What Works – And Doesn’t – For Hair Loss?

People may think of hair loss as a guy thing. But by some estimates, half of all women experience hair loss in their lifetime. And when your social media algorithm gets a whiff? Good. Luck. There are some solutions out there based in science, but not every remedy works for every person — or every type of hair loss. (Yes, there are different types. And the type you have matters!) So today, pharmaceuticals correspondent Sydney Lupkin https://www.npr.org/people/825275572/sydney-lupkin guest hosts the show to talk about causes of hair loss and how to figure out which treatments may be best for you. Interested in more science behind your health? Email us your question at [email protected] mailto:[email protected]. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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  Hey, Short Wavers. NPR Pharmaceuticals correspondent Sidney Lupkin hosting today with a story that starts with Allison Richards, who remembers when she was a little girl, the thing some people noticed most about her was her hair.

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  They're like, oh, your hair is so pretty. It's so long.

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  Allison had long, straight, blonde hair.

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  That was the beauty feature that people commented on.

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  But when Allison was in her 20s, she noticed her hair was changing, getting thinner. Then during COVID, when Allison was living in New York, maybe it was stress, maybe age, she wasn't sure. Something scary happened.

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  There was one day in the shower where just I had hundreds of strands of hair, like fistfuls of hair coming out.

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  Even though it's not, like, threatening, hair loss can be devastating. It can feel like part of your identity is slipping away.

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  It was a very scary experience.

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  And generally, people think of hair loss as a guy thing. But by some estimates, half of all women will experience hair loss in their lifetime. And if that's you and your algorithm gets a whiff, good luck. Lumps in the shower, like clumps, it would come out. And I lost half of my hair.

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  Pumpkin seed oil and minoxidil. It'll decrease hair fall, reduce hormonal hair thinning, and act with-

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  With everything, hair loss, hair growth, hair thinning, dandruff, frizz, dryness, literally everything on my page.

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  And while there are some solutions out there based in science, that science is still evolving. So today on the show, hair loss, what science can tell us about the causes and how to figure out what's best for you or someone you know. You're listening to Short Wave, the science podcast from NPR.

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  We're talking about hair loss. And Dr. Carolyn Go, a clinical professor of dermatology at UCLA Health, has kind of seen and heard it all. She says patients have come to her with all kinds of alleged, quote, you know, solutions they've seen on social media, from onion juice to rosemary oil. By the way, Carolyn says there is one randomized controlled study of 100 people showing rosemary oil could work. There's also a lot of misinformation.

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  Somebody asked me about cucumber today. And I said, you know, I think if that worked, cucumbers would probably be $50 a pop for hair loss. You know, someone would have figured, you know, a way to monetize it.

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  She's also had alopecia areata herself since she was three years old. So she knows what she's talking about on like every level, including when she says that to understand hair loss, it's important to understand hair growth. So here's the deal. Each hair on your head goes through cycles of growth, transition, and rest. The rest phase is called telogen.

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  So it's at the end of that telogen phase is when your hair actually sheds. And when the hair's shedding, it's actually because there's a new hair growing and pushing it out.

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  And usually each strand does this at different times. So all of your hair isn't falling out and regrowing at the same time. Translation, some hair loss is totally normal. Sometimes, however, stress like having a baby or even COVID can cause the hair cycles to sync up. And that causes a bigger shed, but it's temporary.

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  Mostly it's time will tell, and that's really difficult to deal with. You know, you see all this hair coming out. It is this huge change and it seems like the world is ending. But in fact, most of the time, it's fine.

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  That also means that some of the time when people try to remedy it and it seems to work, the temporary hair loss may just be resolving on its own. Maybe wasted some money or time, but on the whole, good news. That said, sometimes hair loss doesn't resolve on its own. Most of the time, it's patterned hair loss or androgenetic alopecia. That's the receding hairline in men. For women, it actually starts with a widening part most of the time. It's hormonal. There are a bunch of other kinds of alopecia, though, and they have different symptoms.

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  Like alopecia areata, or there's these scarring types of hair loss. For the most part, those become very obvious that there's something else going on. So for example, scarring alopecia is often, they can also cause smooth spots. They also often happen with a lot of itching and tenderness and redness, sometimes pimples on the scalp. And so again, it is not always obvious to people who are going through. They might not realize, you know, the extent of it. But usually there's some other signs.

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  For Thea Chasson, the founder and CEO of the nonprofit Bald Girls Do Lunch, she was in her 20s when a hairstylist first pointed out the round, completely bald patch.

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  My hair was long, it was in the back of my head. I had no idea it was there. And she said, "Oh, you have a bald patch in the back of your head. You know, go see a dermatologist."

