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By Vanessa Lyn Gonzales | 7 min read
It took me fourteen months, two GP appointments, and one private referral to a trichologist before anyone sat down and explained to me — properly — what was happening to my hair.
I was 48. The appointment with the trichologist lasted forty-five minutes.
In that time I learned more about my own hair than I had in the preceding year of searching, spending, and worrying. I am going to share the most important things she told me, because I do not think women should have to wait fourteen months and pay for a private consultation to understand what is happening to their own bodies.
Here is what the research actually shows.
"You're not losing more hair. You're retaining less."
This was the first thing she said that genuinely reframed how I was thinking about it. Hair loss during the menopausal transition is not, in most cases, a sudden dramatic increase in shedding.
It is a disruption to the growth cycle — specifically, to the proportion of hairs that remain in the active growing phase at any one time.
Oestrogen prolongs what is called the anagen phase of the hair cycle — the period during which each hair is actively growing. When oestrogen levels fall, more hairs shift prematurely into the telogen (resting) phase.
A greater proportion of your hair is resting rather than growing at any given moment. The density you see in the mirror is a reflection of how many hairs are actively in the growing phase — and during perimenopause and menopause, that number drops.
"The hair you're finding on the pillow and in the drain," she told me, "is the telogen shed. It's not that something has suddenly gone wrong.
Your hormones have changed the conditions, and your hair is reflecting that."
"DHT is the mechanism. And it matters for women, not just men."
This was the part I had not found in any of the standard articles I had read. DHT — dihydrotestosterone — is a hormone produced when the enzyme 5-alpha-reductase converts testosterone.
Men and women both produce DHT, but oestrogen normally suppresses its influence on hair follicles in women. When oestrogen levels fall during the menopausal transition, DHT has more of an effect.
It binds to follicle receptors and causes progressive miniaturisation — finer, shorter strands with each cycle.
"The reason this matters for choosing your products," she explained, "is that ingredients which work to support the follicular environment against DHT are doing something specific and relevant. They're not just making your hair look thicker.
They're working at the level of the problem."
"The research on natural DHT modulators is more meaningful than most people realise."
She mentioned saw palmetto specifically. Studies suggest that saw palmetto extract inhibits 5-alpha-reductase — the same enzyme responsible for producing DHT — and clinical research has shown it to be associated with improvements in hair quality, hair count, and density in some participants.
The evidence base is not equivalent to pharmaceutical treatments, but it is more substantive than most people realise.
She also mentioned topical caffeine, which she said had become one of the more interesting areas of hair loss research. Multiple clinical studies have examined its effects.
Research suggests it may help extend the hair growth phase and has been shown to penetrate the follicle from a brief shampoo application. "It's one of the few ingredients," she said, "where the mechanism of action is well understood and the clinical data is reasonably robust."
If you recognise what's described above, ThickTails has built a detailed guide to perimenopause and menopause hair changes — covering the hormonal science and how to build a consistent routine around it. Read the full guide here →
"Scalp health is not the same as hair health. Most people treat the hair. They should be treating the scalp."
This was the thing I had been doing most wrong. Almost everything I had tried — the volumising sprays, the strengthening masks, the silk pillowcases — was addressed to the hair shaft itself.
The shaft is dead protein. You can make it look better.
You cannot change the conditions in which it is growing without addressing the scalp.
Reduced oestrogen affects the scalp directly: sebum production changes, sensitivity often increases, and circulation can diminish. The follicle environment becomes less hospitable.
Ingredients that support scalp microcirculation, maintain scalp microbiome balance, and deliver active compounds directly to the follicle — rather than just coating the hair shaft — are doing fundamentally different work.
“The hair you are finding on the pillow and in the drain is the telogen shed. It is not that something has suddenly gone wrong — your hormones have changed the conditions.”
"Ninety days is the minimum. Not a suggestion."
This was the last thing she said, and perhaps the most important practically. The hair growth cycle moves slowly.
Any meaningful change to the follicular environment takes time to manifest in visible hair change. Three months is the earliest point at which you can begin to assess whether an intervention is working.
Six months gives you a clearer picture. Most women, she told me, give up at six weeks.
I had given up at six weeks. Twice.
What I changed after that appointment
I rebuilt my routine around the things she had told me. I looked for products formulated with ingredients that had published clinical support — saw palmetto, topical caffeine, red clover extract.
I focused on the scalp rather than the hair. And I committed to ninety days before reassessing.
I am not suggesting that everyone will have the same experience. Hair is complicated, hormones are complicated, and what works for one person may not work for another.
But I wish I had understood the mechanism sooner. It would have saved me fourteen months and a great deal of money spent on things that were simply not designed for what my hair was going through.
Everything the trichologist explained, in one place.
ThickTails has developed a guide specifically for women navigating perimenopause and menopause hair changes — covering the science, the research, and how to build a consistent hormone-aware routine. Use code HORMONEAWARE15 for 15% off your first order.
Build Your Hormone-Aware Routine →
Clinical references
1. Dhurat R, et al. "An Open-Label Randomized Multicenter Study Assessing the Noninferiority of a Caffeine-Based Topical Liquid 0.2% versus Minoxidil 5% Solution in Male Androgenetic Alopecia." Skin Pharmacology and Physiology, 2018. View on PubMed →
2. Evron E, et al. "Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia." Skin Appendage Disorders, 2020. View on PubMed →
3. Lueangarun S, Panchaprateep R. "An Herbal Extract Combination (Biochanin A, Acetyl Tetrapeptide-3, and Ginseng Extracts) versus 3% Minoxidil Solution for the Treatment of Androgenetic Alopecia." Journal of Clinical and Aesthetic Dermatology, 2020. View on PubMed Central →
Vanessa Lyn Gonzales writes about women's health, hormonal transitions, and midlife wellbeing. This article is for informational purposes and does not constitute medical advice. Please consult your GP or a qualified trichologist regarding any health concerns.
