Menopause Masterclass: Why Your Hair Is Thinning and What Works

0:00Your hair is telling you something about your iron, about your thyroid, about your vitamin D, about your hormones, about inflammation, and the metabolic state of your body. Hair loss is not a vanity problem. It is a medical condition with real causes and real treatment options. You deserve better than it. You can have your hair back or at least you can have a fair fight for it. The views and opinions expressed on on-pause are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for a professional medical advice, diagnosis, or treatment. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University

1:00of Texas Medical Branch. Welcome to Unpost, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. This episode is brought to you by Woop, the wearable health and fitness coach that gives you personalized insights into your sleep, recovery, strain, and overall health so you can empower your day. Woop keeps things intentional by staying screen free. It won't buzz to you to hit a step count, but rather works alongside a companion app to deliver clear, actionable, physiological data. With membership tiers like Woop 1 for everyday performance, Woop peak for long-term wellness, and Woop life for medical grade insights, there's a fit for every goal. Lately, I've been spending a lot of time in Colorado, hiking and getting outside whenever I can, and with how much I travel for work and how busy my schedule can get, I'm always looking for ways to better understand how my body is responding to everything I'm asking of it. That's where I think something like Woop 5.0

2:04wearable could be really helpful. It could give me insights into my sleep, recovery, and strain, whether I'm hiking in Colorado, traveling for work, or simply trying to keep up with a busy week. It can help me recognize when I have the energy to push myself, and when my body might be telling me, it's time to slow down and prioritize recovery. To learn more, head to Woop.com. So before we get started, I want to make sure everyone understands the life cycle of healthy hair. The hair cycle has three phases. We have anagen, which is the growth phase. It lasts about two to seven years, and about 85 to 90% of your hair follicles are in anagen at any given time. We have cattagen, which is the transition phase, and it lasts about two to three weeks. This is when the follicle actually shrinks at the end of anagen. And then we have tealagen, which is the resting phase. It lasts two to four months, and hair sits dormant, and then sheds when the new anagen hair comes up

3:08behind it, pushing it out. So our hair follicles are constantly proliferating and growing. Normal shedding for a woman is about 50 to 100 hairs a day. Anything that pushes a longer than normal fraction of follicles into tealagen, at the same time, shows up as a shed two to four months later. So anyone who's had a baby knows exactly what I'm talking about. Typically, after we deliver a baby because of the hormonal influences that pregnancy had on our hair follicles, two to four months after that baby is born, you will notice tremendous amounts of hair shedding. For a healthy hair to grow, we need certain things. One is adequate protein. We need the amino acid availability. So people who have low protein diets tend to have less hair. We need iron, especially for the enzymes that drive hair matrix cell proliferation. We need a healthy functioning beroid gland.

4:12It regulates the metabolic rate of the entire follicle. We need estrogen as women, which extends our anagen phase, the growth phase, and then we need a stable inflammatory state. That chronic inflammation actually disrupts the normal cycling of hair. So in several of these shipped at once, which is exactly what happens around perimenopause and menopause in postpartum, the follicle falters. There's also a sea saw between estrogen and androgens like testosterone or dihydrotostostoram. Estrogen extends the growth phase of the hair cycle. Androgens, DHT, dihydrotostosterone in particular, shrink the hair follicle over time. And this is important. This process is called miniaturization. A thick, juicy, healthy hair follicle suddenly becomes much thinner, much smaller. An impremenopause estrogen is winning in our hair follicles. In postmenopause, our estrogen levels

5:12drop. And then the androgen effects take over. And the follicle gets smaller with every single hair cycle. So the same shift that's changing your sleep, your bones, and your brain is also changing your hair. Stress is real here as well. Stress does affect the follicle. Cortisol directly suppresses the hair follicle stem cells. Translation, so when you say my hair is falling out from stress, you're not being dramatic. You're describing a documented molecular pathway that we actually know about in science. It's the problem is when your doctor said it's just stress, he's ruling out the dozens of other causes that might be leading to your hair loss and the workup that you actually deserve. And we're going to get to that. Why does medicine dismiss women's hair loss? I have to be honest with you. In my training, I wasn't really taught much about hair loss at all. This is something that is quite common in female patients. I was taught that if it's severe,

6:16we may want to look for some nutrient deficiencies or possible levels of high testosterone, high androgens. But this was severe hair loss, like baldness, basically. Not when a woman came to you and in your eyes, it looked like normal hair. You were just taught to reassure her and that things would probably get better over time. So hair loss turns out is the perfect example of a symptom that sits at the intersection of three medical biases at once. One, it affects women, so it gets under-treated. Studies show that women's pain and physical symptoms are routinely attributed to psychological causes like stress, more than men's, even when the symptoms are identical. Number two, it looks cosmetic. So the medical system treats it as optional. And number three, the standard workup is actually poorly defined. So most clinicians don't even know where to start or what to order. Iron deficiency is the cause that we miss the most. In one day of women with hair loss or alopecia, the medical diagnosis, alopecia, nutrient deficiency was the top cause of female

7:21alopecia. And iron deficiency was found in roughly 70 percent of the women. And most of them had a CBC or hemoglobin from the CBC that was actually in the normal range. A normal CBC, a normal blood count, does not rule out iron deficiency hair loss. And we'll dig into those labs a little bit more to help you understand. So hair loss in women over 40 is almost always more than one thing happening at the same time. So I'm not going to tell you there's one single cause. I'm not going to tell you a bottle of biotin or an iron transfusion is going to simply fix or hormone therapy is going to fix all of your problems. I'm going to walk you through the five biggest categories of hair loss, the pattern that goes with each and the labs that can find it and diagnose it. And then we're going to talk about how to treat it. So buckle up. But first, I want to focus on a few red flags. Number one, scarring alopecious. Okay. These are diagnosis. You cannot afford to miss

