Hair Loss and Hormones —Causes, Effects, and Treatment in Menopause and Andropause
How prevalent is hair loss in midlife?
By the time women reach the postmenopausal period of their lives, about two-thirds will experience hair loss in the form of thinning. One in two middle age men will experience some type of balding by age 50 as well.
How does hair loss develop in both men and women?
Androgens are powerful sex hormones and for both males and females hair loss related to androgenic alopecia follows a predictable life pattern. Genetics help determine “anagen” which refers to the hairs’ growing phase where the hair shaft divides multiple times and thickens. Individual hairs then go through a resting phase before new growth begins. With androgenic alopecia, the hairs’ growing phase is shortened and the amount of time between shedding and new growth is lengthened.
Hair quality also changes because hair follicles begin to shrink. This is known as “follicular miniaturization”. Hair follicles called “terminal hairs” that were once thicker, and held color pigment, are replaced with “vellus hairs” that are shorter, thinner, and finer without pigment.
Hair loss for women in Menopause and Hormones
Dihydrotestosterone (DHT) is an endogenous android sex steroid and hormone implicated in the loss of hair throughout the female menopause transition. While DHT is derived from the hormone, testosterone, it is 2.5 times more potent. DHT weakens hair follicles, leading to hair loss in women.
How is female pattern hair loss associated with androgens?
Female pattern hair loss appears to be somewhat androgen dependent.
Physiologically, as women begin to experience menopausal changes in midlife estrogen levels decrease. At this time androgen concentrations in the blood may naturally rise, causing hormone-related hair loss.
The science behind androgens and hair loss in women is not as clearly defined as it is for men and treatment may differ somewhat. It is thought that other mechanisms besides androgen impact may also be partially responsible for female pattern hair loss as well.
How does menopause affect hair loss in women?
Due to fluctuations in sex steroids at the time of menopause, the receptor structure specific to hair declines. Hair growth in humans is not a continuous process, but a cyclical one that includes hair building and shedding.
Now women are living longer than ever before and can expect to live roughly one-third of their lives post-menopause.
Because the mortality rate has significantly slowed for women in mid life, more attention is given to female health and aging. This includes recognizing and treating women’s hormonal issues well into the 60’s, 70’s, and 80’s. Understanding the underlying biological processes happening within women as they age is key to understanding the problem of hair loss and to developing effective treatments and new therapies.
According to studies, more than 21 million American women experience FPHL (female pattern hair loss) with significant social and psychological consequences.
Treatment for Hair Loss in Women
There are several types of treatment available to either help slow or stop the progression of hair loss in women or in some instances to help regrow hair altogether.
Treatment Strategies for Female Pattern Hair Loss
Current therapies include the following:
Hormone therapies—Hormone therapies work well based on biochemical processes where androgens are converted and bind to target receptors.
Androgen receptor blockers—These drugs inhibit testosterone and DHT and the way in which they interact with androgen receptors in certain tissue. They also inhibit androgen synthesis.
5-alpha-reductase inhibitors—Drugs that inhibit conversion of testosterone to DHT resulting in less hair loss and miniaturization of hair follicles.
Estrogen therapy—Estrogen is synthesized in the ovaries and in various other tissue and is carried to receptors including those located in the scalp hair follicles. Estrogen is thought to provide protection against hair loss.
Oral contraceptive medications—Oral contraceptives may work to prevent hair loss in women a number of different ways. These drugs work to increase sex hormone-binding globulin, suppress gonadotropin, and help release luteinizing and follicle-stimulating hormone. This, in turn, inhibits androgen secretion, lessening its effects on hair follicles.
In women, the following drugs or supplements are used as well.
Minoxidil—This drug, when applied to the scalp is said to stimulate moderate hair growth in 13% of women, and minimal hair growth in 50% of female users. Minoxidil is trade named “Rogaine”.
