Menopause Rise and Thrive | Helping Women Navigate Midlife and Menopause

115. Hair Loss in Midlife

• Dr. Sara Poldmae | Healer, Doctor of Acupuncture and Chinese medicine, and Functional Medicine Practitioner

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Are you noticing more hair in your brush, thinning at your part, or just feeling like your ponytail isn’t what it used to be? You’re not imagining things—and you’re definitely not alone. Hair loss is one of the most emotionally distressing symptoms women face in midlife, and yet it’s still not talked about enough. In this powerful episode, I’m joined by Dr. Mary Wendel, a board-certified internist and founder of Medi Tresse, a clinic dedicated to women’s hair loss.

Dr. Wendel brings her decades of experience—and deep compassion—to break down the root causes of hair loss during perimenopause and menopause, plus what you can do about it. If you’ve ever felt dismissed, overwhelmed, or just plain lost trying to understand your changing hair, this conversation will leave you feeling seen, informed, and empowered.

 

In this episode:

  • Why hair loss is so common (but rarely discussed) during perimenopause and menopause
  • The emotional toll of thinning hair—and why it deserves serious attention
  • Common causes of hair loss in midlife: from hormones and genetics to stress and nutrition
  • How to recognize patterns of hair loss—and what they might be telling you
  • The role of stress, iron levels, thyroid, and autoimmune dysfunction in hair health
  • Why getting a thorough medical workup is crucial before starting treatment
  • Treatment options that actually work—from minoxidil and light therapy to functional medicine support

 

Resources Mentioned:

 

Connect with Dr. Mary Wendel:

 

 

Connect with me, Dr. Sara Poldmae:

Website: https://risingwomanproject.com

Instagram:  https://www.instagram.com/drsarapoldmae

Have a question I can answer? Send me a message! I love to hear from my listeners!

Sara Poldmae:

Sarah, welcome to menopause. Rise and thrive. I am Dr. Sarah pulled me and this podcast is your go to guide for navigating perimenopause and menopause. If you are feeling a little overwhelmed, trust me, you are in great company. Each week, I'll bring you expert advice, raw, honest conversations and simple tips to help you stay grounded and maybe even find some humor in the process. Let's rise, thrive and tackle this wild ride together. Hello, ladies, today I am thrilled to bring Mary Wendell on the show. We have had a lot of interesting discussions on this podcast, but one guest I have yet to bring, on, Mary, really fills the gap. So Dr Wendell is a board certified internist, and she did primary care for over 30 years, but the last 15 years, she's been the owner and medical director of medi Trust, which is a medical practice devoted to the care of women experiencing hair loss of all types and of all ages, and I know that daily in clinic, we see women in midlife that are struggling with hair loss, and there can be so many different causes. So I'm hoping that Dr Wendel will break down the causes, share her own story, how she got into this and all of that. So welcome, Dr Wendell to the show.

Mary Wendel:

Thank you so much. I'm actually very excited to be here. Thank you absolutely.

Sara Poldmae:

So yes, give us a little bit more. I mean, that was a really brief introduction. Give us a little bit more about you and maybe your personal journey to where you are today.

Mary Wendel:

