Menopause Masterclass: Why Your Hair Is Thinning and What Works

In this solo episode of unPAUSED, Dr. Mary Claire Haver tells the truth about hair loss in women over 40 — a medical condition with real, identifiable causes, not a vanity complaint to be dismissed as stress or aging. She breaks down the biology of the hair growth cycle and the hormonal mechanism driving midlife thinning: as estrogen declines, androgens like DHT take over at the follicle, shrinking it with every cycle. She walks through the five most common causes of hair loss in midlife women — female pattern hair loss, telogen effluvium (including the dramatic shedding triggered by illness, surgery, stress, and rapid weight loss on GLP-1 medications), iron deficiency, thyroid dysfunction, and nutrient deficiencies and medications — plus the red flags, like bald patches, a receding hairline, or scalp scarring, that need a dermatologist immediately. Dr. Haver then details exactly how to advocate for yourself: the full lab workup to request (and why ferritin must be checked even when standard blood counts look normal), what to bring to your appointment, and the treatment options that actually work — from correcting deficiencies first, to topical and oral minoxidil, finasteride, spironolactone, PRP, microneedling, and laser therapy. She gives the honest answer on whether hormone therapy treats hair loss, which supplements have real evidence behind them, why biotin is unlikely to help without a true deficiency, and shares her own experience with both female pattern hair loss and a post-illness shed. The episode closes with a practical five-step action plan for documenting your hair loss, requesting the right tests, and getting the workup you deserve — because your hair is a vital sign. Resources: Download the FREE Midlife Hair Loss Guide https://thepauselife.com/pages/the-midlife-hair-loss-guide Dr. Mary Claire Haver (Substack) https://drmaryclairehaver.substack.com/ Books: "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mary Claire Haver?

  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 whole 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.

• 0:29Dr. Mary Claire Haver?

  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.

• 0:49Dr. Mary Claire Haver?

  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.

• 1:13Dr. Mary Claire Haver?

  This episode is brought to you by Whoop, the wearable health and fitness coach that gives you personalized insights into your sleep, recovery, strain, and overall health so you can empower your day. Whoop keeps things intentional by staying screen-free. It won't buzz to you to hit a step count, but rather works alongside a companion app to deliver clear, actionable physiological data. With membership tiers like Whoop 1 for everyday performance, Whoop Peak for long-term wellness, and Whoop Life for medical-grade insights, there's a fit for every goal. Lately, I've been spending a lot of time in Colorado, hiking and getting outside whenever I can. And with how much I travel for work and how busy my

• 1:55Dr. Mary Claire Haver?

  schedule can get, I'm always looking for ways to better understand how my body is responding to everything I'm asking of it. That's where I think something like Whoop 5.0 wearable could be really helpful. It could give me insights into my sleep, recovery, and strain, whether I'm hiking in Colorado, traveling for work, or simply trying to keep up with a busy week. It can help me recognize when I have the energy to push myself and when my body might be telling me it's time to slow down and prioritize recovery. To learn more, head to whoop.com.

• 2:32Dr. Mary Claire Haver?

  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 anagen, which is the growth phase. It lasts about two to seven years, and about 85 to 90% of your hair follicles are in anagen 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 anagen. 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 anagen hair comes up behind it, pushing it out. So our hair follicles are constantly proliferating and growing. Normal shedding for a woman is

• 3:17Dr. Mary Claire Haver?

  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

• 4:01Dr. Mary Claire Haver?

  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 anagen 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.

• 4:43Dr. Mary Claire Haver?

  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

• 5:22Dr. Mary Claire Haver?

  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 going to get to that.

• 5:59Dr. Mary Claire Haver?

  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 nutrient deficiencies or possible levels of high testosterone, high androgens. But this was severe hair loss, like 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

• 6:39Dr. Mary Claire Haver?

  example of a symptom that sits at the intersection of three medical biases at once. One, it affects women, so it gets under-treated. Studies show that women's pain and physical symptoms are routinely attributed to psychological causes like stress more than men's, even when the symptoms are identical. Number two, it looks cosmetic, so the medical system treats it as optional. And number three, the standard workup is actually poorly defined, so most clinicians don't even know where to start or what to order. Iron deficiency is the cause that we miss the most. In one study of women with hair loss or alopecia, the medical diagnosis alopecia, nutrient deficiency

• 7:20Dr. Mary Claire Haver?

  was the top cause of female alopecia, and iron deficiency was found in roughly 70% of the women. And most of them had a CBC or hemoglobin from the CBC that was actually in the normal range. A normal CBC, a normal blood count, does not rule out iron deficiency hair loss. And we'll dig into those labs a little bit more to help you understand. So hair loss in women over 40 is almost always more than one thing happening at the same time. So I'm not going to tell you there's one single cause. I'm not going to tell you a botulibiotin or an iron transfusion is going to simply fix, or hormone therapy is going to fix, all of your problems. I'm going to walk you through the five biggest

• 8:02Dr. Mary Claire Haver?

  categories of hair loss, the pattern that goes with each, and the labs that can find it and diagnose it. And then we're going to talk about how to treat it. So buckle up. But first, I want to focus on a few red flags. Number one, scarring alopecia. Okay? These are diagnoses you cannot afford to miss because scarring is permanent. If you see any of the following, you must go to your doctor immediately, and a dermatologist most likely is going to be your best bet here. If you have discreet bald patches, little areas of discreet baldness throughout your head, this is called alopecia areata. If you have a receding hairline, most female pattern hair loss, the hairline stays normal,

• 8:47Dr. Mary Claire Haver?

  okay? We're just losing it, like the part's getting wider, and we'll talk about this in a minute. But if you are seeing that your hairline is starting to recede, that could be frontal fibrosing alopecia. Again, if not treated, this can be permanent.

