how not to f*ck up your face

Dealing With Thinning Hair? Science-Backed Solutions for Hair Loss, According to a Dermatologist

Photo-Illustration: by The Cut; Photo: Getty Images

This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.

Several perimenopausal and menopausal readers have written to me recently about struggles with thinning hair — a problem shared by lots of women. A bad hair day, whether it’s because of weather, an off haircut, or, hardest of all, thinning, can feel like beauty bankruptcy.

The condition and style of our hair are thought of as the most obvious indicators of our health and sexual vitality. Long, thick, flowing, or full hair — what we might have had in our youth if we were lucky — is a signal that our insides are equally hearty. When we notice that our part has started to widen, when we can see our scalps through what now resembles a veil rather than a fur coat, that sinking feeling in our gut is hardwired recognition that we’re more mature (no matter our age).

Just so you don’t feel alone: Around half of postmenopausal women have noticeably thinning hair on their scalps. After age 50, approximately the same number of men and women suffer from it. You shed hair naturally every day, but the loss is considered significant if you start to see thinning behind the hairline or if your part is widening.

First things first: consult a doctor

Dr. Hadley King, a board-certified dermatologist, knows a lot about hair loss and options for dealing with it. “Hair loss can occur for many reasons,” she says, “but genetics and hormones are largely responsible for the most common cause of thinning.” It’s called androgenetic alopecia (female-pattern hair thinning). Need another reason to flinch at the word alopecia? It originates from the Greek word for fox (alopex) and earned its name from the loss of fur observed in fox mange. I mean, we couldn’t call it “androgenetic wispiness”? “Foxy androgenesis”? Whatever you call it, it’s primarily genetically determined, and its only symptom is thinning hair, says King. Hair follicles are sensitive to hormones, so they respond to hormonal changes (like the decrease of estrogen in perimenopause and menopause). The good news is that because of this hormone sensitivity, prescription medications (like some oral contraceptives and the androgen-blocking drug spironolactone) can be very effective in thickening scalp hair. Prescription drugs finasteride and oral minoxidil can also be helpful for some women, says King.

If your hair thinning is the first thing you notice when you look in the mirror, I’m guessing you’ve already taken your troubled self to a doctor. Good job. Your physician can offer you a prescription that’s right for you along with adjunctive treatments like platelet-rich plasma (PRP) injections, if appropriate.

For the rest of us who may have started to glimpse an unwelcome, unobstructed view of the scalp around the hairline and crown, King has a caveat. Because there are many over-the-counter products available that promise results not backed by science, it’s critical to rely on scientific data to weed out the marketing from the genuinely helpful (a full-time job if you live adjacent to the beauty industry).

For me, to rely on data is to step into a haunted house, where spooky percentages shoot out unexpectedly and I’m forced to stick my hands into bags of squishy numbers that feel like eyeballs. So thank you, Dr. King, for this robust, study-rich list of OTC treatments that might help restore thinning hair.

Let’s get started.

Try a topical option

The most proven topical option for hair growth is Minoxidil, “a potassium-channel opener causing hyperpolarization of cell membranes,” says King. “Theoretically, by widening blood vessels and opening potassium channels, it allows more oxygen, blood, and nutrients to reach the follicles.” As Martha Stewart says, it’s a good thing.

Interestingly, a 2015 study compared rosemary oil to Minoxidil, and at six months, both study groups saw a significant increase in hair growth. King cites various studies (among mice and men) that show that massaging different oils — including lavender, peppermint, and pumpkin-seed — into the scalp can decrease hair loss, but she emphasizes that for oils, bigger and better studies are needed to evaluate whether they may help with hair growth. But King warns us away from castor and coconut oils, which can increase luster and slow down breakage but show no evidence of promoting growth.

There are supplements that actually work

Supplements Nutrafol and Viviscal have demonstrated statistically significant results in studies, says King.

“These supplements have ingredients with anti-inflammatory, stress-adaptogenic, antioxidant, and dihydrotestosterone-inhibiting properties,” she says. “The idea is that the combination can address different causes of hair loss. Some of the ingredients’ phyto-compounds include curcumin (which has anti-inflammatory properties), tocotrienol (for antioxidant properties), saw palmetto (which inhibits dihydrotestosterone), ashwagandha (an adaptogen that can help decrease stress), and cortisol to help lengthen hair follicles’ growth phase. I like that Nutrafol has a study published in the Journal of Drugs in Dermatology that shows data to back up these claims.” Meanwhile, Viviscal relies for its effectiveness on marine-based collagen, and King points to this study.

If you decide to bank on supplements, remember that data shows that women who used supplements for six months had an increase in hair growth, density, and quality. So because of the hair-growth cycle, give yourself that long before examining your part.

Think about how you are styling your hair

Another form of hair loss is traction alopecia, which can occur when a style pulls so tightly on the hair follicles that it damages them, which eventually causes hair loss and scarring of the follicles. So keep a loose reign on your braids and ponytails.

Some more tips: Use a sulfate-free shampoo and glycerin-based styling products. Moisturize with conditioners, creams, and oils to help decrease the risk of damage and breakage. Avoid products containing alcohol or other drying ingredients as well as heat and chemical styling. Let your hair air-dry after every couple of shampoos, or always, by choosing a style that doesn’t require a lot of attention. As for styling, don’t overload thinning hair with product, because that weighs it down. Overcompensating — trying to create too much volume — results in wispy-looking, cotton-candy hair, so opt for a sleek style. And avoid parting your hair in the center. An uneven side part makes hair look fuller. Using a volumizing shampoo and conditioner can also help mimic fullness. As can coloring your hair, which thickens strands.

Consider the stress factors in your life

If you’ve noticed hair loss after someone close to you has died — or you lost your job, had a high fever, produced a human being from your uterus, stopped or started or changed hormonal medication, or had surgery — I’d say you deserve a break. You’re probably experiencing telogen effluvium, which means many more hairs than usual are falling out. C’mon, what did you expect? But actually, you’re in luck: This kind of hair loss is reversible, and your hair will grow back. Foot tapping allowed, but try to be patient. It seems wise to end on this happier note.

Last but not least, eat a well-rounded diet

King reminds us that we need sufficient protein and a well-rounded diet (which, for me, means eating a rainbow of foods and a lot of sardines). Once a strand of hair starts growing on your head, it’s physiologically dead, so it can’t be nourished. But it can be preserved.

Guys, I am done here — at least for the moment. Have you found this information helpful? Then join me in a huge round of applause for King. Thank you, Doctor. That was exhaustive!

Valerie Monroe was beauty director at O, The Oprah Magazine, where she wrote the monthly “Ask Val” column for nearly 16 years. Now she writes the weekly newsletter How Not to F*ck Up Your Face. Her goal continues to be to shift our thinking in the beauty arena from self-criticism to self-compassion and to learn how to be loving witnesses to ourselves and one another as we age.

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