head should not remain forever. Each strand goes through a cycle of growth, transition and rest. According to Guo, when hair falls out at the end of its life, it is because new hair grows and pushes it out.

Hair usually falls out in a staggered pattern. You may have a lump in your drain after taking a shower, but that doesn't mean you have to worry about your bald spot. However, sometimes stress such as having a baby or even COVID can cause your hair growth cycles to sync up, leading to increased hair loss.

“You know, you see all this hair falling out and it's a huge change and it feels like the end of the world,” Guo says. But most hair loss in women is temporary, Guo says, and hair often grows back on its own.

When hair doesn't grow on its own

The most common cause of permanent hair loss is androgenetic alopecia, known as male pattern baldness in men and female pattern baldness in women. In both sexes, the disease progresses with age. In women, it usually starts at the top or crown of the head. (If you part your hair, you may notice that part widens, exposing more and more of your scalp).

Less common types of hair loss include alopecia areata, an autoimmune disease in which the immune system attacks hair follicles and often appears as one or more bald patches. There is also cicatricial alopecia, which also causes bald spots, often with itching, soreness and redness, and sometimes pimples on the scalp, Guo said.

Why is it important to make a diagnosis?

It's important to see a doctor for a diagnosis because it's not always clear what type of hair loss is occurring, and different types respond to different treatments, says Thea Chassen, who has alopecia areata and runs the nonprofit support and advocacy group Bald Girls Lunch. But this is easier said than done. It can take months to get an appointment with a dermatologist, and some primary care doctors may be dismissive of hair loss.

Chassen says when she needs to make an appointment with a dermatologist but can't get one right away, she calls her back every day. “And sometimes I ask in advance, when do you call to remind people of their appointments? To give you an idea of ​​what time of day they receive cancellation notices… And I will ask every day, has anyone canceled an appointment?” she says.

Telemedicine companies like Hers offer an alternative option. You can answer a few quick questions online and talk or text the service provider. You then receive a prescription for the medication, which is delivered to your home.

Disclaimer: Hers primarily prescribes medications for androgenetic alopecia and hair loss. Thea Chassen says she wouldn't rely on a telehealth provider to diagnose a less common condition such as alopecia areata or a fungal disease. So if you're unsure what type of hair loss you're dealing with, an in-person visit may be your best option—at least to begin with.

Old reserves and new methods of treatment

Topical minoxidil, also known as Rogaine, is an over-the-counter foam that lengthens the growth phase of the hair cycle, keeping more hair on the scalp at any given time. Guo says it helps with regular hair loss, but “a lot of people find it messy and difficult,” she says. It is also not safe to use if you are pregnant or breastfeeding.

Minoxidil also comes in tablet form. This is what Allison Richards takes along with spironolactone, which some doctors also prescribe to treat hair loss.

Richards' dermatologist prescribes both medications off-label, meaning they have not been approved by the Food and Drug Administration to treat hair loss. Richards says the combination works for her and she considers herself lucky to have found a doctor who asks a lot of questions and monitors her for side effects.

Just in the last few years, new drugs have been approved to treat alopecia areata, called JAK inhibitors, which target the part of the immune system that has become overactive and attacks hair follicles. A recent review of several studies published in the medical journal JAMA Network Open found that patients experienced greater hair growth compared to placebo.

Hair loss is not “game over”

Thea Chassen, diagnosed decades ago, was treated for alopecia areata with steroid injections, which resulted in hair regrowth.

Ten years later, she started losing her hair again and is now completely bald. “And you can live with it beautifully,” says Chassen.

“We're not saying everyone should reach a point where they're comfortable going bald,” she says. But she believes it is an option “that should become as normal for women as it is for men if we want it to be.” Sometimes she leaves the house bareheaded, and sometimes she wears a scarf and hat.

Richards says she has found support and connection with other women with alopecia on online forums such as Reddit, including hair loss influencers.

“There will always be someone who will hold your hand, encourage you. And if you ever feel like your beauty is compromised, beauty will be redefined,” she says.