Reading: Thinning Hair: Your Best-Results Guide

“Everyone loses hair,” says San Francisco–based dermatologist Kaveri Karhade, noting that by “age 50, we all have half of the hair we had as babies. The goal,” she emphasizes, “is to slow the natural process of hair loss.” 

Hormonal changes at various life stages act on the scalp and can impact hair growth and hair loss. Menopause, in particular, can seem to speed up the process. But all is not lost. There are many ways to save your strands, depending on your lifestyle, budget, and tolerance for intervention.

Thinning Hair Rule #1: Intervene Early

Once you notice signs of thinning — fall out, changes in texture, hairline regression — see a specialist.

“Many types of hair loss tend to progress. The earlier you intervene, the better your chance is of getting it to grow back,” explains Karhade, who recommends “being seen by a dermatologist as soon as possible.” (Consultation and in-office treatment at the Berman Skin Institute — where Karhade practices and founder Dr. David Berman helped develop robot technologies for hair transplant procedures — is often covered by insurance.) You can also see a licensed trichologist, a hair and scalp health expert. Numerous organizations and companies offer trichology training and certification, so it’s best to shop around; get a recommendation from a local stylist and don’t hesitate to check references and online reviews as well. 

The Two Major Causes of Hair Loss

Genetic predisposition is the number one cause of hair loss among women, according to Karhade. Female pattern hair loss, as it’s called, affects women of every ethnic background equally. Certain “inflammatory diseases [which precipitate hair loss] do affect some ethnicities more than others,” she notes.

Jacqueline Tarrant, a former lead educator for L’Oréal USA and a licensed trichologist, agrees. Genetic predisposition is the top cause of hair loss among the women she sees at the Hair Trauma Center in Chicago, Illinois. 

According to Tarrant — who literally grew up in Tarrant’s Beauty Salon in Baltimore City, Maryland, which her mother owned and ran — the second most common cause of hair loss among women over 40 is traction alopecia. This is hair loss caused by styles that pull tightly against the follicles in the scalp or along the hairline. These are buns, braids, ponytails, extensions, and weaves, affirms DeShawn Bullard, a certified trichologist, licensed cosmetologist, and president and CEO of NouriTress Hair Products.  

 #1 OTC Treatment

Certain readily available treatments — topical products and in-office procedures — do work well for many women 40+ experiencing hair loss.

Karhade recommends Minoxidil (brand name Rogaine, from $5/month), the first FDA-approved hair regrowth treatment. She is 32 and uses it herself as a preventative treatment because her family history is full of female pattern hair loss. 

While Karhade says some women and men shy away from Rogaine because it requires daily use, she suggests you must make it a habit like brushing your teeth (not exactly something you do for a month and then give up). The fact is, as soon as you stop using Rogaine fall out will increase and your head will return to the baseline of hair loss you would have experienced had you never used the drug. 

Medical Options: Injections, Lasers, and Transplants

Karhade says some women find that platelet-rich plasma injections ($500 – $700/treatment) offer great results, but you have to try it to see if it works for you. The treatment starts with an ordinary blood draw. The blood is then spun out in the dermatologist’s office until only growth factors remain; that part is injected into the scalp. The whole procedure takes only 30 to 45 minutes. When this approach to hair regrowth does work, generally four treatments are needed to attain desired results. The injections “give you a boost, but you’re still susceptible to the original causes of hair loss; so we recommend a booster dose yearly after the initial four treatments,” says Karhade. 

Tarrant finds that many women in her practice benefit from cool-light laser treatment, which is FDA-approved for hair growth. The once-a-week treatment takes 30 minutes and needs to be administered for about three months. A single cool-laser light treatment costs $50 at the Hair Trauma Center and can be done, say, over a lunch break. And as Tarrant explains, if there is a genetic predisposition to hair loss, “ongoing treatment for maintenance is recommended.”

This is in contrast to an at-home cool-laser cap, which needs to be worn three times each week for 20 minutes and costs between $800 and $1500 (a price Tarrant points out is comparable to that of a smartphone or laptop computer). These caps rely on the same laser technology as similar in-office treatments, in which the laser stimulates blood flow and cellular metabolism so more nutrients are available to the hair follicles and more detrimental waste products and hormones like DHT are efficiently removed. (The jury is still out on whether or not these caps really prevent hair loss.)

And while a hair transplant sounds intimidating, it shouldn’t, says Karhade, explaining that “hair is taken from a part of the scalp that is not susceptible to the hormonal changes, so hair growth after the transplant is permanent.” Transplants cost $4000 – $15,000 and are done in the office, but do take several hours. The dermatologist, often with robotic assistance, harvests and processes some 2,000 hairs during the procedure.  

Do Natural Approaches Work?

