If you’ve ever stood in the shower in tears, holding a fistful of hair that you’ve just shed, you know how devastating hair loss can be. It’s easier to ignore a few fine lines and camouflage away a few gray strands, but losing hair seems to be harder to come to terms with than all other beauty issues combined. For many people, trying to figure out which female pattern hair loss treatments truly work is an exercise in frustration — and often means seeing dermatologists and trichologists in constant rotation, undergoing expensive treatments, or swallowing a half dozen supplements a day, all with not much to show for it.
Dr. Maryanne Makredes Senna, M.D., a board-certified dermatologist based in Boston who specializes in hair loss research, wants to change that. In April 2022, she started the Lahey Hospital and Medical Center’s Hair Loss Center of Excellence, where she performs clinical research in hair loss disorders and treats hair loss patients. And, nearly a decade ago, she started a hair loss center and research unit at Massachusetts General Hospital in Boston with a similar focus.
Besides having seen thousands of patients over the years, Seena has personal experience with the issue. When she was in medical school, she had close family members struggling with hair thinning who went from doctor to doctor and were told nothing could be done. “I saw firsthand how devastating it can be, particularly for women,” she shares. “Men can be bald and still be considered hot, but there’s no cultural acceptance around that for women.” It has such a massive impact that she’s heard that a statistically significant number of female breast cancer patients consider not treating their cancer because of concerns around hair loss.
To help those who are dealing with the issue, Senna shares with Bustle the top therapies that work for female pattern hair thinning — and the ones that show no promise, despite massive amounts of hype. To note: In this article, Senna is speaking mainly about androgenetic (also called androgenic) alopecia or female pattern hair loss, and is not addressing other causes of hair loss such as alopecia areata or traction alopecia.
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1. Distinguish Between Telogen Effluvium & Androgenetic Alopecia
Telogen effluvium (TE) is the most common cause of hair loss in women, and for Senna, the crucial first step with any patient is to figure out if their hair loss is actually TE masquerading as androgenetic alopecia (a genetic sensitivity that leads to thin hair and hair loss). For many, TE happens postpartum, but having a baby isn’t the only trigger. “Other causes include weight loss, entering menopause, stopping or starting a new birth control method including hormonal IUDs, COVID 19, any illness or hospitalization, a disruption, increase, or decrease in thyroid medication dosing, and a significant life stressor like the loss of a loved one or a job,” she explains. It might not even be one reason: There can be many at once, or one might occur one after another, leading to a sustained period of TE shedding.
The hair loss one experiences in these situations can be significant and devastating, as women can lose anywhere from 30% to 50% of their hair. And, problematically, the hair starts shedding only three months after the inciting event, so people often don't recognize the timing. As a result, they assume they have female pattern hair thinning and will desperately yet understandably reach for anything that promises to help.
The reason Senna calls attention to this is that TE reverses itself without any intervention. Your ponytail might remain skinny for a while, but the hair will grow back by itself. The only scenario in which this is not the case is with people who also have female pattern hair thinning as well as TE. In that case, the underlying hair loss condition has to be managed while waiting for the TE to resolve.
2. Biotin Does More Harm Than Good
Supplements — biotin in particular — can have a negative effect on hair thinning. High doses of biotin, for instance, actually interfere with a number of laboratory tests, including thyroid. People who complain of hair thinning often have thyroid disease and are on hormone supplementation to manage their thyroid levels. “If they're taking mega doses of biotin, which are frequently present in hair and nail supplements, they will have false elevations in their thyroid function tests,” says Senna. Patients whose endocrinologist are not informed that they're taking biotin might see these falsely elevated blood tests and adjust the dosage of their thyroid medication, leading to shedding.
“Biotin can also lead to other significant issues with regard to laboratory testing that can make people with hair loss have worse outcomes,” she says. Biotin only helps if one is deficient in vitamin B7, she explains, but that deficiency is rare and highly uncommon in people who have a regular diet. A 2007 review of medical research on biotin found there to be lack of sufficient evidence for supplementation in healthy individuals, showing it to help only in cases of acquired and inherited causes of biotin deficiency, or in those with uncommon syndromes such as brittle nail syndrome or uncombable hair syndrome.
3. Iron & Vitamin D Levels Are Important
According to Senna, the two nutrients that play a crucial role in hair growth are iron and vitamin D. “Studies have shown that removing the vitamin D receptor in mice causes significant hair loss, and when the receptor is replaced, the hair regrows,” she notes. She recommends patients’ vitamin D levels to be above 20 nanograms per milliliter at a minimum. “If people are in the range of 20 to 30 ng/ml, we typically still recommend 800 international units (IU) of vitamin D3 supplementation once a day to maintain those levels,” she says.
Similarly, iron levels should be checked in patients suffering from hair loss. “The hair follicle is very reliant on normal iron stores because it's a very metabolically active part of the body and iron is a cofactor in DNA synthesis. There are also iron receptors on the hair follicle in the growth phase,” says Senna. Even if women are not anemic, it still doesn’t mean they have enough iron in their bodies to grow healthy hair. The best marker to test for is the ferritin level, which measure the amount of stored iron in the body. Senna likes to see a ferritin level above 40 nanograms per milliliter (ng/mL) for normal hair growth, though 60 ng/mL is preferred. Usually, it requires supplementation to get women’s iron levels to rise, she notes, due to blood loss during menstruation. “It's very difficult with diet alone to increase it,” she tells Bustle. Senna recommends a supplement with approximately 45 milligrams of elemental iron or 142 milligrams of ferrous sulfate.