Yeah, my journey to hair loss was sort of a wasn't a straight line by any means. I, you know, did primary care for a long time, and there was a little bit of dermatology slash hair loss in that, but mostly not. But my husband, his journey, brought him to hair transplants, and he was been doing that for 30 years. And I really got pulled into that when more and more women started showing up with a lot of questions, and I can also share with you my own journey. I was concerned that my family history was very strong for hair loss in women. My paternal grandmother actually ended up wearing a wig by the time she was in her 60s. And as a little girl, I thought, well, that was kind of fun. We would play with it, take it out of the box and but obviously for her, it was an issue, enough that she would buy a wig. And when she went out, she was a young widow, she would wear that wig. And as a child, I never thought, well, that's going to be, you know, my concern and my future. But as it turned out, the closer I got to menopause, I started noticing thinning in my hair as well. I never had a lot of hair. It was always very fine. But when you start out with less, and you start seeing these changes, it gets frightening. And so when my, you know, when I got pulled into the to the hair loss world from my husband, initially, we didn't have a lot to offer women, you know, it was mostly minoxidil and and just a lot of compassion. Really, we were a good sounding board. You know, we talked about nutrition a bit and the hormones, but there really wasn't a lot initially, but over the last 15 years, that has changed, and we're seeing benefits, things that do help. We've also learned a whole lot more about all the things that play into it. Certainly, hormones play a huge role, and can affect hair loss in women's lives throughout their hormonal journey. We all know the changes that take place during pregnancy and after. We see more and more young women having hormonal imbalances for many different reasons. Our world is kind of filled with hormonal challenges, and so yes, a lot of it is the perimenopausal and postmenopausal timeframe, but even younger. So, you know, we do now have the ability to evaluate better. I myself am and being treated within my own clinic by my own clinicians. And I take, you know, I take that very seriously, but I think more than in the beginning, the thing that really struck me, and I probably wasn't as prepared for it was the emotional impact that it was having on women. You know, there's such a strong emphasis on on how you look, and how does that turn into how you feel about yourself and and when women start losing their hair, they they come in and they'll say, please, I don't want to go bald. And the good news is, most women, that's not an issue, but it's frightening. And once the women start coming in even younger, when their hormonal issues start happening earlier in life, it's really an emotional problem. And I I should have known that it was going to be but I was initially really surprised. And I think until recently, a lot of hair loss specialists really didn't have a lot of experience, and women were not treated very well. They were sort of said, well, just try a little Rogaine or minoxidil, and you'll be fine. Or the other side of it is, I hear women coming in and saying, I just saw somebody a couple weeks ago who said, I better go buy a wig. Because I'm going to be bald in five years, which was a horrible thing to do to somebody, but I hear these stories over and over again, and so we have a clinic that really is made specifically for women. Few men trickle in. Usually they're the husbands or brothers or sons of our female clients, but it's a safe space where they can talk about it and share their feelings, and then hear what really is going on. You know, we talk about, we talk about, you know, hair loss isn't a diagnosis. It's a symptom of something. And so we work very hard to figure out what it is exactly that's driving this hair loss before we even consider, you know, what's the best treatment? So it's, it's, it's been a journey

Sara Poldmae:

that is so nice to hear that we don't just throw things at patients hoping that they'll work. So for women that are in perimenopause or menopause, this specific age group, which is the audience listening today, what are some of the more common reasons that a woman would lose their hair, and kind of walk us through maybe the brief, kind of highlights of what you're looking for clinically, like, whether it's rapid onset, would mean one thing or, you know, give us kind of the breakdown of a couple of different patterns that you're seeing.

Mary Wendel:

Yeah, most typically, when it's hormonal, a combination of hormones and an underlying genetic predisposition, it's a gradual loss, which is, there is some reassurance in that. Women come in and say, you know, the last five years, I'm shedding a bit more. My ponytail isn't quite as thick. I don't need as many clips to hold it back. I'm just seeing these changes. And, you know, they want to slow it down, they want to stop it. And they come in and say, You know what? What's causing this? And, and we do know that, like myself, I inherited this genetic predisposition. Well, that doesn't mean I'm going to lose all my hair, but it means I'm going to slowly lose it and, and the hair follicles kind of shrink up over time, and then the hair itself gets smaller, but we can work on that if that is the primary diagnosis. So the hormones, the estrogen, which is so much higher and in our younger lives, does help stimulate growth, estrogen and progesterone. And as we lose those hormones, we lose that benefit. And so, you know, it doesn't happen overnight. And those, those hormonal changes don't happen overnight. They They occur decades. They take decades to happen. Our hormones really peak sometime in our late 20s, early 30s, and then gradually go down. But and so women tend to see this in their mid 40s. They start to notice it and or a little earlier in fact. And I think women are more in tune to it than they used to be. But so they start to notice that it's just not as thick. They might shed a little bit more. It's gradual. You know, their scalp feels okay, but their their hair just isn't as thick. Ponytails aren't as as thick. And so, you know, a lot of girls have really thick hair when they're younger. You know, their ponytails are huge. And as they get go through these the 30s and then hit their mid 40s, they're like, my ponytail is just not what it used to be, and the hair feels finer, and it doesn't hold styling as well. And so as those hormonal changes continue and women hit menopause, when the hormones are really crashing, we see accelerate even a little bit faster. But it's not usually a quick loss. It's not like all of a sudden they're shedding huge amounts of hair when we see that there's usually something else underlying. And we do see a lot. We do see that as well. You know, in this day and age of of weight loss, rapid weight loss, we see women of all ages coming in with very rapid loss as a result of that rapid weight loss, and not the good enough nutrition to offset that. And so this, this world of the GLP ones were, were amazed by how many women are walking through the door saying, my hair is really shedding badly. And why? You know, this may not even be related to their hormones directly, but so we so that was