8:22because scarring is permanent. If you see any of the following, you must go to your doctor immediately. And a dermatologist most likely is going to be your best bet here. If you have discrete bald patches, little areas of discrete baldness throughout your head, this is called alopecia area. If you have a receding hairline, most female pattern hair loss, the hairline stays normal. Okay, we're just losing it like the part parts getting wider. And we'll talk about this in a minute. But if you were seeing that your hairline is starting to recede, that could be frontal by brosing alopecia again. If not treated, this can be permanent. If you have any patches with scarring, redness, scaling, or a burning sensation, you need to see a doctor immediately. Okay, so we're going to go through the five major categories of hair loss in women. This isn't all of them, but these are the five most common that you are likely going to see. And you may have more than one at the same time. Number one, female pattern hair loss or angrioginetic alopecia is the

9:30medical name for that female pattern hair loss angrioginetic alopecia. The most common cause of hair loss in women over 40. The prevalence climbs through midlife and peaks around or after menopause. What is the pattern? What does this kind of hair loss look like? Often the first sign is a widening part. Okay, wherever you part your hair, you're suddenly noticing that you're seeing more white or flesh color in that area. You may notice thinning across the crown, the crown of your head, though remember the front hair line itself is usually absolutely preserved. Why does this happen? The follicle is still alive, but it is producing thinner, shorter, and less pigmented hairs each cycle thanks to that angriogin sensitivity that I briefly mentioned. So let's go over that one more time. So estrogen dominates and premenopause. We all can agree that. And estrogen promotes hair growth. It keeps the hair in the growing phase. It keeps it thick. It keeps the follicles juicy,

10:32healthy. And then when estrogen declines, angriogin levels might decline as well, but the activity of the angriogins stays elevated and dihydrotasosterone is converted to which actually binds to the hair follicle starts becoming the dominant hormone that is affecting our hair and skin. So we see miniaturization or that hair follicle, those individual hair follicles are getting tinier, skinnier, and less pigmented. This is not reversible without intervention. So that's the good news. And we'll talk about the interventions. Watching and waiting can make it worse. So early treatment matters. So if you are like, whoa, my part is getting wider. You deserve a workout. You deserve to know exactly what's going on. Okay. Number two, so we talked about female pattern hair loss or androgenic alopecia. Number two, tealigen afluvium. If you've had a baby, you know what I'm talking about. If you've had COVID or severe illness, you most likely know what I'm talking about. Tealigen afluvium is when you have that dramatic shedding. I've been through it with both kids.

11:36I've been through it once I had COVID. I've been through it after the flu. Okay. You're in the shower and all of a sudden you are pulling out chunks and chunks of hair, handfuls in the shower on the pillow and the brush. It often starts two to four months after a trigger. There's usually a trigger here. The trigger could be pregnancy, severe illness, a medication, a surgery, a psychological trauma. The brain is working here. A nutritional crash, thyroid disease, a COVID infection, or even just the hormonal turbulence or parimenopause itself. Okay. This isn't a slow gradual process. This is 10 alarm fire. What the hell's going on? I'm pulling out chunks of my hair. When I was still doing obstetrics and delivering babies, I had my postpartum patients calling me in an absolute panic when I first started practicing because I wasn't trained to like let women know this was going to happen and that it would grow back eventually. Once I figured out all these, I would stop the freakouts when I would let them know, hey, at their postpartum visit, which was typically at six weeks,

12:41I would say in the next month or two or three, you are going to start shedding lots of hair. Your hair actually shifted into different phases while you were pregnant. You may have enjoyed thicker hair, you know, bounce your hair and that's going to go away. You're going to lose that hair. And so just knowing this was coming really helped with some of the anxiety around when the shed started to happen. Now, I knew this was going to happen to me, did not make it much better when it did happen to me postpartum. It really freaked me out, but I knew it was going to happen and I knew it would grow back, but it does take up to a year to completely go back to its normal state. So just knowing that might happen. But I do want to talk about GLP ones here specifically. Rapid weight loss from a GLP one receptor agonist is now recognized as a tealagem of luvium trigger. Not because of the drug directly, but because the speed of the weight loss. So it's not like the GLP ones are binding to the hair follicle. It is because your protein energy deficient. Remember,

13:44protein is one amino acids or one of the key things we need for healthy hair growth, the huge metabolic shifts that are happening. It's going to be increasingly common that is more and more women are taking GLP ones. And it's just as important if you're starting on one that you are warned that this might happen. So how does it happen? A system might assault flips a large fraction of the follicles into tealagem at once and they shed simultaneously. Now, this is usually reversible. It is reversible. If the trigger is identified and corrected, but chronic tealagem of luvium when the trigger never resolves can convert to a persistent shedding problem. So typically what patients see is they'll go through a week or two or maybe three of a severe shed. They're in the shower, you know, pulling out this hair, noticing it in their hair brush on the pillows. And then it just kind of slows down and then they go back to their normal daily allotted hair loss. So that is typical tealagem of luvium. The hair, you know, it'll take about a year for everything to come back, but it does tend to come back as long as we can stop the trigger. So you get better from

