Many women experience thinning hair and female pattern hair loss in perimenopause. I won't lie it sucks.

So, here's the scoop: my hair has always been more "wispy" than "wow." Three years ago, I decided to part ways with my partner after 18 years. The stress of watching our relationship go down like a bad sitcom, starting life anew, and worrying about the kids turned me into a stress burrito. And my scalp gave up and my hair started shedding like a cat in summer.

Stress can totally make your hair jump ship. And if you're a woman in your fabulous 40s, navigating the rollercoaster of divorce, single mom life, and a career (I'm breaking a sweat just typing this), you've got a mountain of stress! I've tried a gazillion things, and finally, I threw in the towel and visited a dermatologist after crying, being depressed and stressing about nothing working. My dermatologist confirmed it was a tag team of stress and hormones causing the thinning hair on my head. Fantastic, a double whammy! Naturally, everyone insists you need to chill out so things don't get worse. Meanwhile, I've managed to stress myself out even more, so that's just peachy, isn't it?

Now my grandmother had fairly thin hair but not until she was much older. And NO ONE I know has ever told me about their thinning hair until a few weeks ago.  I must admit, while I wouldn't wish this on my worst enemy, it was kind of a relief to know I'm not some lone weirdo in the thinning hair department!

Women are so mortified about thinning hair that they'd rather discuss the plot of a bad reality TV show. And to add fuel to the fire, the social pressures on women in their 40s are just bonkers. Meanwhile, back at the ranch, most men in their 40s seem to be on a permanent vacation from effort. Imagine if all women swiped left on any guy who didn't have a six-pack (of abs, not beer, ladies). But hey, no need to panic! We'll plunge into the chaotic circus of online dating in a future post, or probably a whole series of them.

Guess what? Here’s a little nugget of wisdom: by the time they hit the big 5-0, 40% of women find themselves in the Hair Club of Female Pattern Hair Loss (FPHL) (source: https://pmc.ncbi.nlm.nih.gov/articles/PMC4573453/).

That's over 21 MILLION women in the United States. And not surprisingly, 55% of women that have hair loss experience depression (https://pmc.ncbi.nlm.nih.gov/articles/PMC5419033/) I've been on a wild ride through the land of hair products, tossing cash at solutions that don’t seem to give a follicle. Everyone’s hair has its own personality, but I’m here to share my epic quest of spending big bucks on stuff that didn’t work for me. I'll throw in a few links to things that actually seem to do something, and if they’re from Amazon, I’m an affiliate. But fear not, I won’t link to anything I wouldn’t bet my last hairpin on!

So what causes FPHL?

Well there is definitely a genetic component to this. While men only need to get one particular copy of the gene to develop Male pattern baldness, women need two copies of that flavor of the gene. So that's why it is not as common in women as in men. But I would say 40% is still pretty common.

It's also, you guessed it, those darn hormones. It is often associated with an increase in androgen levels. Those are hormones that promote male features(like testosterone and Dihydrotestosterone (DHT). To be clear women also produce these male hormones, just at much lower levels. DHT is the biggest hormonal factor in the development of FPHL. DHT binds to androgen receptors in hair follicles, causing them to shrink and stop producing hair. There are drugs such as Finasteride, which target DHT that show significant improvement in women experiencing FPH. But be warned that if you plan on having kiddos, you can't take it. It's actually known to feminize male fetuses.

Medications for Female Pattern Hair Loss

Spironolactone, another drug that interferes with the interaction of testosterone and DHT has been shown to have up to 75% improvement for women with FPHL. I actually started taking a concoction of this and minoxidil ORALLY and after 5 weeks the hair shedding has definitely improved. But don't expect to look like a hair model overnight—it takes months to see real changes. Oh, and brace yourself for frequent bathroom sprints, because this stuff is a diuretic and you'll be lucky if you can hold it for more than an hour!

There are a number of other medications that can be prescribed orally, most targeting those androgens. (see https://pmc.ncbi.nlm.nih.gov/articles/PMC5419033/). The role of female hormones is definitely not fully understood as of yet. However, there is plenty of evidence that estrogen promotes hair growth. So as you hit perimenopause and your hormone levels start to fluctuate and estrogen levels start to plummet, it can cause hair loss. And so that hormone replacement therapy (HRT) that you might be taking for hot flashes and mood stabilization can absolutely help some women stop FPHL.

More on HRT later. I know a lot of women are scared of it, but I will break down the data for you in another post (so subscribe!)

Minoxidil (aka Rogaine) is the only FDA approved treatment for hair loss.