• 9:02Dr. Mary Claire Haver?

  If you have any patches with scarring, redness, scaling, or a burning sensation, you need to see a doctor immediately. Okay, so we're going to go through the five major categories of hair loss in women. This isn't all of them, but these are the five most common that you are likely going to see, and you may have more than one at the same time. Number one, female pattern hair loss, or androgenetic alopecia is the medical name for that. Female pattern hair loss, androgenetic alopecia. The most common cause of hair loss in women over 40. The prevalence climbs through midlife and peaks around or after menopause. What is the pattern? What does this kind of hair loss look like?

• 9:47Dr. Mary Claire Haver?

  Often, the first sign is a widening part. Okay, wherever you part your hair, you're suddenly noticing that you're seeing more white or flesh color in that area. You may notice thinning across the crown, the crown of your head, though remember, the front hairline itself is usually absolutely preserved. Why does this happen? The follicle is still alive, but it is producing thinner, shorter, and less pigmented hairs each cycle, thanks to that androgen sensitivity that I briefly mentioned. So let's go over that one more time. So estrogen dominates in pre-menopause. We all can agree that. And estrogen promotes hair growth. It keeps the hair in the growing phase. It keeps it thick.

• 10:31Dr. Mary Claire Haver?

  It keeps the follicles juicy, healthy. And then when estrogen declines, androgen levels might decline as well, but the activity of the androgens stays elevated and dihydrotestosterone is converted to, which actually binds to the hair follicle, starts becoming the dominant hormone that is affecting our hair and skin. So we see miniaturization of that hair follicle, those individual hair follicles are getting tinier, skinnier, and less pigmented. This is not reversible without intervention. So that's the good news, and we'll talk about the interventions. Watching and waiting can make it worse, so early treatment matters. So if you are like, whoa, my part is getting wider, you deserve a workup. You deserve to know exactly what's going on.

• 11:15Dr. Mary Claire Haver?

  Okay, number two, so we talked about female pattern hair loss or androgenetic alopecia. Number two, telogen effluvium. If you've had a baby, you know what I'm talking about. If you've had COVID or a severe illness, you most likely know what I'm talking about. Telogen effluvium is when you have that dramatic shedding. I've been through it with both kids. I've been through it once I had COVID. I've been through it after the flu. Okay, you're in the shower and all of a sudden you are pulling out chunks and chunks of hair, handfuls in the shower, on the pillow, in the brush. It often starts two to four months after a trigger. There's usually a trigger here. The trigger could be pregnancy, severe illness, a medication, a surgery, a psychological

• 12:00Dr. Mary Claire Haver?

  trauma. The brain is working here, a nutritional crash, thyroid disease, COVID infection, or even just the hormonal turbulence of perimenopause itself. Okay, this isn't a slow gradual process. This is 10 alarm fire, what the hell's going on? I'm pulling out chunks of my hair. When I was still doing obstetrics and delivering babies, I had my postpartum patients calling me in an absolute panic when I first started practicing because I wasn't trained to like, let women know this was going to happen and that it would grow back eventually. So once I figured out all these, I would stop the freakouts when I would let them know, hey, you know, at their postpartum visit, which was typically at six weeks.

• 12:41Dr. Mary Claire Haver?

  I would say, in the next month or two or three, you are going to start shedding lots of hair. Your hair actually shifted into different phases while you were pregnant. You may have enjoyed thicker hair, you know, bouncier hair, and that's going to go away. You're going to lose that hair. And so just knowing this was coming really helped with some of the anxiety around when the sheds started to happen. Now, I knew this was going to happen to me. Did not make it much better when it did happen to me postpartum. It really freaked me out, but I knew it was going to happen and I knew it would grow back, but it does take up to a year to completely go back to its normal state. So just knowing that might happen. But I do want to talk about GLP-1s here specifically.

• 13:25Dr. Mary Claire Haver?

  Rapid weight loss from a GLP-1 receptor agonist is now recognized as a telogen effluvium trigger, not because of the drug directly, but because the speed of the weight loss. So it's not like the GLP-1s are binding to the hair follicle. It is because you're protein energy deficient. Remember, protein is one amino acids are one of the key things we need for healthy hair growth, the huge metabolic shifts that are happening. It's going to be increasingly common as more and more women are taking GLP-1s. And it's just as important, if you're starting on one, that you are warned that this might happen. So how does it happen? A system-wide assault flips a large fraction of the follicles into telogen at once, and they shed simultaneously.

• 14:09Dr. Mary Claire Haver?

  Now, this is usually reversible. It is reversible if the trigger is identified and corrected, but chronic telogen effluvium, when the trigger never resolves, can convert to a persistent shedding problem. So typically what patients see is they'll go through a week or two, or maybe three of a severe shed. They're in the shower, you know, pulling out this hair, noticing it in their hairbrush on the pillows, and then it just kind of slows down, and then they go back to their normal daily allotted hair loss. So that is typical telogen effluvium. The hair, you know, it'll take about a year for everything to come back, but it does tend to come back as long as we can stop the trigger. So you get better from the illness, you recover from COVID, you, you know, your postpartum, you're not pregnant again soon.

• 14:54Dr. Mary Claire Haver?

  But there are a few conditions where you will chronically do this because you've got some nutrition deficiency or something that you've not corrected. Number three, iron deficiency. Speaking of nutritional deficiencies, the most missed cause. Like I said before, in one study, iron deficiency was present in 70% of women with hair loss. Most had normal blood counts. Most had normal iron levels, but what was low? Pheratin. Pheratin, you must check pheratin. We're going to go through the labs again, step by step, together. Hair follicles depend on iron for the enzymatic driving matrix cell proliferation. Basically, you need iron to keep hair cells healthy at the cellular level.

