Hair loss in women & alopecia: identity, culture and coping

For many Black women, hair is tied to culture and self-expression, and also to a history of discrimination. Some types of hair loss, like traction alopecia and CCCA, are seen more often with certain styles or in women of African descent.

The guide Colorism, hair discrimination & self-image covers hair discrimination and the CROWN Act.

Women who cover their hair for religious reasons may find hair loss is hidden from others but still painful. Tight or constant pulling from any style or covering can add to traction, so gentle, loose styling underneath can help.

Comments like “You used to have such beautiful hair” or “Have you tried this oil?” are often meant kindly. You can say: “Thanks, I’m working with a dermatologist. I’d rather not talk about it at dinner.”

It usually shows as a widening part, thinning near the temples, or a thinner ponytail. Women typically don’t lose all their hair. It most often starts in the 40s, 50s or 60s, but can begin earlier.

Shedding can begin a few months after giving birth, an illness, surgery or a stressful event. Hair usually regains its fullness within 6 to 9 months.

The American Academy of Dermatology names polycystic ovary syndrome (PCOS) as a common hormonal cause, and notes that stopping some hormonal birth control can cause a temporary imbalance. Hair also naturally thins with age.

Thyroid disease can cause thinning, sometimes with hair coming out in clumps. Treating the thyroid condition can reverse it.

After chemotherapy, hair often returns 2 to 3 months after treatment ends, sometimes with a different texture or colour at first. The National Cancer Institute suggests buying a wig before hair falls out if you want to match your colour.

NAAF describes how unpredictable hair loss and regrowth can bring loneliness, sadness, stress, anger, embarrassment, fear or guilt. Feeling hopeful one month and devastated the next is common.

Many people say it helps to focus on how they want to live, rather than on what their hair is doing this week.

A review of 8 studies with over 6,000 people found people with alopecia areata had higher odds of anxiety and depression. The authors urged health professionals to check in on mental health routinely.

NAAF notes that many people eventually reach acceptance and even find something positive in their experience.

Tight, constant pulling from hairstyles can cause hair loss that becomes permanent. Changing to looser styles can prevent it. Colouring, perming or relaxing can also damage follicles.

Gentler habits

• Alternate styles so the same spots aren’t pulled every day
• Choose looser braids, ponytails and buns
• Give your scalp breaks between extensions or weaves
• Speak up if a stylist is pulling too tight

Central centrifugal cicatricial alopecia (CCCA) destroys hair follicles and replaces them with scar tissue. It occurs almost only in women of African descent, usually aged 30 to 40. It often starts as thinning or breakage at the crown, sometimes with itching or tenderness.

Hair lost to scarring does not grow back, so seeing a dermatologist early matters. The British Association of Dermatologists suggests less heat, avoiding tight braids, weaves and extensions, and having relaxers applied only by a professional.

Hair pieces clip or weave into your own hair. Half wigs and toppers cover larger areas. Full wigs come in many styles and colours. Custom medical wigs are called cranial prostheses.

NAAF’s steps

1. Call your insurer before buying to ask about a cranial prosthesis
2. Ask your dermatologist for a letter confirming your diagnosis and recommending one
3. Ask the seller for a medical invoice listing a “cranial prosthesis”
4. Submit your claim with the letter and receipts
5. If it’s denied, read the reasons and appeal

Scarves can be tied or pre-shaped, and beanies and headbands are easy everyday options. If wigs feel hot or itchy, a soft scarf or turban may be more comfortable.

Brow pencils and stencils, semi-permanent microblading, and magnetic or glued lashes are all options. NAAF suggests checking with a dermatologist before brow tattoos, and testing for glue allergies first.

Choosing not to cover can be a powerful step. Protect your scalp with sunscreen or a hat outdoors.

NAAF offers support groups, one-on-one phone support, parent support, a youth mentor program, a wig and makeup guide, and an annual patient conference. Visit naaf.org.

The Scarring Alopecia Foundation is a patient advocacy group for people with scarring hair loss. Visit scarringalopecia.org.

Some stylists specialise in thinning hair, wigs or textured hair. A good one can help you find looks you love without pulling or damage.

Use the American Academy of Dermatology’s “Find a Dermatologist” tool at aad.org. NAAF suggests asking your doctor for a referral to a counselor who understands grief and loss or autoimmune conditions.

In the UK, Alopecia UK (alopecia.org.uk) runs support groups. findahelpline.com lists free, confidential emotional-support helplines worldwide.