Hair Loss
Welcome to another edition of the Doctor's Note where we talk about what's on our minds when it comes to your health.
This week, I welcomed Dr. Joni Sago back to Common Sense MD to talk about something that affects more people than you might think—hair loss. For many, losing their hair is more than just a cosmetic concern. It can be frustrating, discouraging, and even affect their confidence. And while we tend to associate hair loss with men, women struggle with it, too. The causes aren't always simple. Genetics certainly play a role, but so do hormones, thyroid function, iron levels, and even autoimmune conditions. In men, we often look at the role of DHT, a hormone closely linked to male pattern baldness. In women, the hormonal picture can be much more complicated. That's why I believe it's so important to take the time to investigate what's really going on rather than simply labeling it as age-related hair loss.
The good news is that we have more treatment options today than ever before. Dr. Sago and I discussed medications like minoxidil, finasteride, and dutasteride, along with newer options such as FDA-cleared red light therapy. But as with most things in medicine, there's no one-size-fits-all solution. What works for one person may not be appropriate for another. We also talked about some of the everyday things that can make a difference, including how we style and care for our hair, the damage excessive heat can cause, and when hair transplantation might be worth considering. My takeaway is simple: If you're experiencing hair loss, don't just assume it's something you have to live with. Find out why it's happening, explore your options, and make sure you're getting the kind of individualized care you deserve.
PODCAST NOTES
Genetic factors in hair loss are multifaceted and unpredictable. While the common belief is that genetic baldness is inherited from your mother's side, the reality is that pattern hair loss can be influenced by numerous genes from both sides of your family tree. Sometimes the source may even be a distant relative, making it almost impossible to perfectly predict your risk based solely on family history. This complexity underscores why two siblings can have drastically different experiences with hair loss.
Hormonal influences are central, but they differ dramatically between men and women. In men, DHT (a more potent form of testosterone) is the primary driver of hair loss—so much so that men without exposure to DHT, such as boys historically castrated before puberty, almost never develop baldness. In women, multiple hormones contribute, and estrogen, progesterone, and testosterone all play roles, leading to varied presentations and requiring careful hormone assessment as part of the workup.
Scalp circulation and changes with age play an underestimated role. As we age, our scalp tissue often tightens and loses some of its blood flow. The extracellular matrix, responsible for nourishing hair follicles, becomes less "squishy," depriving follicles of vital nutrients and oxygen. This reduction in blood flow can hasten hair thinning and miniaturization, especially in men—but is also a factor for women.
Minoxidil, originally a blood pressure medication, is one of the most effective and widely used options for hair regrowth. Both oral and topical forms are used, but topical solutions can be messy and inconvenient, particularly for women with fine or frontal thinning. Oral minoxidil, at safe low doses, is becoming more popular because of its ease of use and dual benefit—supporting both blood flow and directly stimulating follicles, even though the exact mechanism remains unclear.
DHT blockers like finasteride and dutasteride can be game-changers, but they require thoughtful application and monitoring for side effects. Oral finasteride (1mg for hair loss, 5mg for prostate issues) lowers DHT and can slow or reverse hair loss, with the smaller dose causing fewer sexual or energy-related side effects. Dutasteride, often favored for topical compounding, may have fewer systemic or mood-related side effects, and the two drugs have subtle but important differences worth discussing with your provider.
Women’s hair loss demands a far more thorough medical evaluation than often occurs in routine practice. In my experience, many women are misdiagnosed with simple “female pattern hair loss” when in reality they may have underlying autoimmune conditions (like lichen planopilaris, alopecia areata), thyroid dysfunction, or ferritin (iron storage) deficiency. Each of these requires distinct management, and failure to identify them may render typical hair loss therapies ineffective or delay recovery.
Lifestyle habits—particularly related to hair care—are a major but often overlooked contributor to thinning and breakage. Between frequent coloring, straightening, blow drying, and the use of harsh products, the hair’s cuticle and cortex can become damaged, leading to brittle strands and visible changes under the microscope. Even though most women won’t stop blow-drying altogether, using a high-quality hairdryer with cool settings and minimizing heat exposure can make a substantial difference in hair resilience and appearance.
The timing and continuity of intervention are critical for success in hair regrowth and preservation. Hair loss is a chronic, progressive process, and waiting too long allows follicles to miniaturize beyond recovery. Early action offers the best shot at meaningful regrowth. Furthermore, any progress achieved on therapy (such as with minoxidil or anti-androgens) will be lost if treatment is stopped, emphasizing the importance of viewing hair loss as a condition requiring lifelong partnership between patient and provider.
Hair loss is more than just a cosmetic concern. Sometimes it's a sign that something else is going on with your health. And the longer you wait to address it, the harder it may be to reverse. If you're noticing your hair thinning or have a family history of hair loss, don't ignore it. Find a medical professional who will take the time to look at the whole picture and help you understand your options. Don't just chalk it up to getting older. Be proactive, ask questions, and remember—the sooner you address the problem, the better your chances of protecting both your hair and your overall health.
Stay educated. Stay healthy.
Till next week.
