Alison Richards first noticed her long blonde hair thinning and falling out in her 20s. “There was one day in the shower where I just had hundreds of strands of hair, like fistfuls of hair coming out,” she remembers. It was terrifying, she says.
By some estimates, half of all women will experience hair loss at some point. Online searches can quickly lead to ads and influencers promising cures; celebrities also set unrealistic expectations, often aided by wigs or extensions, says Richards.
Some evidence-backed treatments exist, but no single remedy works for everyone or for every type of hair loss. Here are key facts to understand and next steps to get help.
Hair growth is cyclical
Dermatologist Carolyn Goh explains that each hair goes through growth, transition and rest phases. When an old hair sheds, a new one usually pushes it out. Shedding normally happens in a staggered pattern; seeing a clump of hair in the drain doesn’t automatically mean a bald spot is coming. However, major stresses — childbirth, illness or infections such as COVID — can synchronize hair cycles and cause a larger, temporary shed. Most of the time, hair regrows on its own.
When hair doesn’t return
The most common cause of permanent hair thinning is androgenetic alopecia (female pattern hair loss), which progresses with age. In women it often begins at the crown; you may notice a widening part and more visible scalp. Less common causes include alopecia areata, an autoimmune condition that causes one or more round bald patches, and scarring alopecias, which can produce bald areas often accompanied by itching, tenderness, redness or bumps.
Why a diagnosis matters
Different types of hair loss respond to different treatments, so seeing a clinician for a diagnosis is important. That can be challenging: dermatology appointments may be months away, and primary care clinicians sometimes minimize the concern. Thea Chassin, who has alopecia areata and founded the support group Bald Girls Do Lunch, urges persistence when seeking dermatologist appointments, even calling repeatedly to catch cancellations.
Telehealth can be an option for quicker access. Some services let you answer questions online and consult remotely, then deliver prescriptions. But be cautious: many telehealth providers focus on androgenetic alopecia and may not reliably diagnose less common conditions like alopecia areata or fungal scalp disease. If you’re unsure what’s causing your loss, an in-person visit is often best at first.
Treatments: old and new
Topical minoxidil (Rogaine) is available over the counter in foam form and can lengthen the growth phase of hair, helping more hairs remain on the head. It’s effective for pattern hair loss but can be messy and is not recommended during pregnancy or breastfeeding.
Minoxidil is also used orally in some practices. Richards is taking oral minoxidil plus spironolactone, a medication some clinicians prescribe off-label for female pattern hair loss; her dermatologist monitors her for side effects.
For alopecia areata, a newer class of drugs — JAK inhibitors — has been approved in recent years. These target immune pathways that attack hair follicles; clinical reviews have shown improved regrowth compared with placebo. Steroid injections into the scalp are another established treatment that has induced regrowth for many with alopecia areata.
Living with hair loss
Chassin, who regained hair after steroid injections years ago and later lost it again, emphasizes that it’s possible to live beautifully bald or to use scarves, hats, wigs and other options. She believes acceptance — making baldness a normalized option for women as it is for men — should be more common.
Support can be crucial. Richards found community in online forums and with others who have alopecia. “There’s always going to be somebody to hold your hand, cheer you on,” she says. If hair loss affects your sense of beauty, she adds, “beauty gets redefined.”