Understanding changes to your hair and nails as you age and how to treat them.
Your hair and nails play an important role in your health, acting as protection against the outside environment and helping to regulate body temperature, but most of us pay attention to them because they are a part of our external identity – together, with our skin they define how we look. For most of us, the importance of feeling good about our hair and nails cannot be overstated, making hair products and nail care huge industries in our society.
Aging is a fact of life. While that is easy to understand, it can be difficult to experience, especially because changes to our hair and nails seem to happen suddenly. Changes in your levels of estrogen during the menopausal transition play a big role in changes to your hair and nails, because estrogen is very involved in keeping your hair and nails healthy and repairing them if they get damaged.
For women, the menopausal transition can lead to multiple symptoms affecting the skin, hair and nails. Common symptoms include:
Generally, humans shed between 50 and 100 single hairs per day. Hair shedding is part of a natural balance — some hairs fall out while others grow in. When the balance is interrupted — when hair falls out and less hair grows in — hair loss happens. Hair loss is different from hair shedding. The medical term for hair loss is alopecia. 
During menopause, you might see one of two things happen with your hair. You might start growing hair where you didn’t before. Or, you might notice that the hair you have is starting to thin. One cause may be changing levels of hormones during menopause. Estrogen and progesterone levels fall, meaning that the effects of the androgens, male hormones, are increased because there is less estrogen and progesterone to balance against them.
During and after menopause, hair might become finer (thinner) because hair follicles shrink. Hair grows more slowly and falls out more easily in these cases. 
Changing hormones, and hormone balance, where the effects of the androgens, male hormones, are increased because there is less estrogen and progesterone, affect hair growth. You may see increases in unwanted hair around your upper lip and chin. While this can be annoying, it is also easily treated and managed with plucking or waxing as discussed in the self-care section, or you can Lean In to Movember!
Keratin is a protein in your body that builds your nails, your hair and the outside layer of your skin. The root cause of problems with your nails during the menopausal transition is the reduction in levels of estrogen because estrogen drives the production of keratin. As your estrogen levels drop and keratin production is affected, your nails can start to show distinct vertical ridges (called onychorrhexis). If your nails have become brittle and break easily or peel, this can also be a result of dehydration in combination with lowering levels and strength of keratin.
There are many approaches to taking care of your hair and nails that do not require prescriptions, although you should inform your healthcare provider or dermatologist of anything that you are doing – there may be impacts on treatments that they suggest or prescribe.
At age 40 find a reliable, educated primary care provider familiar with recognizing and treating symptoms of perimenopause and menopause. The North American Menopause Society provides a list of menopause practitioners here.
Many of the treatments for your hair may be over the counter or home therapies. If you are not finding success, talk to your healthcare provider as there are treatments that need to be overseen by a professional. You and your healthcare provider can discuss options. Hormone Therapy (HT) may be one approach, as the root of menopausal transition problems with hair are driven by changes to your hormones.
Treatment for hair loss and thinning hair depends on what is causing your hair loss. Consult with your healthcare provider or your dermatologist to discuss treatment options. For hair loss associated with changing hormones, the following treatments can be used:
Your skin, hair, and nails together make up your integumentary system, which in addition to containing the largest organ in your body (your skin), also forms the physical barrier that protects your internal environment from the outside world. Its other functions include helping regulate your temperature and fluid balance, making Vitamin D (from sunlight) and sensing stimuli (sense of touch). The skin contains immune cells (including myeloid and lymphoid cells) some of which have the ability to activate the body’s larger immune system if necessary. The skin plays a key role in healing wounds, controlling the coagulation of cells to form a clot (a scab), inflammation, growth of new cells and the final remodeling stage resulting in new healed skin. 
The main parts of the integumentary system are the epidermis, dermis, hypodermis, associated glands, hair, and nails.
Hair comes out of the epidermis, but it is actually rooted deep in the dermis. There are two parts to the structure of hair. The hair shaft, made of a protein called keratin, can vary in length and width and it is what we see on the outside of our body. The hair follicle is a complex structure that contains the hair bulb, which is the place where the hair grows to make the shaft grow up vertically out of the skin. The grouping of the hair shaft, the hair follicle, the sebaceous gland, and the erector muscle is called the pilosebaceous unit.
There are two types of hair – one that is affected by hormones, typically found under the arms, in the pubic region, on the scalp, and the chest. The second type is hair that isn’t affected by hormones, called vellus hair and it covers the rest of the body with the exception of the palms of the hands, soles of the feet, lips and parts of the genitals.