Sara Poldmae:

more of like a micronutrient and macronutrient issue. Yes,

Mary Wendel:

yes. Women, women, as they approach the other thing that happens is they approach menopause, you know, after decades of getting a monthly period, their iron levels drop very slowly. And you know, for myself, I don't eat any red meat, and that's a big source of iron, so I have to work to get it elsewhere. But if you're not careful about that, the iron levels do fall. And low iron is one of the most common causes of excessive shedding. So nutrition is incredibly important for all types of hair loss. But the the androgenic alopecia, which is the genetic hair loss that is the most common, is is more common around those hormonal changes of perimenopause and then through the other types of hair loss can occur, really, at any time of life. Oftentimes, after childbirth, you can have excessive shedding, and that is due to hormonal changes, but they're rapid changes. You know, you give birth to this beautiful baby, your hormones dramatically drop, and your hair will then shed. That's a different problem than the kind of hair loss that are. Occurs in hormonal changes and menopause,

Sara Poldmae:

and is that similar to what we see with patients that come in that have just had a hysterectomy? Well, all of a sudden, about a month post op, will say, I'm losing hair in batches, similar to after a pregnancy.

Mary Wendel:

Yes, it's that sudden change. It's like it's instant menopause. It's, you know, even if you're in your 40s or early 50s, and you know, they take the ovaries out for whatever reason, you still have been producing some hormone. Suddenly, it's gone. And so it's these instant changes that cause that really excessive shedding, which is a little different than just what would be the normal, inherited androgenic loss.

Sara Poldmae:

And we we had spoken, we had mentioned really quickly before we hopped on the call about stress. So I think something like a hysterectomy, it is hormones come. Even if you have maintained your ovaries, your hormones have still shifted. But then it's confounded by the fact that you went through a major, you know, abdominal surgery,

Mary Wendel:

that's right. And I actually did a webinar on the effects of stress on hair. And the research is, is, is quite impressive, the hormonal changes that take place during stress and physical stress, which, you know, from illness. We saw this after COVID. We saw, we can see it after any significant illness or surgery, this just the physical stress on your body can have, me have shedding as a result of that, but also the nutritional changes that occur after after a serious illness, but the immune changes that occur with stress. You know, I talk about stress a lot in my practice, I will say that that really profound emotional stress can cause excessive shedding. One of the worst cases I ever saw was in a middle aged woman who was going through a profound stress with her mother, who was quite ill, and her hair was just coming out in fistfuls, and we worked her up to make sure nothing else was going on and there wasn't. And she she had to make some changes in her life, and her hair did recover, but it was impressive how much stress she was under and the effects that it had on her body.

Sara Poldmae:

Well, being in the more functional medicine slash holistic space, we see a lot of that as well. And you know, are pre you're preaching to the choir, because they all know, you know, if you're under stress, it can cause sickness, and if you're under stress, it's going to make it a heck of a lot harder to recover from an illness, even if it was an illness like COVID, that had nothing to do with stress, you know. So it's kind of a double edged sword. And okay, so then let's say that it is stress, for example, that's causing the hair loss, like with your patient that was going through some really emotional times in her life and challenges, were you treating it in any other way besides Stress management techniques? What did you do for that particular patient? Yeah,

Mary Wendel:

there are things that can be done once we can figure out the actual cause. And sometimes, as I said, women can have very low iron or vitamin D levels or other nutritional deficiencies that can accelerate hair shedding. We rule all those things out. We do a battery of blood work, and we try and get their diet better. We encourage them. We do a lot of dietary counseling, which is interesting, because that wasn't a big part of my training. But you learn as you go, and it's important for these patients. So you fix what needs to be fixed, you know, biochemically fix what we find and but then there are things that can be done to help stimulate the hair to recover faster. You know, we do use an oxidal Most people remember it as being Rogaine, but it can be done orally or topically. And those that can actually increase the recovery make it happen faster. There's something called laser light therapy, low level light therapy, which also can stimulate regrowth to happen faster. So and then nutritional supplements, if it's if we find those things that are off, we need to fix those things. And and as a functional practitioner, you know that there can be many things that can be contributing. So you fix what needs to be fixed, and then try to stimulate the regrowth to happen faster.