• 15:38Dr. Mary Claire Haver?

  Iron deficiency reduces our pheratin, which reduces follicle function long before your hemoglobin drops. What does iron deficiency hair loss look like? So the pattern, it might mimic the female pattern hair loss, telogen effluvium or both. You might have also had heavy periods for years and were never told your iron is low. Number four, thyroid dysfunction. 10% of you listening to this have unhealthy thyroid function, if not more. Thyroid hormone is one of the master regulators of metabolic rate in every tissue, including the hair follicle. So the pattern in thyroid dysfunction is thinning hair, often accompanied by the other symptoms of hypothyroidism, fatigue, cold intolerance, weight changes, constipation,

• 16:23Dr. Mary Claire Haver?

  mood changes, dry skin, all things we also see in perimenopause. So you deserve to get your blood work checked to see if you're having one or both of these conditions at the same time. Hypothyroidism is the most common culprit, but hyperthyroidism, an overactive thyroid, can also cause some shedding as well. Number five, other causes, usually nutrient deficiencies and some medications. So vitamin D. Low D is associated with hair loss in multiple studies, and they want to target a vitamin D level of at least 40. Okay, in our clinic, because vitamin D is, is active in so many other enzymatic processes and tissues and body functions that have, you know, different levels we shoot for,

• 17:07Dr. Mary Claire Haver?

  we're looking for 60 to 100 for our vitamin D levels. But for hair, it looks like getting it above 40 helps if you have low vitamin D. Vitamin B12, often associated is, and is low with a lot of women who are on GLP-1s, who are vegetarians, or who are on long-term PTIs proton pump inhibitors. So if you're on something like a metrazol or one of the other proton pump inhibitors for a long time, you may have low B12 levels and you deserve to have that checked and then replaced. Zinc, zinc deficiency is, also can cause hair loss. So, but on the flip side, excessive supplementation of zinc can also cause hair loss as well. Medications, I'm going to read off this list. Medications that can cause hair loss.

• 17:52Dr. Mary Claire Haver?

  ACE inhibitors and beta blockers. ACE inhibitors are a blood pressure medication. Beta blockers are used in several conditions, including hypertension. Anticoagulants, so those of you who are in blood thinners. Antidepressants, SSRIs, and brucopreon or wellbutrin are common causes of hair loss. Anticonvulsants, I've seen lots of patients with hair loss on an anticonvulsant. Retinoids, statins, and certain hormonal contraceptions. There are certain progestins, progestogens, that have a higher rate of hair loss than others. Make sure to talk to your doctor if you're noticing you started on a new birth control pill and you're noticing hair loss all of a sudden.

• 18:36Dr. Mary Claire Haver?

  This podcast is sponsored by Midi Health. Have you noticed the conversation around menopause is suddenly everywhere? It's trending on social media. Celebrities are opening up about their symptoms, and conversations that used to happen in whispers are finally out in the open. And honestly, it's about time. For decades, women were dismissed, ignored, or told their symptoms were just part of aging. And while I'm glad the conversation is happening, here's the truth. Menopause care isn't a trend. It's long overdue medical care that women have always deserved. If you've been listening to me, you know this isn't new territory for me.

• 19:16Dr. Mary Claire Haver?

  This is my life's work, helping women navigate perimenopause and menopause with real science. That's why I want to tell you about Midi Health. Midi is a virtual menopause clinic staffed by clinicians who listen, who take your symptoms seriously, and never utter the words, it's all in your head. Like me, Midi focuses on your health span, not just your lifespan. That means taking a comprehensive look at your metabolic health, bone density, cardiovascular risk, and cognitive function, because all of it matters. Midi delivers the kind of proactive, evidence-based care I've always believed women deserve. And the best part?

• 19:56Dr. Mary Claire Haver?

  Women in all 50 states can access personalized care, and it's almost always covered by insurance. So yes, I'm glad menopause is finally getting attention, but don't settle for noise. Get care from clinicians who are in this with you for the long haul. Book your virtual visit today at joinmidi.com. That's join M-I-D-I dot com. Insurance coverage varies. Check with your plan for coverage.

• 20:27Dr. Mary Claire Haver?

  So, okay. How do we get the help that you need? I think it's important that you are an informed patient, that you can go in and with confidence discuss your hair loss, what patterns you're seeing, and know what type of workup that you deserve. Because unfortunately, again, as why we discussed this earlier, a lot of us just weren't trained. We were taught this was a vanity complaint, a cosmetic issue, and not a diagnostic red flag, right? Your hair is a vital sign. It's a vital sign. And if your hair is suddenly not as healthy as it used to be, then you deserve a workup because there may be something metabolic. There probably is something metabolic going on with you, and we can get to the bottom of it.

• 21:11Dr. Mary Claire Haver?

  So how to get to help? Well, you're gonna need a clinician because you're gonna need to get some blood work done, and you might need some therapeutic intervention. Ask for the full workup. That includes at least a ferritin, a full thyroid panel, including the free T3 and T4. Those are two different hormone levels, a vitamin D, a B12, a blood count, the CVC, and then CMP, which is a complete metabolic panel. Let them know if any of your results are off. Like if you had blood work done recently, make sure you take a copy with you to your clinician's appointment. And if they're all normal, then you need a dermatologist referral. It's not like, oh, everything's normal. Just go home and have no hair. It should be, okay, I've done everything I know how to do as a clinician.