14:48the illness you recover from COVID, you, you know, your postpartum, you're not pregnant again soon, but there are a few conditions where you will chronically do this because you've got some nutrition deficiency or something that you've not corrected. Number three, iron deficiencies, speaking of nutritional deficiencies, the most missed cause. Like I said before, in one study, iron deficiency was present in 70% of women with hair loss. Most had normal blood counts. Most had normal iron levels, but what was low? Faratin. Faratin, you must check Faratin. We're going to go through the labs again, step by step together. Hair follicles depend on iron for the enzymatic driving matrix cell proliferation. Basically, you need iron to keep hair cells healthy at the cellular level. Iron deficiency reduces our Faratin, which reduces follicle function long before your hemoglobin drops. What does iron deficiency hair loss look like? So the pattern it might mimic the female pattern hair loss, um, tillage in a flu game or both. You might have also

15:53had heavy periods for years and were never told your iron is low. Number four, thyroid dysfunction. 10% of you listening to this have unhealthy thyroid function, if not more. Um, thyroid hormone is one of the master regulators of metabolic rate in every tissue, including the hair follicle. So the pattern and thyroid dysfunction is thinning hair often accompanied by the other symptoms of hypothyroidism fatigue, cold intolerance, weight changes, constipation, mood changes, dry skin, all things we also see in perimenopause. So you deserve to get your blood work checked to see if you're having one or both of these conditions at the same time. Hypothyroidism is the most common culprit, but hyperthyroidism and overactive thyroid can also cause some shedding as well. Number five, other causes usually nutrient deficiencies and some medications. So vitamin D, low D is associated with hair loss in multiple studies and they want to target a vitamin D level

16:56of at least 40. Pay in our clinic because vitamin D is is active in so many other enzymatic processes and tissues and body functions that have, you know, different levels we shoot for. We're looking for 60 to 100 for our vitamin D levels, but for hair it looks like getting it above 40 helps if you have low vitamin D. Vitamin B12 often associated is and is low with a lot of women who are on GLP1s, who are vegetarians, or who are on long term PTIs proton pump inhibitors. So if you're on something like a meprizle or one of the other proton pump inhibitors for a long time, you may have low B12 levels and you deserve to have that checked and then replaced. Zinc, zinc deficiency is also can cause hair loss. So, but on the flip side, excessive supplementation of zinc can also cause hair loss as well. Medications, I'm going to read off this list. Medications that can cause hair loss, ACE inhibitors and beta blockers, ACE inhibitors are a blood pressure

17:57medication, beta blockers are used in several conditions, including hypertension, anticoagulants. So those of you who are in blood thinners, any depressants, SSRIs and Bropoprion are well-butrin are common causes of hair loss. Anti-convulsants, I've seen lots of patients with hair loss on an anticonvulsant, retinoid statins and certain hormonal contraceptions, there are certain progestines, progestigins that have a higher rate of hair loss than others make sure to talk to your doctor if you're noticing you started on a new birth control pill and you're noticing hair loss. All of a sudden. Get into a fall state of mind with pura. Start the season with a free pura plus home diffuser when you subscribe to two cents for six months. Choose from seasonal and best-selling fall fragrances. Swap your cents any time and set a custom schedule so your home always feels like a crisp, cozy autumn day. Bring the sense of fall like pumpkin, apple,

18:59an vanilla home with this exclusive offer only at pura.com. You must remember this presents The Bisexuals. Libby Holman was a sexually fluid blue singer who became famous in the 1920s and then infamous when she was indicted for her husband's murder. Later, Libby began an affair with movie star Montgomery Clifft who had to keep his own bisexuality secret in Hollywood in the 1950s. Also featuring Elizabeth Taylor, Josephine Baker, Drugs or Gs and of course movies. Follow and listen to you must remember this wherever you get your podcasts. This podcast is sponsored by Midi Health. Have you noticed the conversation around menopause is suddenly everywhere? It's trending on social media, celebrities are opening up about their symptoms and conversations that used to happen in whispers are finally out in the open. And honestly, it's about time. For decades, women were dismissed, ignored or told their symptoms were just part of aging. And while I'm glad the conversation is happening, here's the truth.

20:03MediPause care isn't a trend. It's long overdue medical care that women have always deserved. If you've been listening to me, you know this isn't new territory for me. This is my life's work. Helping women navigate parry menopause and menopause with real science. That's why I want to tell you about Midi Health. Midi is a virtual menopause clinic staffed by clinicians who listen, who take your symptoms seriously and never utter the words. It's all in your head. Like me, Midi focuses on your health span, not just your lifespan. That means taking a comprehensive look at your metabolic health, bone density, cardiovascular risk and cognitive function. Because all of it matters. Midi delivers the kind of proactive evidence-based care I've always believed women deserve. And the best part? Women in all 50 states can access personalized care, and it's almost always covered by insurance. So yes, I'm glad menopause is finally getting attention,

21:05but don't settle for noise. Get care from clinicians who are in this with you for the long haul. Book your virtual visit today at joinmidi.com. That's joinmidi.com. Insurance coverage varies. Check with your plan for coverage. So, okay, how do we get the health that you need? I think it's important that you are an informed patient, that you can go in and with confidence discuss your hair loss, what patterns you're seeing, and know what type of workup that you deserve. Because unfortunately, again, as why we discussed this earlier, a lot of us just weren't trained. We were taught this was a vanity complaint, a cosmetic issue, and not a diagnostic red flag, right? Your hair is a vital sign. It's vital sign. And if your hair is suddenly not as healthy as it used to be, then you deserve a workup because there may be something metabolic. There probably is something metabolic going on with you, and we can get to the