4. Devices Work On The Right Patient If Used Correctly
Low-level laser light devices (also called red light devices) show promising research for growing hair in women who have hair thinning. “Again, you have to have hair thinning — they won’t do anything for telogen effluvium,” Senna says. According to a study conducted over six months, a low-level laser light comb used three times a week increased hair growth to a level that was comparable to the results from topical minoxidil. Minoxidil is currently considered the gold standard treatment for hair loss, so the findings are significant.
“The most important part of using devices is ensuring that the light reaches the scalp,” Senna says. People who have significant hair thinning might not have much to worry about, since the light will be able to get through to the scalp. However, for people who have more dense hair growth, she recommends a device like a comb over one that’s hands-free, such as a helmet or cap.
5. PRP Can Be Helpful
Platelet-rich plasma (PRP) is a therapy used in various branches of medicine such as hematology and orthopedics, and increasingly, for hair loss. “The idea is that platelets contain a number of different growth factors that can help stimulate regeneration of tissues and thus it’s used in hair thinning,” explains Senna. In the autologous (meaning generated from a person’s own body) PRP process, the patient's blood is drawn, spun in a centrifuge to separate the different components of blood, and the platelet-rich plasma is drawn up and injected into the scalp. Senna recommends three sessions one month apart, and though the process can be expensive (the average cost begins at $1,500 for three treatments), she believes it can be helpful for the right candidate.
“There are professionals who will just do PRP to anyone who shows up at their door and that is not what I advise,” she notes. “An important screening factor is making sure someone doesn't have a scarring alopecia.” Scarring alopecia is a condition in which the hair follicles are damaged by inflammation. Since the hair loss caused by this can sometimes visually appear similar to female pattern baldness, patients are often treated with PRP, which doesn’t help scarring alopecia. Biopsies are often recommended to rule out scarring alopecia before PRP is recommended. And, of course, TE needs to be ruled out as well.
6. Topical Minoxidil Works Great, But Oral Minoxidil Is Easier & Just As Effective
Topically applied minoxidil (the active ingredient in Rogaine) is one of the most effective hair loss treatments, but takes a considerable amount of dedication. The medicine needs to be applied to the scalp daily, and it can make the hair sticky and dry out the scalp in the long term. “In the past few years, the use of very low dose oral minoxidil has become a great treatment for women and men who have thinning hair,” says Senna. She typically prescribes doses of 1.25 to 2 milligrams for women but never goes higher than 5 milligrams, since it can stimulate unwanted hair to grow on the face and body. “It’s very well tolerated with few side effects, is inexpensive, and works quite well,” she says.
Oral spironolactone is another prescription drug that, when used in low doses, stimulates hair growth. Senna typically recommends starting at 50 milligrams for younger women, and at 200 milligrams for women suffering from polycystic ovarian syndrome (PCOS). Women over the age of 60 are at a higher risk of developing hyperkalemia or increased potassium in the blood on higher doses, so a much lower one of 12.5 or 25 milligrams a day has also been proven to show good results.
7. Your Hair Care Products & Styling Habits Could Contribute To Hair Loss
Allergies and irritation to ingredients in hair care and hair styling products are not uncommon. They’re often triggered by ingredients like synthetic and natural fragrances (including essential oils), certain preservatives, and paraphenylenediamine (PPD) in hair dyes. “Itching or inflammation of the scalp can cause the hair to not grow properly,” says Senna, who recommends her patients with persistent scalp itch or sensitivities switch their products to ones that are fragrance-free and don't contain some of the more common allergenic ingredients. The same holds true for people who suffer from persistent dandruff and seborrheic dermatitis — the inflammation and itching caused by those conditions can also impact hair growth, and they should be treated.
Senna also advises being mindful of your styling practices such as over-bleaching hair, using too much heat, and avoiding extended use of hair extensions and other hairstyles that can put traction on the hair. “Consistent pulling on the hair from extensions or tight hairstyles over long periods can lead to permanent hair loss in the form of traction alopecia,” she explains. “Then, when women see that thinning, they'll put more extensions in and now we're adding fuel to the fire, making it worse in the long run.”
Below, Senna and Bustle’s editors share some products that might help with thinning hair.
Products For Hair Thinning
The Gentle Shampoo & Conditioner
This color-safe duo decreased shedding by 44% in a randomized, controlled clinical trial performed by Senna at the Hair Loss Clinic at Harvard’s Massachusetts General Hospital. The products are fragrance-free and uber gentle on your strands.
The Curly Hair Essentials
Senna likes this cruelty-free shampoo and conditioner for curly hair. Both products are formulated with hydrating aloe vera extract, rose, and cherry blossom to nourish stressed-out strands.
The Hair Dye
This hair color gets Senna’s green light as it’s free of PPD, a chemical that causes skin reactions and irritation in some people, causing hair loss in the long term.
The Nourishing Wash
This shampoo cleanses beautifully without stripping the scalp and is gentle on thin, fragile hair. Besides being fragrance-free, it contains hair-strengthening yuzu, galactoarabinan, and omega-3-rich chia seed extract.
This gentle shampoo is powered by zinc pyrithione to bust flakes, but won’t strip your hair and dry out your scalp like other dandruff shampoos. Team it with the brand’s Purifying Mask if your dandruff is more severe. FYI: Persistent dandruff can cause scalp irritation leading to hair loss.
The Iron Supplement
These iron supplements help in hair regrowth, and their slow-release formula makes them easier to digest compared to others. Take it with some orange juice to get its full benefits, as vitamin C helps iron absorption.
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