• 21:56Dr. Mary Claire Haver?

  It's time to get you in to see the subject expert, which is dermatology, because they may need to do biopsies. They can take hair follicles out of your hair and take a look at the health of it, the miniaturization, et cetera. So let's talk about the lab work. Now, before I start off on this, I'm not going to expect you to take notes while you're doing housework or driving, listening to a podcast. If you go to the show notes section, we have everything that's critical to know here. The full list of labs to order, questions to ask your doctor, and all of the different treatment options, why they work and what they work for, is all available in a downloadable guide called The Hair Loss Guide. So just go to the show notes, click on that, and put in your email. And we will email you this beautiful PDF

• 22:40Dr. Mary Claire Haver?

  with everything you need to get the most out of your clinician's visit. Okay, but I want to spend some time on each lab we're talking about here because they're all really, really important. Okay, number one, I think for this is ferritin. Ferritin, F-E-R-R-I-T-I-N. This measures your iron stores, your storage iron. Ferritin is a protein that grabs on to iron and just hangs on to it and stores it throughout your body. It's probably the most common miscontributor to hair loss. It's the first thing to drop when you're having low iron. Okay, you're either, and why do we have low iron? We're either losing too much. Hello, 90% of us have dysfunctional uterine bleeding and perimenopause. Or you're not taking enough iron in.

• 23:24Dr. Mary Claire Haver?

  You're on a GLP-1, you've had gastric bypass, you're a vegetarian, you know, hard to get foods rich in iron. You're in a food desert. There's lots of reasons you don't like a lot of iron-rich foods. So there are lots of reasons why you might have low iron. But the first thing we see is a decreasing ferritin level. When I was in medical school and residency until about, oh, God, maybe 10 years ago, the level of ferritin that was low was 15 nanograms per milliliter. 15 was normal. Okay, well, that's changed. It is now 30. They've doubled it, okay? The baseline, the bottom of, you know, normal is 30, okay? Normal still goes up to 100 or higher.

• 24:07Dr. Mary Claire Haver?

  So when we're talking about hair, most hair specialists want to see that ferritin at least 40 to 60. Okay, if not higher. Some prefer the 70 to 100 range for optimal hair support. So if the ferritin results are borderline or confusing, you may want to get a full iron panel, including a serum iron, a TIBC, which is total iron binding capacity, and the iron saturation. This can really help clarify whether iron deficiency is actually present. And in general, an iron saturation above 20% is considered to be reassuring. So number two, thyroid testing. It doesn't just measure TSH here. Here, we're trying to get really, really specific. TSH is thyroid stimulating hormone.

• 24:51Dr. Mary Claire Haver?

  TSH is produced in the brain, and it talks to the thyroid gland to create this T3 and T4 hormones that go out into the body and do their work. And then T3 is converted to T4 in the periphery. I'm getting in the weeds here. TSH, a lot of clinicians will only order a TSH, and then it'll do a reflex T3 and T4. But most people who diagnose hair loss and think it's attributed to hypothyroidism want to go ahead and get all the labs upfront. So, and with TSH is best around 0.5 to 2.5, rather simply within range specifically for the hair follicle. Number three, vitamin D. Vitamin D, vitamin D. You hear me talk about vitamin D all the time.

• 25:34Dr. Mary Claire Haver?

  Levels below 40 are common, common, common in midlife. 60 to 80% of women who are in post-menopause, who are post-menopausal, will expect to have a low vitamin D level. So the cutoff for, you know, deficiency is 30 for vitamin D, but low is considered to be less than 60. And in our clinic, we are shooting for a 60 to 100 vitamin D level. And it has been linked to weight gain, increased cancer risk, like lots of things. And it's such a simple thing. Most women do not know what their vitamin D level is. So the next time you're in your clinician's office, make sure you ask for vitamin D, and certainly if you're having hair loss. Okay, number, we're on number four, vitamin B12.

• 26:19Dr. Mary Claire Haver?

  B12 deserves attention, particularly for women taking a GLP-1. I know many of you are. Or that acid-reducing medication like omeprazol or PPIs. Or if you're following a strict vegetarian diet or a low-meat diet, many clinicians like to see a B12 above 500 picograms per milliliter for optimal neurologic and cellular function. Reasonable thing to check. Okay, and then next is the CBC. That is a really common lab. Most of you will have it at your annual exam, at your well-woman exam. It helps to rule out anemia. It helps to rule out low platelets. It looks at your white cells, your red cells, and your platelets, and their distribution, as well as their size.

• 27:01Dr. Mary Claire Haver?

  If you're iron deficient, we tend to see the red cells shrink in size. So it really helps with this workup of looking at low iron levels and anemia. And then the comprehensive metabolic panel, or CMP, what we say in medicine. This is just a general baseline. Look at your metabolic function, your liver, your kidney function. It's not really hair-specific, but it's still really important in context. And it is usually drawn routinely at your annual visit. If there are signs of androgen excess, meaning higher testosterone levels or DHT or androgen levels than we would expect, things like physical symptoms of acne, of temporal hair loss specifically,

• 27:45Dr. Mary Claire Haver?

  of new facial hair growing where you never had it before, chin hair, nose hair, et cetera, growing out of your ear. Anybody had ear hair? Like, I had one, and it freaked me out beyond, I think that was one of the...

• 28:03Dr. Mary Claire Haver?

