Interview with Dr. Isabelle Raymond, Nutrafol’s Head of Clinical and Medical Affairs

Hair thinning can feel sneaky at first. A ponytail gets smaller. A part looks wider. More strands show up in the shower, on the pillow, or wrapped around a brush. For many of us, especially during perimenopause and menopause, it can feel like it happens all at once. But in reality, hair loss is usually the end result of several changes building over time.

Dr. Thais Aliabadi and Mary Alice Haney talk hair health with Dr. Isabelle Raymond. It’s not just about one vitamin, one shampoo, or one hormone. It is tied to the hair growth cycle, genetics, stress, inflammation, nutrition, scalp health, and the dramatic hormonal shifts that happen across a woman’s life.

Table of Contents

• Conversation on women’s hair thinning, menopause, and a whole body approach
• FAQ
• Where we land on all of this

Conversation on women’s hair thinning, menopause, and a whole body approach

Why do so many women struggle with hair thinning?

Hair thinning is incredibly common, and it affects far more women than many of us realize. A major point here is that women often experience it differently than men do. Men may notice a receding hairline or bald spots. Women more often see diffuse thinning, meaning the hair gets less dense overall, especially at the crown or through the part line.

That difference matters because women’s hair loss can be easier to dismiss. If there is still hair on the head, people may assume it is not significant. But we know our own hair. We notice when the ponytail is thinner, when the elastic wraps one more time, or when styling suddenly becomes harder.

What makes this even more complicated is that hair loss in women is rarely caused by just one thing. It is usually a layered issue that can involve:

• Genetic predisposition
• Hormonal changes
• Stress
• Nutritional deficiencies
• Inflammation
• Changes in metabolism
• Scalp and microbiome health
• Major life events like surgery, illness, childbirth, or divorce

That is why a narrow explanation usually falls short. Hair is often a mirror of what is happening throughout the body.

What do we need to understand first about how hair grows?

To make sense of thinning, we have to start with the hair growth cycle. We are born with all the hair follicles we are ever going to have. We do not create new follicles later in life, which means protecting the ones we have becomes very important.

Each follicle cycles through three main phases.

• Anagen: the active growth phase
• Catagen: the brief transition phase
• Telogen: the resting phase that leads to shedding

The growth phase is the big one. It can last anywhere from a couple of years to several years, which is why scalp hair can grow long while eyebrow hair does not. At any given time, most healthy scalp hairs are in this active growth stage.

Then comes a short transition period, followed by a resting phase. After resting for a few months, the hair sheds and a new one begins to grow from the follicle.

This cycle is normal. Shedding itself is not the problem. The problem begins when the balance shifts and more hairs move out of the growth phase too early, or when the resting phase lasts longer than it should. That is when density drops.

How do hormones affect that cycle?

Hormones have a huge influence on how long the hair stays in that growth phase. Estrogen is especially important because it helps keep hair in active growth longer.

That is one reason many women notice fuller hair during pregnancy. Higher estrogen levels tend to keep more hairs in the growth phase. Then after birth, hormone levels shift abruptly, and many hairs move together into the resting and shedding phases. That is why postpartum shedding can feel so dramatic.

Perimenopause and menopause create a different version of that same disruption. As estrogen declines, we lose some of that support for prolonged growth. At the same time, androgen effects can become more noticeable.

One key androgen player is DHT, short for dihydrotestosterone. It is formed when testosterone is converted into a more potent form. In people whose follicles are sensitive to it, DHT can shrink or weaken follicles over time. It can also shorten the growth phase and increase time spent in the resting phase, which means thinner, weaker hair and more shedding.

This sensitivity is partly genetic, but genetics are not the whole story. They are a predisposition, not a life sentence.

So is hair loss really genetic, or can we do something about it?

One of the biggest misconceptions is the idea that we are simply destined to have whatever hair pattern runs in the family and that nothing can be done. Genetics certainly matter. They can influence how sensitive our follicles are to hormonal changes, especially DHT. They can also influence the pattern of thinning.

But genetics are only one part of a much bigger picture.

The hair cycle responds to many internal and external signals. Diet, nutrient status, inflammation, stress, hormone balance, lifestyle habits, and even gut health can all affect whether the follicle functions at its best. If we focus on only one pathway, we miss a lot of meaningful opportunities to help.

That whole body perspective is especially important for women in midlife. If you want more background on how hormonal changes can affect hair over time, this overview of women’s hormonal hair loss is a useful companion resource.

Why does perimenopause hit hair so hard?

