Female pattern hair loss and what to do

Female pattern hair loss. Source: Indian Journal of Dermatology
Female pattern hair loss. Source: Indian Journal of Dermatology

Millions of women worldwide are also affected by hair loss, with females comprising 14.2% of all hair restoration patients worldwide, according to the International Society of Hair Restoration Surgery. 

Women are more likely to be devastated emotionally and psychologically when they lose their hair says Professor Vera H. Price of the Department of Dermatology at the San Francisco School of Medicine.

For men, hair loss and shaving their heads as baldness progresses is generally more accepted; in contrast, the emphasis on looks and societal pressure on women to be attractive means scant support and approval if they have little or no hair.  

A survey by one of Europe’s largest hair loss clinics, the London-based Belgravia Centre Hair Loss Clinic, found that the body issue women feel would make them least attractive to men is hair loss.

Women generally regard the hair on their head as a crucial aspect of their femininity, appearance and identity, so hair loss can make them feel they are losing part of their identity.

New York City Psychologist and author Dr Vivian Diller agrees, saying while men may be unhappy about hair loss, women report much deeper feelings of fear, shame and humiliation with thinning tresses.

Hair loss differences between men and women

Aging is often associated with hair loss or thinning for both men and women. But that doesn’t mean that hair loss is the same for both genders.

For starters, the types and causes of hair loss in women are not always as clear-cut as they are in most men.

Many of the reasons for female hair loss don’t apply to men or impact on them differently. These include hormonal changes, diet, hair products and styling habits that can cause breakage and hair thinning.

In men, hereditary male pattern baldness (androgenetic alopecia) causes about 90% of hair loss. 

In women, this type of hair loss – also called female pattern hair loss (FPHL) – affects around 50% of those over 65.

Another key difference is patterns of hair loss. Women usually experience fine and thinning hair, while men generally experience diverse thinning patterns and differ in how the hair thinning process progresses.

Types of hair loss in women

Female-pattern hair loss (androgenetic alopecia) is the most common type of progressive alopecia in women.

The first signs of FPHL may be that a woman notices her ponytail is smaller or that her hair parting seems wider.

With a strong genetic component, pattern hair loss is usually inherited from either the mother or father.

Both men and women produce a male hormone called dihydrotestosterone (DHT), which scientists say is the main culprit in pattern hair loss. DHT causes a shortening of the growth phase by attaching to, and shrinking hair follicles, destroying healthy hair.

In both genders, this shortened hair growth cycle also results in hair follicles undergoing a process called miniaturisation. Since hair remains on the head for a shorter period of time, a person develops baby-fine wispy hairs that do not reach their usual length or width.

Read more about the different types of hair loss in men and women

Miniaturisation causes men to develop a receding hairline or baldness on top of the scalp.

However, women keep a normal frontal hairline, but experience visible thinning at their hair parting and over the crown. Women rarely progress to being near or totally bald unless due to illness.

Pattern hair loss in women includes three stages of hair miniaturisation, based on age when it starts (onset).

Read: Fighting hair loss in women

These stages are:

Androgenetic alopecia (AGA) is genetically determined and linked to male hormones (androgens).

It starts between puberty and age 40, and is generally considered the female equivalent of male pattern baldness. Female pattern hair loss (FPHL) is increasingly being used by hair loss experts as a less committal term when the function of androgens is less specific and other hormonal and non-hormonal factors may be a factor.

It appears between ages 45 to 55.Senescent alopecia refers to age-related hair thinning that starts at around age 60 and older. It differs from AGA and is not dihydrotestosterone (DHT)-mediated.

Alopecia areata
(AA): Patients with alopecia areata usually lose coin-sized round patches of hair on the scalp, face and chest. It may also affect other areas of the body including the eyelashes, eyebrows and pubic area. These patchy areas of hair loss are usually linked to obvious skin disorders or systemic autoimmune diseases like lupus, cancer, vitiligo and Addison's disease.

Telogen effluvium
: This form of hair loss can develop when the body experiences extreme stress due to triggers such as pregnancy, child birth, major surgery or menstrual-related iron deficiency.

It involves a sudden shift from hair growth or resting phases to the hair shedding phase (telogen) and can occur within six weeks to three months after a stressful experience.

Traction alopecia: This type results from trauma to the hair follicles, usually through hair styling that continuously pulls at them like braiding, hair extensions, weaves and tight ponytails.

Read: Don't lose your hair braids 

Other causes of hair loss in women include:

•    Medications such as antidepressants, thyroid medications and chemotherapy cancer drugs. Hair re-growth usually occurs within a year of stopping.
•    More frequent/regular use of potentially damaging chemical treatments (perming, bleaching and straightening) and hairstyling devices like curling tongs, hairdryers and hair straighteners.
•    Hormonal imbalances (e.g. thyroid disorders or menopause-related hormonal changes) and nutritional deficiencies especially iron.
•    Contraceptive use: Hair loss may occur if you use oral contraceptives and are prone to hormone-related hair loss or are oversensitive to hormonal body changes. This usually happens several weeks or months after stopping the pill.

Diagnosing and managing female hair loss

Fortunately female pattern hair loss is simple to diagnose and easy to treat.

Whether you opt to see your GP, a dermatologist (skin specialist), trichologist (specialist in diagnosing and treating hair and scalp disorders) or a doctor at a hair loss clinic, make sure the doctor has specific knowledge and expertise in hair loss and restoration.

If your hair loss is not due to the easily diagnosable female pattern baldness, your doctor will examine your scalp and take a detailed medical and hair loss history. He/she may also use other diagnostic tools like blood tests, a hair pull test and microscopic hair examination.

After diagnosis, your doctor will recommend the best hair restoration treatment.

For female pattern hair loss, clinical studies have shown that the topical medication Minoxidil 2% (Rogaine) is very effective in stimulating hair follicle growth. However, it must be used twice daily and usually only shows noticeable results in three to four months.

Read more:

How can I stop my hair from falling out?

Why women lose their locks

Divorce triggers hair loss in women

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