  I just didn't expect it. And I was like doing something, and I looked in the mirror, and I have like a 30x magnifying mirror because my eyesight has dwindled dramatically in menopause and with age. And I swear to God, it was two and a half feet long by the time I found it. And I was like, how have I been walking around with this giant ear hair? And I had no idea. So just, I just say this story so that you don't feel alone and that these things happen to me as well. I plucked it, it's never come back again, thank you, Jesus. But I'm always looking for it and feeling for it. Okay, so signs of androgen excess. New hair where you never had it before. Scalp thinning specifically at the temples or at the crown, irregular cycles, et cetera.

• 28:48Dr. Mary Claire Haver?

  That's when we need to start checking your testosterone levels and something called SHBG. SHBG, you'll hear a lot about, and I did a great podcast with Dr. Jim Simon. He really did a deep dive into SHBG, is steroid hormone binding globulin. Okay, so you know, we talked about ferritin is like the protein that hangs on to iron. SHBG is a protein that hangs on to estrogen, progesterone, and testosterone. It is sex hormone binding globulin. It binds those hormones and renders them inactive until the hormone falls off, and then it can like be free and go be active in the tissue. So the higher our levels of SHBG are, the lower the activity of our sex hormones like estrogen and testosterone. When we have a low SHBG,

• 29:33Dr. Mary Claire Haver?

  we may have higher activity of our testosterone, of our DHT. Our SHBG goes up when our estrogen levels are up. So especially with oral estrogen. So if you are on a break control pill for treatment of, you know, heavy periods or for contraception, you will have higher SHBG typically than you would have had without it. That is going to bind the activity of your androgen hormones, okay? If you have low SHBG, as we see in menopause, you will have higher activity in more free, more of that testosterone that you have circulating will be free and active. What do you want to bring to this appointment when you go?

• 30:13Dr. Mary Claire Haver?

  I would take photos, show your scalp from above and your part line and the full head. Make sure to take them under the same lighting every four to six weeks. In the intro, I talked about you're scrolling through old pictures when you were younger. If you can show what your hair used to look like and now what it looks like now, I mean, that's, that's evidence enough. Um, I wish I could just tell you that you could, uh, talk to someone and they would believe you right away, but it is nice to have proof in the pictures to make it more dramatic and how serious you are about wanting to get this fixed and evaluated. If you're still having cycles, if you're in perimenopause, premenopause, you know, be specific about your menstrual cycles. How often, how heavy are your periods?

• 30:58Dr. Mary Claire Haver?

  Are they heavier than they used to be? How many hours can you last with a tampon or with a pad? Are you having to leave meetings? You know, you can't get through the night sleeping in your bed as your mattress a crime scene, you know, on certain days of the month. These are all very, very, very important. Remember your period should be painless, predictable, and never cause you any drama or trauma in your life. Common does not mean it's okay. Common means it happens to a lot of people. It does not, normal means common in medicine. It doesn't mean, well, you just have to live with it. So, okay. You want to bring your medicines. So write down your medication list, your doses, how often you actually take it, including the Pura in medicines as needed medicines and how often you're actually taking those

• 31:43Dr. Mary Claire Haver?

  and any supplements that you're taking. Please bring that all, or at least the information so that you have that ready to discuss with your clinician. You want to make note of your diet. How much protein are you intake it in? And so when I say diet, I want you, before you go to this doctor's appointment, to track your nutrition for a week or two. Download a free nutrition tracker. My favorite is Chronometer, C R O N O M E T E R, chronometer.com. Um, we do have a partnership with them, so full disclosure, but like my daughter Catherine, who's now in medical school, her undergrad was in nutrition science. And this was the app they use to track nutrition. It wasn't built for weight loss or calorie counting.

• 32:26Dr. Mary Claire Haver?

  You can do all that with it, but it was really developed to track actual nutrition. The database is really, really clean. And so use a nutrition tracker to track protein intake, caloric intake. You know, if you're in a, you know, in a GLP one, you need to know how many calories you're getting in. And if you're in a very, very restrictive caloric intake, this could be contributing to your hair loss. If you're not getting enough protein, this most likely is contributing to your hair loss. Um, and any recent weight loss that's not related to, you know, medication or doing it on purpose. So, um, family history, do, you know, is there hair loss in your mother and your sisters and your grandmothers? You know, how did they, how did their hair age with them? That's all very, very, very important.

• 33:14Dr. Mary Claire Haver?

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• 33:59Dr. Mary Claire Haver?

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• 34:43Dr. Mary Claire Haver?

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• 35:26Dr. Mary Claire Haver?

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• 36:11Dr. Mary Claire Haver?

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• 36:56Dr. Mary Claire Haver?

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• 37:31Dr. Mary Claire Haver?

  So now we're going to talk about treatment and I'll go over, you know, I had female pattern hair loss. Um, I've had post shed recently, actually about three months ago. I don't know, you guys on video, you can see my hair like it's thinner towards the bottom. Um, I had COVID and the flu kind of back to back last fall and was really, really ill. Also launching a book and working my tail off. And four months later, started having tremendous shed. Um, that's all stopped, but I had to reassure myself in the shower, like, don't freak out. Think what was happening three to four months ago? What was happening? I was like, I'm sick. I was sicker than I've been in years and years and years. I was also flying all around the country incredibly rundown and all of that probably

• 38:16Dr. Mary Claire Haver?

  contributed to the telogen effluvium that I was having. But on top of that, I had female pattern hair loss. My part was getting wider. My hair was getting thinner, right? Um, I didn't have any loss of hairline, but I could just tell my ponytail was getting narrower. I used to pop rubber bands as a kid all the time. I couldn't, you know, do more than two twists. And then I was, now I was doing like four. I had like had half the volume of what I used to have. And so of course I got upset about it. So researched hair loss, even though I was a doctor, I've realized I don't know much about it, didn't know how common it was. And went and had my own labs done and figured out this was hormonally related to the changes I was going through in menopause and then got on some treatment therapy.