Hair grows in phases – a growth phase (anagen phase), a transition phase (catagen phase) where the hair follicle detaches from the bulb but doesn’t yet fall out, and the resting phase (telogen phase) where the hair prepares to fall out of the follicle after dying from lack of blood supply. In the case of scalp hair, the shaft stays in the growth phase for two to six years on average – individual variation is determined by genetics. About 80 to 90% of the hair on your head is in the growth phase at any given time. Shorter hair like the hair on your arms, legs, and your eyelashes have a shorter growth phase, on average about one month.  
There are three reasons you lose hair. Anagen effluvium is a result of medications that poison the hair follicles during the growth phase, for example during chemotherapy. Telogen effluvium happens when increasing numbers of hair follicles reach the resting phase and fall out. This can happen as a result of physiologic stress. Causes of physiologic stress include nutrient deficiencies associated with crash diets or starvation, illness, emotional stress, or starting on new medications.
The most common reason for hair loss is called androgenetic alopecia or male or female pattern hair loss or baldness. Hair thins over the top and on the sides of the head. Despite the fact that male pattern baldness is well known and commonly discussed, it has recently been estimated that more than 50 % of women will experience hair loss that is noticeable. 
Nails are made up of layers of keratin, a type of protein that also forms hair. The root cause of problems with your nails during the menopausal transition is the reduction in levels of estrogen because estrogen drives the production of keratin. Much like a hair shaft growing out of the bulb of the hair follicle, your nail grows from the nail matrix and pushes the older cells out lengthwise. The nail bed keeps the nail nourished, and once the nail cells are pushed past the nail bed, the cells die and can break off or be cut off without any pain.
Your skin contains four different types of glands – sweat glands, sebaceous glands, ceruminous glands and mammary glands. There are two types of sweat glands – eccrine glands and apocrine glands. Eccrine glands excrete a fluid directly to the surface of the epidermis, your skin, and as this sweat evaporates it cools your body and regulates your body temperature. This sweat doesn’t usually cause any smells. The second type of sweat gland, apocrine glands, excrete a sweat into your hair follicles, not directly to the surface of your skin. The sweat that these glands excrete doesn’t smell until it combines with bacteria on the surface of your skin. The bacteria break down this secreted fluid and it is this process that causes body odour. Apocrine glands do not become active until puberty, which is why children do not have body odour. Sebaceous glands are found in the pilosebaceous unit, so they are associated with a hair follicle and shaft. These glands secrete a substance called sebum that makes up the natural oils covering your skin in a thin film. This adds a protective layer on top of the epidermis and works to repel bacteria as well as keep your skin moisturized.  
NOT TRUE at all
If you care about both your skin and your wallet, carefully read the list of ingredients first and notice the fancy packaging second. The simplest and cheapest precautions are often as, or even more, effective than the more expensive products. Using inexpensive sunscreen and moisturizer (after confirming the ingredients) will have the same long-term results as more expensive products. The key is to be consistent with your skin care and to start as early in life as possible. No amount of expensive or fancy treatments started after your appearance starts to age will give you better results than starting early and sticking with it.
The thickness of your hair is determined by the density of your hair follicles in your skin. This is absolutely not affected by shaving or cutting your hair short.
Stress can cause temporary hair loss, called telogen effluvium, but learning how to cope with and manage your stress will result in your hair returning to its normal thickness.
Chemicals can damage your hair and it is possible that your hair could break or be weakened, but shampooing, even vigorously, and normal hair treatments are not going to affect the hair follicle and cause the actual hair shaft to detach from the blood supply, die and fall out.
[4a] Herman, J., Rost-Roszkowska, M., & Skotnicka-Graca, U. (2013). Skin care during the menopause period: noninvasive procedures of beauty studies. Postepy dermatologii i alergologii, 30(6), 388–395. https://doi.org/10.5114/pdia.2013.39430
[4c] Man, M. Q., Xin, S. J., Song, S. P., Cho, S. Y., Zhang, X. J., Tu, C. X., Feingold, K. R., & Elias, P. M. (2009). Variation of skin surface pH, sebum content and stratum corneum hydration with age and gender in a large Chinese population. Skin pharmacology and physiology, 22(4), 190–199. https://doi.org/10.1159/000231524
 Stevenson, S., & Thornton, J. (2007). Effect of estrogens on skin aging and the potential role of SERMs. Clinical interventions in aging, 2(3), 283–297. https://doi.org/10.2147/cia.s798
 Kim JY, Dao H. Physiology, Integument. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554386/