22:08bottom of it. So, how to get to help? Well, you're going to need a clinician because you're going to need to get some blood work done, and you might need some therapeutic intervention. Ask for the full workup. That includes at least a fair attend a full thyroid panel, including the free T3 and T4. Those are two different hormone levels of vitamin D, a B12, a blood count, the CDC, and then CMP, which is a complete metabolic panel. Let them know of any of your results. I would all like if you had blood work done recently, make sure you take a copy with you to your clinician's appointment. And if they're all normal, then you need a dermatologist referral. It's not like, oh, everything's normal. Just go home and have no hair. It should be okay. I've done everything. I know how to do as a clinician. It's time to get you in to see the subject expert, which is dermatology, because they may need to do biopsies. They can take hair follicles out of your hair and take a look at the health of it, the miniaturization, et cetera. So let's talk about the lab work. Now, before I start off on this, I'm not going to expect you to take notes while you're doing

23:11housework or driving, listening to a podcast. If you go to the Shemnet section, we have everything that's critical to know here. The full list of labs to order questions to ask your doctor and all of the different treatment options, why they work, and what they work for is all available in a downloadable guide called the HairLoss Guide. So just go to the show notes, click on that, and put in your email, and we will email you this beautiful PDF with everything you need to get the most out of your clinician's visit. Okay, but I want to spend some time on each lab. We're talking about here because they're all really, really important. Okay, number one, I think for this is Faratin. Faratin F E R R IT IN. This measures your iron stores. Your storage iron Faratin is a protein that grabs onto iron and just hangs onto it and stores it throughout your body. It's probably the most common miscontributor to HairLoss. It's the first thing to drop when you're having low iron. Okay, you're either, and why do we have low iron? We're either losing too

24:15much. Hello, 90% of us have dysfunctional uterine bleeding and perimenopause. Or you're not taking enough iron in. You're on a G-O-P-1. You've had gastric bypass. You're a vegetarian. You know, hard to get foods rich in iron. You're in a food desert. There's lots of races. You don't like a lot of iron rich foods. So there are lots of reasons why you might have low iron. But the first thing we see is a decreasing Faratin level. When I was in medical school in residency until about, oh god, maybe 10 years ago, the level of Faratin that was low was 15 nanograms per milliliter. 15 was normal. Well, that's changed. It is now 30. They've doubled it. The baseline, the bottom of normal is 30. Okay, normal still goes up to 100 or higher. So when we're talking about hair, most hair specialists want to see that Faratin at least 40 to 60. Okay, if not higher, some prefer the 70 to 100 range

25:16for optimal hair support. So if the Faratin results are borderline or confusing, you may want to get a full iron panel, including a serum iron, a T-I-B-C, which is total iron binding capacity, and the iron saturation. This can really help clarify whether iron deficiency is actually present. And in general, an iron saturation above 20% is considered to be reassuring. So number two, thyroid testing. It doesn't just measure TSH here. Here, we're trying to get really, really specific. TSH is thyroid stimulating hormone. TSH is produced in the brain, and it talks to the thyroid gland to create this T3 and T4 hormones that go out into the body and do their work, and then T3 is converted to T4 in the periphery. I'm getting in the weeds here. TSH, a lot of clinicians will only order a TSH, and then they'll do a reflex T3 and T4, but most people who diagnosed hair loss and think it's a tributed type of thirties and want to go ahead and get all the

26:17labs up front. So, and then with TSH is best around .5 to 2.5, rather simply within range, specifically for the hair follicle. Number three, vitamin D. Vitamin D, vitamin D, you hear me talk about vitamin D all the time. Levels below 40 are common, common in midlife, 60 to 80% of women who are in postmenopause, who are postmenopausal, will expect to have a low vitamin D level. So, the cutoff for, you know, deficiency is 30 for vitamin D, but low is considered to be less than 60. And in our clinic, we are shooting for a 60 to 100 vitamin D level, and it has been linked to weight gain, increased cancer risk, like lots of things, and it's such a simple thing. Most women do not know what their vitamin D level is, so the next time you're in your clinicians office, make sure you ask for a vitamin D, and certainly if you're having hair loss. Okay, number four, vitamin B12. B12 deserves attention, particularly for women taking a GOP1,

27:21I know many of you are, or that acid-producing medication like omaprizol or PPI's, or if you're following a strict vegetarian diet or a low meat diet, many clinicians like to see a B12 above 500 pycograms per milliliter for optimal neurologic and cellular function. Reasonful thing to check. Okay, and then next is the CBC. That is a really common lab. Most of you will have it at your annual exam, at your well-woman exam. It helps to rill out anemia, it helps to rill out little platelets, it looks at your white cells, your red cells, and your platelets, and their distribution as well as their size. If you're ironed efficient, we tend to see the red cells shrink in size. So it really helps with this workup of looking at low iron levels and anemia. And then the comprehensive metabolic panel, RCMP, what we say in medicine. This is just a general baseline. Look at your metabolic function, your liver, your kidney function. It's not really hair specific, but it's still really important in context, and it is usually drawn routinely

28:25at your annual visit. If there are signs of Androgen excess, meaning higher testosterone levels, or DHT, or Androgen levels, then we would expect things like physical symptoms of acne, of temporal hair loss, specifically of new facial hair growing where you never had it before, chin hair, nose hair, etc. Growing out of your ear, anybody out of your hair? Like, I had one, and it freaked me out beyond, I think that was one of the, I just didn't expect it, and I was like doing something and I lived in the mirror, and I have like a 30x magnifying mirror because my eyesight has dwindled dramatically in menopause, and with age, and I swear to God, it was two and a half feet long by the time I found it. And I was like, how have I been walking around with this giant ear hair? And I had no idea. So just, I just say this story so that you don't feel alone,

