Dr Dray Warns HRT Lacks Evidence to Treat Menopausal Hair Loss

Dr Dray

Hormone replacement therapy lacks clinical trial support to treat menopausal thinning, which stems from complex androgen sensitivity and follicle aging that require targeted therapies rather than supplemental estrogen.

AI-assisted summary of Menopause Hair Loss: Can HRT Help or Make It Worse? | Dermatologist Explains — original source. Check the original for full context.

Source published: 2026-09-03

Key ideas

Hormone replacement therapy (HRT) is not an established standard-of-care treatment for menopausal hair loss, as recent literature reviews conclude there is insufficient clinical evidence to prescribe systemic hormones for alopecia alone. (12:19)
Declining estrogen during menopause reduces hepatic production of sex hormone-binding globulin (SHBG), increasing free testosterone that converts to dihydrotestosterone (DHT) and drives follicular miniaturization. (6:05)
Not all menopausal thinning represents female pattern hair loss; clinicians must differentiate it from telogen effluvium and frontal fibrosing alopecia (FFA), an irreversible scarring alopecia marked by hairline recession and eyebrow loss. (9:46)
Double-blind clinical trials of low-level light therapy (LLLT) demonstrated an average 43.2% increase in terminal hair counts over 16 weeks, validating it as an evidence-based non-pharmacological modality. (1:22)

Detailed notes

## Background Published on YouTube by dermatologist Dr Dray on September 3, 2026, this video examines the physiological links between menopause, hormonal fluctuations, and hair thinning. The show notes emphasize that hair loss around menopause has diverse etiologies, addressing whether hormone replacement therapy (HRT) is an appropriate treatment while highlighting evidence-based solutions like low-level light therapy with the featured sponsor, iRESTORE.

## TL;DR Dr. Dray explains how declining estrogen during menopause reduces sex hormone-binding globulin, increasing free testosterone and follicle-miniaturizing DHT. She highlights that thinning hair around menopause is not solely female pattern hair loss, but can also stem from telogen effluvium or scarring frontal fibrosing alopecia. Crucially, the video debunks the idea that HRT is an established treatment for hair loss, noting that insufficient clinical evidence supports its use for alopecia. Instead, patients should rely on proven therapies—such as minoxidil, anti-androgens, and FDA-cleared low-level laser devices—and seek a dermatologic evaluation to identify the exact cause rather than accepting shedding as inevitable aging.

## Atmosphere & style The presentation is clinical, empathetic, and methodically reassuring, blending medical expertise with accessible patient education. Speaking directly to the camera, Dr. Dray balances rigorous physiological explanations with practical skepticism toward internet quick fixes and unproven hormone claims. The tone feels like an empowering, no-nonsense consultation that validates the emotional distress of hair loss while equipping viewers with scientific clarity and encouragement to advocate for themselves.

## Bulletin - [12:19](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=739s) Hormone replacement therapy (HRT) is not an established standard-of-care treatment for menopausal hair loss, as recent literature reviews conclude there is insufficient clinical evidence to prescribe systemic hormones for alopecia alone. - [06:05](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=365s) Declining estrogen during menopause reduces hepatic production of sex hormone-binding globulin (SHBG), increasing free testosterone that converts to dihydrotestosterone (DHT) and drives follicular miniaturization. - [09:46](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=586s) Not all menopausal thinning represents female pattern hair loss; clinicians must differentiate it from telogen effluvium and frontal fibrosing alopecia (FFA), an irreversible scarring alopecia marked by hairline recession and eyebrow loss. - [01:22](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=82s) Double-blind clinical trials of low-level light therapy (LLLT) demonstrated an average 43.2% increase in terminal hair counts over 16 weeks, validating it as an evidence-based non-pharmacological modality.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=0s) Postmenopausal hair loss does not automatically warrant hormone replacement therapy, as thinning hair alone is not an established medical indication for systemic HRT. - [01:22](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=82s) Low-level laser therapy (LLLT) promotes hair regrowth through photobiomodulation by enhancing microcirculation, calming scalp inflammation, and re-energizing dormant cellular pathways. - [06:05](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=365s) A sharp drop in estrogen lowers sex hormone-binding globulin (SHBG), elevating unbound testosterone that 5-alpha reductase converts into DHT within scalp tissue. - [07:03](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=423s) While estrogen stimulates follicle cycling via pathways such as Wnt/beta-catenin signaling, hair biology is too complex to treat supplemental estrogen as a straightforward growth promoter. - [07:59](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=479s) Female pattern hair loss affects over half of postmenopausal women, presenting primarily as diffuse thinning over the crown and a widening part line rather than frontal hairline recession. - [09:01](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=541s) Chronological aging naturally slows follicular cell division and hair growth, meaning thinning hair should not be assumed to require anti-androgen therapy without a proper diagnosis. - [09:46](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=586s) Telogen effluvium causes widespread, premature shedding during the menopausal transition, often triggered by emotional stress, medications, rapid weight shifts, or unmanaged thyroid disease. - [10:45](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=645s) Frontal fibrosing alopecia (FFA) is an inflammatory scarring alopecia that permanently obliterates hair follicles, presenting with perifollicular redness, itching, and loss of the frontal hairline and eyebrows. - [12:19](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=739s) Clinical literature reviews and dedicated studies confirm that evidence remains insufficient to establish HRT as an effective standard-of-care intervention for menopausal alopecia. - [14:05](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=845s) Hair shedding that appears shortly after initiating HRT often reflects a delayed telogen effluvium episode triggered months earlier rather than a direct adverse drug effect. - [15:19](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=919s) Validated treatments for female pattern hair loss include topical or oral minoxidil, spironolactone, finasteride, and FDA-cleared low-level light therapy devices. - [16:29](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=989s) Immediate dermatologic consultation is critical if shedding is abrupt, presents with scalp dysesthesia, redness, or scale, or involves circular bald patches and eyebrow loss. - [18:16](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=1096s) Comprehensive diagnostic workups for menopausal hair loss can uncover critical systemic conditions, including thyroid dysfunction and iron deficiency. - [19:07](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=1147s) Hair loss therapies require persistent, consistent use over several months to produce visible results, and multimodal regimens combining devices and medications often yield the best outcomes.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=0s) Menopause, Hair Loss, and the HRT Misconception

Hair loss during perimenopause and menopause is an increasingly common concern among women. As individuals transition through menopause, they frequently notice their hair becoming significantly finer, experiencing increased daily shedding (such as finding clumps in the shower), or noticing that their central part is widening. Beyond the classic thinning associated with female pattern hair loss—which predominantly affects the crown and frontal/central scalp—dermatologists also observe an uptick in other major hair disorders around menopause, namely telogen effluvium and frontal fibrosing alopecia.

These manifestations occur because the transition brings complex hormonal shifts that act directly upon the hair follicles. However, a major misconception is that postmenopausal hair loss automatically indicates a woman should start hormone replacement therapy (HRT). HRT is not currently an established standard-of-care treatment for any form of hair loss, and thinning hair alone is not an automatic medical indication for systemic hormone therapy.

