Estrogen, the power player in women’s bodies, is your friend when it’s appropriately balanced. It makes you feel energized, helps stabilize your moods and contributes to a healthy sex drive. Yet too much estrogen, which can be caused by weight gain, perimenopause or toxicity from exposure to endocrine disruptors (which are rampant in our food, water and plastic products), can lead to thinning hair. During and after pregnancy, for example, estrogen levels peak and then dip, causing sudden hair loss for many women.
Topical estrogen and progesterone creams and oral medications are generally the forms prescribed for post-menopausal women with androgenetic alopecia. But HRT will rarely, if ever, be prescribed for treatment of hair loss alone.] If you have other bothersome symptoms which might warrant HRT, in addition to hair loss, you'll first need to undergo a thorough gynecologic and physical exam, and will likely have blood tests done to measure hormone levels before these drugs are prescribed.
The hormonal process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women. And certainly when those levels rise, DHT is even more of a problem. Those levels can rise and still be within what doctors consider "normal" on a blood test, even though they are high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even its regular levels of chemicals, including hormones.
Low estrogen levels are most common during menopause, but it can happen to women at any age. As estrogen levels decline, the greater influence of testosterone shortens the growth phase, and the subsequent hair loss is usually gradual but can become noticeable over time. Hair loss caused by changing estrogen levels tends to be visible all over the scalp or evident in a widening part, rather than missing patches of hair or a horseshoe pattern as with male pattern baldness.
Reduce stress. When you are stressed, your body starts shutting down processes that aren’t necessary for survival. This shutdown can occur with physical stressors, like surgery or an illness, and emotional stress, which often manifests as physical symptoms. Loss may occur up to three months after the stressful event and may take another three to grow again.
Trichotillomania is a hair pulling disorder associated with anxiety, stress, depression, boredom and frustration. It is where a person manually removes hairs with their finger, either a few strands throughout the day or sometimes many strands at one time during an emotional outburst. This behavior is usually a means of coping with stress or emotional turmoil. However, it can sometimes become a habit that is difficult to break. The eyebrows is a commonly targeted area as is the scalp.
Take extra care in looking after your hair. Use a gentle, nourishing shampoo (we love Bumble and Bumble Gentle Shampoo) to promote good condition and prevent breakage. Try using a silk or satin pillowcase. Avoid harsh styling products and techniques that apply heat to the hair (blow drying, curling irons etc) as these can cause more damage to fragile hair.
The real culprit appears to be dihydrotestosterone (DHT), a more potent form of testosterone. DHT is made from testosterone by a specific enzyme in the body, and while both testosterone and DHT are known to have a weakening effect on hair follicles, there appears to be something unique about the conversion process of testosterone to DHT that relates to thinning hair. This is why some drugs that are marketed for hair loss block the conversion of testosterone to DHT. (It’s important to note, however, that these drugs tend to be less effective in women than men, and that one of them—finasteride—is only approved for hormonal hair loss in men, not women. What’s more, the drug has been associated with increased risk of sexual side effects, depression, nausea, hot flashes, and increased estrogen levels—and too much estrogen is its own risk factor for thinning hair; more on that below.)
There is also a different in the form of 5AR enzyme (5 alpha reductase) found on the facial hair follicles vs. the scalp hair follicles. This enzyme converts testosterone into that more problematic DHT. Type I DHT is found in sebaceous glands on the face and genital area whereas Type II is found in hair follicles of the scalp. Type II DHT is typically more of a problem in men, but Type II is increased in disorders with high testosterone like PCOS.
FPHL or androgenetic alopecia is the most common cause of hair loss in women and one of the most common chronic problems seen by dermatologists worldwide (Varothai and Bergfeld, 2014). FPHL is a nonscarring form of alopecia in which the frontal hairline is maintained, but there is progressive hair thinning at the vertex of the scalp. Thinning of the hair is secondary to alteration of the hair cycle with shortening of the anagen phase and simultaneous lengthening of telogen. This increase in the resting phase and decrease in the growth phase of the hair cycle results in the miniaturization of hair because long terminal hairs are gradually replaced by short vellus hairs (Messenger and Sinclair, 2006, Sinclair et al., 2011).