Everything I Didn't Know About Hair Loss Until My Dermatologist Sat Down and Explained It

Hair loss is one of those topics that comes up constantly at this age and yet most of the information out there is either too vague to be useful or too overwhelming to know where to start.

So I brought in Dr. Doris Day, board certified dermatologist, clinical professor of dermatology at NYU Langone, and one of the top cosmetic dermatologists in the country, to answer your questions directly. She came in with a bag full of products, tools, and real information and we got into everything.

Here's what I learned…

1. The timing of hair loss is not what most people think.

When you experience stress, your hair doesn't fall out right away. It shifts from the growth phase into a resting phase and sits there for three to four months before it falls out. So by the time you're noticing significant shedding, the stressor is long over. This is why the connection is so easy to miss. 

Dr. Day said when someone comes in with sudden hair loss, the first question she asks is what happened three to four months ago. A divorce, a major illness, a move, or even a wedding. Positive stress counts too because your body doesn't distinguish between good and bad, it just responds to change.

2. Stress shedding and female pattern hair loss are two different things.

With stress shedding you see hair everywhere. On your pillow, in the shower drain, in your brush. With female pattern hair loss it's more subtle. Each strand miniaturizes and becomes finer before it ever falls out. Your part gets wider and your ponytail gets thinner. You might not see as much on the floor, but you'll notice it on your head. Many women have both happening at the same time, which is what makes it so hard to figure out on your own.

3. Perimenopause makes everything more complicated.

During perimenopause, estrogen levels fluctuate wildly. They’re high one month and almost nonexistent the next. That hormonal roller coaster is itself a physiologic stress on the body, which means you can be stress shedding from the hormonal fluctuations while also experiencing the hair miniaturization that comes from lower estrogen overall. 

For women in this season, Dr. Day said that considering hormone therapy is worth a real conversation with your doctor, not just for hair but because it matters for so many other things too.

Now here’s what actually helps and where to start…

Dr. Day was clear that most people are either doing too many things at once or the wrong things entirely and then giving up when they don't see results. Her recommendation for most women is to start simple: one topical treatment, one oral option if appropriate, and red light therapy if you can.

On minoxidil, topical is available over the counter at most drugstores without a prescription and is a reasonable place to start. Oral minoxidil requires a prescription from your dermatologist. She typically starts women on a low dose and adjusts from there. One reassuring thing she said: minoxidil keeps working as long as you use it and doesn't become less effective over time. In studies, 80% of women regrew hair and the hair that came back was up to 50% thicker.

On red light therapy, it is FDA cleared for hair growth and you don't need to spend a lot of money to get results. She likes helmet and hat styles because they're hands free and mentioned Revian and Care Factor as two of her favorites. Anything dramatically overpriced is likely more marketing than science.

On supplements, Nutrafol Balance has the strongest data she's seen in this category. Her 93 year old mother takes it and refuses to run out of it. ExtraSE is a good gummy option for people who don't want to take multiple pills. She recommends not taking multiple hair supplements at the same time because you risk overdosing on certain ingredients.

On shampoo, her top recommendation for hair growth support is Care Factor, which has peptides and botanicals that mimic the growth factors your scalp needs. For a more accessible option, Redken's Acidic Bonding Concentrate makes hair feel significantly thicker within a few washes. For managing scalp inflammation, she recommends an anti-dandruff shampoo with selenium sulfide or zinc pyrithione used once a week alongside your regular shampoo.

Hair changes in midlife are real, they're common, and they're worth paying attention to. What Dr. Day kept coming back to is this: find what works for you, commit to it consistently, and don't try to do twenty things at once because you'll end up doing none of them.

Listen to The Hair Loss Episode: THIS Is What a Top Dermatologist Wants You to Know here or you can watch it here.