What women need to know about hair loss

London, Ont.-resident Marcy Gallant began losing her hair when she was around five years old.

The alopecia advocate says she woke up one morning and noticed hair on her pillow. Her mother investigated and found a bald spot, and Gallant was soon diagnosed with alopecia areata, a condition sometimes called spot baldness.

Over the course of the next decade or so, Gallant embarked on a journey that included numerous doctor visits. Her alopecia areata grew into alopecia universalis, and she eventually lost all the hair on her body.

"When I was a kid, whether it was at school or at soccer, I was always constantly thinking about it," said Gallant, who co-ordinates youth engagement and special projects at the Canadian Alopecia Areata Foundation (CANAAF).

She spent years receiving treatments ranging from lotions to steroid injections, with her hair even growing to shoulder length at one point in her teens.

Now 24, Gallant has fully embraced her condition, and is an advocate for those living with partial or full hair loss.

While hair loss is usually believed to happen mostly in men, experts say that women can also experience it, for a variety of reasons.

According to the Canadian Dermatology Association, roughly 40 per cent of women will have some form of thinning hair by the age of 50. Research suggests that those numbers increase during menopause.

While there are treatments that can slow down the process, there is no cure.

Here's what women should know about alopecia.

Alopecia is a medical term that denotes any kind of hair loss, according to dermatologist Dr. Renee Beach, who runs a clinic in Toronto.

Alopecia can be either scarring or non-scarring. Non-scarring alopecia is the most common form, says Beach.

With the scarring condition, hair follicles are replaced with scar tissue, which can be harder to treat, she says.

"Scarring alopecia is the minority of circumstances, but it's troubling because there tends to be more of an inflammatory component," Beach told Dr. Brian Goldman, host of CBC podcast The Dose.

"I liken it to, instead of growing a lawn of grass, our scalp has replaced the lawn of grass with concrete; and it's a scenario where, oftentimes, once the hair is gone, it's very hard, if not impossible, to regenerate."

In addition to alopecia areata, examples of non-scarring alopecia include androgenetic alopecia, sometimes called male- or female-pattern hair loss, which is predominantly a genetic condition, and telogen effluvium, which is temporary hair loss due to stress.

In the case of pattern hair loss, female-pattern baldness and male-pattern baldness can differ, says Beach.

Female-pattern hair loss or thinning usually occurs along the crown or top of the scalp, and the scalp becomes more visible.

In contrast, traditional male-pattern hair loss features thinning along the temples and behind the crown of the head.

Dr. Lisa Kellett, a dermatologist who also runs a clinic in Toronto, says there are "hundreds" of reasons why women experience hair loss.

For example, androgens — hormones that produce male sex characteristics — are often associated with male pattern hair loss. While androgens play a role in androgenetic alopecia in women, Beach said a variety of other factors can contribute.

"The other component of androgenetic alopecia are genes or genetic factors," she said.

"We know that, when we look at our parents or siblings, our first-degree relatives, that's a very strong marker of how our own hair will progress."

People sometimes erroneously believe that their maternal or paternal grandfathers are responsible for passing down so-called hair loss genes, but Kellet says causes are "multifactorial."

Pregnancy, personal stress and even low nutrients can all contribute to hair loss.

"Some of it can be elicited with a blood test and blood screening, but some of them we really have to look at our own selves and say, 'OK, what has changed in my life in the past three to six months, and how has my body responded to that change?'" said Beach.

Hair loss treatments range from over-the-counter lotions to prescription medications and even scalp injections for hair growth.

"One of the on-label treatments that's been around for over 20 years is using minoxidil," said Beach, referring to a drug more commonly known as Rogaine.

"It's been shown when used both topically and in the last almost 10 years more commonly orally, to be able to extend the growth phase of the hair … and to do this with minimal side effects."

Oral finasteride, sold under the brand Propecia, is authorized by Health Canada for male-pattern baldness, but is sometimes prescribed off-label to women.

"When those are taken in particular dosages, they help to retain hair in those androgen sensitive sites like the crown," said Beach.

But finasteride has been found to cause debilitating side-effects in men, including the inability to feel emotions, loss of libido and even suicidal ideation. In late April, U.S. drug regulators warned there are "potential serious risks" associated with topical formulations of finasteride as well. Although increasingly popular in both Canada and the U.S., the topical versions are not approved by either the U.S. Food and Drug Administration or Health Canada.

Finasteride isn't approved by Health Canada for women, but studies have shown that women who take it can sometimes experience side effects like decreased libido, breast swelling and tenderness, headache and irregular menstruation.

When it comes to dealing with hair loss, however, Beach says it's important to remember two principles: there's no cure, and any treatment only works for as long as patients commit to it.

"I tell patients, treat [solutions] like your toothbrush," she said.

"You've got to use [treatments] as long as you care about keeping your hair and sustaining what you have and perhaps growing a modest bit."

Nonetheless, Beach acknowledges that hair loss can be especially difficult for women, saying that it "does a number on one's self-esteem."

Marcy Gallant underwent various treatments for years, all while wearing hats and wigs to hide her hair loss.

She experienced bullying from her peers during her school years, and slowly took to advocacy to better educate her classmates, while also in some ways working on regaining her own self-confidence.

In high school, she organized assemblies to educate new students about alopecia, in part to avoid the stigma of hair loss.

"Was I 100 per cent comfortable in my own skin? Absolutely not," said Gallant.

"I still hid under a wig for many years after that, but at least I started to experiment with wigs and have fun with them rather than simply wearing them for the sake of hiding."

She ultimately decided to fully embrace her hair loss in Grade 12, shaving her head before her high school graduation photos.

"I love rocking the bald and I love being that representation in the world that we so need," said Gallant.

She says women worried about thinning hair should weigh their options before attempting any and every possible treatment, sometimes at great cost.

"Now that I know that there is a community out there, I feel like maybe I would have reacted a bit differently," said Gallant about her own treatment journey.

She says organizations like CANAAF help provide encouraging, safe spaces for anyone living with hair loss.

"When you do find that community and you find people that you can connect with who have similar lived experiences as you, our stories are the most powerful thing about us," said Gallant.