Perimenopause can start many years before the final menstrual period, and hair changes often begin during that window. It is not something that only starts once menopause is official.

The reason is simple, even if the experience is not. Hormones become less predictable. What used to be a relatively steady monthly pattern can turn into a roller coaster. Estrogen falls, progesterone changes, and androgen effects can become stronger. That shifting balance creates a difficult environment for the follicle.

As estrogen drops:

• Hair spends less time in the growth phase
• Follicles may receive less support for healthy cycling
• Blood flow around the follicle may be affected
• Androgen effects may become more pronounced

Progesterone matters too. When it declines, it can reduce some of the natural buffering against androgen activity. So it is not just one hormone falling. It is the changing relationship between multiple hormones that alters the environment around the follicle.

And because the hair cycle moves slowly, the effects do not show up overnight. What we notice today may reflect changes that started months earlier. That is also why improvement takes time. Hair recovery is gradual by nature.

How long does it take to see improvement once we start addressing hair loss?

This is one of the most important mindset shifts. Hair is slow. The cycle is long. Even if we are doing the right things, visible change usually takes patience.

A realistic timeframe for noticing improvement is often three to six months, and sometimes longer depending on what is driving the thinning. That delay can be frustrating, but it makes sense once we remember that follicles are cycling over months, not days.

It also means panic reactions do not help much. Hair tends to respond best to a consistent strategy over time, not to constantly switching products every few weeks.

What makes a whole body approach to hair health different?

The core idea is that hair is not isolated from the rest of the body. Follicles are biologically active structures, and they are sensitive to what the body is experiencing. If stress is high, nutrients are low, inflammation is elevated, hormones are fluctuating, or the gut is not functioning well, the hair may reflect it.

A whole body approach asks a broader set of questions:

• Are hormone changes pushing more hairs into shedding?
• Are nutrient deficiencies limiting healthy growth?
• Is stress prolonging the resting phase?
• Is scalp health being overlooked?
• Are metabolism and inflammation part of the picture?
• Is the gut microbiome affecting absorption and internal balance?

This framework moves us away from the idea that hair loss should be treated from only one angle. Instead, it encourages support from the inside and the outside.

That same broad lens is often useful during menopause in general, not just for hair. For a wider look at common body changes after 40, this article on changes women can experience after 40 gives helpful context.

Where does the gut microbiome fit into hair health?

This is an area that is getting more attention, and for good reason. If the gut microbiome changes, which it often does during menopause, it can influence how well the body processes and uses nutrients. So even if we are taking helpful nutrients, that may not tell the whole story.

In other words, what we swallow is not the same as what the body actually absorbs and uses.

That is why gut health belongs in the conversation. It does not replace other interventions, but it can shape how effective they are. A probiotic may be part of that support for some people, depending on their needs and clinician guidance.

What ingredients were highlighted as especially relevant in Nutrafol’s formulas?

The formulas discussed were built around the idea that women in different stages of life may have different dominant root causes. Rather than making a single one size fits all product, the approach described includes targeted formulations for women, vegan needs, postpartum, and menopause.

Some of the key ingredients mentioned included:

• Saw palmetto, which is known for helping reduce the conversion of testosterone to DHT
• Curcumin, used for its support around inflammation
• Ashwagandha, often included for stress support
• Tocotrienols, antioxidant compounds associated with hair support
• Maca, added in the menopause formula for hormone balance support
• Astaxanthin, included as an added antioxidant in the menopause formula
• Various vitamins and minerals that contribute to nutrient sufficiency

The point was not that one star ingredient does all the work. The emphasis was on combining ingredients that address different pathways involved in hair thinning.

Why were menopausal women given their own formula instead of just using a men’s product?

That question gets to the heart of women centered formulation. Some clinicians had noticed that the men’s formula contained more saw palmetto, which is relevant because androgen activity matters during menopause too. But rather than simply relabeling a product intended for men, the better solution was to create something specifically designed for the menopausal transition.

That matters because menopausal hair thinning is not just about androgens. It is also about falling estrogen, changing progesterone, oxidative stress, altered nutrient dynamics, and broader physiological transition.

A menopausal formula can be built around that reality rather than borrowing a male template.

What myths about hair loss need to go?

Several myths came up that deserve to be retired.

