I Never Thought My Hair Defined Me — Until I Was Told I Was Balding

I have always complained about having thick hair. There’s so much of it that my hairdresser builds an extra half hour into my appointments to account for the additional blow-drying time, and it’s not an exaggeration to say that if I left it to dry naturally, it would take a good few days. 

I’ve always taken having a lot of hair for granted, so when I visited a trichologist while researching an article not too long ago, I was completely unprepared for his diagnosis: the early signs of female pattern hair loss. Balding was certainly not on my bingo card.

Female pattern hair loss (or FPHL for short) is similar to male pattern hair loss in some respects but different in others: “Female pattern hair loss is a gradual reduction in the length and diameter of hairs on your scalp in ‘pattern’ areas — usually over the top of the scalp,” explains consultant trichologist Anabel Kingsley. “At first, hair’s anagen (aka growth) phase shortens, and hairs do not grow as long,” adds Kingsley. “The follicles then start to produce slightly finer hairs with each passing growth cycle.” A single hair growth cycle typically lasts between two and seven years, varying from person to person.

Essentially, the amount of hair you have decreases over time. But instead of developing bald spots like men tend to, Kingsley says that women experience a more ‘spread out’ loss of density that results in a wider hair part and increased scalp visibility. This is especially noticeable if, like me, you have dark hair.

As soon as the trichologist said the words “female pattern hair loss”, I started bargaining for a different diagnosis. Surely that’s not right, I thought. I get Brazilian blowdries, color my hair, straighten it a lot, and tie it up with hair bands that are probably too tight. I assumed that it must be any of those things causing damage and contributing to a bit more hair loss than usual rather than my follicles starting to slack. Patiently, the trichologist showed me what he could see under the microscope. It was easy, then, for even my untrained eye to see that the follicles were smaller and dramatically sparser on the sides of my head than at the back. Unfortunately for me, the trichologist hinted that it would only get worse. 

I’m not angling for a sympathy vote, but I did want to know why it was happening to me. Was it because I had been overprocessing my hair? Was it my lifestyle? My genes? According to Kingsley, experts don’t completely understand the causes of female pattern hair loss yet: “It is thought to be linked to a variety of factors,” says Kingsley, including “genes, hormones, lifestyle, environment, and a state of health.” In teenagers, Kingsley has often seen female pattern hair loss linked to polycystic ovary syndrome (PCOS). I don’t have PCOS, so the cause of my female pattern hair loss must be one (or possibly more) of the many other factors Kingsley mentioned. 

I was pregnant at the time, so I couldn’t undergo the blood tests needed to investigate further. Honestly, I brushed it off when I left the trichologist’s office. With all the extra estrogen during pregnancy, my hair was incredibly thick. But the reality of female pattern hair loss soon hit when I experienced postpartum shedding.

The amount of hair I lost after having my baby was extreme. Not a few hairs here and there, but clumps upon clumps of it coming out in the shower. Loose strands followed me around the house and I’d find them everywhere — in drawers, in the washing machine, nestled in my baby’s tiny palms. My vacuum cleaner — designed to be so good at picking up hair that it’s marketed for people with pets — could hardly keep up with the sheer amount of strands on the carpet. Friends reassured me that this so-called “big shed” lasts for two weeks and then be over. Mine went on for eight. Every week, I looped my scrunchie one more time as my ponytail got thinner and thinner.

The impact on my confidence was huge. At best, I didn’t want to wear my hair down so people couldn’t see how thin it had gotten, and at worst, I didn’t want to go out at all. My sense of self was already so distorted with the physical and emotional changes of being six months postpartum that I barely recognized myself in the mirror. That was when it hit me that dealing with thinning hair wasn’t just going to be a temporary phase for me due to hormonal re-adjustment, but likely a very real part of my future. 