Antiandrogens—Androgens, including testosterone, promote hair loss in women. Some medications may help fight against this by lessening the effects of androgens, or male hormones.
Iron supplements—Some women may lose hair because of an iron deficiency. This may be due to anemia or heavy menstrual flow. Supplementing with iron will only decrease hair loss if iron deficiency is the cause.
Treating Hair Loss in Men
Men, Hair Loss, and Hormones
The association between hormones and MPB (male pattern balding) has long been made, linking male hair loss to androgens (male sex hormones) and androgen receptor activity. Men often respond well to ant androgen therapy as well.
Men who seek medical treatment for hair loss may be prescribed minoxidil as well. This is a topical medication massaged into the scalp. Male pattern balding may also respond well to oral medications including finasteride (Propecia, Proscar) or dutasteride (Avodart). Some men will choses to undergo hair transplant procedures or a specific scalp-reduction surgery.
Many scales are used to classify the severity of hair loss in men. The Hamilton classification model was introduced first and assigns non-bald men scores of I-III based on hair loss patterns on the head. Bald males are classified from IV-VIII where hair loss is considered more significant. Since this method of evaluating hair loss in men was developed in the 1970’s, many other classification systems, with many variants have followed.
How is female pattern hair loss (FPHL) unique to women?
Female pattern hair loss is very common in women and differs from hair loss patterns in men. Hair tends to shed near the center part of a woman’s head and thin out around the crown at the top of the scalp. FPHL rarely results in complete balding more prevalent in men.
While the definitive cause of female hair loss is not quite as clear as it is for men, some factors are thought to play a part including:
- Menopause stage
- Family history
Hair loss in men in mid life, genetic?
By the time men reach age 50, about half will experience hair loss. Hair loss in men may be caused by androgenic alopecia. If a man is genetically predisposed, androgen-responsive hair loss may be the cause.
How is a diagnosis of female pattern hair loss from androgenic alopecia made?
Before determining the cause of hair loss in a woman physicians must first rule out other medical conditions or contributing factors.
Other causes may include:
- Physically stressful events such as an illness or accident
- Excess of vitamin A
- Insufficient protein
- Vitamin B deficiency
- Autoimmune disorder or illness
- Sudden or extreme weight loss
- Polycystic ovarian syndrome (PCOS)
- Medications including some antidepressants and blood thinners
- Styling too much/too often
- Trichotillomania (a mental health disorder involving compulsive hair Pulling)
- Steroid medications
Some of these causes for hair loss may affect men as well.
How is androgen dependent hair loss diagnosed or determined?
Once no other physical or mental condition is found, physicians conduct a scalp examination involving the specific pattern of hair loss, the appearance of the hair, and scalp conditions. A thorough medical history is taken as well. In female pattern hair loss, physicians will check for signs of excess male hormones (androgens) by examining hair growth on other areas of the body such as the face or torso. Changes in the menstrual cycle or the presence of acne may also indicate hormonal changes in androgens. Blood tests to determine hormone levels may be ordered as well.
Generally, if patients are not experiencing serious hormone related symptoms and are satisfied with their appearance, no treatment is necessary. Many people, both male and female will wish to pursue treatment for hair loss to stop or slow the shedding process.
Female pattern hair loss is classified by grades I, II, or III depending on the severity of hair loss and location.
What are the signs of female pattern baldness?
Women with female pattern baldness experience thinning around the crown and the scalp that usually begins around the center part. Hair loss in women may be easily observed in the front of the head.
What are indications of hair loss in men?
Men with male pattern hair loss (MPHL) may begin to show signs of balding by age 30. Male hair loss is often directly related to testosterone levels as hair begins to thin at the temples and on top of the head.
How does hair change with age?
The quality of hair in terms of color and thickness changes, as our body’s mature. Hair is made up of several stranded proteins that will live between 2 and 7 years. After this period, individual hairs fall out (the process of shedding) and new ones grow in their place.