• Myth: Hair loss is mostly a men’s issue.
  Reality: Women experience hair thinning all the time, and it is especially common in midlife.
• Myth: If hair loss runs in the family, nothing can help.
  Reality: Genetics influence risk, but stress, hormones, nutrition, inflammation, and lifestyle all shape the outcome.
• Myth: Hair should grow back quickly if we start treatment.
  Reality: Hair changes happen slowly, so improvement takes time.
• Myth: Wearing hats causes hair loss.
  Reality: This is not a meaningful cause of hair thinning.
• Myth: Washing hair often causes hair loss.
  Reality: Shedding seen during washing is usually hair that was already ready to come out.

These myths matter because they can distract us from the real drivers. If we focus on hat wearing or shampoo frequency while ignoring hormones, nutrient status, and stress, we are aiming at the wrong target.

How much does stress actually affect hair?

Stress is a major factor. Both physical and emotional stress can push more hairs into the resting phase and prolong how long they stay there. That means more shedding later.

Physical stress can include:

• Surgery
• Illness
• Hospitalization
• Major weight changes
• Poor nutrition during recovery

Emotional stress can include:

• Divorce
• Grief
• Burnout
• Chronic anxiety
• Major life upheaval

This is why hair loss often follows big events. The body shifts resources toward survival and recovery, and hair can become less of a priority. Stress related shedding is common enough that it deserves its own serious place in the conversation. For more on that connection, this piece on stress related hair loss gives a clear overview.

What role do nutrition and lab testing play?

Nutrition sits near the root of a lot of hair issues. If the body is low in key nutrients, hair growth may suffer. But the answer is not to grab every supplement on the shelf and start stacking blindly.

A much smarter approach is to figure out what is actually missing.

That is why checking labs and getting a clinical workup can be so helpful. A targeted panel may reveal deficiencies or other medical contributors that deserve attention. The conversation emphasized that we do not want to take things we do not need, especially when many of us are already juggling multiple supplements in midlife.

The broader message was practical:

• Get a proper evaluation
• Understand deficiencies
• Rule out other medical conditions
• Build a strategy based on real needs

What should we do first if we are losing hair?

The first step recommended was to speak with a board certified dermatologist. Hair loss has many causes, and a specialist can help sort out whether a medical condition, hormonal issue, nutritional deficiency, or other factor is contributing.

That history and exam matter because hair thinning is not one diagnosis. It is a symptom pattern with multiple possible drivers. Once the major contributors are identified, treatment can become much more intelligent.

And importantly, supplements do not have to compete with other treatments. They can be part of a bigger plan.

Can a supplement be combined with other hair treatments?

Yes. One of the most useful points raised in the discussion was that hair treatment is often a kitchen sink problem. Once serious medical causes are ruled out, many dermatologists combine multiple strategies to give follicles the best chance.

That may include:

• Nutritional support
• Topical therapies
• In office treatments
• Laser based approaches
• Scalp care
• Hormonal treatment when appropriate

The idea is not that one supplement replaces everything else. It is that internal nutritional support can strengthen the foundation while other treatments target additional pathways.

What about hormone replacement therapy?

For some women who are appropriate candidates, hormone replacement therapy may help support hair indirectly by improving the hormonal environment, including estrogen related support for circulation and the growth phase. That said, it is not something to start casually or purely for hair. It should be considered in the context of overall menopausal symptom management and individual risk factors.

In other words, it can be part of the picture, but only under medical guidance.

How important is scalp health?

It is easy to focus only on the strands, but scalp health deserves real attention. Healthy growth starts at the follicle, and the scalp is the environment where that follicle lives.

That means issues like irritation, flaking, inflammation, and microbiome imbalance are worth addressing. Internal support and topical care can work together. The inside supports the biology of growth. The outside supports the scalp environment.

This is especially relevant for women who notice scalp sensitivity, flaking, or inflammatory skin changes during perimenopause. Hair health is not just about what grows out. It is also about the condition of the skin it grows from.

What everyday hair care habits actually help?

There were a few practical hair care tips that stood out.

• Wet hair is more fragile than dry hair
• Try to detangle gently, ideally while conditioning or in the shower if that works for your hair type
• Avoid going to bed with wet hair
• Use heat and chemical processing in moderation if your hair is fragile
• Condition regularly to support the hair shaft
• Wash frequency should depend more on scalp needs than on myths

There is no universal perfect routine for everyone because hair texture, fragility, and scalp condition differ from person to person. But kindness goes a long way. Gentle handling matters, especially when density is already reduced.

Are there dietary changes that may support healthier hair?

Diet advice was framed in a realistic way rather than as a rigid list of forbidden foods. The central idea was to support metabolism and reduce inflammation.