29:25and these things happen to me as well. I plucked it, it's never come back again, thank you Jesus, but I'm always looking for it and feeling for it. Okay, so signs of Androgen excess, new hair where you never had it before, scalp thinning specifically at the temples or at the crown, irregular cycles, etc. That's when we need to start checking your testosterone levels. Something called SHBG, SHBG, you'll hear a lot about it, and I did a great podcast with Dr. Jim Simon, he really did a deep dive into SHBG, is steroid hormone binding, clobulin. Okay, so no, we talked about ferritin is like the protein that hangs on to iron. SHBG is a protein that hangs on to estrogen progesterone, antistosterone. It is sex hormone binding, clobulin, it binds those hormones and renders them inactive until the hormone falls off and then it can like be free and go be active in the tissue. So the higher our levels of SHBG are, the lower the activity of our

30:26sex hormones like estrogen and testosterone. When we have a low SHBG, we may have higher activity of our testosterone of our DHG. Our SHBG goes up when our estrogen levels are up, so especially with oral estrogen. So if you are on a very controlled pill for treatment of heavy periods or for contraception, you will have higher SHBG, typically than you would have had without it. That is going to bind the activity of your androgen hormones. Okay, if you have low SHBG, as we see in menopause, you will have higher activity and more free, more of that testosterone that you have circulating will be free and active. What do you want to bring to this appointment when you go? I would take photos, show your scalp from above and your part line and the full head, make sure to take them under the same lighting every four to six weeks. In the intro, I talked about your scrolling through old pictures when you were younger. If you can show what your hair used to look like,

31:28and now what it looks like now, I mean, that's evidence enough. I wish I could just tell you that you could talk to someone and they would believe you right away, but it is nice to have proof in the pictures to make it more dramatic and how serious you are about wanting to get this fixed and evaluated. If you're still having cycles, if you're in perimenopause, premenopause, you know, be specific about your menstrual cycles. How often how heavier your periods are they heavier than they used to be? How many hours can you last with a tampon or with a pad? Are you having to leave meetings, you know, you can't get through the night sleeping in your bed as your mattress a crime scene, you know, on certain days of the month. These are all very, very, very important. Remember, your period should be painless, predictable, and never cause you any drama or trauma in your life. Common does not mean it's okay. Common means it happens to a lot of people. It does not. Normal means common in medicine. It doesn't mean well, you just have to live with it. So, okay, you want to bring your medicines.

32:33So, write down your medication list, your doses, how often you actually take it, including the period in medicines as needed medicines and how often you're actually taking those and any supplements that you're taking. Please bring that all or at least the information so that you have that ready to discuss with your clinician. You want to make note of your diet. How much protein are you and take it in? And so, when I say diet, I want you, before you go to this doctor's appointment, to track your nutrition for a week or two. Download it for nutrition tracker. My favorite is chronometer, C-R-O-N-O-M-E-T-E-R chronometer.com. We do have a partnership with them, so full disclosure. But like my daughter, Catherine, who's now in medical school, her undergrad was in nutrition science. And this was the app they used to track nutrition. It wasn't built for weight loss or calorie counting. You can do all that with it, but it was really developed to track actual nutrition. The database is really, really corny. And so, use a nutrition tracker to track protein intake, caloric intake. If you're in a GLP1, you need to know how many calories you're

33:39getting in. And if you're in a very, very restrictive caloric intake, this could be contributing to your hair loss. If you're not getting in a protein, this most likely is contributing to your hair loss. And any recent weight loss that's not related to medication or doing it on purpose. So, family history, is there hair loss in your mother and your sisters and your grandmothers? How did their hair age with them? That's all very, very, very important. If you work in healthcare, you know your scrubs aren't just a uniform. They're what you live in for 10, 12, sometimes even 24 hours at a time. When you're constantly moving, seeing patients and trying to stay focused, the last thing you need is uncomfortable scrubs distracting you. That's why I were figs. I've worn figs for years because they hold up to the demands of long clinical days. The fabric is incredibly soft, breathable, and has just the right amount of stretch. So, I'm comfortable

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36:45actually use, and then enjoy it for a really long time. Find the fall pieces you'll reach for most at Quence. Download the Quence app for app exclusive offers or go to quence.com slash unpause. Get free shipping on your order and 365 day returns. Now available in Canada and the UK too. That's q-u-i-n-c-e.com slash unpost. I think at a certain point, you just stop wanting your maker for a team to be a whole production. I want to get ready, look like myself, and move on with my day. That's what I like about Jones Road Beauty. Their miracle bomb is such an easy, do-it-all product. You can use it for a little color on your cheeks, some warmth, a touch of glow, even on your lips. One product, a whole lot less fuss. And I really appreciate that Jones Road puts good for you skin-leaving ingredients into their formulas. Because if makeup is part of your everyday routine, it makes sense to think about what you're putting on your skin too. They've just launched their new minimalist defining mascara. The flexible silicone wand separates and defines

37:48each lash for soft, feathery look without the clumps smudging or flaking. It's a simple approach to makeup that makes a lot of sense for real life. Fewer steps, fewer products, and a little more time for everything else you have going on. Modern day makeup that's clean, strategic, and multifunctional for effortless routines. For a limited time, our listeners are getting a free, full-size mascara on their first purchase when they use the code unpaws.checkout. Just head to Jonesroadbeauty.com and use the code unpaws.checkout. After you purchase, they will ask you where you heard about them. Please support our show and tell them our show sent you. So now we're going to talk about treatment. And I'll go over, you know, I had female pattern hair loss. I've had post-shed recently, actually, about three months ago. You guys on video, you can see my hair like it's thinner towards the bottom. I had COVID and the flu kind of back-to-back

