Losing Your Hair in Midlife? Here’s Where I’d Start
Maybe you’ve noticed more hair than usual in the shower drain or your hairbrush. Your ponytail feels smaller. Your part looks wider. Or perhaps you’ve caught sight of an old photo and realised just how much your hair has changed over the past few years.
Hair loss can be incredibly distressing. And worrying about it doesn’t make you vain. Our hair is tied up in how we see ourselves, so when it starts to change, it can really affect how we feel.
It’s also something I’m seeing more and more in clinic.
The frustrating part is that women are often told it’s just hormones, just stress, or simply part of getting older. But hair loss in midlife is rarely that simple. Perimenopause can absolutely play a role, but so can low iron stores, thyroid issues, rapid weight loss, inadequate protein or overall food intake, illness, chronic stress, some medications, PCOS and nutrient deficiencies. Often, there’s more than one thing going on.
If your hair is changing, the first step is to work out what type of hair loss you may be dealing with and what could be driving it. The woman whose hair started shedding three months after a major illness may need a very different approach from the woman whose part has been gradually widening over several years.
First, what type of hair loss are we dealing with?
Not all hair loss looks the same, and this matters.
If your part is getting wider, your ponytail feels smaller or you’re noticing more scalp showing through around the crown, this may be female pattern hair loss. This tends to happen gradually. Rather than suddenly losing large amounts of hair, individual hairs become finer and shorter over time, so overall density slowly decreases. Genetics can play a role, as can sensitivity to androgens, and it often becomes more noticeable around and after menopause.
If you’re suddenly finding much more hair in the shower, on your pillow or in your brush, you may be experiencing telogen effluvium, sometimes described as the “big shed”. One of the tricky things is that it often starts two to four months after the trigger, so women don’t always connect the two. Common triggers include illness, surgery, major emotional stress, postpartum changes, medication changes and rapid weight loss. I’m also thinking about this more often now in women using GLP-1 medications, particularly when weight loss has been fast or protein and overall food intake have dropped significantly.
Patchy hair loss is a different pattern again. One possible cause is alopecia areata, an autoimmune condition affecting the hair follicles, although there are other causes too. Smooth, clearly defined bald patches deserve a proper assessment rather than simply being put down to stress or hormones.
And some patterns need more urgent attention. A progressively receding hairline, loss of eyebrow hair, or a scalp that feels painful, burning, red or significantly scaly can sometimes point to an inflammatory or scarring form of hair loss. These are important to identify early because permanent follicle damage can occur, so I’d recommend prompt assessment by a dermatologist with an interest in hair disorders.
What could be driving it?
Once we’ve looked at the pattern, the next question is what might be contributing. And in midlife, there is often more than one factor at play.
Hormonal changes are one possibility. As oestrogen levels fluctuate and eventually decline through the menopausal transition, changes in hair density, growth and texture can become more noticeable. But I’m always cautious about blaming everything on hormones. Just because hair loss begins in your 40s or 50s doesn’t automatically mean perimenopause is the only cause.
Iron stores are high on my list, particularly if you’ve had years of heavy or prolonged periods. I also want to see the actual result, not simply hear that it was “in range”.
Thyroid function matters too. Both an underactive and overactive thyroid can contribute to diffuse shedding or thinning. If hair loss is sitting alongside fatigue, feeling unusually cold or hot, changes in weight, constipation or dry skin, thyroid function is certainly something I’d be thinking about. Family history matters too, particularly when autoimmune thyroid disease is part of the picture.
Rapid weight loss and under-eating are becoming increasingly relevant. Hair is not essential tissue for survival, so when the body suddenly has much less energy or protein available, hair growth can take a back seat. This is one reason rapid weight loss, restrictive dieting and significant drops in food intake can trigger shedding a few months later. I’m thinking about this more often now with GLP-1 medications. These medications can be incredibly useful for the right person, but if appetite drops so much that you’re barely eating, losing weight very quickly or struggling to meet your protein and nutrient needs, hair shedding may follow.
And yes, protein matters. Hair is largely made from keratin, a protein, so I always want to know whether a woman is actually eating enough, particularly if she’s actively losing weight, exercising regularly or finding her appetite has disappeared.
Sometimes the trigger happened months ago. A major illness, surgery, significant emotional stress or high fever can disrupt the hair cycle, with shedding only becoming obvious two to four months later. This is why I often ask women to think backwards: what was happening in your life a few months before the shedding started?
I also want to know about medications and recent changes. Did you start something new? Stop something? Change the dose? Begin a weight-loss medication? Change contraception or hormone therapy? This doesn’t mean you should stop prescribed medication because you suspect it’s affecting your hair, but the timing can provide an important clue.
Finally, if hair thinning is happening alongside acne, increased facial or body hair, irregular cycles or a history of PCOS, I’m thinking about androgens and metabolic health too.
You might be in perimenopause and have low iron stores from years of heavy periods. You might have started a GLP-1 medication and be struggling to eat enough protein. You might have a genetic tendency towards female pattern hair loss that became more noticeable after a period of major stress.
That’s why I rarely see hair loss as a one-supplement problem. The goal is to work out which pieces of the puzzle actually apply to you.
So, what would I investigate?
There’s no single blood test for hair loss, and what’s appropriate will depend on your symptoms, history and the pattern of hair loss. But as a starting point, these are some of the tests I commonly consider in clinic and may suggest discussing with your GP:
Full blood count
Iron studies, including ferritin
Vitamin D
Thyroid function tests: TSH, free T4 and free T3
Thyroid antibodies: TPOAb and TgAb, particularly with a personal or family history of autoimmune thyroid disease
Vitamin B12
Zinc
Total testosterone
SHBG
Calculated free testosterone
DHEA-S
I’ve put together a simple Midlife Hair Loss Checklist that you can download, work through and take to your next appointment.
Hair loss in midlife can be incredibly frustrating, but the first step is working out what type of hair loss you’re dealing with and what might be driving it.
And remember, ask for a copy of your blood results. If you’d like help making sense of them and understanding what they might mean in the context of your hair loss, bring them along to an appointment and we can work through them together.
Know someone else struggling with hair loss in midlife? Send this article to her. She may find it helpful too.
Bobbie x