Menopause Masterclass: Why Your Hair Is Thinning and What Works

Mary Claire Haver (0:00)

Your hair is telling you something about your iron, about your thyroid, about your vitamin D, about your hormones, about inflammation and the metabolic state of your full body. Hair loss is not a vanity problem. It is a medical condition with real causes and real treatment options. You deserve better than this. You can have your hair back, or at least you can have a fair fight for it.

The views and opinions expressed on unPAUSED are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to unPAUSED, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

So before we get started, I want to make sure everyone understands the life cycle of healthy hair. The hair cycle has three phases. We have antigen, which is the growth phase. It lasts about two to seven years and about 85 to 90 percent of your hair follicles are in antigen at any given time.

We have catagen, which is the transition phase, and it lasts about two to three weeks. This is when the follicle actually shrinks at the end of antigen. And then we have telogen, which is the resting phase. It lasts two to four months and hair sits dormant and then sheds when the new antigen hair comes up behind it, pushing it out. So our hair follicles are constantly proliferating and growing. Normal shedding for a woman is about 50 to 100 hairs a day.

Anything that pushes a longer than normal fraction of follicles into telogen at the same time shows up as a shed two to four months later. So anyone who's had a baby knows exactly what I'm talking about. Typically, after we deliver a baby, because of the hormonal influences that pregnancy had on our hair follicles, two to four months after that baby is born, you will notice tremendous amounts of hair shedding.

For a healthy hair to grow, we need certain things. One is adequate protein. We need the amino acid availability. So people who have low-protein diets tend to have less hair. We need iron, especially for the enzymes that drive hair matrix cell proliferation. We need a healthy, functioning thyroid gland. It regulates the metabolic rate of the entire follicle. We need estrogen as women, which extends our antigen phase, the growth phase. And then we need a stable inflammatory state. That chronic inflammation actually disrupts the normal cycling of hair. So when several of these shift at once, which is exactly what happens around perimenopause and menopause and postpartum, the follicle falters. There's also a seesaw between estrogen and androgens, like testosterone or dihydrotestosterone. Estrogen extends the growth phase of the hair cycle. Androgens, DHT, dihydrotestosterone in particular, shrink the hair follicle over time, and this is important. This process is called miniaturization. A thick, juicy, healthy hair follicle suddenly becomes much thinner, much smaller, and in pre-menopause, estrogen is winning in our hair follicles. In post-menopause, our estrogen levels drop, and then the androgen effects take over, and the follicle gets smaller with every single hair cycle. So the same shift that's changing your sleep, your bones, and your brain is also changing your hair.

Stress is real here as well. Stress does affect the follicle. Cortisol directly suppresses the hair follicle stem cells. Translation. So when you say, my hair is falling out from stress, you're not being dramatic. You're describing a documented molecular pathway that we actually know about in science. The problem is when your doctor said it's just stress, he's ruling out the dozens of other causes that might be leading to your hair loss and the workup that you actually deserve. And we're gonna get to that. Why does medicine dismiss women's hair loss? I have to be honest with you. In my training, I wasn't really taught much about hair loss at all, though this is something that is quite common in female patients. I was taught that if it's severe, we may want to look for some nutrition deficiencies or possible levels of high testosterone, high androgens. But this was severe hair loss, baldness basically, not when a woman came to you, and in your eyes, it looked like normal hair. You were just taught to reassure her, and that things would probably get better over time. So hair loss turns out is the perfect example of a symptom that sits at the intersection of three medical biases at once.