• 39:00Dr. Mary Claire Haver?

  Um, and it's much, much better. So those of you who can see me on video, I still have hair. Hair loss in midlife is rarely one lever problem, right? We talked about the five main causes, but really rarely is it ever just one. Combination therapy is the rule, not the exception, right? So I can't tell you, take this big expensive bottle of Viatin or, you know, there's topical treatments, there's oral medications, we'll go through them all. And there's procedures that in combination may stop, may stop or reverse your hair loss. Um, but the first step, the first step should be to correct any nutritional deficiencies.

• 39:41Dr. Mary Claire Haver?

  Let me say that again, you know, nothing topical, nothing oral, nothing procedural will compensate for an unaddressed iron, thyroid, or nutrient deficiency. Start with those. What is your vitamin D? What is your ferritin? Do you have a normal functioning thyroid? Do you have normal functioning thyroid hormone levels? You must know those first. Again, I'm not expecting you to pull over and take notes if you're driving. We have all of this in a beautiful guide for you. It'll be in the show notes. You link, put in your email and we will email you the whole guide. Okay. So let's correct the deficiencies. So how do we do that? All right. So iron, let's talk about iron, most common thing. 70% of women have low iron, low ferritin. Okay.

• 40:24Dr. Mary Claire Haver?

  How do we, oral iron is the cheapest and easiest way. To get it back up. So eating iron-rich foods. But if you can't do that, if you have allergies or don't like iron-rich foods or struggling to get them, you can take oral iron, typically taken with vitamin C and often the iron has vitamin C in it. And away from calcium, coffee and tea, okay, for maximum absorption. 325 milligrams of iron sulfate typically once a day, twice a day. And what I've learned is you can actually have the same benefit by skipping, you go every other day with that iron dose.

• 41:05Dr. Mary Claire Haver?

  You don't have to take it every day. So some of the gastrointestinal side effects, some of the constipation can be lessened by just taking it every other day rather than every single day. So there is also, and I think massively underutilized, but very, very expensive if you don't have insurance, is IV iron. IV iron, I've watched it work miracles in patients. I've seen it work in restless leg syndrome. I've seen it for hair loss. I've seen it for chronic fatigue. I've had IV iron myself when I was in perimenopause and having these crazy heavy periods. In getting ready for this podcast, I looked at the cost of IV iron. Like if you wanted to have it done,

• 41:47Dr. Mary Claire Haver?

  it's in the thousands of dollars. It can be. And often you need multiple treatments. So without insurance, it may be cost prohibitive, but is definitely worth, if you have insurance, asking your clinician if you're a good candidate for IV iron, especially if you're on oral iron and you can't get your ferritin level up. This may be kind of critical for you to be as healthy as possible. For a thyroid disease, you want to treat to the optimal range, not just the normal range. For vitamin D, at least to get that vitamin D serum level above 40 nanograms per milliliter. And then for protein, it looks like 0.8 to 1 grams for every pound of body weight for women in midlife,

• 42:33Dr. Mary Claire Haver?

  especially for those on GLP-1s or in active weight loss. I have a Substack that we just published about a week before I recorded this video, where I talked about, for those of you on GLP-1s, how much protein do you actually need? Now, we're not talking about protein intake as far as hair loss goes in that Substack, but we're talking about where we limited the amount of muscle loss and how much protein that would take. So we will link that Substack in the show notes so that you can go and read that if you're on a GLP-1. So the second front, so we've talked about the common deficiencies. Now we're going to talk about treatment options, medical treatment options. So minoxidil, alright?

• 43:17Dr. Mary Claire Haver?

  Minoxidil extends the antigen phase of the follicle. So remember, back in the very beginning of this podcast, we talked about the three phases of hair growth, antigen, telogen and catagen. We want 80 to 95% of our hair follicles to be in the growing phase and stay there. And so it looks like minoxidil, as well as being a blood pressure medicine, also will extend that phase for us. Now, minoxidil is the mainstay of treatment for female pattern hair loss. It has decades of data behind it. So for women, there's a women's version and there's a men's version because the studies were done at a lower percentage strength

• 43:59Dr. Mary Claire Haver?

  for hair loss in women at 2%. Men are given the 5%. Every dermatologist I've talked to says, tell women to just do the 5%. Don't pay the ping tax. Go with the higher strength and use it topically. Topical minoxidil comes in a spray. It comes in a foam. It comes in several different ways to apply it. You just have to figure out what's best for you. When I was using topical minoxidil, I've switched to oral and we're going to talk about that. I got the liquid version and it came with a dropper. I found the dropper to be messy and I would get drips on my face and hard to kind of put. So a dermatologist friend told me to put it in a cheap spray bottle. So I bought a little half ounce spray bottle from Walgreens.

• 44:41Dr. Mary Claire Haver?

  Just poured the minoxidil in there and I would divide my hair into sections and just spray along. I'd divide it five ways. So one, two, three, four, five. And I would spray along the hairline, massage it in and go to bed. And I would just sleep like that. I was using a lot of minoxidil topically when I was working as a hospitalist. So and it was super easy for me. My hair was up in a surgical cap almost every single day at work. And so it was easy for me to put the minoxidil on, throw it up in the scrub cap and just forget about it. I didn't have to worry about styling my hair, having it pretty. That topical minoxidil did tend to make my hair a lot harder to style. It tended to make it a little flat and oily. So over time, when I transitioned out of that position to where I was going to clinic every day,

• 45:26Dr. Mary Claire Haver?

  the hair math was getting hard. On top of that, I come from a family with lots of gray hair. My brothers are all silver foxes. My sister has let her gray come in. It's beautiful. I haven't, I obviously have not gotten there yet. I'm at least 60% gray. So I have to color my hair now every two to three weeks, you know, to keep up with the gray. Again, that's my choice. Eventually I will let the gray come in. So just the hair math was getting a lot because it has to be squeaky clean to get the color to stick. So I couldn't have minoxidil in it. And my derm friends were like, "Switch to oral minoxidil." And I was like, "Oh, I can do that." So yeah, so oral minoxidil is typically, you can get it in a 5-milligram or 2.5-milligram dose.