[01:22](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=82s) Low-Level Light Therapy and the iRESTORE Elite

Faced with distressing shedding and thinning, many people fall into the trap of trying unproven at-home gimmicks and remedies in search of a quick fix. An evidence-based, drug-free, non-invasive home option is low-level laser therapy (LLLT) / red light therapy. Dr. Dray shares her personal experience using red light therapy several years ago following a bout of excessive hair shedding caused by training for and running a marathon. After evaluating different consumer units, she selected the iRESTORE device as the most robust option, observing that within about three months of consistent use, her shedding slowed down and the regrowing hairs were visibly thicker and fuller than prior to the shedding event.

The modern version she uses and recommends is the iRESTORE Elite, an FDA-cleared hands-free device designed for broad scalp coverage, specifically targeting the crown and hairline. Sessions take as little as 12 minutes per day. The underlying photobiomodulation works across three primary mechanisms: 1. Enhancing microcirculation to the scalp to deliver essential nutrients and growth factors to the hair follicle. 2. Calming scalp inflammation. 3. Re-energizing follicular cells at the cellular level so they divide and transition from a dormant, miniaturized state back into an active, terminal growing (anagen) phase.

In a double-blind clinical trial evaluating the technology, participants achieved an average increase of 43.2% in terminal hair counts after 16 weeks compared to sham placebo devices. While individual responses differ depending on the specific underlying etiology, evidence supports its utility in androgenetic alopecia, with growing support for telogen effluvium and frontal fibrosing alopecia. Consistency is essential—initial visual improvements generally take at least 3 months to manifest, which is why the company provides a one-year money-back guarantee.

- **Device specs**: The iRESTORE Elite incorporates 500 diodes (a combination of 300 lasers for targeted penetration and 200 LEDs for broad coverage), generating a total power output of 2,500 mW. - **Treatment duration**: Requires 12 minutes daily. - **Trial outcomes**: Demonstrates an average 43.2% increase in terminal hair count over 16 weeks in double-blind testing.

[06:05](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=365s) The Hormonal Cascade: Estrogen, SHBG, and Androgen Activity

During menopause, circulating estrogen drops sharply, setting off a cascade that alters the hormonal environment surrounding hair follicles. This shift is characterized by a relative rise in androgen activity rather than an outright spike in total androgen production.

```mermaid flowchart TD accTitle: Hormonal Cascade Leading to Follicle Miniaturization accDescr: Diagram illustrating how declining estrogen levels during menopause lead to lower SHBG, increased free testosterone, conversion to DHT, and follicular miniaturization.

subgraph Estrogen_Decline ["Estrogen Decline"] A["Menopausal Transition"] --> B["Estrogen Drops"] B --> C["Decreased Liver Production of SHBG"] B --> D["Reduced Wnt/beta-catenin Signaling"] end

subgraph Androgen_Activity ["Relative Androgen Dominance"] C --> E["Less Testosterone Bound"] E --> F["Higher Free Testosterone Available"] F --> G["5-Alpha Reductase Conversion"] G --> H["Dihydrotestosterone (DHT)"] end

subgraph Follicular_Impact ["Impact on Scalp Follicle"] H --> I["Binding to Androgen Receptors"] D --> J["Impaired Hair Growth Cycle"] I --> K["Follicle Miniaturization"] J --> K end ```

Under normal premenopausal physiology, estrogen signals the liver to manufacture sex hormone-binding globulin (SHBG), a carrier protein that binds testosterone in circulation. When estrogen plunges, SHBG production falls correspondingly. Even if the ovaries and adrenal glands do not synthesize excess testosterone, less of the circulating testosterone remains bound to SHBG, leaving more free, unbound testosterone available to target peripheral tissue. Within the scalp tissue, the enzyme 5-alpha reductase converts this free testosterone into dihydrotestosterone (DHT), a substantially more potent androgen that drives follicular miniaturization in genetically vulnerable follicles.

[07:03](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=423s) Estrogen's Role in Follicle Biology and the Limits of Estrogen Therapy

Estrogen plays an active role in maintaining healthy hair growth cycles. Hair follicles are inherently hormone-responsive structures, and estrogen influences pathways such as Wnt/beta-catenin signaling, which stimulates follicular activity and maintains the anagen (growth) phase. In addition, estrogen supports the microvasculature and metabolic processes required to meet the high energetic demands of constant hair fiber production.

When estrogen levels diminish, these supportive signals drop. Nonetheless, Dr. Dray cautions against oversimplifying follicle biology into a crude equation where "more estrogen must mean more hair growth." Attempting to resolve menopausal thinning simply by administering supplemental estrogen under the assumption that it acts like "gasoline" for follicle growth ignores the multifaceted signaling networks involved in follicular pathology.

[07:59](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=479s) Female Pattern Hair Loss (Androgenetic Alopecia)

Female pattern hair loss (FPHL)—the female presentation of androgenetic alopecia—is exceptionally prevalent following menopause. In one cited study of postmenopausal women, more than half exhibited some degree of female pattern hair loss. While it can occur at any adult age, the hormonal shifts of menopause often accelerate its clinical presentation.

Clinically, FPHL presents differently than classic male pattern baldness: - **Presentation**: Women typically preserve their frontal hairline, experiencing progressive diffuse thinning focused across the crown and central scalp, often evidenced by a part line that gradually widens. - **Pathophysiology**: Genetically determined androgen receptor sensitivity at the follicular level makes specific hairs vulnerable to DHT. However, DHT is not solely responsible for the hair loss; complex genetic, vascular, and inflammatory signaling pathways operate simultaneously to influence follicle miniaturization.

[09:01](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=541s) Aging Follicles and the Diagnostic Pitfall: Telogen Effluvium vs. FFA

Hair loss involves multiple overlapping factors, including individual genetics. In androgenetic alopecia, certain people inherit hair follicles that are exceedingly sensitive to minor hormonal shifts, which readily disrupt the normal hair growth cycle, while others without that genetic predisposition remain largely unaffected. On top of genetics, natural chronological aging slows down follicle activity, leading to reduced hair growth across the board. Because aging itself causes thinning, Dr. Dray emphasizes that clinicians and patients should never simply assume every woman experiencing hair loss automatically requires androgen-blocking therapy. Establishing an accurate diagnosis is essential before jumping to conclusions, particularly because menopause triggers several distinct types of hair loss beyond classic female pattern hair loss.

```mermaid flowchart TD accTitle: Differential Causes of Menopausal Hair Loss accDescr: Three distinct categories of hair loss seen around menopause and their clinical traits.

subgraph FPHL["Female Pattern Hair Loss"] A["Androgenetic Alopecia"] --> B["Follicles sensitive to hormonal shifts"] A --> C["Age-related growth slowdown"] end

subgraph TE["Telogen Effluvium"] D["Excessive Hair Shedding"] --> E["Premature transition to resting phase"] E --> F["Triggers: stress, illness, weight changes, meds, thyroid"] end

subgraph FFA["Frontal Fibrosing Alopecia"] G["Scarring Alopecia"] --> H["Inflammation: redness, scale, itch"] H --> I["Follicles permanently destroyed"] I --> J["Receding frontal hairline, loss of eyebrows"] end ```

One common culprit is telogen effluvium, characterized by excessive, widespread shedding when a higher-than-normal percentage of follicles abruptly shift into the resting (telogen) phase. The menopausal transition brings a cluster of physiological and environmental triggers capable of prompting this shift: fluctuating hormones, elevated stress, intercurrent illnesses, significant weight changes, and the introduction of new medications. Furthermore, non-reproductive endocrine conditions—particularly thyroid disorders—become more prevalent postmenopause and exert a profound impact on follicle cycling.

