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What are the Causes of Hair Loss at Menopause?

And What are the Cures?

Introduction

Welcome to “Ask Barbie,” where I answer all your questions about menopause. This is a service in which I give you the opportunity to pose questions.

In this particular Ask Barbie, I have chosen to combine three of your questions:

What causes hair loss at menopause?
Can HRT cause hair loss?
How can I prevent hair loss at menopause?

Well, since all questions pertain to hair loss, I decided to address all of them. So the question I will address is, “What are the causes and cures for hair loss at menopause?”

Three Kinds of Hair

There are three kinds of human hair:

Lanugo hair, which is the soft, furry hair that covers a newborn in the first few months of life.
Vellus hair, which is the soft, short hair on the majority of your body.
Terminal hair, which is the thick, coarse hair on your scalp (as well as your eyebrows, armpits, and pubic region).

Lifespan Hair

To understand why your hair changes at the time of menopause, you need to understand how your hair changes over the course of your lifetime. So here is a quick run-through of your hair over the course of your lifetime:

As a newborn, you have lanugo hair.
As a child, you have vellus or very soft hair.
At puberty, your body gets pummeled with the influx of estrogen, progesterone, and testosterone. All three have an effect on your hair, causing it to become thicker and fuller, while still remaining wonderfully soft.
During each menstrual cycle, your hair changes depending on whether your estrogen is high or your progesterone is high. Overall:
- In the first half of each menstrual cycle, high estrogen makes your hair full, soft, vibrant, and bouncy.
- In the second half of each menstrual cycle, high progesterone makes your hair dull, oily, greasy, and unmanageable.
- At mid-cycle, a brief testosterone surge makes your hair absolutely lovely, full, voluptuous, bouncy, and sexy … at the same time that it makes you absolutely horny.
During pregnancy, both estrogen and progesterone get sky high, making your hair fuller, thicker, and faster-growing.
During your post-partum phase, your estrogen and progesterone plummet from their super high pregnancy levels to very low levels. And this causes your hair to fall out massively. It can also cause a change in your hair texture or degree of curl.
During peri-menopause, your progesterone disappears … while your estrogen is dropping. At the same time, you still have testosterone at its pre-perimenopausal levels. The loss of progesterone improves the appearance of your hair. And the presence of testosterone maintains the ‘oomph’ in your hair.
During post-menopause, your estrogen disappears. This leaves your testosterone higher than your estrogen or progesterone. At this point, estrogen deficiency causes you to lose hair. And high testosterone has the same effect on your scalp as it does on a man: Balding begins. So post-menopause is a double-whammy for hair loss. And it is due to two things:
- Estrogen deficiency
- Testosterone (androgen) excess

Good and Bad Hair Days

So you see that all your sex hormones affect all the hair on your body. And your sex hormones can affect all your hair in several ways:

They can cause your hair to change from one kind of hair to another.
They can cause your hair to grow or shed.
They can cause good hair days and bad hair days.

Estrogen deficiency causes terminal hair to turn into vellus hair.
Testosterone excess causes vellus hair to turn into terminal hair.

Estrogen deficiency causes hair loss.
Testosterone excess causes hair loss.

So depending on where you are in the timeframe of your life with regard to your reproductive hormones, you may be ‘glad or sad’ with the effect of reproductive sex hormones on your hair.

The underlying principle is this: Scarcity of estrogen equals sparsity of hair!

If we chart your hair changes over the various hormonal phases of your life, we get this:

Patterns of Hair Loss at Menopause

Hair loss at menopause is hormonal hair loss. It is due entirely to the changes in your sex hormones. There are two patterns of hair loss at the time of peri- and post-menopause:

Female Pattern Hair Loss (FPHL)
Male Pattern Hair Loss (MPHL)

Here they are charted:

Female Pattern Hair Loss

Female Pattern Hair Loss is due to one thing, and one thing only: Estrogen deficiency.

