More than half of women will experience noticeable hair loss by age 50, yet hair and scalp health remain largely absent from many of the conversations surrounding women’s health and aging.
“As we age, we have certain illnesses, so it’s important for us to pay attention to what’s happening with our hair because what most people don’t understand is that our hair is sending a signal,” certified trichologist and hair health and wellness expert DeShawn Bullard tells BlackDoctor.
When hair starts thinning, it can be easy to blame a cosmetic habit, such as wearing extensions for too long.
But thinning can also signal that something more serious is happening.
“It could represent an illness that we may not know is present. Something may be showing up that we don’t know about. So it’s important to pay attention to the little changes happening with our hair and scalp and talk to our doctors about them,” Bullard notes.
Hair changes often send people into panic mode, prompting them to reach for a new conditioner or follow advice from an online creator.
Bullard says a conversation with a doctor can help rule out more serious causes, including high blood pressure, diabetes, or another underlying condition.
Thinning is often one of the first warning signs, yet many women overlook it when it begins.
“They just attribute it to aging or something cosmetic, but it’s important not to overlook it,” Bullard says.
She’s seen it firsthand with the women who come into her clinic, the NouriTress Salon & Hair Clinic.
Another warning sign Bullard frequently sees is excessive shedding.
“If we’re pulling out handfuls of hair, if it’s shedding more than normal, and normal is 80 to 100 hairs a day, if it’s shedding more than that, that’s a conversation where we need to seek expert advice,” she notes.
Temporary shedding can sometimes improve with an at-home protein conditioner or another product designed to reduce shedding. But if repeated treatments do not help, Bullard says it is time to consult a doctor.
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A trichologist will typically begin with a full consultation.
During that visit, the trichologist may ask the client to bring in their medications to determine whether any could be contributing to hair loss.
The next steps usually include a full hair and scalp analysis and a review of the client’s health and hair history.
“When was the last time they’ve been to the doctor? With many Americans not having health insurance during this time, it’s important as a trichologist that I ask these questions because sometimes people come in literally with bags of hair in their hands. It can look like they’ve undergone cancer treatment, and they’ll say it’s from a hair color service that a stylist did. And I’m thinking, hair color normally wouldn’t cause that type of hair loss,” Bullard explains.
Bullard’s role as a trichologist is to take a deep dive into the consultation process, conduct a scalp analysis, and determine whether the issue can be treated in her clinic. If it can, she begins a treatment plan. If it cannot, she directs the client to a primary care physician or another medical professional for additional help.
That referral may be to a dermatologist or a general practitioner who can investigate other health issues. Bullard’s goal is to help clients identify the appropriate next step.
“If it’s something we can begin treating, we set them up with a treatment plan that generally takes about 12 weeks before we start to see significant recovery,” she adds.
For a woman going through cancer treatment, concerns about her health and longevity understandably take priority. Even during that difficult period, however, she can still care for her scalp.
“Some of the things we do include having clients come in for scalp care because the scalp is still skin. We want to keep the scalp healthy so that once treatment is over, the hair has a healthy environment in which to grow back,” Bullard shares.
You can still wear wigs, but maintaining scalp care remains important. Bullard recommends removing the wig regularly and scheduling treatments every two weeks or once a month, depending on your needs.
Treatments such as oxygen scalp therapy may also help. The therapy uses hyperbaric pressure to infuse treatments into the scalp and support the health of this living tissue.
As the hair begins to return after treatment, a healthy scalp can help support that process.
“For cancer patients, one thing I recommend, if they’re comfortable with it, is shaving the hair. We do that for some of our clients because it helps psychologically as they move through the process of recovering their health,” Bullard adds.
If you choose to wear a wig, Bullard recommends taking it to a salon to have it professionally customized to fit your face.
“People don’t always understand that a wig purchased off the shelf is exactly that, a wig off the shelf. Having it customized can help her feel better, and when you feel better emotionally, it can help you along your recovery journey,” she notes.
Hair loss does not affect women only physically; it can also take a toll on emotional and mental health.
“I wish people understood that it is serious. It’s not a joke. We live in a world of social media, and there are so many memes about women’s edges. We make jokes about it. But the Bible refers to a woman’s hair as her crown and glory. A crown is something held in high esteem. If you think about a woman’s hair as her crown and glory, it’s often one of the first things people notice,” Bullard explains.
In the Black community specifically, people sometimes make judgments about social or economic status based on appearance, including hair.
“Emotionally, these things can deeply affect a woman. If she’s experiencing hair issues or losing her edges, it can place her in a state of depression. She may withdraw and begin to hide. She may take on a different persona because she’s struggling emotionally,” Bullard says.
Bullard often sees women become so emotionally distressed that friends begin to notice a change and say, “I see someone different.”