Sara Poldmae:

And so what kind of testing do you do in your clinic? Like are you doing, besides the general, you know, ferritin, iron, all that good stuff to make sure someone's not anemic? Are you testing micronutrients, things like that? We

Mary Wendel:

do. We do check zinc levels. Sometimes we check magnesium. We do check cortisol levels, which is your stress hormone. We do check hormones. We do check progesterone, estrogen, testosterone. We take we test DHEA, which is the precursor to a lot of these hormones. Thyroid is huge. That tends to go along with as women approach menopause, the likelihood of thyroid disorders also goes up, and the likelihood of autoimmune dysfunction goes up as well, which also can't be separated too much from stress. Autoimmune dysfunction is an increasing cause of hair loss in women, and so we look for that as well, and we do some testing for autoimmune disorders. Hmm. So yes, we do a lot of those as well. We don't do specific gut testing. We don't have the capability to do that, but I do think in some women that's important to do, and so we will send them to a practitioner who can, who can test their gut health. We've had women who've had gut dysfunction and had significant hair loss, and once the gut was healed, the hair grew back. So again, if we think that's playing a role, we will arrange for that to happen as well. Wonderful.

Sara Poldmae:

So what other what other pieces of information do you think would be relevant for women in midlife? Things to watch out for, things to know. It sounds like you're counseling patients on the daily. So you know you've already provided some words of comfort in that. It sounds like there's a lot more options out there these days versus for, let's say, our mothers 20 years ago, 30 years ago, when they were going through it.

Mary Wendel:

Yes, you know, we really try to cover all the bases. We take a good, thorough medical history. You know, medications. What medications are you on? Could these be playing a role? It gets a little tricky when we think medications might be contributing to shedding because we don't want to interfere with their medical care. But we generally work with their primary care physicians to try and resolve that issue, if it is an issue. So we do a very complete family history of hair loss, a very complete medical history, what surgeries have you had? What hormones have you taken? Sometimes going on and off. Hormones can accelerate some shedding. So, you know, we get a very good timeline. We do a very careful timeline of what their hormonal status has been, pretty much throughout their life. Were you taking hormonal birth control at some point? Are you off of it? Now, all of those things can play a role. So a very careful, very, very careful, family history, medical history, surgical history, see if we can pinpoint things that might be, you know, contributing. And it's interesting, because, you know, I would say 80% of our patients still have this genetic form, which we call androgenic but there are also, oftentimes, other things that are playing into it. It's often not just one thing. And again, thyroid disorders are on the rise. And so a lot of women will have a family history of thyroid disease, and particularly their mothers, their sisters. It's very common in women, much more so than men. And so we, you know, we take all of those histories and consider them and how they might be contributing, because it's going to affect our treatment plan, and it's important that the hormones are stabilized before we start any treatment plan, because if you don't fix those things, your treatments not going to be as successful. And we want that to happen. We can, we can stop further loss. We can stimulate regrowth, but biochemically, nutritionally, immunologically, all those things need to be stable in order to get the best possible result. And I think this is the frustration for a lot of women, is there are a lot of spas out there in places who are not, perhaps as in tune to all of these issues, and they might be treating hair loss in women, and the women aren't getting the results they're looking for, and it's very discouraging, but they haven't had the full medical workup, and that's, that's something that we take very seriously, and we work with their patients and their doctors to make sure that we're getting everything properly done. So it's, it's really, it's, we work together with the patients. We develop a good relationship with them, and I think that's important. They they trust us. We spend the time with them. We offer them a lot of emotional support, but we also, you know, they can tell we know what we're doing. We know the medical part of it, and we take it all into account before making any decisions about treatment. You know, unfortunately, most of these treatments aren't covered by insurance, and so, you know, it's, it's a it's an investment and and you want to make sure that investment is respected and the time and the and the effort put into fixing this problem,

