Hair Today...

By Andrea Sachs/New York

Barbara Cox was distraught. By the time the Darien, Conn., fund raiser was in her mid-50s, her hair had become thin and wispy. "I didn't want to go swimming," recalls Cox. "I didn't want to exercise because when I did and my hair got wet, it made the receding spots particularly apparent." Despite her distress, Cox never uttered a word. "I felt kind of silly obsessing about it, but it was increasingly important to me." Finally she broached the topic with her husband. "He said, 'You look fine. No problem,'" she says. But that didn't stop her from worrying.

For years, women like Cox have suffered in silence, fretting about thinning hair but saying nothing. Suddenly, it seems, they are becoming more talkative. You might have noticed a couple more television ads touting cures for the problem--nothing to rival the come-ons for male-pattern baldness, though. Still, the topic is getting more airtime as remedies proliferate and people become more comfortable confronting it.

Cox is just one of more than 30 million U.S. women who experience androgenetic alopecia, or hereditary hair loss. For some women, it can begin as early as their 20s, but prevalence jumps up dramatically by 40 or 45. "Menopause is a heralding event," explains Dr. Wendy Roberts, a clinical professor of dermatology at Loma Linda University in California.

Women who suspect they are losing their hair should talk with a dermatologist. Androgenetic alopecia is the most common diagnosis. As women get past 40, they tend to exhibit more signs of female-pattern hair loss, which is a diffuse thinning all over the scalp, most severely at the top. Men, conversely, experience male-pattern baldness, which involves receding hairlines and large patches of baldness. However, the triggers for female hair loss can be diverse, including emotional or physical stress--giving birth, a hysterectomy, an eating disorder or depression. Many medications can be culprits, including high-blood-pressure drugs, cholesterol-lowering remedies and antidepressants. So can continually getting permanents and frequently using hair dyes.

The closest thing to a miracle cure for hair loss in women is minoxidil, best known by the brand name Rogaine. A majority of women with genetic hair loss show hair growth within four months of using it. Rogaine is applied topically, and its use must be continued to sustain the results. Dermatologists also recommend other medications and natural remedies.

If the drugs don't work, there is a wide world of wigs, weaves and extensions. Yves Durif, a top New York City stylist, says women who are losing their hair can get smart haircuts that help hide the problem. "For straight hair, it's much better to keep it all one length, as close to the head as possible, a very simple haircut, like a very short bob," he says. "For women who have curly hair, I would go pretty short and very layered."

The most dramatic technique for women is a hair transplant, which is expensive but extremely effective. Dr. Michael Reed, a dermatologist and hair-transplant surgeon, directs New York University's hair-transplant clinic. Half his transplant patients are women, says Reed.

After five years of thinking about having the procedure done, Cox, who originally found it impossible to talk about her hair loss, showed up in Reed's office. Her surgery took four hours. "It was not painful at all," says Cox. "Afterward, my scalp was a little sore in some places." Three or four months later, she had an inch of brown hair growing where there had been none. Though her wallet was a bit sore too--the procedure cost $5,000--Cox enthuses, "I feel my appearance reflects my age and my vitality, where before I was unhappy with both. I'm a happy camper."