“Sometimes women start wearing styles they normally wouldn’t wear because they’re trying to cover what’s happening. Emotionally, they’re ashamed and feel they just have to accept it and live with it,” she shares.
Bullard hopes more people will understand that hair loss isn’t funny.
“It’s not a joke because we often don’t know why she’s losing her hair. It could be stress. It could be the loss of a loved one. It could be relationship changes. It could be financial difficulties,” she says.
Instead, she encourages more compassion and support.
“Sometimes we notice changes in our friends and say, ‘Your hair looks different.’ That can open up a conversation. There may be something much deeper going on that they’re ashamed to talk about,” Bullard explains.
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Another underlying cause that could be contributing to hair loss is menopause.
“Menopause comes in like a roaring lion, and it can wreak havoc across many areas of the body, with hair being one of them,” Bullard notes. “One of the first things we notice with women going through menopause is thinning hair. Most people don’t understand that estrogen plays a major role in the hair growth cycle. When estrogen levels decrease, one of the things we may see is thinning in the crown area.”
Thinning around the edges may point to traction alopecia or hairstyling practices that pull on the hairline. Thinning in the crown area, however, can suggest that hormonal changes or menopause are contributing factors.
“What I want people to understand is that menopause is simply a stage of life. We need to figure out what support the body needs during that stage so hair can recover,” Bullard adds. “The earlier we detect what’s going on, the better. As soon as you notice thinning in the crown area, seek help.”
Many women respond by covering thinning hair with a protective style. But a style that seems protective can make it harder to monitor the hair and scalp, allowing the problem to worsen unnoticed.
“A year goes by very quickly. Before you know it, you’ve been wearing a protective style for months and then remove it only to discover the thinning is much worse than before,” Bullard shares. “So during menopause, even if you’re going to wear protective styles, make sure you’re treating the hair throughout the process and understanding that hormonal changes are happening in your body.”
Bullard encourages women to ask themselves: What does my body need right now?
Some women choose hormone replacement therapy. Bullard recommends speaking with an OB-GYN or another doctor to determine whether it is an appropriate option.
Others may benefit from DHT blockers, hair vitamins, folic acid, or other supportive treatments, depending on their individual needs.
Black women have a wide range of styling options, from braids and twists to wraps and ponytails.
That versatility still calls for care and caution.
“Styles like quick weaves that are glued down can make it difficult to access and treat the scalp. If you’re trying to recover your hair during menopause, those may not be the best choice,” Bullard says. “If you’re wearing crochet styles or braids, that’s okay. But if you’ve worn braids for three months, take them down and wear your natural hair for a while. Give your hair a break. It’s about creating balance and finding style options that work for you.”
Protective styles can be part of a healthy routine, but Bullard emphasizes the importance of consulting a professional and giving the hair regular breaks.
Product choices should also reflect your stage of life and the specific changes you are experiencing.
During menopause and aging, that means choosing products designed to address changing hair and scalp needs.
Recognizing that need, Bullard created NouriTress Hair Products, a 25-year hair recovery and treatment brand focused on anti-aging hair care and maintaining healthy hair at every age.
“In particular, we focus on women experiencing menopause, hair thinning, shedding, and breakage,” she says. “We developed products that support internal hair development through DHT-blocking vitamins as well as targeted scalp treatments designed to maintain healthy hair growth. You want products that address your specific concerns.”
If your scalp is dry, find products that provide moisture to your scalp. Most people only apply conditioner to the hair itself and never to the area where the problem actually exists.
Dry hair is different from a dry scalp. Someone can have an oily scalp and still have dry hair.
If you have tightly coiled natural hair, you may benefit from steam treatments that open the cuticle and allow deep-conditioning treatments to penetrate more effectively.
The key is understanding the root cause of what’s happening with your hair and scalp and then finding products that address that specific issue.
With today’s technology, women no longer have to guess about what is happening with their hair.
One tool Bullard recommends—and wishes more women knew about—is a scalp analysis.
“We use a microscope that is placed on the scalp to look at how the hair is growing out of the scalp. This gives us a clear understanding of whether hair is actually growing from the scalp,” she explains.
Some people assume they are experiencing hair loss because the scalp appears bare.
A microscope may reveal that hair is still growing but that the strands are extremely fine. Because finer strands provide less coverage, hair thinning can look like complete hair loss.
“If it’s hair thinning, we’re excited because we know our goal becomes providing the nutrition and support needed to produce thicker strands.” Bullard adds. “That’s what I wish everybody knew. Just as we get annual physicals and eye exams, we should consider annual scalp analyses, especially as we age or experience changes in our bodies.”
Even without a scalp analysis, Bullard recommends beginning with a consultation. A professional can help determine whether the concern can be addressed at the salon level or requires medical attention from a dermatologist or primary care physician.
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