In this conversation Dr. Sophia Kogan highlights the substantial research gap surrounding female hair loss, especially during perimenopause and menopause, noting that roughly half of all hair‑loss sufferers are women yet most studies focus on men. She explains that women spend about one‑third of their lives in menopause, a period marked by a rapid decline in ovarian estrogen and progesterone while androgen production declines more slowly, creating a relative androgen dominance. Stress‑induced cortisol further suppresses estrogen/progesterone synthesis and reduces sex‑hormone‑binding globulin (SHBG), increasing free androgen exposure at the hair follicle. The balance of estrogen and androgen metabolism at the follicle governs hair growth, though the precise role of estrogen remains unclear. Dr. Kogan also discusses industry implications: clinicians observed that a men’s hair‑loss product performed better for older women than the women’s formulation, prompting a re‑examination of product design to address women’s distinct hormonal pathways. Throughout, she emphasizes the importance of recognizing women’s distinct life phases—menarche, pregnancy, postpartum, and menopause—and the cultural undervaluing of menopausal women in medical research.
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Why do women lose hair during perimenopause? I mean, I've seen it in so many of my friends. They're like, what? What just happened? Do we know that pathway?
So to give you perspective, all right, there's a lot more studies on men than women. A lot more. And not only that, but there's a lot more, less studies on menopausal women. So I think there's that kind of like, there's the gap in terms of the gender, but there's also a gap in terms of who are we targeting, who are we looking for, and who are we forgetting? And so, but to give you perspective, I believe it's almost 50% of people who are suffering from hair loss are women. So it's not really adequate to have such a, you know, misplaced amount of attention on research on men versus women. And then also, we have a fastly aging population, and one third of a woman's actually. Sorry, yes. One third or two thirds of a woman's life is spent in menopause. One third. Right. Yeah. Okay. So we.
We really not in my world.
At least.
180 maybe. So it might be a lot more than that.
It might be even more than that. Exactly. In your world, if we're really doing everything that Dave tells us to do, then we might be spending even more time during that period of time.
You could easily spend 50 to 100 years in menopause.
Exactly. And so it's really important that not only does the research community pay attention to this population, but also the industry. And so for us, what happened to us is that actually the doctors came to us and said, hey, it seems like the men's product is working slightly better for the older women than your women's product. They figured out themselves. And so we said, oh, that's interesting. Okay, let us go back and see. Well, it turns out that not only are women not little men, like you said, we have absolutely different hormonal pathways and factors that contribute to what we need. But also, women have very strict sort of phases in their lives. Right. Men don't really have that as much. I know that they have hormones that are much gradual, much more gradual. But a woman, you know, she has menarche when she starts having her periods, then she has children if she wants to have children. So it was post, you know, postpartum. There is obviously a shift. And often enough women lose hair shedding after pregnancy. Exactly. Also for the reason that the body kind of adjusts and knows what to do. And then there's menopause. Right. And so we're often forgetting that there is that stage in life. And what's interesting is that in many cultures, and this used to be a celebrated age, and in fact, we know now that women in this age group are leaders in society. And so to treat them as, you know, kind of like lost and sundowned and turned off and completely, like, studied.
In medical studies is ridiculous.
Yeah, it's ridiculous. So what we did is we decided to see what's happening and so we went back and researched it. So essentially, and there's very little literature there. So it's a lot about tying the dots together and understanding what's happening. And I think you know a lot about aging and, you know, mitochondrial aging and all of that. So that all contributes. But essentially one of the most important things that happens to a woman during that time is that the ovaries tend to shut down rather quickly. And so the estrogen and progesterone are actually kind of declining at a rather quick rate while the androgens are still being produced. And although they decline with age, they decline much slower. And relative to the estrogen and progesterone, there's going to be a dominance of androgens. And if you're stressed, you're actually going to contribute to that. So in addition to having, you know, the estrogen progesterone and androgen disbalance, you also have high levels of cortisol, which we just talked about. And that can additionally add to the disbalance because that shuts down your estrogen progesterone production even more. And it kind of, you know, it diminishes the sex binding hormone, sex hormone binding globulin, so you have more androgens to float around at the follicle. And what we know now is that it's both estrogens and androgens that play a role in the finely tuned mechanism of hair growth. We don't actually know the exact impact of estrogens 100%, but we do know that they play a role. It's really the balance. It's the metabolization of both hormones at the follicle itself, which is why some people are more predisposed and some are not.