Another critical diagnosis that disproportionately affects postmenopausal women is frontal fibrosing alopecia (FFA). Unlike androgenetic alopecia and telogen effluvium, FFA is a scarring alopecia. When left undiagnosed and untreated, the surrounding inflammation permanently destroys the follicle: "once that scar forms, you will not get hair to grow out of that follicle ever again. It is cut off." FFA typically presents with a receding frontal hairline, often accompanied by the loss of eyebrow hair and thinning in other body areas. In its early stages, key warning signs include perifollicular redness, flaking, and scalp itching, which a dermatologist typically identifies using a handheld dermatoscope.

- **Non-scarring menopausal shedding triggers:** Stress, medical illness, rapid weight fluctuations, newly initiated medications, and unmanaged thyroid disease. - **Hallmark signs of Frontal Fibrosing Alopecia (FFA):** Progressive recession of the anterior hairline, thinning or loss of eyebrows, and perifollicular erythema (redness) with scale and pruritus.

---

[12:19](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=739s) Can Hormone Replacement Therapy (HRT) Treat or Worsen Hair Loss?

When addressing whether hormone replacement therapy can resolve menopausal thinning, Dr. Dray notes that while estrogen plays a known biological role in supporting the hair cycle, there is currently no strong clinical evidence supporting HRT as an indicated treatment for hair loss. While small investigations have hinted at potential advantages—such as a small pilot trial of 11 postmenopausal women showing minor improvements in frontal thinning with estradiol therapy—the tiny sample sizes and absence of control groups prevent these findings from guiding routine clinical care. Both a broad recent literature review and a dedicated 2026 study evaluating HRT specifically concluded that the evidence remains insufficient to establish HRT as a standard of care for postmenopausal alopecia. Consequently, HRT should be initiated in consultation with a primary care provider or gynecologist for recognized vasomotor symptoms like hot flashes, night sweats, or genitourinary symptoms, rather than as an intervention for thinning hair.

The inverse question—whether HRT can actually worsen hair thinning—reveals equally complex dynamics. Hair follicle responses vary widely based on individual genetic traits, underlying alopecia diagnoses, specific hormone formulations, and dosages. Some patients see no change, others notice modest improvement, and some experience new or increased shedding. When shedding occurs shortly after beginning HRT, Dr. Dray cautions against instinctively blaming the hormones. Because telogen effluvium typically lags two to three months behind its inciting trigger, the perceived timeline can be deeply deceptive. Patients should not discontinue prescribed hormone therapy on their own due to hair changes; instead, substantial shedding upon starting or stopping therapy warrants a detailed evaluation with both the prescribing clinician and a dermatologist.

- **State of HRT evidence for hair loss:** Insufficient data from controlled trials; small pilot studies (e.g., 11 participants without control arms) cannot justify using HRT as primary alopecia therapy. - **Appropriate indications for HRT:** Vasomotor instability (hot flashes, night sweats) and vaginal atrophy symptoms, not isolated scalp thinning. - **HRT-shedding paradox:** Post-HRT shedding may be an unrelated episode of telogen effluvium triggered months prior, rather than an adverse drug reaction.

---

[15:19](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=919s) Evidence-Based Interventions and When to Consult a Dermatologist

Because HRT lacks sufficient evidentiary support as a targeted hair loss remedy, patients dealing with diagnosed female pattern hair loss should look to established, evidence-based options. Primary therapies include topical or oral minoxidil, as well as prescription anti-androgens such as spironolactone or 5-alpha reductase inhibitors like finasteride. Alongside medical therapies, low-level laser therapy (LLLT) devices—such as the iRESTORE Elite—offer an evidence-supported, at-home approach. LLLT can serve as a monotherapy or be safely combined with medications like minoxidil, finasteride, or dutasteride, frequently producing superior outcomes when utilized in multimodal regimens. Dr. Dray underscores that regardless of the modality chosen, consistency is paramount: "You're not going to use a hair growth treatment for 3 days and suddenly get a full head of hair. It doesn't work that way."

Recognizing when to move beyond home observation and seek professional dermatologic care is vital. Sudden, heavy hair shedding rather than a gradual, multi-year thinning pattern is an immediate signal to see a specialist. Other red flags include distinct, circular bald patches—which may indicate autoimmune alopecia areata—as well as persistent scalp pain, burning, flaking, or redness surrounding the hair follicles. These signs of scalp inflammation demand rapid intervention to stop irreversible scarring, especially when paired with a receding frontal hairline or shedding from the eyebrows and body. Dr. Dray strongly encourages women to advocate for themselves if a healthcare provider dismisses hair loss as merely an inevitable consequence of aging. Beyond evaluating the scalp, a dermatologist can order targeted blood work, such as thyroid function panels, which can uncover underlying systemic conditions where identifying the root cause through hair changes can prove truly life-saving.

- **Validated female pattern hair loss treatments:** Topical minoxidil, low-dose oral minoxidil, spironolactone, finasteride, and low-level laser therapy (iRESTORE Elite). - **Key indicators requiring dermatologic evaluation:** - Sudden-onset, rapid hair shedding or discrete, bald patches (suspected alopecia areata). - Scalp dysesthesia, persistent pain, itching, redness, or perifollicular scaling. - Loss of the frontal hairline accompanied by thinning of eyebrow or body hair. - Possible underlying systemic dysfunction requiring targeted laboratory panels (such as thyroid tests).

[18:16](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=1096s) Addressing Underlying Deficiencies and Final Takeaways on Menopause Hair Loss