• 46:09Dr. Mary Claire Haver?

  I do the 2.5-milligram and I just break it in half. It's scored. It's super easy for me to break open and I take one of those at night. Just because it's easy, I put it at my bedside with my progesterone and that's when I take it. So I switched to the oral at night. It works great. Some of the unexpected side effects and do not laugh, but I was noticing a little more hair growth in areas that I wasn't used to it. I was with my daughter and she was like, "Mom, Maddie, you have hair coming out of your nose." And I was like, "Excuse me, what?" And I run into the mirror, into my 30X Magnum of eye mirror and did see, yeah, there was a little more hair growth there. So I've learned how to manage that. That is a unfortunate side effect of my minoxidil use,

• 46:52Dr. Mary Claire Haver?

  but one that is easy for me to manage and I understand where it's coming from and it is worth the incredible hair of my head. Those of you on video can see all the baby hairs here. This is from the minoxidil. Minoxidil is a long-term commitment. Whatever hair you gain from using it will go away when you stop using it. So it is not a permanent fix. It's treating a symptom and will only treat it as long as you are using it. And you really have to use it for a consistent six months before you can throw in the towel. Another thing to remember is you will shed when you start using minoxidil, either topical or oral. This is normal. Remember,

• 47:37Dr. Mary Claire Haver?

  we're going to shift some hair into different phases. So I always warn patients, if you want to start minoxidil, you're going to shed. You're going to have this telogen effluvium thing in this first month. Don't worry, the hair will come back, but it is a little freaky because you're taking medication to grow hair and all of a sudden you're losing hair faster. But the medication does work and the daily reality of it can be harder than some people anticipate. So I just like to like put all the warnings up front. It works. It takes a serious commitment. There may be side effects you're not used to. You're going to shed before it gets better. But if you stick with it, you probably will be fairly happy with the results. So oral minoxidil, some fun facts about the oral minoxidil.

• 48:19Dr. Mary Claire Haver?

  A lot of people are worried about potential safety issues. So there's several studies I'm quoting here and most are since 2021. So in 1,400 patients, only 1.2% discontinued due to systemic side effects. So you know, 99-ish% of patients continued the course and were happy with it without side effects. There were no clinically significant blood pressure changes in patients with normal blood pressure. So don't worry about dropping your blood pressure, taking it at this very, very, very low dose. This is, remember the 1.25, you're cutting the two and a half in half. There was no association with tachycardia, which is

• 48:56Dr. Mary Claire Haver?

  rapid heart rate in a large retrospective cohort study done in 2025. No association with pericardial effusion or any heart issues. And all the cardiovascular data is supported across multiple studies. So the studies consistently show that combining minoxidil with an anti-androgen, something that blocks that DHT, that dihydrodistosterone, that's what actually binds at the hair follicle receptors, with or without procedure, outperforms any single treatment for female pattern hair loss. Okay? And we're going to get to those. What are the anti-androgens? Okay, we're going to talk about them. So again, it works great by itself. It works synergistically

• 49:39Dr. Mary Claire Haver?

  when you combine it with an anti-androgen, if you have female pattern hair loss, which most of you who are listening to this this far, this is the number one cause.

• 49:54Dr. Mary Claire Haver?

  All right, so let's talk about the anti-androgens. All right, so two big groups here are finasteride and speronolactone. Oral finasteride improves hair density in many post-menopausal women. It's been studied in female pattern hair loss and better evidence in post-menopausal patients than in pre-menopausal patients. So it seems to be a sweet spot for post-menopausal patients. You can do oral finasteride, and there is actually some topical available as well. Speronolactone has an anti-androgen action. It binds to that DHT receptor. It's really useful in women with signs who also have androgen excess. So acne, they're having unwanted hair growth, they're having irregular cycles, or polycystic ovarian syndrome.

• 50:39Dr. Mary Claire Haver?

  So if you're in our younger patient cohort, we're going to lean more towards speronolactone for you versus a finasteride product. What is the HRT questionnaire? Does HRT really help? HRT by itself, hormone replacement therapy in the form of estrogen plus or minus a progestin is not a hair loss treatment, not. Despite the biological plausibility that estrogen extends anagen, there's really no robust randomized clinical trial or evidence to support that systemic hormone therapy alone reverses female pattern hair loss. So that is a fallacy. Hormone therapy may slow progression by maintaining estrogen's protective effect on

• 51:22Dr. Mary Claire Haver?

  the follicle, but the data is really observational and inconsistent, probably because most of us have multiple causes of hair loss, all contributing to what's happening on our head. Hormone therapy addresses many of the contributors. It can improve your sleep, reduce cortisol-driven stress on the follicle. It supports iron status by reducing heavy bleeding in perimenopause. All right, hormone therapy cannot be the mainline therapy for hair loss. It can help. It could probably help. We don't have great data to prove it, but that is not like if you go in and you're like, I'm losing hair, and they're like, you just need hormone therapy. Stop, no. Okay, so let's talk about procedural options. And I had to do like, these are things that I don't do in clinic. Okay, but there are things I know some about. And Dr.