As we move through menopause, metabolic changes can become more common. If metabolism is off balance, hair can be affected too. That is why an anti inflammatory way of eating may help support hair health as part of an overall plan.

The details will vary by person, but the broad principles are sensible:

• Prioritize nutrient dense foods
• Support blood sugar balance
• Reduce inflammatory patterns where possible
• Think about the body as a whole rather than treating hair in isolation

Can we take hair supplements with a multivitamin?

Possibly, but it depends on the formulas. The key concern is overdoing certain nutrients by stacking products without checking amounts. Upper limits matter, and more is not always better.

That is why this question really belongs in a conversation with a clinician who can look at the full supplement list, the dosage ranges, and any known deficiencies. The safest and smartest path is individualized guidance.

Why has research on women’s hair loss and menopause lagged behind?

This part of the conversation was especially important. Women’s health has been underfunded and understudied for a long time. Even when research exists, it often centers on reproductive issues while leaving many other life stages underexplored.

Hair thinning in menopausal women is a good example. Despite how common it is, very little research has focused specifically on this population. Historically, there has been a tendency to assume that findings in men can simply be applied to women. But that misses key biological and experiential differences.

Women are not just smaller men with different anatomy. The causes, patterns, and consequences of hair thinning can differ meaningfully across sex and life stage.

One of the notable points shared was that a published clinical study on a hair growth supplement specifically in menopausal women was a first in this space at the time. That should be encouraging, but it should also make us ask why it took so long.

Why does women centered research matter so much?

Because it validates experience. When studies include women at the right ages and stages, the results become more meaningful. We do not have to guess whether something that worked in a male population translates to a woman in perimenopause or menopause.

Research that includes women does three important things:

• It confirms that women’s symptoms are real and worth studying
• It helps identify root causes that are specific to women’s life stages
• It gives clinicians and patients better evidence for decision making

That is how we move from being overlooked to being properly served.

FAQs

Does menopause really cause hair loss?

Menopause and perimenopause can absolutely contribute to hair thinning. Falling estrogen, changing progesterone, and relatively stronger androgen effects can shorten the growth phase and increase shedding.

How long does it take to see hair regrowth or improvement?

Hair changes usually take time. A realistic expectation is often three to six months before noticing meaningful improvement, sometimes longer depending on the cause and the treatment plan.

Is women’s hair thinning always genetic?

No. Genetics may increase susceptibility, especially around follicle sensitivity to DHT, but stress, hormones, nutrition, inflammation, and lifestyle all influence the outcome.

Should we see a dermatologist for hair thinning?

Yes. A board certified dermatologist can help identify the likely causes, rule out medical conditions, review lab work, and build a more tailored treatment plan.

Can stress alone make hair fall out?

Yes. Significant emotional or physical stress can push more hairs into the resting phase, leading to increased shedding later. Surgery, illness, grief, and major life events can all trigger this response.

Does washing hair every day cause hair loss?

No. Washing does not usually cause the loss itself. It may simply reveal hairs that were already ready to shed. Wash frequency should be based more on scalp needs and hair type.

Is wet hair more vulnerable to damage?

Yes. Wet hair is generally more fragile than dry hair, so gentle detangling and avoiding rough handling can help reduce breakage.

Can a hair supplement be taken with a multivitamin?

Sometimes, but it depends on the ingredients and doses in both products. It is important to avoid excessive stacking of certain nutrients, so clinician guidance is a good idea.

Why does scalp health matter if the problem is hair loss?

Because the scalp is the environment where the follicle lives. Inflammation, irritation, flaking, and microbiome imbalance can all affect how well hair grows.

What is the biggest takeaway on women’s hair health?

Hair thinning is usually multifactorial, especially in perimenopause and menopause. The most effective approach tends to be broad, combining medical evaluation, nutrition, stress support, scalp care, and targeted treatment rather than relying on a single explanation.

Where we land on all of this

The most reassuring idea in this conversation is that we are not powerless. Hair thinning may be common, especially in midlife, but it is not something we have to silently accept or reduce to one simplistic cause.

We can understand the cycle. We can recognize the hormonal shifts. We can take stress seriously. We can investigate nutrient status. We can care for the scalp. We can seek expert help. And we can insist on women centered research that treats our experiences as worthy of real scientific attention.

Hair health is personal, emotional, and biological all at once. The more we respect that complexity, the better our options become.

This article was created from the video The Secrets to Hair Health: Nutrafol’s Dr. Isabelle Raymond on Women’s Unique Hair Needs | SHE MD for Dr. Thais Aliabadi’s website.