Hair loss in older adults: what changes after 60

Many people expect their hair to thin as they get older, and to some extent it does. But hair loss after 60 is not one single thing. A review of hair loss in elderly people found that the causes are often multifactorial, with more than one process going on at the same time ¹. Knowing the main possibilities helps you decide when a change is worth checking.

Pattern hair loss continues, and may speed up

Pattern hair loss (androgenetic alopecia) is the most common type in both men and women, and it runs in families ². In women, it tends to worsen after menopause ¹. One study of 178 postmenopausal women aged 50 to 65 found that about half (52.2%) had female pattern hair loss, mostly in its mildest grade ³. For how this is graded, see the Ludwig scale.

The same review notes that if hair loss suddenly worsens, or comes with signs such as new facial hair, deepening voice or acne, hormone levels should be checked ¹. This is uncommon, but it is a reason not to dismiss every change as age.

Shedding often sits on top of other hair loss

Telogen effluvium is a sudden increase in shedding a few months after a trigger. Common triggers include fever, surgery, crash dieting, low protein intake, iron deficiency, an underactive thyroid and certain medicines such as beta-blockers and retinoids ⁴. Older adults are more likely to have had an operation, a hospital stay or a new prescription, so this matters.

In older people, telogen effluvium is often superimposed on another hair loss, such as pattern thinning ¹. That can make hair look as if it is suddenly getting much worse. Finding and dealing with the trigger may help shedding settle, though underlying pattern loss continues. See chronic telogen effluvium.

Scalp ringworm is not only a children's problem

Tinea capitis, a fungal infection of the scalp, is usually thought of as a childhood infection. But the review reported that it is increasingly seen in postmenopausal women ¹. Signs can include scaling, itching, broken hairs or patchy loss. It needs proper diagnosis and treatment, often with tablets, rather than shampoo alone.

Frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a scarring condition that mainly affects older women ¹. It usually causes a band of hair loss along the front and sides of the scalp, and most women with it lose eyebrow hair too ⁵. It is usually diagnosed after menopause, although men can be affected and it may start earlier ⁵. Because FFA destroys hair follicles, early diagnosis matters; treatment can help halt it ⁵. See frontal fibrosing alopecia.

Alopecia areata

Alopecia areata can start at any age. The review notes that extensive forms (totalis and universalis) are less common in older age ¹. Round bald patches appearing suddenly still deserve a check.

Medicines and general health

Older adults are more likely to take several medicines. Some, such as beta-blockers and retinoids, are known triggers for shedding ⁴. Never stop a prescribed medicine because of hair loss without speaking to your doctor; ask instead whether any of your medicines could be involved.

Thyroid problems, low iron and poor nutrition are also worth considering. A doctor may suggest blood tests based on your history; see blood tests for hair loss.

When to see a doctor

The NHS advises seeing a GP if you are worried about your hair loss, and doing so before going to a commercial hair clinic ². In older adults, it is especially worth getting checked if you notice:

• a receding band at the front or sides, or thinning eyebrows
• scaling, redness or pain on the scalp
• shedding that started a few months after an illness, operation or new medicine
• sudden worsening of long-standing thinning

Treatment in later life

Many of the same treatments used in younger people can be considered, but your doctor will weigh other health conditions and medicines. No treatment works for everyone, and treatments for pattern hair loss usually only work while you keep using them ². Wigs are also listed among the options ², and choosing camouflage instead of treatment is a valid choice.

If thinning bothers you, a dermatologist can help sort out which processes are involved and what is realistic. For a general starting point, see what to do first when hair loss begins.

Frequently asked questions

Is hair loss after 60 just ageing?

Not always. Causes in older adults are often multifactorial, including pattern loss, shedding, fungal infection and scarring conditions ¹.

Does menopause make hair loss worse?

Female pattern hair loss tends to worsen after menopause ¹, and one study found about half of postmenopausal women aged 50 to 65 had it ³.

Can older adults get scalp ringworm?

Yes. Tinea capitis is increasingly seen in postmenopausal women ¹ and needs proper diagnosis.

When should I worry about my hairline receding?

A band of loss at the front and sides, especially with eyebrow loss, can be frontal fibrosing alopecia and should be checked early ⁵.

Educational content. Not medical advice.