Alison Richards, first noticed her long, blonde hair began to thin and then fall out in her 20s. "There was one day in the shower where I just had hundreds of strands of hair, like fistfuls of hair coming out," Richards remembers. "It was a very scary experience," she says.
By some estimates, half of all women experience hair loss in their lifetime. And if you've searched for content on the topic, you may soon be inundated by ads and influencers touting cures. This can be a painful experience in an online environment where celebrities create an unrealistic expectation for how much hair women should have, when in reality the celebrities are often wearing wigs or extensions, says Richards, who lives in New York City.
While there are some hair loss solutions based in science, not every remedy works 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 starts with understanding hair growth, says Dr. Carolyn Goh, a clinical professor of dermatology at UCLA. First of all, the hairs on your head aren't meant to stick around forever. Each strand goes through a cycle of growth, transition, and rest. When a hair sheds at the end of its life, it's because there's a new hair growing and pushing it out, Goh says.
Usually, hairs shed in a staggered pattern. You might have a clump in your drain after taking a shower, but that doesn't mean you have to worry about a bald spot. Sometimes, however, stresses like having a baby or even COVID can cause the hair cycles to sync up, and that causes a bigger shed.
"You know, you see all this hair coming out, and it's this huge change, and it seems like the world is ending," says Goh. But most of the time, hair loss for women is temporary, Goh says, and often your hair will regrow on its own.
When hair doesn't grow back 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 condition progresses with age. For women, it typically starts at the crown or top of the head. (If you part your hair, you may notice the part widening, exposing more and more scalp).
Less common types of hair loss include alopecia areata, an auto-immune disease where the immune system attacks the hair follicles, and often appears as one or more bald spots. There are also scarring alopecias, says Goh, which also cause bald spots, often with itching, tenderness and redness, and sometimes pimples on the scalp.
Why a diagnosis is key
It's important to see a doctor for a diagnosis because it's not always clear what type of hair loss is happening, and different types respond to different treatments, says Thea Chassin, who has alopecia areata and runs the nonprofit support and advocacy group "Bald Girls Do Lunch." But that's easier said than done. It can take months to get an appointment with a dermatologist, and some primary care physicians can be dismissive about hair loss.
Chassin says when she needs an appointment with her dermatologist and can't get one right away, she calls back every day. "And sometimes I'll ask ahead of time, when do you do your calls to remind people of their appointments? So you have some idea of what time of day they're getting notified of cancellations… And I will ask every day, did someone cancel?" she says.
Telehealth companies like Hers provide an alternative option. You can answer a few quick questions online and talk or message with a provider. Then you get a prescription for medication, which is shipped to your home.
A note of caution – Hers mainly prescribes medication for androgenetic alopecia, pattern baldness. Thea Chassin says she wouldn't rely on a telehealth provider to diagnose a less common condition like alopecia areata or a fungal condition. So if you're uncertain about what type of hair loss you're dealing with, an in-person visit may be your best bet – at least to start.
Old standbys and new treatments
Topical minoxidil, also known as Rogaine, is a foam available over-the-counter that lengthens the growth phase of the hair cycle, keeping more hair on the head at any one time. It does work for pattern hair loss, says Goh, but "a lot of people find it to be messy and difficult," she says. It's also not safe for use if you're pregnant or nursing.
Minoxidil also exists in pill form. That's what Allison Richards is taking, along with spironolactone, which some doctors also prescribe to treat pattern hair loss.
Richards' dermatologist prescribes both medications off-label, meaning they weren't approved by the Food and Drug Administration to treat hair loss. Richards says the combination is working for her, and she feels lucky to have found a doctor who asks lots of questions and monitors her for side effects.
New drugs to treat alopecia areata called JAK inhibitors were approved in just the last few years, which target the part of the immune system that has become overactive and attacks the hair follicles. A recent review of several studies published in the medical journal JAMA Network Open found that patients had more hair regrowth compared with placebo.
Hair loss is not "game over"
Thea Chassin – who received her diagnosis decades ago – was treated for alopecia areata with steroid injections, which resulted in hair regrowth.
Ten years later, she started losing hair again, and now she's completely bald. "And there's ways to live beautifully with this," Chassin says.
"We're not saying that everybody should reach this stage where they just are so comfortable going out bald," she say. But she thinks it's an option "that should become as normal for women as it is for men, if we want to." She sometimes leaves home with her head uncovered, and other times wears a scarf and hat.
Richards says she's found support and community with other women with alopecia in online forums like Reddit – including hair loss influencers.
"There's always going to be somebody to hold your hand, cheer you on. And if you ever feel like your beauty is compromised, beauty gets redefined," she says.
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