Getting evaluated by a clinician is vital not only to preserve your hair, but for your systemic health. A proper workup can uncover hidden issues like thyroid disease, which demands medical treatment for overall well-being, as well as nutritional deficiencies such as low iron. When an iron deficiency is identified and corrected, hair growth can rebound into a far healthier, more active state.

```mermaid flowchart TD accTitle: Hormonal Drivers and Clinical Diagnoses in Menopausal Hair Loss accDescr: Chart illustrating how hormonal shifts lead to distinct clinical hair loss diagnoses.

subgraph HormonalMechanisms["Hormonal Shift Mechanisms"] direction TB A["Estrogen Drops Dramatically"] --> C["Disrupted Hair Cycle"] B["Relative Androgen Increase"] --> D["DHT Follicle Miniaturization"] end

subgraph Diagnoses["Possible Clinical Diagnoses"] direction TB E["Female Pattern Hair Loss"] F["Telogen Effluvium"] G["Frontal Fibrosing Alopecia"] H["Alopecia Areata"] end

HormonalMechanisms --> Diagnoses ```

Menopause and hair shedding are intimately intertwined, but the underlying biology is nuanced. With menopause, circulating estrogen drops sharply, which alters the standard hair growth cycle. Simultaneously, a relative increase in androgen activity takes hold at the hair follicle level, where dihydrotestosterone (DHT) drives follicle miniaturization. Crucially, not every woman navigating hair loss during menopause shares the same diagnosis: - **Female Pattern Hair Loss (FPHL):** Miniaturization driven by follicular sensitivity to androgens. - **Telogen Effluvium:** Generalized, rapid shedding triggered by systemic or hormonal shifts. - **Overlapping Presentations:** A patient can experience both female pattern hair loss and telogen effluvium at the same time. - **Scarring and Autoimmune Conditions:** Potential causes also encompass frontal fibrosing alopecia (a scarring alopecia receding the frontal hairline) or patchy loss from alopecia areata.

[19:07](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=1147s) Evidence-Based Treatments and the Critical Need for an Accurate Diagnosis

Although hormone replacement therapy (HRT) can benefit certain women—and may make sense to continue for hair maintenance if well-tolerated—it is emphatically not considered the standard-of-care medical treatment for hair loss. Instead, clinicians rely on evidence-based therapies supported by robust scientific data: - **Topical or Oral Minoxidil** - **5-Alpha Reductase Inhibitors:** Finasteride and dutasteride - **Androgen Receptor Blockers:** Spironolactone - **Device-Based Options:** FDA-cleared low-level laser therapy (such as the sponsored iRESTORE Elite device)

Self-advocacy in the exam room is essential. Patients invest significant time and emotional energy describing their symptoms, and healthcare providers have an obligation to listen closely and conduct a thorough diagnostic workup. Without a precise diagnosis, women are left "spinning your wheels trying to figure out how to make things right." Dr. Dray closes out the discussion by encouraging viewers to take advantage of the iRESTORE promotion, reminding them to share the video, subscribe, and as always, never forget their sunscreen.

## Notable quotes > [00:00](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=0s) HRT is not currently an established standard-of-care treatment for any form of hair loss, and thinning hair alone is not an automatic medical indication for systemic hormone therapy. — Dr Dray

> [01:22](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=82s) Enhancing microcirculation to the scalp to deliver essential nutrients and growth factors to the hair follicle. — Dr Dray

> [07:03](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=423s) more estrogen must mean more hair growth — Dr Dray

> [07:03](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=423s) gasoline — Dr Dray

> [09:01](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=541s) once that scar forms, you will not get hair to grow out of that follicle ever again. It is cut off. — Dr Dray

> [15:19](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=919s) You're not going to use a hair growth treatment for 3 days and suddenly get a full head of hair. It doesn't work that way. — Dr Dray

> [19:07](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=1147s) spinning your wheels trying to figure out how to make things right. — Dr Dray

> [19:07](https://www.youtube.com/watch?v=ZJrftYOYyPY&t=1147s) never forget their sunscreen — Dr Dray

## Mentioned Dr Dray, iRESTORE, iRESTORE Elite, Sex hormone-binding globulin (SHBG), Dihydrotestosterone (DHT), Minoxidil, Spironolactone, Finasteride, Dutasteride, Estradiol, Wnt/beta-catenin

## Video description Code DRDRAY4TH https://glnk.io/5xmkn/dr-andreasuarez48m to save $905 iRESTORE Elite — Early Labor Day Sale

Hair loss during perimenopause and menopause is incredibly common, but not all menopausal hair loss has the same cause. In this video, dermatologist Dr. Dray explains the connection between menopause, hormones, HRT, and hair loss, including why thinning hair does not automatically mean that hormone replacement therapy is the right treatment.

Dr. Dray discusses the most common causes of hair loss around menopause, including female pattern hair loss, telogen effluvium, and frontal fibrosing alopecia, as well as how declining estrogen and changes in androgen activity can affect the hair follicle.

The video also explores whether HRT can help menopausal hair loss, whether HRT can potentially contribute to hair shedding, and which evidence-based treatments may actually help with thinning hair.

Dr. Dray also discusses low-level light therapy for hair loss and shares information about the iRESTORE Elite, an FDA-cleared, non-invasive, drug-free device designed to deliver low-level red light therapy to the scalp.

In this video:

00:00 Introduction 00:27 Why hair loss becomes more noticeable around menopause 01:22 Low-level light therapy and iRESTORE Elite 06:05 What happens to your hormones during menopause? 07:03 What does estrogen have to do with hair? 07:59 Female pattern hair loss 09:46 Not all menopausal hair loss is female pattern hair loss 12:18 Can HRT help with hair loss? 14:05 Can HRT actually make hair loss worse? 15:19 What can actually help menopausal hair loss? 16:29 When should you see a dermatologist? 18:33 Final takeaway

Hair loss can have many different causes, and identifying the correct type of hair loss is an important first step toward choosing an appropriate treatment. Women experiencing sudden or significant shedding, bald patches, scalp inflammation, eyebrow loss, or progressive hairline recession should consider seeing a dermatologist for evaluation.

This video is sponsored by iRESTORE.

#Menopause #HairLoss #MenopausalHairLoss #FemalePatternHairLoss #HRT #HormoneReplacementTherapy #HairThinning #HairGrowth #Dermatologist

FTC: This video is sponsored by iRESTORE

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=ZJrftYOYyPY)

中文简报

Dr Dray提醒：HRT缺乏治疗更年期脱发的证据支持激素替代疗法缺乏临床试验支持来治疗更年期头发变稀疏，此现象源于复杂的雄激素敏感性和毛囊老化，需要针对性疗法而非单纯补充雌激素。 Dr. Dray解释了更年期雌激素下降如何导致性激素结合球蛋白减少，从而增加游离睾酮和致使毛囊微小化的DHT。她强调，更年期前后的头发变稀疏不仅是女性型脱发，还可能源于休止期脱发或瘢痕性额部纤维化脱发。至关重要的是，该视频打破了HRT是公认脱发治疗方案的观点，指出缺乏足够的临床证据支持将其用于治疗脱发。相反，患者应依赖米诺地尔、抗雄激素药物和获FDA批准的低能量激光设备等经证实的疗法，并寻求皮肤科评估以明确确切病因，而不是将脱发视为不可避免的衰老现象。激素替代疗法（HRT）并非更年期脱发的公认标准治疗方案，因为近期的文献综述认为，缺乏充分的临床证据支持仅针对脱发开具全身性激素处方。 (12:19) 更年期雌激素下降会减少肝脏产生性激素结合球蛋白（SHBG），进而增加游离睾酮，后者转化为二氢睾酮（DHT）并促使毛囊微小化。 (6:05) 并非所有更年期头发变稀疏都属于女性型脱发；临床医生必须将其与休止期脱发以及额部纤维化脱发（FFA）区分开来，后者是一种以发际线后移和眉毛脱落为特征的不可逆瘢痕性脱发。 (9:46) 低能量光疗（LLLT）的双盲临床试验显示，终毛数量在16周内平均增加了43.2%，证实其为一种有循证依据的非药物疗法。 (1:22)

Reading summary

