Q&A: coping with female hair loss; long COVID risk; & Parkinson’s versus benign hand tremors
A deep dive into three hot topics
ICYMI 👉
In this week’s reader-submitted Q&A, we’re tackling these questions:
How do I deal with hair loss after menopause?
How concerned should I be about long COVID?
Is my tremor normal—or is it Parkinson’s?
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: FEMALE HAIR LOSS
You must get this a lot - do you recommend hair vitamins for women after menopause? My hair has gotten a lot thinner with age. Is there anything else I can do? Thank you in advance.
-Lauren
Hi Lauren,
Yes, I do get this question a lot! Specifically, patients often ask me about biotin for hair growth. The data on biotin aren’t terribly compelling, however, there’s a lot of anecdotal evidence that biotin and vitamins like Nutrafol or Viviscal can help. They also probably can’t hurt. (The major downside is their expense.) I do see dermatologists recommending these to patients.
But should they? Let’s dive a little deeper. Female pattern hair loss (FPHL) is the most common type of hair loss during and after menopause. It is also called “androgenic alopecia.” Women usually report being able to see parts of their scalp that they couldn’t before. This is usually most noticeable in the crown and/or top of the scalp. They also notice an increase in short, tiny hairs and a smaller ponytail. This type of hair loss happens when the normal hair growth cycle becomes dysregulated.
FPHL is often hereditary, which means that people who have a family history are more likely to develop it themselves. Hormones, particularly androgens (male hormones that are also present in women), play a key role. Androgen sensitivity in hair follicles may lead to shrinking or “miniaturization” of hair follicles, causing thinner and shorter hairs to be produced. Age is also a factor. With age, hair follicles become more sensitive to hormonal changes, thereby shortening the hair growth cycle and contributing to hair loss. The drop in estrogen levels during menopause also shifts the balance between androgens and estrogens, leading to more noticeable hair thinning. (Let me know if you are interested in the specifics of the hair cycle, and I can explain it in a Q&A next week!)
If you and your dermatologist decide you have FPHL, the first line therapy is usually prescription oral minoxidil or over-the-counter topical minoxidil (i.e., “Rogaine”)—plus or minus spironolactone which helps block the effect of androgens on hair follicles.
Note that hair thinning and loss during or after menopause can be caused by many other phenomena such as stress, iron deficiency, thyroid imbalances, and certain dermatologic conditions. In other words, be careful not to blame your hormones for your thinning hair before ruling out other causes. For example, if your hairline is receding, you might have something called frontal fibrosing alopecia. This type of hair loss can be permanent if left untreated, however treatments do exist. In other words, when in doubt, see a dermatologist for a diagnosis.
I hope this helps!
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QUESTION #2: LONG COVID
What is the straight story with long Covid? I am worried mostly about my parents in their 80s who have had Covid twice now- and my mother has cognitive impairment. How concerned should we be, or is it something that is only a rarity?
- Rachel
Hi Rachel,
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