38:48last fall. And was really, really ill also launching a book and working my tail off. And four months later, started having tremendous shed. That's all stopped, but I had to reassure myself in the shower. Like, don't freak out. Think what was happening three to four months ago? What was happening? I was like, I was sick. I was sicker than I've been in years and years and years. I was also flying all around the country incredibly rundown. And all of that probably contributed to the tealogy in a fluveum that I was having. But on top of that, I had female pattern hair loss. My part was getting wider. My hair was getting thinner, right? I didn't have any loss of hair line, but I could just tell my ponytail was getting narrower. I used to pop rubber bands as a kid all the time. I couldn't, you know, do more than two twists. And then I was now doing like four. I had like half the volume of what I used to have. And so of course, I got upset about it. So researched hair loss, even though I was a doctor, I've realized I don't know much about it. I didn't know how common it was. And when it had my own lab done and figured out this was hormonally

39:53related to the changes I was going through in menopause. And then got on some treatment therapy. And it's much, much better. So those of you who can see me on video, I still have hair. Hair loss in midlife is rarely one-lever problem, right? We talked about the five main causes, but really rarely is it ever just one. Combination therapy is the rule, not the exception, right? So I can't tell you take this big expensive bottle of biotin or, you know, there's topical treatments, there's oral medications will go through them all. And there's procedures that in combination may stop a reverse or hair loss. But the first step, the first step should be to correct any nutritional deficiencies. Let me say that again, you know, nothing topical, nothing oral, nothing procedural will compensate for an unaddressed iron, thyroid, or nutrient deficiency. Start with those. What is your vitamin D? What is your fairytale? Do you have a normal functioning thyroid? Do you

40:57have normal functioning thyroid hormone levels? You must know those first. Again, I'm not expecting you to pull over and take notes if you're driving. We have all of this in a beautiful guide for you. It'll be in the show notes. You link, put in your email and we will email you the whole guide. Okay. So let's correct the deficiencies. So how do we do that? All right. So iron, let's talk about iron. Most common things. 70% of women have low iron, low ferritin. Okay. How do we? Oral iron is the cheapest and easiest way to get it back up. So eating iron rich foods, but if you can't do that, if you have allergies or don't like iron rich foods or struggling to get them, you can take oral iron, typically taken with vitamin C and often the iron has vitamin C in it and away from calcium coffee and tea, okay, for maximum absorption. 325 milligrams of iron sulfate, typically once a day, twice a day. And what I've learned is you can actually have

41:57the same benefit by skipping, you go every other day with that iron dose. You don't have to take it every day. So some of the gastrointestinal side effects, some of the constipation can be lessened by just taking it every other day rather than every single day. So there is also, and I think massively underutilized, but very, very expensive if you don't have insurance is IV iron. IV iron, I've watched it work miracles and patients. I've seen it work in restless legs syndrome, I've seen it for hair loss, I've seen it for chronic fatigue. I've had IV iron myself when I was in parimenopause and having these crazy heavy periods. In getting ready for this podcast, I looked at the cost of IV iron. Like if you wanted to have it done, it's in the thousands of dollars, it can be. And often you need multiple treatments. So without insurance, it may be cost prohibitive, but it's definitely worth if you have insurance asking your clinician if you're a good candidate

43:00for IV iron, especially if you're on oral iron and you can't get your ferritin level up, this may be kind of critical for you to be as healthy as possible. For thyroid disease, you want to treat to the optimal range, not just the normal range for vitamin D, at least to get that vitamin D serum level above 40 and anagrams per milliliter. And then for protein, it looks like 0.8 to 1 grams for every pound of body weight for women in midlife, especially for those on GLP ones or an active weight loss. I have a substack that we just published about a week before I recorded this video where I talked about, for those of you on GLP ones, how much protein do you actually need? Now we're not talking about protein intake as far as hair loss goes in that substack, but we're talking about where we limited the amount of muscle loss and how much protein that would take. So we will link that substack in the show notes so that you can go and read that if you're on

44:02a GLP one. So the second front, so we've talked about the common deficiencies. Now we're going to talk treatment options, medical treatment options. So, monoxidil. All right. Monoxidil extends the antigen phase of the follicle. So remember back in the very beginning of this podcast, we talked about the three phases of hair growth, antigen, tealigen, and catagen. We want 80 to 95 percent of our hair follicles to be in the growing phase and stay there. And so it looks like monoxidil, as well as being a blood pressure medicine, also will extend that phase for us. Now, monoxidil is the mainstay of treatment for female pattern hair loss. It has decades of data behind it. So for women, there's a women's version and there's a men's version because the studies were done at a lower percentage strength for hair loss in women at 2 percent. Men are given the 5 percent. Every dermatologist I've talked to says, tell women to just do the 5 percent. Don't