The pattern of hair loss typical of estrogen deficiency is very specific. It involves loss of hair at the very top of your head (the crown). Most women first notice it as a widening in the center part of their hair.

It initially maintains the hair on your forehead. Only later do you lose your forehead hair.

The solution for Female Pattern Hair Loss is estrogen replacement. That’s it.

Estrogen deficiency is what caused the hair loss; and estrogen replacement is what will prevent more hair loss and replace hair loss.

It’s that simple.

The problem is that women commonly blame HRT for the hair loss! And HRT is the only thing that can prevent the hair loss. The key is to take a high enough dosage of estrogen to prevent hair loss.

Male Pattern Hair Loss

Male Pattern Hair Loss due to one thing, and one thing only: Androgen excess.

Androgens include:

Testosterone
DHEA, which is an acronym for Di-Hydro-Epi-Androsterone
DHEA-S, which is an acronym for Di-Hydro-Epi-Androsterone Sulfate

So when you lose all of your estrogen and progesterone at the time of menopause, but do not lose all your testosterone … you have androgen excess.

If you take any kind of testosterone or DHEA as part of your hormone replacement therapy, they can all cause Male Pattern Hair Loss.

Male Pattern Hair Loss involves hair loss at the back of your head (the vertex). Unlike Female Pattern Hair Loss, you do not keep the hair at your forehead. Instead, forehead hair loss occurs very early in the process, before there is a complete bald spot at the back of your head. And Male Pattern Hair Loss also involves hair loss at your temples.

Just as you see with males, the hair loss starts at the forehead and temples … and then starts expanding toward the hair loss at the back of your head.

When it comes to management of hair loss that is due to androgen excess, the only effective option is to avoid androgen excess.

Avoiding androgen excess involves two things:

Taking a high enough dosage of estrogen
Avoiding any kind of testosterone or DHEA as part of your HRT

In addition to that, some women need anti-androgens. Anti-androgens are medications that oppose testosterone and DHEA. It is very common for women to start with anti-androgen medications for hair loss, even though they would have much better success if they:

Took a high enough dosage of estrogen
Avoided any kind of testosterone or DHEA as part of their HRT

Anti-androgens include:

Spironolactone
Finasteride
Flutamide
Cyproterone Acetate

So, this is really very simple: Regardless of whether you have Female Pattern Hair Loss or Male Pattern Hair Loss, you will not succeed with management if you don’t take enough estrogen.

Hormonal hair loss requires hormonal management.

Non-Hormonal Medical Management of Hair Loss

But, what if you are opposed to hormonal management of hair loss?

If you prefer non-hormonal management for your hair loss, you have a variety of options. None will work as well as the hormonal options. This is because the very cause of the hair loss is hormonal.

Non-hormonal management options for hair loss include:

Minoxidil
Several less familiar medications with complicated names (which I’ll list in a chart)
Injecting platelet rich plasma into your scalp
Mechanical options that range from:
- Hairpieces…
- to laser light therapy
- to hair transplants

Vitamins, Minerals, Supplements

The least effective options for hair loss at menopause are vitamins, minerals, and supplements. Ironically, most people use these before employing any of the more effective options.

Biotin used to be the most popular supplement for hair growth. But recent studies have suggested that zinc is more effective.

But no vitamin, mineral, or supplement can come even close to what estrogen replacement and androgen avoidance can do.

Here’s a chart of all the options:

The Answer: What Causes and Cures Hair Loss at Menopause?

It’s really simple.

HRT does not cause hair loss. It prevents it (as long as you do not take testosterone or DHEA)
You can prevent hair loss by taking a high enough dosage of estrogen and avoiding androgens.
And if you need to take an anti-androgen medication, you can do that too.

But now I think you understand why the answers are as they are. And blaming the wrong thing for your hair loss is the worst thing you can do. It will definitely result in more hair loss.

Watch the video version on YouTube

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