How Cancer, Alopecia and More Affect Hair Loss and Emotional Response

Hair loss in women: why it happens and what to do about it.

Blondes do have more fun, especially Heather and Kelly. The sisters have the same blue eyes, freckles—and golden-tressed wigs.

Heather and Kelly have been coping with female pattern hair loss since their mid-40s. They’re not alone. According to the American Academy of Dermatology, about 30 million women are dealing with it in some form.

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Thyroid dysfunction, autoimmune disease and chemotherapy are among the things that can cause hair loss in both sexes. But, as the name implies, Heather and Kelly’s androgenic alopecia is a matter of genetics, not disease. “Unless aging is a disease,” Heather quips.

As they age, men and women can see signs of androgenic alopecia, but the condition presents itself differently. “In men, most of the time, the hair loss starts on the vertex of the scalp—what we call the bald spot—and/or there’s a recession of hair in the frontal scalp’s temporal triangles,” says Dr. Franziska Ringpfeil, a dermatologist in Haverford. “In androgenic alopecia’s final stage, the man will have a rim of hair remaining on the lower temporal scalp and the back of the scalp, and that’s it.”

In women, however, hair usually begins thinning over the parietal scalp—the top-front part of the head. In most cases, the hairline doesn’t recede, but it does thin considerably. Most women won’t become completely bald from androgenic alopecia, but the thinning will progress and is irreversible.

Blame it on hormones—the “andro” part of androgenic alopecia. Simply put, testosterone is bad for women’s hair, and estrogen is good for it. Aging shifts the testosterone-estrogen balance and can trigger androgenic alopecia. When the estrogen ebbs and how much hair loss occurs are largely determined by genetics.

As such, there isn’t a lot women can do to prevent or control hereditary hair loss. But that doesn’t stop them from trying. “There are so many products that promise to help,” says Heather. “It’s a question of how much time and money you want to spend on them.”

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Carol, who lives near Heather and Kelly in Lower Merion Township, went to see a physician with expertise in hair loss. “It was very disappointing,” she admits. “It took thousands of dollars in blood work—some paid through insurance, some not—for him to advise me to take vitamin C, lysine and iron supplements. That was a waste of time and money. And I didn’t really want to try Rogaine for women because, while it’s supposed to help retain existing hair, it hasn’t been proven effective in regrowing hair. Then someone told me to go see Liz.”

That would be Liz Stelmach, the Main Line’s queen of wigs. Tucked into her Salon Ziza are Stelmach’s private wig rooms, which have the simple glamour of celebrity dressing rooms. Lining the walls are head forms topped in faux hair of all colors, lengths and styles.

“Once I know what style they want, the next option is human or synthetic hair,” Stelmach says.

Synthetic hair can be colored to match a client’s real hair; it can be styled in a variety of ways; and it’s less expensive. But it doesn’t last as long as human hair and can get matted without proper care. And human hair also has its drawbacks. It’s more fragile and more expensive.

If price is a deterrent or the client’s hair loss doesn’t demand full coverage, there are other choices. Wefts are layers of hair that fit around the head, ear to ear. Stelmach attaches them with her specialized knotting technique to avoid damaging existing hair. Top pieces are another option. They can be used for everyday wear or to add drama for special occasions.

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Carol decided on an option she found at JA Alternatives, a Marlton, N.J., salon. Every six weeks for 90 minutes, Carol gets Interlink, a weave-like system that knots four faux strands of hair to one real strand. Does the hair fall out of the knots? Yes. Can people see the knots? Quite often, says Carol, who’s considering hair transplant surgery.

Why not try a wig? “The biggest problem is not my hair or my scalp, but the brain underneath that struggles with the emotional part of the hair situation,” Carol says. “I haven’t talked to my husband or my teenage kids about my hair loss, and it’s been five years that I’ve been dealing with it.”

Heather and Kelly can relate to Carol’s struggle. Neither of their husbands see them without their wigs or the soft caps they wear to bed. “We have a ‘don’t ask, don’t tell’ policy about hair—and a few other things,” Heather says. “Husbands learn that fast.”

The sisters are content with their wigs. “Someone told me that most of the Real Housewives wear hair,” says Kelly. “So if they ever do The Real Housewives of the Main Line, we’ll fit right in.”


Wigs, top pieces, wefts, faux bangs … These gals have done it all. Sources:, New York Times

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