Laura J. Martin, MD
Michele Rosenthal of Palm Beach Gardens, Fla., has tried every styling trick in the book to make her hair look thicker. She’s grown bangs to provide the illusion of more hair in the front and uses wide headbands to make it look fuller in the back.
She is self-conscious about her hair and over the years it has affected her. On dates, when a man would ask her to let her hair down, she often found herself exclaiming, “Don’t touch the headband!”
Rosenthal has dealt with thinning hair since the age of 21, after a diagnosis of post-traumatic stress disorder (PTSD). At 42, she has recovered from PTSD, but her hair is still thin - and at times it still bothers her.
“It makes you feel frustrated and powerless and pathetic,” Rosenthal tells WebMD. “There is no explanation, nothing wrong with me, but I looked like I was 80. You feel like you are not being represented by your body as the person you are in your mind.”
There are various medical treatments that can cure or improve hair loss like Rosenthal’s. But, like her, many women prefer not to take medication or have hair transplants.
Luckily, there are a wide range of cosmetic options that can help the situation and make women feel more comfortable with their appearance.
Rosenthal is not alone in her struggle. Female pattern hair loss, or alopecia, impacts about 30 million American women, according to the American Academy of Dermatology.
Amy McMichael, MD, has a hair disorders clinic that she runs one day a week at her practice at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. She often has a 10-month waiting list and said, if she chose, she could fill her practice with these patients.
“There is a huge demand by women to get consultations,” McMichael says. “I think female pattern hair loss is one of the most common things I see in women from the early 40s on up.”
People typically shed 110-150 hairs per day. That's normal.
Beyond that, hair loss in women can occur at any time, but often begins after menopause. It is most often due to hormonal changes and genetics (either side of the family). But it can also occur after pregnancy, because of stress to the body like trauma or surgery, when there are hormone abnormalities like excessive testosterone or a thyroid deficiency, or simply from too much hair breakage. If it is not treated, in some cases it may be permanent.
While hormones and genetics are often the cause of hair loss, dermatologist Victoria Barbosa, MD, of Millennium Park Dermatology in Chicago, says it's a good idea to check with a dermatologist to make sure it is not a sign of some other problem like an autoimmune, thyroid, or scalp disease.
McMichael, a consultant for Johnson & Johnson (the makers of Rogaine), tells WebMD that women typically don’t experience hair loss all at once. It frequently occurs over time. There is usually thinning around the crown and at the sides and some gradual, increased shedding. The hair’s part begins to widen, a ponytail has less volume, and the scalp may start to show through the hair.
“Some people start in their 30s and some in their 60s,” she says. “It happens over time. It is slow, and then one day, it starts to bother you.”
One of the first steps to improving the look of thinning hair is to experiment with styling products.
Most women start with shampoo, and volumizing products do a good job of giving the appearance of fuller hair, Barbosa says. She tells WebMD that there are too many ingredients to list, but looking for one with some sort of protein is a good place to start. Kutcher recommends looking for words like “body,” “volume,” “texture” or “thickness.”
It is also a good idea to avoid products with a lot of moisture, which only weighs the hair down. Barbosa recommends focusing conditioner on the ends of the hair, not at the roots. Shampoo and conditioners combined often have too much moisture.
“I think that, for a lot of women, there is unfortunately a lot of trial and error involved (in finding the right products),” says Barbosa, who used to work for L'Oreal. “I would also say that women should not expect superior results just from a shampoo system alone - it’s like step one and best for people with little loss.”
A second group of products are mousses, gels, and sprays. Kutcher says mousses and sprays are the best bet because they tend to add texture, but are lighter than gels.
Two other options are cosmetic enhancements -- powder and scalp concealer.
The powder made up of keratin fibers that matches one’s hair color and is sprinkled on the hair and scalp. The products (such as HairMax Hair Fibers, Super Million Hair Enhancement Fibres, Toppik Hair Building Fibers, and XFusion Keratin Hair Fibers) adhere by static electricity and create volume.
Another option is a scalp concealer, a loose powder that is close to the color of the hair, that is applied directly to the scalp. It works to reduce the visibility of skin under thinning hair. These products can’t always be found in drug stores, but are readily available online.
There are also some styling tips that can be performed in a salon or at home, that can thicken and bulk up the hair’s texture.
One is a good haircut. Although many women may be tempted to grow their hair out to have more of it, they should keep it relatively short, so it weighs less, says Kristopher Kutcher, owner of Kristopher’s Hair Studio, Inc. in Quincy, Ill. If it’s not too thin, layers can also give lift, he says.
When done well, chemical treatments won’t damage the hair and can also help add texture, Kutcher says. Perms change the hair’s physical texture and make each strand fuller.
“It is all about taking that hair strand and bulking it up or causing the cuticle to swell or be rougher to add texture,” he says.
Coloring products swell the cuticles and add more texture while leaving the hair’s integrity, Kutcher says. A combination of highlights and lowlights can create contour and the illusion of texture. Demi-permanent colors can also be good for thin hair. Kutcher says those products work like a shellac on wood - they coat the strands and build up over several applications, adding thickness.
At home, women can do their best to keep hair healthy and reduce breakage. Kutcher recommends letting it dry naturally after washing, using a mousse, thermal protectant, and drying just briefly on medium heat while brushing with a round boar’s hair brush.
When using any kind of heated styling appliance, don’t let it get intensely hot, Barbosa says. Use the lowest heat possible and never use curling or flat irons on wet hair.
Aside from her cherished headbands, Rosenthal uses small clips to gather her hair in sections, to make it look fuller. She uses “granny clips” to make pin curls at night or braids it before bed so it has more volume the next day.
Rosenthal used to worry that she would be bald by the time she was 50. Although she has moved beyond awkward dating moments (she has a partner now who loves her hair), she is still self-conscious.
And though she has essentially made peace with her hair loss, she still seeks ways to make it look as good as she can.
“I’m not a vain person, so I hate that it bothers me,” Rosenthal says. “I looked at extensions and wigs, but I try to do the things that help me stay most true to myself and at the same time help make me feel better about how I look.”
SOURCES:American Academy of Dermatology: “Hair Loss.”American Osteopathic College of Dermatology: “Female Pattern Hair Loss.”American Hair Loss Association: “Causes of Hair Loss.”Amy McMichael, MD, dermatologist; professor of dermatology at Wake Forest University School of Medicine, Winston-Salem, N.C. Disclosure: Consultant for Johnson & Johnson.Victoria H. Barbosa, MD, dermatologist, Millennium Park Dermatology, Chicago. Disclosure: Former employee of L'Oreal.Kristopher Kutcher, owner, Kristopher’s Hair Studio, Inc., Quincy, Ill.
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