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  She did and eventually got a diagnosis of alopecia areata, an autoimmune disease. Her immune system was attacking the hair follicles. So it wasn't female pattern hair loss. She wound up getting some steroid injections and it cleared up. A decade later, though, there was another bald patch and now she's completely bald.

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  And there's ways to live beautifully with this.

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  We're not saying that everybody should reach this stage where they just are so comfortable going out bald. It's an option. It's just another option that should become as normal for women as it is for men. If we want to, and I do, I go out bald when I want to. But it's an option and I'm all about putting women in the driver's seat of their life with alopecia.

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  In the last few years, there have been some breakthroughs, new prescription drugs that weren't available when she was going through this.

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  When it comes to trying to treat hair loss, it's important to get a formal diagnosis because different kinds of hair loss respond to different treatments. What works for one kind might be useless for another and waste valuable time saving the hair you do have. But that diagnosis of alopecia areata, or androgenetic alopecia, or one of the others, can be tricky to get. Sometimes, primary care doctors are dismissive and it can be hard to get an appointment with a dermatologist.

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  Now, in today's climate of American healthcare, sometimes it can be frustrating and difficult to get in to see your doctor. So I have a method, what I do. And in fact, I did it this morning, as a matter of fact. Call the doctor's office regularly. And sometimes I'll ask ahead of time, "When do you do your calls to remind people of their appointments? So you have some idea of what time of day they're getting notified of cancellations." And I call them every single day. And I will ask every day, did someone cancel?

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  It sounds pretty frustrating. That's where telehealth companies are stepping in. You can answer a few quick questions online and talk or message with a provider. Then you get a prescription for medication, which is then mailed to your home. Dr. Jessica Shepherd, chief medical officer of HERS, says the company takes women's hair loss seriously. The company knows it's filling a gap elsewhere in the healthcare system.

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  We are going to be there, you know, when you're scrolling your phone, you know, on commercials. That's really how we are exposed or how we introduce ourselves to our community.

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  But HERS is mainly prescribing products, including gummies, for people with hormonal female pattern hair loss, androgenetic alopecia. So Thea Chassin says telehealth isn't always the answer. She says a telehealth visit alone wouldn't have gotten her diagnosis right.

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  They don't know. Because even with alopecia areata, there are lookalike conditions that are completely different. For example, you could have a fungal condition. And yeah, and that's treatable, but you don't want to wait.

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  New drugs to treat alopecia areata were approved in just the last few years. They're called JAK inhibitors. They target the part of the immune system that has become overactive and attacks the hair follicles. A recent review of several studies published in the medical journal JAMA Network Open found that patients had more hair regrowth compared with placebo. But something like that likely wouldn't work for someone with run-of-the-mill pattern hair loss, androgenetic alopecia. Here's Dr. Carolyn Go at UCLA again.

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  In the past, we haven't had a whole lot of options. Topco monoxyl has been around for, I think, 30 years or so now. And does work, but a lot of people find it to be messy and difficult, and it doesn't work necessarily quite as well as people would like.

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  She's talking about what we would normally know as Rogaine, the foam you can buy at the drugstore. It works by lengthening that phase of the hair cycle before it rests and falls out. So you keep more of the hair on your head at any one time. But you're not supposed to use it if you're pregnant or nursing, for example. As for Allison Richards, who first noticed hair loss in the shower, she considers herself lucky. She was able to get to a dermatologist in person who took her seriously. She was diagnosed with androgenetic alopecia, which is pattern hair loss. Now Allison Richards takes oral minoxidil, the same compound in Rogaine topical foam, but in a pill, and spironolactone. Both are being prescribed off-label, meaning they weren't approved by the Food and Drug Administration to treat hair loss.

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  But they're working for her, and her doctor monitors her for side effects.

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  So my doctor, in the beginning, it was not uncommon for her to spend 45 minutes or an hour with me. And she would literally like go through a checklist, like, you know. And it was also, it was all like, we would go through, she'd be like, how, you know, how are you feeling? Like emotionally, physically, mentally? Are you noticing you're going to the bathroom more? Do you have muscle cramps?

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  She also gets regular blood work done to monitor for things like kidney damage. For her, social media has been a mixed bag. On the one hand, she thinks celebrities have created an unrealistic expectation for how much hair women think they should have, when in reality, they're wearing wigs or extensions. On the other hand, she's found that there are hair loss influencers who make her feel seen, and platforms like Reddit, where she can connect with other women who have alopecia. Allison Richards mostly wants other women like her to know they're not alone.

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  There's always going to be somebody to hold your hand, cheer you on. And if you ever feel like your, your beauty is compromised, beauty gets redefined.

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  This episode was produced by Rachel Carlson and edited by Brent Bachman and Rebecca Ramirez. Tyler Jones checked the vax. Kwasi Lee was the audio engineer. Beth Donovan is our vice president of podcasting. Thanks for listening to Short Wave from NPR.

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