Thinner hair with age: what is normal

"My hair is not what it used to be." It is a phrase heard a lot from the age of 40 or 50, in women and men. Hair seems thinner, has less volume, grows more slowly, loses shine, changes texture and goes grey. Part of this is normal ageing, which happens to everyone, just as skin loses elasticity.

But "normal for age" does not mean everything should be accepted without a second look. A significant proportion of people who put thin hair down to age actually have a pattern hair loss (female or male), which can be treated and whose progression can be halted. Learning to tell the two apart is the aim of this article.

What changes in hair with age

The hair shaft gets thinner

Hair diameter increases during childhood and adolescence and, in women, stays relatively stable until middle age. From the age of 40, on average, it begins to decrease. Cosmetic science studies, such as that of Mamada and Nakamura (2007) in Japanese and white women, confirm that diameter decreases with age and that hair also loses internal stiffness, which contributes to the loss of "body" and volume. Because volume depends on the square of the diameter, a small reduction in each hair is quite noticeable overall.

Fewer hairs

Density (the number of hairs per square centimetre) decreases progressively throughout adult life. In the study by Birch, Messenger and Messenger (2001), of 377 women in the United Kingdom, density decreased with age, both in women with pattern hair loss and in those without it. Some follicles enter longer resting periods and some stop producing hairs.

Hair grows more slowly

The growth phase (anagen) tends to shorten with age and the growth rate decreases. That is why letting hair grow very long becomes harder, and the ends are thinner than the root.

Hair goes grey

The follicle's melanocytes, which give hair its colour, gradually run out. The old "50/50/50" rule (50% of people with 50% grey hair at the age of 50) was revised in a worldwide survey (Panhard et al., 2012): in reality, only 6% to 23% of people have half their hair grey at 50, depending on geographical origin. Grey hair tends to be drier and sometimes coarser or more unruly, which changes the texture of the whole head.

Changes texture and shine

With age, and especially at the menopause, the layer of lipids that coats the hair shaft decreases and the scalp produces less sebum. Hair becomes drier, with more friction between strands, less shine and more frizz. The cuticle lifts more easily, and thin hair absorbs dyes and chemicals faster, which increases the risk of damage.

"Senile alopecia"

Some authors, since Kligman (1988), describe a "senescent alopecia": a diffuse, uniform reduction in density after the age of 50 to 60, without the pattern or the miniaturisation typical of androgenetic alopecia. Whether it is a separate entity is debated, but the concept is useful: some loss is simply that of ageing.

Normal ageing or pattern hair loss?

Female and male pattern hair loss also become more common with age. In Australia, Gan and Sinclair (2005) found female hair loss in 41% of women aged 60 to 69 and in 56% after 70. In other words: many people with "age-related thin hair" in fact have both at the same time. The difference lies in the pattern.

Trichoscopy is very helpful in telling the two situations apart, because it shows the variability in hair thickness, comparing the top with the back of the head. See also Female hair loss: what it is and how to recognise it, Wider parting: when it is worth assessing and Male pattern baldness: what it is and how to recognise it.

Signs that are not "just age"

What can speed up the loss

Menopause

The fall in oestrogen alters the hormonal balance and may reveal or accelerate female hair loss (Mirmirani, 2011). Many women notice the change at this stage, along with dry hair. See Menopause and hair loss: what is known and Hair care in the menopause: a simple routine.

Sun

UV radiation damages the hair shaft and, with age, thinner hair with less pigment is more vulnerable. A more exposed scalp also accumulates sun damage.

Tobacco

Smoking is associated with premature skin ageing and, in several observational studies, also with more hair loss and earlier grey hair. In a study of identical twins, the factors associated with more hair loss included smoking (Gatherwright et al., 2013). It is one more reason to stop.

Deficiencies and illnesses

With age, iron deficiency (for example, through digestive losses or a poorer diet), vitamin B12 deficiency (through reduced absorption or medicines such as metformin and proton pump inhibitors), vitamin D deficiency and thyroid changes become more common. All can make hair loss worse. A diet with insufficient protein, common in older people, also counts.

Medicines

Some medicines more commonly used with age can be associated with hair loss: certain anticoagulants, beta-blockers, retinoids, some antidepressants, breast cancer therapy (aromatase inhibitors), among others. Never stop a medicine on your own initiative; talk to the doctor who prescribed it.

Repeated cosmetic treatments

Fine, dry hair absorbs dyes and chemicals faster. Bleaching, straightening and frequent heat break hairs that are already fragile and accentuate the loss of volume.

Looking after mature hair

Day to day

• Gentle shampoo and light conditioner. Fine hair gets "heavy" with very rich products; apply conditioner only from the mid-lengths to the ends.
• Wash as often as is comfortable for you. With less sebum, many people can space out washes, but washing does not make hair fall out.
• A mask or light oil once a week to make up for dryness and reduce friction.
• Comb with care, preferably with damp hair and conditioner, using a wide-toothed comb.
• Moderate heat: hairdryer at a medium temperature, heat protectant, flat iron only occasionally.
• Sun protection: a hat in summer and sunscreen for the scalp in areas with less hair.

Cut, colour and style

• Layered cuts and a medium length give fine hair more volume than very long hair.
• Colour helps: lighter shades or ones close to skin colour reduce the contrast with the scalp. Prefer ammonia-free or semi-permanent colours and avoid frequent bleaching.
• Embracing grey hair is a valid option and reduces chemical damage; there are specific care steps to avoid the yellowish tone.
• Hair fibres and coloured sprays disguise thinner areas.

Diet and general health

Enough protein at every meal, pulses, fish, eggs, vegetables and fruit. With age, the need for protein stays the same or even increases in order to preserve muscle. Regular physical activity, not smoking and treating chronic conditions contribute to the health of your hair just as they do to the rest of the body.

What has evidence

For normal hair ageing, there are no medical treatments with solid evidence: care is mainly cosmetic. When there is an associated pattern hair loss, minoxidil and other treatments can halt progression, even in older people, and should be discussed at a consultation. Supplements only make sense if there is a deficiency.

When you should ask for an assessment

At Luxmed, the hair medicine consultation includes a clinical history, examination of the scalp and trichoscopy, which makes it possible to distinguish normal ageing of the hair from a pattern or scarring alopecia. When indicated, we request blood tests. It is never too late to get assessed.

This article is for information purposes and does not replace a medical consultation. The results of any treatment vary from person to person.

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