Ladies, gather 'round! Here's the scoop: this magical potion, usually in a 2-5% brew, is meant for you to sprinkle on your noggin twice a day. Originally, it was the knight in shining armor for high blood pressure, but surprise, surprise—it also moonlights as a hair fairy, sprouting new strands where baldness once reigned. However, 30-60% of women see no change, and some end up with a fiery, itchy scalp thanks to contact dermatitis, forcing them to bid farewell to this follicle potion. (https://doi.org/10.1016/j.abd.2022.09.006). A lot of the contact dermatitis is not related to the minoxidil but the alcohol solution it is dissolved in. SO if you do react to the topical solution, there is a low dose oral minoxidil that is often prescribed along with spironolactone. I'm actually taking this combo but it's too early to say much other than my shedding is definitely decreased. I will report back on this in a few weeks.

Iron supplements. Did you know that up to 40% of women are secretly members of the Iron Deficiency Club? Yep, and it might just be the reason your hair is plotting its escape! Your doctor can check your blood iron levels, especially if you're a veggie lover, have a history of anemia, or experience periods that are more like a waterfall. But you need to ask for this test because most doctors don't look at it in routine bloodwork. If you find out you're low on iron, try a supplement, and who knows, it might just convince your hair to stick around! I took iron during my pregnancy and it helped so much with energy levels. It can cause constipation though. I recommend using Floradix, which is actually a tasty liquid and it is much gentler on your tummy than iron pills. You can find it on amazon using this link https://amzn.to/3BBAH3n.

Okay let's talk products!!!!!

Many of you have probably seen commercials or ads for Hers. I tested out their product for a few months. I specifically used the thickening shampoo and the triple threat conditioner as shown in the photo below. I can say that the shampoo seemed ok but I definitely would not recommend the conditioner for thin hair. It is WAY too much and leaves your hair greasy. And I used their topical solution daily for almost a year. I'll save you the trouble. Not only did I not see any improvement, I ended up with contact dermatitis. And honestly at first I thought the itchiness was part of FPHL, but as soon as I stopped using it, itchiness went away. I will say that like the minoxidil topical, the dermatitis is probably from what it is dissolved in and so you might have better luck.

Next up....My stylist recommended the Ethica brand for hair loss. You can get a bundle that includes Shampoo, Conditioner and a topical spray for daily use on your scalp. Ok, I actually thought the shampoo and conditioner was nice, but again I had contact dermatitis afte rusing the growth serum for a few months and I didn't see any improvement at all. Now I do have to say that since I had contact dermatitis it is possible this can work for you but my reaction prevented it from working. My stylist has seen many clients that found an improvement. It is pricey though. But here are the links to the products and, like I said, the shampoo and conditioner is really nice. Here are the amazon links to the hair growth serum/spray  https://amzn.to/3PgiCuS and the shampoo and conditioner https://amzn.to/4gVnqkP.

And finally, I tried MD Hair for over a year now. I will say that I also got contact dermatitis from the daily scalp serum so I had to stop using it. But I will say that this is THE BEST Shampoo and Conditioner I have ever used in my life. So if you have thin and fine hair, even if it is not FPHL, I highly recommend it. It doesn't weigh your hair down at all and the quality of my hair has really improved with a lot fewer damaged ends. This one you cannot get on Amazon but it is worth going to their website mdhair.co

Below is a photo of the shampoo and conditioner I use.

I've started giving my scalp a little spa treatment during my shampoo and conditioning sessions, using a fancy scalp massage tool like the one shown below. While the research is as thin as my hair was before I started, the current evidence suggests that scalp massages, though not a miracle cure for hair loss, might just encourage those stubborn hairs to grow. You can use your fingertips or a scalp massaging tool to give your scalp some love! Here is a link for a 2 pack on amazon and it's really cheap and feels good even if it's effects are minor. https://amzn.to/49ZD6l8

I have also started using a Biotin mask twice a week. I swim for exercise so I need to really be careful about the chlorine damage. I LOVE this mask. My hair feels like silk after I use it. Here's a link to Amazon for the mask. https://amzn.to/49UcRMK. And finally if you are a swimmer, use something to protect your hair under your cap. Your hair still gets wet even with a cap on, but if you use a protectant it minimizes the damage. I have gone through quite a few and I can say that Aqua Guard really works.

Here's a link to the one I use. https://amzn.to/3Pff0ZZ

Conclusion: I've blown a small fortune testing out all sorts of hair remedies. Turns out, my scalp is as delicate as a soap bubble, so topical stuff is a no-go for me. But hey, it might work wonders for you! On the bright side, I stumbled upon a fabulous Shampoo and Conditioner, plus some great hair products, especially handy if you find yourself doing laps in a pool often.

After my epic quest for the perfect solution turned up zilch, I waved the white flag and visited a dermatologist. Got myself an oral prescription. I'm only 5 weeks in, but the shedding is slowing down. Stay tuned for the thrilling saga of actual hair growth in a few months!