When Kim Laudati realized she was losing her hair, every glance at the mirror was torture. She had always been proud of her long, lush hair, and she was shocked when she could see through it, right down to the crown of her scalp. “I guess I hadn’t been paying attention,” she recalls. “But one day I caught my reflection in the bathroom mirror, saw my scalp, and freaked.”

Laudati, an aesthetician who owns and operates the eponymous Midtown skin-care salon Kim Laudati Skin Care, was 40 at the time. Suddenly she started to notice that she was shedding strands of hair almost everywhere she went. “On my shirt, on the couch, on the car seat—it was unbelievable” she says. “I couldn’t figure out what was going on, especially since I’ve always eaten well, am fit, and had no health concerns.”

Clearly, in a culture in which a dense head of hair is an integral part of our perception of femininity, losing your hair or seeing it turn baby-thin can be traumatic.

Thinning hair is typically thought to be limited to men—but some 40 percent of women have visible hair loss by the time they reach age 40. “I’ve had women come to my office crying,” says one dermatologist. “They say they can’t believe this has happened to them.”

However, there is good news: “Many women get improvement, even if it means just stopping further hair loss,” says New York dermatologist Francesca J. Fusco, M.D., who specializes in hair loss. “The earlier you start treatment, the better. And frequently, regrowth is a possibility.”

Why It Happens

There are plenty of reasons—from genetics to medications—why hair can fall out or thin. Before you start any hair-loss treatment, you need to know the cause of the problem, just in case that loss is a symptom of something more serious. Here are the usual reasons:

Hormones: The most common cause of hair loss in women is androgenetic alopecia, also called female-pattern baldness, a hereditary condition that affects about 30 million American women. When men have hereditary hair loss, they usually develop the telltale receding hairline and bald spot on the crown. However, women generally experience gradual, diffuse hair thinning all over their scalp, especially on top of the head. The condition can start any time after puberty, but it often accelerates at menopause. As women enter their 50s, 60s, and 70s, they often notice that their hair isn’t as thick anymore.

Stress has also been linked to hair loss and a condition called telogen effluvium. This can cause a sudden loss of hair (up to 70 percent), usually months after a specific event—childbirth or a period of intense stress (for instance, having surgery or a death in the family). When the short-term situation passes, hair frequently grows back. 

Diet and Disease: Other common causes of hair loss include crash dieting; not getting enough protein, iron (anemia), or B vitamins (especially biotin and folic acid); too much vitamin A; autoimmune disorders such as lupus or rheumatoid arthritis; thyroid imbalance; general anesthesia; Accutane; beta-blockers; the antidepressants Prozac and Zoloft. “It’s important to talk with a doctor to see if there’s an underlying hormonal or medical issue that might be causing your hair loss,” says Spencer Kobren, president of the American Hair Loss Association.

Hairstyling: “Braiding, tight hair buns or ponytails, and extensions are the most common styling causes of hair loss,” says Dr. Fusco, an assistant clinical professor of dermatology at Mt. Sinai Medical School. “If you want extensions, go to a pro who really knows how to do them. This is not something you want done at your local nail salon,” she says. “Sew-in extensions are more damaging to the hair than glue-in ones. But whatever you do, you should go back to your stylist for maintenance at least once a month to make sure the extensions are on properly or are not pulling at the hair.” She recommends the Upper East Side Davide Torchio Salon.

And what about hair dyes? Despite rumors, hair dyes are safe, as long as they are applied according to their directions and don’t burn the scalp, says Robert M. Bernstein, M.D., clinical professor of dermatology at Columbia University’s College of Physicians & Surgeons. But too-frequent bleaching or permanents, or use of gels, relaxers, and hair sprays, can cause damage and breakage to the hair itself.

What’s Worth Trying

Some hair loss drugs are available only by prescription. Like all drugs, they can cause side effects that should be discussed with your doctor.

Minoxidil: To date, there is only one FDA-approved medication for female hair loss. Minoxidil, marketed under the brand name Rogaine, is applied topically and is believed to lengthen each hair’s growing phase. According to the National Institutes of Health’s MedlinePlus site, “Minoxidil may help hair grow in 20 percent to 25 percent of women. In most women it may slow or stop hair loss.” It’s available over-the-counter in 2 and 5 percent formulas. Many doctors recommend the higher dose, even though only the lower dose is approved for women. The medication, which is also available in generic form, needs to be massaged into the scalp twice daily. “I tell my patients to put it next to their toothpaste. They need to use it every day for the rest of their lives,” says Dr. Fusco.

Spironolactone: Known as Aldactone, this is a prescription medication primarily used to treat high blood pressure. However, it has been used in the treatment of hair loss in women because it partially blocks the effects of androgen—a male hormone implicated in hair loss in both men and women.

Cosmetics: Concealers and thickeners aren’t new, but they have improved over the years. One recommended by Dr. Bernstein: Toppík, which combines color with keratin protein fibers and is sprinkled on top of balding or thinning areas to create a fuller look.

Latisse: Currently being tested as a potential treatment for baldness, Latisse is the first FDA-approved topical treatment for eyelash growth. It can also help those who want thicker brows. “In our practice we have found that Latisse is effective in thickening eyebrows, although the results are not quite as dramatic as with eyelashes,” says Dr. Bernstein. The product can, however, cause itchy eyes, redness, and possible browning of iris pigment. Available only by prescription, Latisse has not been approved by the FDA as a hair-loss treatment. However, some doctors are experimenting with the product for baldness. 

Laser Comb: There are several over-the-counter handheld lasers marketed for hair growth, but the HairMax LaserComb Lux 9 is the only one that has received FDA approval for female hair loss. You glide it over your scalp for 11 minutes, every other day, to stimulate hair growth.

Hair Transplants: This is a possibility if your hair loss is concentrated in specific areas and you still have sufficient hair elsewhere on your scalp. Hair follicles are removed from the back and sides of the scalp and then implanted in the thinning areas. However, according to Dr. Bernstein, who specializes in these procedures, the majority of women have diffuse hair loss, and, therefore, only about 20 to 25 percent of female patients are candidates for the surgery.

Tricks of the Trade: Since hair loss treatments can take several months to a year to produce results, there are styling tips to create the illusion of a thicker head of hair. According to stylist Mairead Gallagher at the Oscar Blandi salon, keep your hair length above the shoulder level and do not over-layer it. If you color your hair, try to pick a color that’s closer to the color of your scalp. If you are light-skinned, for instance, don’t go too dark. But, she notes, hair loss is very personal, so “working with a good stylist is always a must.”  

Natural Remedies: Some women opt for essential oils to help with hair loss. The oils nourish the deep layers of skin where hair follicles are located and stimulate tiny blood vessels. Kim Laudati, who realized later that she had been under intense stress before her hair started to fall out, wanted to take a holistic approach to her problem. She massaged organic Moroccan argan oil into her scalp three or four times a week. She also used organic hair products, stopped using a flatiron on her hair, and washed her hair in lukewarm, not hot, water. It took about six months for her to start seeing results. Two years later, just about all of her hair had grown back, she says. Of course, hair normally grows back spontaneously anyway if the cause is hormonal or metabolic stress or reaction to medications but Laudati says her whole hair-loss experience was so traumatic that she wanted to take extra steps to “give nature every fighting chance at starting over.”