• 52:07Dr. Mary Claire Haver?

  Erica Kelly and I on the podcast discussed these in detail. But in general, we have PRP, which is platelet-rich plasma. So you, you get a blood draw, they extract blood out, they get a little tube of it, and then they spin it down and they get the platelets from your own blood to facilitate healing and, and with a serum to combat hair loss. This is not usually a standalone therapy. And basically, they pull the blood, they pull out the good stuff that they want, and they inject it into where you're losing hair. But this should not be standalone therapy. You need to have someone who knows what they're doing. You often need multiple treatments. And again, eventually, the processes that cause your hair loss, this is not something you're going to do once and then be done with it.

• 52:52Dr. Mary Claire Haver?

  Microneedling. So microneedling is when we take tiny, tiny needles and poke holes in your head at the scalp. You've, some of you may have microneedling done on different parts of your body. It's, it's treating the dermis and epidermis by causing microdamage that makes your body react in a way that makes the skin and hair follicles healthy in the long term. Okay, it kind of drives healing to the area. So microneedling is particularly effective when combined with minoxidil, likely works by enhancing absorption and inducing a growth factor release to make the hair follicle healthier. There is low-level laser therapy. Again, you need to go to somebody who knows what they're doing.

• 53:35Dr. Mary Claire Haver?

  You want to do an FDA cleared treatment that has, and it has modest evidence. It can be really expensive. If you have a laser done in the hands of someone who doesn't know what they're doing, you can end up worse off. And before, you can end up with scarring. And then, of course, there's hair transplantation, less common in women, but it is available. This can be really effective as a last resort and is best for women who have also gotten medical therapy. So let's talk about supplements. There are some supplements that have been shown to target inflammation and enzymes that can contribute to hair growth, such as palmetto. When I was researching for the new menopause, because of the SHBG we talked about earlier,

• 54:17Dr. Mary Claire Haver?

  a lot of people struggle with signs of estrogen, androgen excess. So basically, their testosterone levels aren't higher, just the activity of that testosterone is higher because their SHBG is lower. And sal palmetto is one of the things that can actually help to combat some of those. I mean, it's an, it's an anti-androgen. So for people who have like phantom smells or have new body odor that they never had before, sal palmetto can be one of the treatment options. And I learned about that when I was researching for the new menopause. Pumpkin seed oil, curcumin, marine collagen. I've seen on TikTok, and you guys may have seen it, people using rosemary oil or making their own rosemary extract by boiling rosemary down and putting that water in a spray bottle.

• 55:00Dr. Mary Claire Haver?

  And there's actually decent evidence to support hair growth there. Most people know about biotin, but I have to tell you, there's essentially no evidence that it helps women unless you have a biotin deficiency. So if you have a deficiency, we want to correct it. Taking mega doses of said vitamins does not give you a superpower. And like in the case of zinc, may also contribute to hair loss. There's a very popular supplement available for, I think, $90 a bottle, $90 a month. That showed like a couple of extra hairs a month. If you want to spend your money on that, that's fine. But outside of a documented biotin deficiency, you might be wasting your money. Action plan. So where do we go from here?

• 55:42Dr. Mary Claire Haver?

  So I've given you a ton of information. I want you to go right now to the show notes and go get your guide. Okay, everything I've said today is in there. Questions to ask your doctor, different treatment options, when to do what treatment and in what order, what labs to ask for to make sure that all stones are being turned for you. We're not leaving anything, no stone left unturned. So I'm going to give you an action plan. Do these five things. Number one, take three photos of your scalp today from above in your part line and the full head and do it under good lighting and repeat that every month. Okay. Go look at old photos that showed that you had more hair and with a photo of today. Just know your baseline so that you can go in with evidence to support your face.

• 56:27Dr. Mary Claire Haver?

  Okay. Number two, schedule a visit with your primary care doctor or maybe your OB-GYN, your family medicine doctor, your internist, and bring in the lab list. Ask, ask, okay? Number three, review your current medication list, okay, and your supplement list. If you've started anything new in the last six months, look up whether or not hair loss is a known side effect. Number four, know your protein intake, audit your protein intake. Women in general are not getting enough protein to support bone, muscle, or hair. So again, chronometer, CRO, N-O-M-E-T-E-R is my favorite app. There is a free version, just track protein and fiber.

• 57:10Dr. Mary Claire Haver?

  I'm always saying to check fiber, unrelated to hair, but it's a good idea. If you're going to check one, just check both and see how much protein you're actually getting every day. And you might be surprised, especially if you're undergoing weight loss, especially if you're on a GLP-1 or had a gastric bypass. You should know this. If you're under 0.8 grams for every pound of body weight, you're probably running low. Most women run about 0.5 to 0.6. So you may need to up that protein in your diet. And if you've been told it's just menopause, women go through this, it's just stress, you deserve better than this. You deserve a workup and not a brush off. So hair loss is not a vanity problem. It is a medical condition with real causes and real treatment options.

• 57:54Dr. Mary Claire Haver?

  And the failure for us to take this seriously is one of the most reliable ways the medical system dismisses the female experience. 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 whole body. You deserve a clinician who treats your hair the way that it would treat any other tissue in your body. You can have your hair back, or at least you can have a fair fight for it. Hopefully, you learned something today and hopefully you will download our free guide and take it to your clinician and get some answers. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr.

• 58:36Dr. Mary Claire Haver?

  Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. Full episodes of UnPaused are available on YouTube at Dr. Mary Claire. UnPaused is presented by Odyssey in conjunction with Good Roommate Media and Long Wave Digital.