Dermatologist Dr. Dray explains that hair loss during menopause stems from a complex cascade of declining estrogen, relative androgen dominance, and follicular aging, rather than a simple hormone deficiency. Consequently, hormone replacement therapy (HRT) lacks strong clinical evidence as a primary hair loss treatment, underscoring the need for accurate diagnosis and established therapies. Hormonal Drivers of Follicular Miniaturization (6:05) During menopause, a sharp decrease in circulating estrogen alters the scalp environment by diminishing liver production of sex hormone-binding globulin (SHBG). Because less testosterone is bound to SHBG, higher levels of free testosterone become available to peripheral tissues. Within the scalp, the enzyme 5-alpha reductase converts this free testosterone into dihydrotestosterone (DHT), a potent androgen that drives follicular miniaturization in genetically predisposed follicles. Simultaneously, the loss of estrogen impairs supportive follicle signaling pathways, including Wnt/beta-catenin signaling, which normally sustains the active anagen growth phase. However, Dr. Dray cautions against treating follicles as simple engines fueled by estrogen. Hair biology involves intricate genetic, vascular, and inflammatory networks; administering supplemental estrogen under the assumption that it directly restores hair growth overlooks these multifaceted mechanisms. Differentiating Pattern Loss, Shedding, and Scarring Conditions (9:01) Postmenopausal hair thinning encompasses several distinct clinical entities beyond classic female pattern hair loss (FPHL). While FPHL affects more than half of postmenopausal women—characteristically presenting as diffuse thinning across the crown and a widening central part—chronological aging also naturally slows follicular regeneration. Clinicians therefore cannot assume that every instance of postmenopausal thinning requires androgen-blocking therapy. Two other conditions frequently coincide with menopause. Telogen effluvium causes widespread, rapid shedding when triggers such as metabolic stress, illness, rapid weight loss, or postmenopausal thyroid disorders push follicles prematurely into the resting phase. More critically, frontal fibrosing alopecia (FFA) is an inflammatory scarring alopecia that permanently destroys follicles, causing a receding frontal hairline, eyebrow loss, and perifollicular redness and scaling. Dr. Dray notes that once scar tissue forms in FFA, the hair follicle is permanently destroyed. Limitations and Misconceptions of HRT for Alopecia (12:19) A widespread clinical misconception is that postmenopausal hair loss serves as an automatic indication for hormone replacement therapy. Dr. Dray emphasizes that HRT is not an established standard of care for any type of alopecia. Documented clinical trials showing benefit remain small and uncontrolled, such as an 11-patient pilot study evaluating estradiol, while broader reviews and a 2026 study concluded that evidence remains insufficient to recommend HRT for hair loss. The accepted indications for HRT remain vasomotor instability and genitourinary symptoms. Regarding whether HRT can worsen shedding, responses vary based on dosage, formulation, and individual genetics. When women report increased hair loss shortly after initiating or adjusting HRT, Dr. Dray cautions against assuming direct causality. Because telogen effluvium typically surfaces two to three months after a physiological disturbance, the shedding may reflect an earlier trigger. Patients are advised not to discontinue prescribed hormone regimens without consulting their gynecologist and dermatologist. Validated Treatment Options and Clinical Red Flags (15:19) Patients with confirmed female pattern hair loss should rely on clinically validated modalities rather than systemic HRT. Proven pharmacotherapies include topical or low-dose oral minoxidil, 5-alpha reductase inhibitors such as finasteride and dutasteride, and androgen receptor blockers like spironolactone. Non-invasive options include FDA-cleared low-level laser therapy (LLLT), such as the iRESTORE Elite device; double-blind trials showed that 12-minute daily photobiomodulation treatments produced an average 43.2% increase in terminal hair count over 16 weeks by calming inflammation and stimulating microcirculation. Dr. Dray highlights specific red-flag symptoms requiring immediate medical evaluation rather than home observation. These include abrupt shed events, discrete circular bald patches indicating possible alopecia areata, loss of eyebrows, and persistent scalp burning, itching, or redness. A comprehensive dermatologic evaluation also incorporates laboratory panels to detect systemic drivers, such as thyroid dysfunction or iron deficiency, which can restore follicular activity when corrected. Dr. Dray concludes that hair changes during menopause require thorough clinical evaluation rather than automatic reliance on HRT or unproven at-home remedies. Because thinning can reflect overlapping conditions—from genetic miniaturization and thyroid illness to irreversible scarring alopecias—self-advocacy and early, accurate diagnosis remain essential to protecting long-term scalp and systemic health.

Source quotes

[0:00] Dr Dray: HRT is not currently an established standard-of-care treatment for any form of hair loss, and thinning hair alone is not an automatic medical indication for systemic hormone therapy. [1:22] Dr Dray: Enhancing microcirculation to the scalp to deliver essential nutrients and growth factors to the hair follicle. [7:03] Dr Dray: more estrogen must mean more hair growth [7:03] Dr Dray: gasoline [9:01] Dr Dray: once that scar forms, you will not get hair to grow out of that follicle ever again. It is cut off. [15:19] Dr Dray: You're not going to use a hair growth treatment for 3 days and suddenly get a full head of hair. It doesn't work that way. [19:07] Dr Dray: spinning your wheels trying to figure out how to make things right. [19:07] Dr Dray: never forget their sunscreen

Original transcript

[0:00] Well, hey guys. Welcome back. If you're [0:01] new here, I'm Dr. Dray. I'm a [0:03] board-certified dermatologist, and in [0:05] this video, we are going to talk about [0:07] something that I know is of concern for [0:09] many of you. Hair loss with menopause. [0:12] And what role, if any, hormone [0:14] replacement therapy, otherwise known as [0:16] HRT, might have here. We're also going [0:18] to talk about what you can do if you [0:20] notice that your hair is getting finer, [0:22] you're shedding a lot more, or your part [0:24] is getting wider. Today's video is [0:26] sponsored by iRestore. Female pattern [0:28] hair loss becomes more common after [0:30] menopause, and the hair can become [0:32] finer, less dense, and you can start [0:34] noticing thinning, particularly over the [0:36] central scalp and the frontal scalp. Not [0:39] only do we see more female pattern hair [0:41] loss, but we also see more telogen [0:43] effluvium as well as frontal fibrosing [0:45] alopecia with menopause. Female pattern [0:48] hair loss, telogen effluvium, and [0:50] frontal fibrosing alopecia are important [0:53] hair loss disorders that are more common [0:56] after menopause. Why exactly does this [0:58] happen? There are a variety of hormonal [0:59] changes that happen with the menopausal [1:01] transition and thereafter. And these [1:03] hormonal changes have a direct impact on [1:06] the hair follicle itself. Well, this is [1:08] an important misconception. Hair loss [1:10] itself, postmenopause, is not [1:12] necessarily an indicator that you must [1:15] go on hormone replacement therapy. [1:16] Hormone replacement therapy is not [1:19] currently a standard of care treatment [1:21] for any type of hair loss. Hair loss is [1:23] something that can be incredibly [1:24] frustrating. If you've been experiencing [1:26] hair thinning, increased hair shedding, [1:28] you know how very frustrating that can [1:30] be. You're noticing more hair in the [1:31] shower, or that your central part is a [1:33] lot wider. During this time, people [1:35] become tempted to try out all sorts of [1:38] different at-home remedies, hold out [1:40] great hope that there's going to be just [1:42] that one thing that's going to get [1:43] things back on track and make a big [1:45] difference. There are a lot of gimmicks [1:47] out