Sara Poldmae:

yeah, we just went consumers. There's no way that you can practice this in depth medicine with the amount of time that the insurance panels give you to work. Oh, gosh,

Mary Wendel:

no. There's just no way. The other thing you know, the dermatologist spent five minutes with the patients. And the women are sitting there after the doctor leaves the room, and they're like, Well, I you know, that was five minutes. And you know, they come in and see us, and we give them 45 minutes to an hour, you know, that's what they really need to do, the to do the full evaluation, to make a determination, yes, and then treatment. But it can be a challenge working within the standard medical care. I did it for many years. So I understand, you

Sara Poldmae:

understand, yeah, I just, I'm starting to slowly transition out of that, because I want to give women the care that they need. And it is an investment. It's not for everybody, but I think it's so important the work that we're doing, because it's so empowering to get the right answers the first time. Because, you know, it takes a lot of time and effort, money to travel to 17 different doctors to get no results. True, most

Mary Wendel:

of the women we see have already seen, you know, 3456, different practitioners of varying types and shapes and sizes before they walk in to see us and and it is, it's agonizing to go through all of this, and they travel all over the country. And, you know, I get calls from Cal. California, and I had a lady call me from Alaska. She lived out in the boonies. It was really, you know, she had seen one of my webinars and had a question, and I felt so bad for her. She had no place to go. But, you know, we had a nice chat. But anyway, it's, it's really hard. It's really hard, and women traditionally have not been respected as much as they needed to be,

Sara Poldmae:

that's a whole nother episode, isn't it? It truly, is it? Yeah, it really, really, well, tell us the name of your clinic again. Tell us how to get in touch with you.

Mary Wendel:

Yeah, we actually the name of our clinic is medi trust, and we have offices in the Boston area and we have offices in New York area as well in Manhattan as well as in Scarsdale. We're right outside of Boston as well. And you know my if you go, if you Google medi trust, it's M, E, D, i, t, R, E, S, S, E, we will show up there. And you know my email address is there, I'm very happy to take any emails and take answer any questions. Again, I know it's hard for people to arrange travel, but we're very open to doing some zoom meetings. We're a little bit limited in our licensure, but we still can do some and so, yeah, we're very, very accessible. We're very open to hearing from people,

Sara Poldmae:

other people in our area. I mean, from BWI to Boston, it's a quick hop, skip and a jump. So if they want to see you in person, it would be certainly accessible. And there's listeners on here that are in your area too. So I hope they reach out any final wrap up thoughts or things you want our audience to know. I

Mary Wendel:

think that it's very important now to be careful about what treatments are being recommended for you, and again, when when you're feeling desperate, you might agree to something that truly might not be in your best interest. You know, we do PRP we do some immunotherapies. We do treat virtually every type of hair loss, but not everybody is as capable, and you can sometimes get pulled in to treatments that are not really in your best interest. So I think it's important to do your research and make sure you're seeing somebody who really is an expert in hair loss. And I will tell you that you know, if people contact me from outside of my general area, I will help direct them to other providers that I know are good, because there are, there are good providers out there. It's just a challenge and and when you're feeling desperate, you might get pulled into a treatment that might not be the the right one for you. So my my recommendation is, do your research. Be careful. Most women come in very knowledgeable. They they have the right questions, and they've done their their research, which is great. I don't object to that at all. I really like it when they come in and they know what they're talking about. But, you know, look for look for an expert who knows what they're doing and can really do the thorough evaluation and find the treatment plan that will be best for your type of hair loss.

Sara Poldmae:

Yeah. Well, thank you so much, Dr Wendell for sharing your expertise, we will link your clinic in the show notes, and hope that some of our audience members reach out. There are so many options out there for us now for women experiencing hair loss. So thank you. Thank you.

Mary Wendel:

Oh, you're welcome. I am very happy to have joined you today. It's really exciting to be able to reach out to women and let them know that really good quality care is there for them, and we do take the time and listen. We're good we're very good listeners. I think that's probably one of our strongest attributes at our clinic, is we are very good listeners. Wonderful.

Sara Poldmae:

But thank you. Thank you again, and thank you everybody for tuning in, and we'll see you next week. You

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