“The demand for something natural — but effective — is creating prospects for hair oils (e.g. argan oil, castor oil, coconut oil), which both contribute to hair health and are perceived as ‘natural’ by consumers,” says Kayla Villena, senior beauty analyst at market research provider Euromonitor International. “The overarching idea of addressing ‘hair health’ and ‘scalp health’ as part of wellness is resulting in female-targeted hair regimens that include hair loss treatments in the shower, topical treatments out of the shower, and supplements.” 

Karhade finds that a lot of clients want to try natural home remedies, but she questions the efficacy. Tricks like rinsing with apple cider vinegar or finishing a wash with coconut oil may feel nice, but rarely get the job done. “Coconut oil,” she says, “is the only oil proven to penetrate the hair shaft and make the hair shaft stronger.”

And no treatment is a one-and-done proposition. “Consistency, commitment, and patience” are key to good results, says Tarrant.

The Truth About Diet and Supplements 

Stress, trauma, diet, illness, and medication can all impact the health of the scalp and its ability to support hair growth. 

In her most recent book, Beauty from the Inside Out ($24.95; Chronicle Books), makeup artist and beauty entrepreneur Bobbi Brown includes a chart showing foods with nutrients that are beneficial to hair. She cites biotin (vitamin B7), folate (vitamin B8), and vitamin E. In the Beauty Foods section of the book, Brown passes on guidance from Dr. Frank Lipman, founder of the Eleven Eleven Wellness Center in New York City, who encourages nutrients, iron, omega-3 fatty acids, silica, zinc, B-complex vitamins, and vitamin C.

Vitamin D and B12 do help with hair health, says Karhade, who notes that biotin, while popular, has unproven impact. She says: “There are no studies showing biotin does anything for the hair and no studies on the risk of taking too much biotin. I don’t recommend biotin to patients. I discourage it, because it doesn’t make sense.” 

If you want to do anything and everything that helps, she says, try natural supplements Nutrafol ($79) and Viviscal ($49.99), which are “both shown to work, but are inferior to Minoxidil.”

The Camouflage Options

For women with noticeably sparse hair, Karhade points to two products that can be helpful as “options to conceal the appearance of loss.” TOPPIK Hair Building Fibers ($24.95) is “a powder that looks like hair fibers and is shaken on to the scalp. From a cosmetic distance of three feet, you can’t tell,” she says, adding that TOPPIK comes off when you wash your hair. She also likes Color Wow ($34.50), a cosmetic that’s meant to cover gray but also makes hair appear thicker. Bullard recommends NouriTress Make it Fuller Hair Building Fibers ($29.99) for women with curly hair. 

Experts advise against using hair extensions to conceal thinning hair. “Extensions can sometimes pull on the hair and worsen hair loss,” explains Kaharde, who suggests wigs for more advanced hair loss. Bullard agrees: “If the hair loss is at a point of full [scalp] exposure, I recommend a wig rather than extensions because the wig doesn’t cause pulling.” She also advises women who wear wigs to conceal hair loss to remove the wig at home to “give the scalp room to breathe and allow for treatment.” That said, the extension design known as a halo (starting at $375 from HaloCouture) requires no clips or glue and promises to be a damage-free option for women with thinning hair. 

A New Generation of Preventive Hair Care

“Age,” says Sonsoles Gonzalez, “is really an opportunity to look and feel better.” Which is why in March, the former global president of Pantene and longtime executive at P&G and later at L’Oréal launched a direct-to-consumer hair care brand called Better Not Younger. 

Sonsoles and the brand’s formulating chemist, Dr. Debra Ling, worked through countless prototypes to develop products that effectively address the thin, dry, and brittle hair many women experience after age 45. Her goal is to deliver products that get results. And focus groups and conversations with friends confirm her own experience. She hears over and over again that women her age (55) and older “don’t know what to do with their hair…Everything that used to work in the past doesn’t work anymore.”

In addition to developing Better Not Younger products ($25 – $47) for hair, scalp, and inner health, Sonsoles and her team are out to alter assumptions about what women want and like. One of the women she was checking in with while developing the brand put it best when she said: “I wouldn’t be 30 again even if you paid me.” Members of her focus group asked for truly premium, elegant options with quips like, “I may be old, but I’m not beige.”

Superpower Fortifying Hair & Scalp Serum ($47) is the brand’s best-selling product; Sonsoles describes it as a hair-fortifying, lightweight, alcohol-free serum that gets massaged onto the scalp nightly and delivers nutrients to the scalp and hair follicles. 

The Psychological Impact of Hair Loss

Though there are many hair-loss solutions, the truth is the psychological impact of losing your hair at any age can be devastating. This is why Tarrant’s practice is not a street-level shop where the community gathers for conversation, like they did at her mother’s salon, but is instead a discreet suite in a nearly 40-story building on Chicago’s Michigan Avenue, where she personally welcomes and works with every client. “The one thing I know about hair loss,” she says, “is that it impacts self-esteem in a way that many other things do not.”