there, but one thing that, without a [1:49] doubt, is evidence-based that you can do [1:51] at home is low-level laser therapy. It's [1:54] an interesting option for people dealing [1:56] with different types of hair loss [1:58] disorders. I personally decided to try [2:00] out red light therapy myself several [2:03] years ago when I was going through about [2:05] of excessive hair shedding after [2:06] training for and running a marathon. [2:09] After researching the different at-home [2:11] devices available, I tried out a few [2:12] different models and decided that [2:14] IRestore far and away was the most [2:16] powerful, the most robust option that if [2:19] anything was going to make a difference, [2:21] it was going to be this device. And [2:23] after using it consistently for about 3 [2:25] months, I really started noticing not [2:27] only a decrease in hair shedding, but I [2:29] noticed that the hair that was growing [2:30] back was growing back a lot thicker. I [2:32] was having more fullness in comparison [2:34] to how my hair was prior to the shedding [2:36] event. And one of the things I [2:38] appreciated the most about this device [2:40] was how easy it is to use. It's [2:42] hands-free and you can multitask while [2:44] you're wearing it. It just takes as [2:45] little as 12 minutes a day. The device I [2:47] continue to use today is IRestore Elite, [2:50] which is designed to deliver low-level [2:51] red light therapy to the scalp. The [2:53] Elite device consists of 500 diodes, [2:55] which combine 300 lasers and 200 LEDs. [2:59] It has a total power output of 2,500 mW. [3:02] It's designed for broad scalp coverage, [3:04] including the crown and the hairline. [3:06] It's not only FDA-cleared, but it's [3:08] non-invasive and it's a drug-free option [3:10] that you can do in the privacy of your [3:12] own home. Importantly, it is [3:14] evidence-based. Low-level laser therapy [3:16] continues to be something that comes up [3:19] and something that has shown to be [3:21] effective for androgenetic alopecia as [3:23] well as other hair loss disorders. The [3:25] way it works is by improving, first of [3:28] all, circulation to the hair follicle, [3:30] which is going to allow for good [3:31] delivery of growth factors and nutrients [3:33] to the follicle to get it back into the [3:35] growing phase. Secondly, it reduces [3:37] inflammation in the scalp, and third, it [3:40] also helps to reawaken and re-energize, [3:43] if you will, the cells of the hair [3:45] follicle so that they can begin to [3:47] divide and to make that hair and get it [3:49] to go back into the growing phase so [3:51] that that previously miniaturized hair [3:54] that was very sparse and unnoticeable to [3:56] you now goes back to a terminal growing [3:58] hair. And well, the result is not only a [4:00] decrease in hair shedding, but an [4:02] improvement in thickness, fullness, and [4:04] density. The technology is really [4:05] interesting because it combines lasers [4:07] and LEDs. So, the lasers deliver [4:10] targeted therapy, whereas the LEDs [4:12] provide more broader scalp coverage. In [4:15] contrast to some other devices on the [4:17] market, there's actual clinical research [4:19] with their devices. In a double-blind [4:21] study, users experienced an average [4:23] 43.2% increase in terminal hair count [4:26] after 16 weeks, compared with a much [4:28] smaller increase in the placebo group. [4:30] Now, of course, this doesn't mean that [4:32] every single user is going to experience [4:34] a 43% increase in hair. Remember, hair [4:36] loss has many different causes. [4:38] Treatments are going to work differently [4:39] depending on the hair loss type that you [4:41] have. But, low-level laser therapy can [4:43] be an option, particularly for people [4:46] with androgenic alopecia, but also with [4:48] growing evidence to support its use for [4:50] telogen effluvium and frontal fibrosing [4:52] alopecia. Now, you don't see results [4:55] overnight. Like anything worth having, [4:57] you have to stick with it and be [4:58] consistent in order to really obtain [5:01] those benefits. Usually around 3 months, [5:04] you can kind of start to see an [5:05] improvement, but it can take much [5:07] longer. One of the things I like most [5:09] about iRestore is they realize this, and [5:11] they realize that not every customer is [5:13] necessarily going to benefit from their [5:15] device. So, not only do they give you [5:17] ample time to try it out, but if you're [5:19] not completely satisfied after a year, [5:22] you can get your money back. iRestore is [5:24] far and away the longest-standing [5:26] sponsor of this channel. I have [5:28] continued to use the device and [5:30] recommend it for many years. It is my [5:32] go-to recommendation as far as a device [5:34] when people are on the hunt for a [5:36] [clears throat] low-level laser therapy [5:37] device for hair restoration. Right now, [5:40] you guys, they have reactivated my code [5:43] with Labor Day coming up, and if you use [5:45] my code, which I will put everything [5:48] down in the description box, you can [5:49] save quite a bit on the Elite device. [5:51] So, definitely take advantage of it if [5:53] this is something that you've either [5:55] heard me talk about or you've read about [5:56] elsewhere or your dermatologist has [5:58] recommended that you pursue and you're [6:00] wondering about this, um this is a great [6:02] time to go ahead and check it out [6:03] because you can save quite a bit. During [6:05] the menopausal transition, estrogen [6:07] hormone levels decline, but at the same [6:09] time, there's a relative increase in [6:12] androgen hormone activity. Now, notice I [6:14] say androgen hormone activity because [6:17] this doesn't mean that the androgen [6:18] hormones dramatically rise as a result [6:21] of menopause. It's a lot more [6:22] complicated than that. Before menopause, [6:24] estrogen stimulates the liver to produce [6:26] something known as sex hormone binding [6:28] globulin or SHBG. And normally, SHBG is [6:32] binding to testosterone, which is an [6:34] androgen hormone. But when estrogen [6:35] levels decline, SHBG levels also [6:38] decline. What this means is that while [6:40] your body is not producing more [6:42] testosterone, less of it is bound up in [6:44] that SHBG, so more of it is available [6:47] to, well, impact the hair follicle. Some [6:49] of that testosterone is going to get [6:51] converted to a more potent form known as [6:54] dihydrotestosterone [6:55] through the action of an enzyme known as [6:57] 5-alpha reductase. This matters because [7:00] your hair follicle responds differently [7:02] to dihydrotestosterone. [7:03] Estrogen has a really important effect [7:05] on the hair follicle. Hair follicles are [7:08] hormonally responsive structures, and [7:10] estrogen influences different pathways [7:12] involved in the hair growth cycle, [7:14] including something known as [7:15] Wnt/beta-catenin. So, when estrogen [7:17] levels fall dramatically with menopause, [7:19] there can be less signaling through this [7:21] pathway to stimulate hair follicle [7:23] growth. There are also some changes in [7:25] the metabolic activity of these cells, [7:27] as well as the vasculature, the blood [7:29] flow delivering the growth factors and [7:31] nutrients necessary to grow hair, which [7:33] is metabolically demanding as a side [7:35] note, but I want to emphasize this up [7:36] front. Hair follicle biology is pretty [7:38] complicated. So, while it's helpful to [7:41] understand a bit what's going on, don't [7:43] take that to mean, "Oh, well, more [7:45] estrogen must mean more hair growth." [7:47] And think that the solution to all of [7:49] your hair growth woes is to just, well, [7:52] take estrogen because surely that's [7:54] going to give it the gasoline it needs [7:56] to grow healthy hair. It's a lot more [7:58] complicated than that. Now, one of the [8:00] most common types of hair loss out there [8:02] is known as androgenetic alopecia. It [8:04] actually affects men and women. And I [8:05] have a lot of videos on this hair loss [8:07] disorder. In women, we refer to it as [8:10] well, female pattern hair loss. If you [8:12] have this, you might notice that your [8:13] part is becoming wider or that your hair [8:16] is thinning over your crown or central [8:18] scalp. Unlike typical male pattern hair [8:20] loss, women typically maintain their [8:22] frontal hairline. Now, female pattern [8:24] hair loss can happen at any age, but it [8:27] becomes particularly common around [8:28] menopause. For example, in one study, of [8:31] postmenopausal women, more than half of [8:32] them had female pattern hair loss some [8:34] extent. So, if you're a postmenopausal [8:37] female woman watching this, there's a [8:38] good chance you have some amount of [8:41] female pattern hair loss. Androgen [8:43] hormone sensitivity at the level of the [8:44] follicle as dictated by your genetics [8:47] definitely plays a role, but it's not [8:49] the complete picture here. It's not [8:51] merely the androgen hormone, [8:53] dihydrotestosterone, that is doing all [8:55] of the heavy lifting when it comes to [8:57] sabotaging your hair. There's a lot more [8:59] going on behind the scenes that is [9:01] involved in androgenetic alopecia. As I [9:03] mentioned, there's a contribution of [9:05] your genetics. Some people's hair [9:07] follicles are going to be a very, very [9:09] sensitive to these hormonal shifts such [9:12] that the slightest shift alters the hair [9:14] growth cycle. Whereas for other people [9:17] without those genes, well, they're not [9:19] going to be impacted to the same extent [9:21] or necessarily even have this condition. [9:23] Like the rest of our body, our hair [9:24] follicle ages. So, as it relates to just [9:27] simply an aging hair follicle, you're [9:29] going to have less hair growth as you [9:32] get older. It's just a natural part of [9:34] the aging process for things to slow [9:37] down, including hair growth. That's why [9:39] I don't recommend assuming that women [9:41] with hair loss all need androgen [9:44] blocking therapy to treat the hair loss. [9:46] The most important thing is to first [9:48] determine what type of hair loss you [9:50] have because not all menopausal hair [9:53] loss is androgenetic alopecia, aka [9:56] female pattern hair loss. There's also a [9:58] condition known as telogen effluvium. [10:00] Telogen effluvium is essentially [10:01] excessive hair shedding. This happens [10:04] when more hairs than usual enter the [10:06] resting phase of the hair cycle. Because [10:08] menopause is a time period where you [10:10] have several triggers that could lead to [10:13] this transition of all these follicles [10:15] over to prematurely enter the resting [10:18] phase. You've got not only the hormonal [10:21] changes, but you have stress. You might [10:23] have an illness. Changes in weight are [10:25] not uncommon with menopause. It's not an [10:27] uncommon time period in a woman's life [10:29] for new medications to be started, which [10:31] certainly can impact the hair. And then [10:34] outside of the menopause hormones, you [10:37] also have to think of hormonal disorders [10:39] that tend to be also more common [10:41] postmenopausal, namely thyroid hormone [10:44] disorders. And thyroid hormone is [10:46] another one that plays a huge role in [10:49] hair follicle growth. So, all of these [10:51] things can contribute to the onset of [10:53] shedding. There's another diagnosis that [10:55] becomes a lot more common in [10:57] postmenopausal women that's really [10:58] important to make sure you don't have [11:00] going on here, and that is frontal [11:02] fibrosing alopecia. Because this type of [11:04] hair loss, in contrast to androgenetic [11:06] alopecia and telogen effluvium, it is a [11:08] scarring type of hair loss. And if left [11:11] undiagnosed and subsequently untreated [11:14] through the proper specific treatments, [11:17] well, the follicle will go on to scar, [11:18] and once that scar forms, you will not [11:21] get hair to grow out of that follicle [11:23] ever again. It is cut off. Um, so that's [11:26] why knowing the diagnosis is paramount [11:29] before you attempt to fix it. And this [11:32] type of scarring hair loss [11:33] disproportionately affects [11:35] postmenopausal women. Not only does it [11:37] affect the frontal hairline in such a [11:38] way that over time you get a receding [11:41] frontal hairline, but it also often [11:43] impacts the eyebrows and you get hair [11:45] loss at other body sites as well. The [11:47] hair loss initially is accompanied [11:50] around the follicle by redness, [11:52] scaliness, and often scalp itch. These [11:54] are signs of inflammation. That [11:56] inflammation comes in to destroy the [11:59] follicle if left unchecked untreated, [12:01] well, it'll cause the follicle to scar. [12:04] So, in the early stages, you are going [12:05] to see on your scalp that redness and [12:08] subsequent flaking of the scalp just [12:11] around the follicle. So, that's an [12:12] important early warning sign that your [12:14] dermatologist is going to be evaluating [12:16] usually with that handheld dermatoscope. [12:19] Now, the answer to the question that I [12:21] know many of you wondering is, well, [12:23] does HRT help? So, it's possible that [12:26] HRT, hormone replacement therapy, can [12:28] help here. Unfortunately, we do not have [12:30] strong evidence for recommending HRT as [12:33] a treatment for hair loss, any type of [12:35] hair loss. There are biological reasons [12:38] to think why estrogen can influence the [12:41] hair cycle post-menopause. And of [12:43] course, several small studies do suggest [12:45] potential benefit with estrogen [12:47] replacement from hormone replacement [12:49] therapy. For example, a very small study [12:52] involving just 11 postmenopausal women [12:55] found some improvements in measures of [12:57] frontal hair thinning with estradiol [12:59] therapy. But, it had a really small [13:01] sample size and no control group. So, [13:03] that's not a high-quality enough study [13:05] for us to be like, "Okay, postmenopausal [13:08] woman, hair loss, let's give her HRT." A [13:10] recent review that specifically examined [13:12] menopause and hair loss concluded that [13:15] there was not enough evidence for [13:17] hormone replacement therapy as a [13:19] treatment for hair loss in comparison to [13:21] standard therapies and that it is not [13:24] adequately backed up to recommend it as [13:27] a treatment for hair loss in the [13:29] postmenopausal woman. A 2026 study [13:32] focused specifically on HRT and hair [13:35] loss similarly concluded that the [13:37] evidence was insufficient for HRT to be [13:40] recommended as a standard of care [13:42] therapy for hair loss in the [13:44] postmenopausal woman. So, if you're [13:45] considering HRT because you have hot [13:47] flashes, night sweats, vaginal symptoms, [13:50] which are characteristic of menopause, [13:52] that's a conversation to have with your [13:55] gynecologist or your primary care [13:57] provider. I would not start HRT or think [14:01] to start HRT simply for the hair [14:04] thinning, the hair loss. And this is [14:06] another interesting part of the [14:07] discussion, and that is can HRT worsen [14:10] hair loss? Because HRT isn't necessarily [14:13] going to impact everyone's hair loss in [14:16] the same way. The specific hormones that [14:18] you're taking as part of the HRT [14:19] matters. The dose matters, and of course [14:22] your genetics and your diagnosis. What [14:25] type of hair loss do you actually have? [14:26] Some people may notice hair changes [14:28] after starting HRT, while others notice [14:31] no change, and in some cases they even [14:33] notice a little bit of improvement. The [14:35] relationship between hair loss and HRT [14:37] is complicated. Different hormone [14:39] formulations have different effects on [14:41] the hair cycle. Also, if you notice [14:42] significant shedding when you start HRT, [14:45] don't assume that the HRT is the cause. [14:47] Because here's the thing, when it comes [14:49] to telogen effluvium, aka excessive hair [14:52] shedding, well, that is well known to [14:54] occur months after the trigger happened. [14:57] So, the timing of the hair loss in [14:59] association with something can be pretty [15:02] misleading. But, if you do notice [15:03] substantial hair loss either with [15:05] starting or stopping HRT, definitely see [15:07] your health care provider um to talk to [15:10] the clinician about managing the hormone [15:12] replacement therapy um and consider [15:14] seeing a dermatologist. In other words, [15:16] don't just stop prescribed hormone [15:17] replacement therapy because you're [15:19] noticing hair hair If there's inadequate [15:21] evidence to go recommending HRT, what [15:23] actually helps with postmenopausal hair [15:26] loss? Like I said, the most important [15:28] thing is getting the correct diagnosis. [15:30] If it's female pattern hair loss, well, [15:32] topical minoxidil is an effective [15:34] treatment here. There's also oral [15:35] minoxidil and anti-androgen therapies [15:38] like spironolactone and even finasteride [15:40] might be considered here. But, these are [15:42] prescription medications, they're not [15:43] necessarily right for everyone. So, it's [15:46] important to talk about your treatment [15:47] options with your dermatologist. And [15:49] then we have low-level laser therapy. [15:51] This is where a device like iRestore [15:52] Elite can really come in and help you [15:54] out because not only can it help by [15:56] itself, but it can be used in [15:58] conjunction with other established hair [16:00] loss treatments like minoxidil or [16:02] finasteride or dutasteride safely and in [16:04] some cases patients get better results [16:07] with the combination of treatments than [16:08] they do with either treatment alone. [16:10] Like I mentioned, it's really easy to [16:12] stay consistent with the iRestore device [16:14] at home and that's key because when it [16:16] comes to treating female pattern hair [16:18] loss, consistency is key. You've got to [16:21] stay consistent with these treatments in [16:22] order to get and maintain the results. [16:25] You're not going to use a hair growth [16:26] treatment for 3 days and suddenly get a [16:28] full head of hair. It doesn't work that [16:29] way. When should you see a [16:30] dermatologist? Well, there are a few [16:32] situations where I think a dermatologist [16:34] can really, really, really be an [16:35] important player on your treatment team [16:37] here. And that is if you really start [16:39] noticing the hair loss all of the [16:41] sudden. Like it's not just this slow, [16:43] gradual over the past several years [16:45] since maybe went through menopause or [16:47] you're going through menopause already [16:49] noticing some thinning over time very [16:51] slowly. Also, if you are losing large [16:54] amounts of hair. If you see frank bald [16:56] patches, definitely see a dermatologist. [16:59] That could be another type of hair loss [17:00] we didn't talk about today known as [17:02] alopecia areata, an autoimmune hair [17:04] loss. Importantly, if your scalp is [17:05] painful, itchy, you have redness and [17:07] flaking, see a dermatologist. Those are [17:09] warning signs of scalp inflammation. You [17:12] could have a brewing inflammatory scalp [17:14] disorder that is affecting your hair [17:16] follicle and if left untreated could go [17:18] on to scar. So, you don't want to sleep [17:20] on that, either. Especially if it's [17:21] affecting your frontal hairline, and if [17:23] you've noticed hair loss at other [17:25] locations, like your eyebrows, under [17:27] your arms. These are all situations [17:29] where we want to make sure we're not [17:30] missing anything. We're not just [17:31] chalking it up to the aging process. I [17:34] think one of the things that frustrates [17:35] women the most when they go through [17:37] menopause is feeling like they're not [17:38] being heard by their healthcare [17:39] provider. So, definitely be your own [17:41] advocate here, and make sure that you [17:43] speak up, and that somebody doesn't just [17:45] brush off your hair loss to just getting [17:47] older, because if you have these [17:48] symptoms in particular, it could be a [17:51] clue that you have some other type of [17:53] hair loss aside from what is caused by [17:56] menopause or associated with menopause [17:58] or aging. And even if it is menopause [18:00] and aging, there are effective [18:02] treatments, so the diagnosis really [18:04] matters here. Depending on your history [18:05] and examination, your dermatologist [18:07] might need to order some blood work. [18:08] Like, maybe there's some concern that [18:10] your thyroid isn't optimally [18:11] functioning, and that's a game-changer. [18:13] The hair is going to save your life in [18:15] that case if the diagnosis is made, [18:16] because thyroid disease is something [18:18] that needs to be treated not just for [18:19] the state of your hair, but for your [18:21] overall health. Also, they might [18:22] identify an underlying nutritional [18:24] deficiency, such as iron deficiency, [18:26] which can [clears throat] be corrected [18:28] in most cases, and once that happens, [18:30] well, you can get your hair back into a [18:32] better state as far as growth. As a [18:34] final takeaway, remember menopause and [18:36] hair loss are intimately connected, but [18:37] the relationship is very complicated. [18:39] Estrogen levels, of course, fall [18:40] dramatically with menopause, and this, [18:42] without a doubt, has an impact on the [18:44] hair cycle. And there's also that [18:45] relative increase in the androgen [18:47] presence, if you will, at the level of [18:49] the hair follicle that can contribute to [18:50] that miniaturization process through [18:53] dihydrotestosterone. [18:54] But not every woman with hair loss with [18:57] menopause has the same exact diagnosis. [18:59] You'd have female pattern hair loss, you [19:01] could have telogen effluvium, you could [19:02] have both. You could have frontal [19:04] fibrosing alopecia, you could even have [19:06] alopecia areata. While HRT may help some [19:09] women and may be appropriate to continue [19:11] for hair benefits in some women provided [19:14] they tolerate it. It's not a standard of [19:15] care treatment for hair loss. There are [19:18] other evidence-based treatments with a [19:20] lot more solid research backing up their [19:22] use for treatment such as minoxidil, [19:24] finasteride, dutasteride, [19:26] spironolactone, and low-level laser [19:28] therapy. So, if you're interested in [19:30] trying out low-level laser therapy, [19:32] definitely take advantage of my code. [19:34] Again, I'll put all the details [19:36] regarding the iRestore savings in the [19:39] description box. But, I want to [19:41] emphasize this to you guys. It is so [19:43] important that you have your hair loss [19:46] properly evaluated. Make sure you're [19:47] being heard by your health care provider [19:50] and that you get that accurate [19:51] diagnosis. That is their job. Make sure [19:53] they do it, okay? Because that's why [19:55] you're spending your time in there [19:57] reiterating everything that you've been [19:58] through for them to properly work up. [20:02] Because without the right diagnosis, [20:04] you're going to be spinning your wheels [20:05] trying to figure out how to make things [20:07] right. I hope you all found today's [20:08] video helpful. Thank you iRestore for [20:10] sponsoring. If you guys enjoyed it, give [20:13] it a thumbs up, share it with your [20:14] friends, and as always, don't forget [20:15] sunscreen and subscribe. I'll talk to [20:17] you guys tomorrow. Bye. [20:36] >> [music]