45:05pay the pain tax. Go with the higher strength and use it topically. Topical monoxidil comes in a spray, it comes in a foam, it comes in several different ways to apply it. You just have to figure out what's best for you. When I was using topical monoxidil, I've switched to oral and we're going to talk about that. I got the liquid version and it came with the dropper. I found the dropper to be messy and I would get drips on my face and hard to kind of put. So a dermatologist friend told me to put it in a cheap spray bottle. So I bought a little half ounce spray bottle from Walgreens. Just poured the monoxidil in there and I would divide my hair into sections and just spray along, I'd divide it five ways. So 1, 2, 3, 4, 5 and I would spray along the hairline, massage it in and go to bed and I would just sleep like that. I was using a lot of monoxidil topically when I was working as a hospitalist. So and it was super easy for me. My hair was up in a surgical cap, almost every single day at work. And so it was easy for me to put the monoxidil on, throw it up in

46:06the scrub cap and just forget about it. I didn't have to worry about styling my hair, having it pretty. That topical monoxidil did tend to make my hair a lot harder to style. It tend to make it a little flat and oily. So over time when I transitioned out of that position to where I was going to clinic every day, the hair map was getting hard. On top of that, I come from a family with lots of gray hair. My brothers are all several foxes. My sister has let her gray come in. It's beautiful. I have, obviously, I've not gotten there yet. I'm at least 60% gray. So I have to color my hair now every two to three weeks, you know, to keep up with the gray. Again, that's my choice. Eventually I will let the gray come in. So just the hair map was getting a lot because it has to be squeaky clean to get the color to stick. So I couldn't have monoxidil in it. My derm friends were like switched to oral monoxidil. And I was like, oh, I can do that. So yeah. So oral monoxidil is typically you can get it in a five milligram or 2.5 milligram dose. I do the 2.5 milligram and I just break it in half. It's

47:10scored. It's super easy for me to break open. And I take one of those at night just because it's easy. I put it at my bedside with my progesterone. And that's when I take it. So I switched to the oral at night. It works great. Some of the unexpected side effects and do not laugh. But I was noticing a little more hair growth in areas that I wasn't used to it. I was with my daughter and she was like, mom, Maddie, you have hair coming out of your nose. And I was like, excuse me, what? And I run into the mirror into my 30x magnum of eye mirror and did see, yeah, there was a little more hair growth there. So I've learned how to manage that. That is an unfortunate side effect of my monoxidil use. But one that is easy for me to manage. And I understand where it's coming from. And it is worth the incredible hair of my head. Those of you on video can see all the baby hairs here. This is from the monoxidil. Monoxidil is a long term commitment. Whatever hair you gain from using it will go away when you stop using it. So it is not a permanent fix. It's treating a symptom.

48:14And we'll only treat it as long as you are using it. And you really have to use it for a consistent six months before you can throw in the towel. Another thing to remember is you will shed when you start using monoxidil, either topical or oral. This is normal. Remember, we're going to shift some hair into different phases. So I always warn patients if you want to start monoxidil, you're going to shed or you're going to have this tealogen effluvium thing in this first month. Don't worry. The hair will come back, but it is a little freaky because you're taking medication to grow hair and all of a sudden you're losing hair faster. But the medication does work. And the daily reality of it can be harder than some people anticipate. So I just like to put all the warnings up front. It works. It takes a serious commitment. There may be side effects. You're not used to. You're going to shed before it gets better. But if you stick with it, you probably will be fairly happy with the results. So oral monoxidil, some fun facts about the oral monoxidil.

49:16A lot of people are worried about potential safety issues. So there's several studies I'm quoting here and most are since 2021. So in 1400 patients, only 1.2% discontinued due to systemic side effects. So 99% of patients continue the course. And we're happy with it with outside effects. There were no clinically significant blood pressure changes in patients with normal blood pressure. So don't worry about dropping a blood pressure. Taking it at this very, very, very low dose. This is, remember, the 1.25. You're cutting into 1.5. And half. There was no association with TACCA Cardio, which is rapid heart rate in a large research respective cohort study done in 2025. No association with her cardiovascular fusion or any heart issues. And all the cardiovascular data is supported across multiple studies. So the studies consistently show that combining monoxidil with an antichandrogen, something that blocks that DHT, that dihydrodistosterone,

50:18that's what actually binds at the hair follicle receptors with without procedure outperforms any single treatment for female pattern hair loss. Okay? And we're going to get to those. What are the antichandrogens? Okay, we're going to talk about them. So again, it works great by itself. It works synergistically when you combine it with an antichandrogen. If you have female pattern hair loss, which most of you who are listening to this, this far, this is the number one cause. All right. So let's talk about the antichandrogens. All right. So two big groups here are finasteride and sprenal actone. Oral finasteride improves hair density and many postmenopausal women. It's been studied in female pattern hair loss and better evidence in postmenopausal patients than in premenopausal patients. So it seems to be a sweet spot for postmenopausal patients. You can do oral finasteride and there is actually some topical available as well. Sprenal actone

51:21has an antichandrogen action. It binds to that DHT receptor. It's really useful in women with signs who also have android access. So acne, they're having unwanted hair growth, they're having irregular cycles or polycystic ovarian syndrome. So if you were in our younger patient cohort, you were going to lean more towards boron lactone for you versus a finasteride product. What is the HRT question here? Does HRT really help? HRT by itself, hormone replacement therapy in the form of estrogen plus or monisiprogestigen, is not a hair loss treatment. Not. Despite the biological plausibility, that estrogen extends antichand, there's really no robust randomized clinical trial or evidence to support that systemic hormone therapy alone, reverses female pattern hair loss. So that is a fallacy. HRT may slow progression by maintaining estrogen's protective effect on the follicle, but the data is really observational and inconsistent probably because most of us have

52:25multiple causes of hair loss all contributing to what's happening on our head. HRT addresses many of the contributors. It can improve your sleep, reduce cortisol driven stress on the follicle. It supports iron status by reducing heavy bleeding impairment. All right, hormone therapy cannot be the mainline therapy for hair loss. It can help. It could probably help. So we don't have great data to prove it, but that is not like if you go in and you're like, I'm losing hair and they're like, you just need hormone therapy. Stop. No. Okay. So let's talk about procedural options. And I had to do it. Like these are things that I don't do in clinic. Okay, but there are things I know some about. And Dr. Erica Kelly and I on the podcast discussed these in detail. But in general, we have PRP, which is platelet rich plasma. So you you get a blood draw. They extract blood out. They get a little tube of it. And then they spin it down and they get the platelets from your own blood to facilitate healing and with a serum to combat hair loss.

