Why Hair Thinning Takes Time to Improve on HRT

By Dr. Purity Carr | Menopause Health Blog

Hair thinning is one of the most distressing symptoms women experience in perimenopause and menopause. It’s not just cosmetic-it affects confidence, identity, and emotional well-being. So when women start hormone replacement therapy (HRT), they often hope for quick results, especially when it comes to restoring their hair.

Hair takes time to recover, even when hormones are balanced. And there are good reasons why.

1. Hair Has a Natural Life Cycle

Hair grows in cycles:

• Anagen (growth phase) lasts 2- 7 years

• Catagen (transition phase) lasts a few weeks

• Telogen (resting and shedding phase) lasts 2–3 monthsWhen hormones shift-such as in menopause-the body can push more hairs into the telogen phase.

This is known as telogen effluvium, a type of diffuse shedding. Even when you correct the hormonal imbalance with HRT, it can take 3–6 months or longer for the hair to cycle back to the growth phase and for visible regrowth to begin.

2. Estrogen and Progesterone Need Time to Rebuild Tissue

Estrogen is a key hormone for maintaining skin and hair follicle health.

• It Increases scalp blood flow- Supports collagen and skin hydration

• Helps prolong the anagen (growth) phase of hair

• Progesterone can also help balance androgen levels that may contribute to thinning.

However, these changes don’t happen overnight. Just as skin takes time to glow again, hair follicles need time to respond to estrogen’s regenerative effects.

3. Testosterone and DHEA May Be Missing

Many women think only of estrogen and progesterone when it comes to hormone health.

But testosterone and DHEA play a crucial role in:

• Hair density, Muscle tone, Skin thickness. If testosterone is too low, something that commonly occurs with age or after childbirth, surgery, or stress, hair loss may persist, and muscle tone may decline even with good nutrition and exercise.

4. Other Root Causes Need to Be Addressed

Hair thinning is often multifactorial. Even with perfect hormones, hair will not thrive if:

- Iron or ferritin is low- Zinc, B12, or vitamin D is depleted

- Thyroid function is suboptimal - Scalp inflammation is present (dryness, dermatitis, seborrheic changes)

These factors are often overlooked and may require parallel treatment alongside HRT.

5. Genetic Pattern Hair Loss May Be Unmasked

For some women, estrogen decline unmasks a genetic predisposition to female pattern hair loss.

This type of thinning typically starts at the crown and widens the part line.

HRT may slow this down, but regrowth can be limited. In these cases, additional treatments such as topical minoxidil, low-level laser therapy, or PRP (platelet-rich plasma) may be help, however, strong evidence is lacking in these treatments,

Final Thoughts: Patience Is Key

Hormones are powerful, but they’re not magic overnight fixes-especially for hair. Recovery is possible, but it often requires:

- Time (3–12 months for visible change)

- Optimisation of all hormone layers (including testosterone and thyroid)

- Nutritional and scalp support

If you’re on HRT and your hair hasn’t improved yet, don’t give up hope. You may simply need more time-or a tweak in your treatment plan.

If you’re unsure whether testosterone or another factor is contributing, speak to your menopause-informed doctor.

It might be time to take your investigation one step further.