In adults, the amount of body hair and hair on the head is primarily determined by genetics. Not only is more hair lost with aging, but hair also grows more slowly as we get older. Where once locks were thick, more coarse and full of pigment, hair is now thin, fine, and lighter in color.
The human adult scalp supports roughly 100,000 hairs at a time. About 100 hairs are lost each day.
What is the pattern of male hair loss?
Men lose hair in a distinctly different pattern than women. Men’s hair usually begins to thin above the temples. As the hairline recedes it usually forms an “M” shape. Eventually a man may experience thinning hair on the top of the head as well which can lead to complete baldness altogether.
How does nutrition affect hair loss in middle age?
Nutritional support is critical at this very important time in a woman’s life, for general wellness and the health of hair. Various substances and ingredients in an individual’s diet act as precursors in the synthesis of steroid hormones. These impact the structure and growth of hair.
Good nutrition supports healthy hair in both sexes.
Sulphur amino-acids, cysteine and methionine are precursors to keratin synthesis, the protein necessary for building healthy hair. Some sources of amino acids include fish, meat, dairy, beans, and whole grains.
L-lyseine promotes collagen growth and collagen is the structural protein necessary for healthy hair, skin, and nails. Exogenous L-lysine is found in the inner root of the hair that impacts hair shape and volume.
Foods that contain L-lyseine include red meat, chicken, eggs, fish, such as cod or sardines, beans, lentils, Parmesan cheese, cottage cheese, wheat germ, nuts, soybeans, and brewer’s yeast.
Fats in the diet facilitate steroid hormone synthesis and keep hair healthy as well. Healthy fats may be found in fish, walnuts, and flax seeds as well as poultry, eggs, and plant oils, such as olive oil.
Complex carbohydrates are necessary for energy and support healthy hair as well. Foods including rice, whole wheat pasta, low glycemic fruits and vegetables and whole grain breads are good sources of carbohydrates that don’t negatively affect blood sugar and insulin levels in the body.
Vitamins A, B, and C are important in hair health and support general health and wellness as well. Green leafy vegetables, fruit, citrus fruits, berries, whole grains, eggs, and milk contain the A,B,C’s.
Minerals such as iron and copper are important for hair regeneration and can be found in meats including, beef, pork, poultry, lamb, liver and fish. Selenium, magnesium, calcium, niacin, and zinc support healthy hair as well. White beans, pistachio nuts, dried apricots and figs are rich in important vitamins and minerals for hair.
Testosterone and estrogen are thought to be the primary causes of androgenic alopecia in both men and women.
What are the major differences in menopause, andropause, and hair loss?
Andropause and Male Hair Loss
After a man reaches his 30’s testosterone levels begin to decline. Because androgen loss happens more gradually, balding may occur over the course of several decades. Actual testosterone levels may be harder to gauge as well, since time of day effects hormone values in tests.
Menopause and Female Pattern Balding
Menopause in women is a more clearly defined timeline as it happens usually after age 40 with discernable signs and symptoms. This may make it easier to attribute hair loss to definite androgen changes in midlife.
Men and women lose hair at different rates and the pattern and progression of hair loss is different as well. The age at first hair loss, areas of the scalp affected, and the rate at which thinning and balding occur are different in both sexes.
While women begin to lose hair at the crown of the head, men’s hair loss generally begins above the temples, eventually forming an “M” pattern. Men may begin to experience thinning hair on the top of the head as well.
What are the psychosocial effects of hair loss in women?
While several studies have examined the psychological impact of androgenic alopecia on men, scientific evidence is limited when discussing causal relationships between hair loss in women and negative outcomes. We do know however that female hair loss has a dramatic effect on women and the way they view themselves in society. In one recent study, women reported negative feelings concerning overall body image, personality and adjustment to hair loss. Women also experienced considerable social impairment associated with hair loss as compared to men.