I hadn’t appreciated how much of my identity was tangled up in my thick hair until I didn’t have it. After years of trying to make my hair smoother, sleeker, and straighter, I now wished it could be fuller and bouncier again. I felt exposed without it, like I no longer had a comfort blanket to shield myself from my heightened emotions. I felt guilty, too, for being obsessed with — and devastated by — something that on paper seemed so frivolous. I thought putting this much weight on my appearance was shameful and a poor example to be setting for my daughter.

Both sadly and reassuringly, Dr. Alia Ahmed, a dermatologist specialising in psychodermatology at GetHarley, told me that I am not alone in finding hair loss — and the prospect of more hair loss — difficult to deal with: “Female pattern hair loss has been specifically linked to depression, decreased life quality, poor self-esteem, and negative body image,” she says, adding, “Studies have shown women report hair loss as worse than the dermatologist’s assessment, indicating a disproportionate impact on their mental health.” Dr. Ahmed says she is seeing more patients with female pattern hair loss and associated mental health conditions, but it is not always clear which may have come first. Perhaps ironically, stress can worsen hair loss, and this may become a vicious cycle, says Dr. Ahmed.

Trust me, I’ve tried, and it’s pretty much impossible not to be stressed about losing your hair, especially considering the pressure society and beauty standards place on having thick, luscious, and healthy lengths, which is so often linked to femininity. Dr Ahmed’s comments on the gap between the diagnosis and how women view the extent of their hair loss struck a chord with me, too. When I confided in a close friend about my hair loss, she told me that at the height of experiencing telogen effluvium, a type of hair loss triggered by stress, she gathered all of the hair she had lost in a month and took it to her trichologist in a plastic sandwich bag. She wanted to know what was ‘normal’ and if she fitted into that bracket. Quantifying ‘normal’ hair loss is difficult; what feels like a handful to one person may seem like just a few strands to another, especially when you're too distressed to think rationally.

Now, eight months after the shedding had stopped, my post-patrum regrowth is slowly coming through, and I have a teeny tiny full fringe beneath the rest of my hair. It’s making styling a nightmare, but I don’t want to be ungrateful that it is returning. I haven’t had any treatment for my female pattern hair loss just yet, but I have started to look into my options. As Kingsley said, there’s no one clear cause, which, annoyingly, means there isn’t one wonder cure. 

The best place to start, though, is a medication called minoxidil, which increases blood flow to the hair follicles, stimulating them to enter the growth phase. It typically takes a minimum of six months to see results. “Minoxidil is the most well-researched and studied treatment for female pattern hair loss,” Kingsley says. It is usually applied topically to the scalp and is available over the counter at places like Walmart and CVS. Minoxidil can also be taken in pill form if you have sensitive skin. It's important to note that there are a few potential side effects of both treatments, including scalp irritation, lower blood pressure, and a possible increase in heart rate.

Besides minoxidil, there are more expensive options like platelet-rich plasma injections (PRP), which use your blood to stimulate hair follicles, and low-level laser therapy (LLLT), which delivers light energy to the scalp and is said to boost hair growth. “In all instances, alongside a topical or oral treatment, you should take a holistic approach that optimizes all things which can impact hair growth and health,” advises Kingsley. Managing stress, eating a balanced diet, and taking good care of your scalp, such as washing your hair regularly, are especially beneficial.

Additionally, beware of anything that sounds too good to be true: “Non-medicated peptide and growth blends can help normalize hair shedding and prolong the growth phase, but they are not a treatment for female pattern hair loss and won’t grow back hair,” says Kingsley. She adds, “I would also avoid buying into any brand that uses before and after pictures of alopecia areata [a patchy autoimmune hair loss] in their marketing as it’s incredibly misleading.” It often overlooks the complexity of the multiple reasons for hair loss.

As someone who considered having thick hair a key part of their identity, I could never have imagined that female pattern hair loss would be a part of my life in my 30s. There are good days and bad days, but generally, I feel positive knowing that there are things I can do to reduce how noticeable it becomes. In the meantime, I’ll try to be kinder to myself when the psychological weight of it all feels too heavy. On the plus side, thinner hair might save me time at the hair salon — and I’ll take the small wins where I can.