53:27This is not usually a standalone therapy. And basically they pull the blood. They pull out the good stuff that they want. And they inject it into where you're losing hair. But this should not be standalone therapy. You need to have someone who knows what they're doing. You often need multiple treatments. And again, eventually the processes that caused your hair loss. This is not something you're going to do once and then be done with it. Micro needling. So micro needling is when we take tiny, tiny needles and poke holes in your head at the scalp. You've some of you may have micro needling done on different parts of your body. It's it's treating the dermis and epidermis by causing micro damage that makes your body react in a way that makes the skin and hair follicles healthy in the long term. Okay, it kind of drives healing to the area. So not micro needling is particularly effective when combined with monoxidil. Likely works by enhancing absorption and inducing a growth factor release to make the hair follicle healthier. There is low level laser therapy.

54:30Again, you need to go to somebody who knows what they're doing. You want to do an FDA clear treatment that has and it has modest evidence. It can be really expensive. If you have a laser done in the hands of someone who doesn't know what they're doing, you can end up worse off. And before you can end up with scarring. And then of course, there's hair transplantation less common in women, but it is available. This can be really effective as a last resort and is best for women who have also gotten medical therapy. So let's talk about supplements. There are some supplements that have been shown to target inflammation and enzymes that can contribute to hair growth such as palmetto. When I was researching for the new menopause, because of the SHBG, we talked about earlier, a lot of people struggle with signs of estrogen, antigen excess. So basically, their testosterone levels aren't higher, just the activity of testosterone is higher because their SHBG is lower. And salt palmetto is one of the things that can actually help to combat some of those.

55:31It's an anti-antigen. So for people who have phantom smells or have new body odor that they never have before, salt palmetto can be one of the treatment options. And I learned about that when I was researching for the new menopause. Pumpkin seed oil, curcumin, marine collagen. I've seen on TikTok, and you guys may have seen it, people using rosemary oil or making their own rosemary extract by boiling rosemary down and putting that water in a spray bottle. And there's actually decent evidence to support hair growth there. Most people know about biotin, but I have to tell you, there's essentially no evidence that it helps women unless you have a biotin deficiency. So if you have a deficiency, we want to correct it. Taking megadosis of said vitamins does not give you a superpower. And like in the case of zinc, may also contribute to hair loss. There's a very popular supplement available for I think $90 a bottle, $90 a month. That showed like a couple of extra hairs a month. If you want to spend your money on that, that's fine. But outside of a documented biotin deficiency,

56:35you might be wasting your money. Action plan. So where do we go from here? So I've given you a ton of information. I want you to go right now to the show notes and go get your guide. Okay, everything I've said today is in there. Questions to ask your doctor, different treatment options, when to do what treatment and in what order what labs to ask for to make sure that all stones are being turned for you. If you're not leaving anything, no stone left unturned. So I want to give you an action plan. Do these five things. Number one, take three photos of your scalp today from above in your part line and the full head and do it under good lighting and repeat that every month. Okay. Go look at old photos that showed that you had more hair and with a photo of today. Just know your baseline so that you can go in with evidence to support your face. Okay. Number two, schedule a visit with your primary care doctor or maybe your OB-GYN, your family medicine doctor, your internist and bring in the lab list. Ask. Ask. Okay. Number three, review your current medication

57:39list. Okay. And your supplement list. If you've started anything new in the last six months, look up whether or not hair loss is a known side effect. Number four, know your protein intake. Audit your protein intake. Women in general are not getting enough protein to support bone muscle or hair. So again, chronometer, CRO and O-M-E-T-E-R is my favorite app. There is a free version. Just track protein and fiber. I'm always saying to check fiber. Unrelated to hair, but it's a good idea. If you're going to check more and just check both and see how much protein you're actually getting every day. And you might be surprised, especially if you're undergoing weight loss, especially if you're on a GLP one or had a gastropypass, you should know this. If you're under 0.8 grams for every pound of body weight, you're probably running low. Most women run about 0.5 to 0.6. So you may need to up that protein in your diet. And if you've been told, it's just menopause, women go through this. It's just stress. You deserve better than this. You deserve a workup

58:42and not a brush off. So, hair loss is not a vanity problem. It is a medical condition with real causes and real treatment options. And the failure for us to take this seriously is one of the most reliable ways the medical system dismisses the female experience. Your hair is telling you something about your iron, about your thyroid, about your vitamin D, about your hormones, about inflammation, and the metabolic state of your whole body. You deserve a clinician who treats your hair the way that it would treat any other tissue in your body. You can have your hair back or at least you can have a fair fight for it. Hopefully you learned something today and hopefully you will download our free guide and take it to your clinician and get some answers. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating their life at thepauselife.com. Full episodes of Unpause are available on YouTube at Dr.

59:45Mary Claire. Unpause is presented by Odyssey in conjunction with good roommate media and long wave digital.