And while hair loss is upsetting to both sexes, it appears to be more stressful for females who may avoid social relationships and settings out of discomfort or embarrassment.
Mental Health and social consequences of Female Pattern Hair Loss
Because female hair is associated with societal norms in many cultures, it may be tied a woman’s sexuality and identity. Research finds that women with significant hair loss experience a lower quality of life that impacts individual and social acceptance. Men, while significantly distressed over hair loss tend to do better than their female counterparts, because male hair loss has been normalized in most societies.
In one recent study, more than half of women surveyed reported depression over hair loss. Mental health was significantly impacted by anxiety, obsessive thinking, low self-esteem and preoccupation with appearance as well. About half of women experienced marital problems and difficulties at work as a result of Female Pattern Hair Loss (FPHL).
How important do men consider hair loss?
Self image and how we look and feel around others partially dictates our level of comfort in social settings. Attractiveness, and how we think others see us, affects how we see ourselves. In one multinational study of middle aged males, at least half reported significant hair loss. Of these men, more than 70% agreed that hair and hair loss are important factors in defining self-image and attractiveness.
What are the psychological effects of hair loss in men?
In studies that explore the psychological effects of hair loss in males, the majority reported significant preoccupation with balding and moderate distress over hair loss. The overall effects of hair loss included negative body image and loss of confidence. The finding was more pronounced in younger men, men with early onset hair loss, and single men.
While the physical effects of hair loss in both sexes may be minimal, the damage done to self-esteem and self-perception can be great. Finding a healthcare professional or natural practitioner who understands hormonal changes and age-related issues is critical for health, happiness, and overall well-being.
1Alfonso, Mariola, et al. “The Psychosocial Impact of Hair Loss among Men: a Multinational European Study.” Current Medical Research and Opinion, U.S. National Library of Medicine, Nov. 2005, www.ncbi.nlm.nih.gov/pubmed/16307704.
2“Andropause: The Men’s Version of Menopause.” U Of U Health, healthcare.utah.edu/the-scope/shows.php?shows=0_slesbxiv.
3Brough, Kevin R, and Rochelle R Torgerson. “Hormonal Therapy in Female Pattern Hair Loss.” International Journal of Women’s Dermatology, Elsevier, 24 Feb. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5419033/.
4Cash, T F. “The Psychological Effects of Androgenetic Alopecia in Men.” Journal of the American Academy of Dermatology, U.S. National Library of Medicine, June 1992, www.ncbi.nlm.nih.gov/pubmed/1607410.
5Cash, T F, et al. “Psychological Effects of Androgenetic Alopecia on Women: Comparisons with Balding Men and with Female Control Subjects.” Journal of the American Academy of Dermatology, U.S. National Library of Medicine, Oct. 1993, www.ncbi.nlm.nih.gov/pubmed/8408792.
6Dinh, Quan Q, and Rodney Sinclair. “Female Pattern Hair Loss: Current Treatment Concepts.” Clinical Interventions in Aging, Dove Medical Press, June 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2684510/.
7“Female Pattern Baldness: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/001173.htm.
8Goluch-Koniuszy, Zuzanna Sabina. “Nutrition of Women with Hair Loss Problem during the Period of Menopause.” Przeglad Menopauzalny = Menopause Review, Termedia Publishing House, Mar. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4828511/.
9Harvard Health Publishing. “Treating Female Pattern Hair Loss.” Harvard Health, www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss.
10Harvard Health Publishing. “Hair Loss.” Harvard Health, www.health.harvard.edu/a_to_z/hair-loss-a-to-z.
11Piérard-Franchimont, Claudine, and Gérald E Piérard. “Alterations in Hair Follicle Dynamics in Women.” BioMed Research International, Hindawi Publishing Corporation, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3884776/.
12Wirya, Christopher Toshihiro, et al. “Classification of Male-Pattern Hair Loss.” International Journal of Trichology, Medknow Publications & Media Pvt Ltd, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5596658/.