What Causes Hair Loss in Women?
The underlying cause of female androgenic alopecia is believed to be related to production of androgenic (male) hormones and the effect of androgenic hormones on the hair follicle—the same underlying cause responsible for male androgenic alopecia (male pattern baldness). The pattern of hair loss in female androgenic alopecia has some distinctive features that differentiate it from male-pattern hair loss. In general, there are three patterns of hair loss in female androgenic alopecia:
Grade I: Thinning hair on the central scalp (top of the head).
Grade II: Thinning hair and patches of greater scalp hair loss.
Grade III: Male-pattern alopecia with hair loss at the front of the scalp to mid-scalp. However, it is very rare to see complete male-pattern "cue-ball" baldness in a woman.
Other causes of hair loss in women include scalp scarring from injury or an underlying disease, traction alopecia due to injury from tight braiding or corn-rowing of hair, and trichotillomania (compulsive hair plucking)
Female hair loss occurs in more than one pattern. If you are a woman with loss of scalp hair, you should seek professional advice from a physician hair restoration specialist.
In most cases, female hair loss can be effectively treated. If you are a woman who has started to lose scalp hair, you are not alone if:
The patterns of hair loss in women are not as easily recognizable as those in men.
Unlike hair loss in men, female scalp hair loss may commonly begin at any age through 50 or later, may not have any obvious hereditary association, and may not occur in a recognizable "female-pattern alopecia" of diffuse thinning over the top of the scalp. A woman who notices the beginning of hair loss may not be sure if the loss is going to be temporary or permanent—for example, if there has been a recent event such as pregnancy or illness that may be associated with temporary hair thinning.
Self-diagnosis is often ineffective. Women tend to have less obvious patterns of hair loss than men, and non-pattern types of hair loss are more frequent in women than in men. Diagnosis of hair loss in a woman should be made by a trained and experienced physician.
In women as in men, the most likely cause of scalp hair loss is androgenic alopecia—an inherited sensitivity to the effects of androgens (male hormones) on scalp hair follicles. However, women with hair loss due to this cause usually do not develop true baldness in the patterns that occur in men—for example, women rarely develop the "cue-ball" appearance often seen in male-pattern androgenic alopecia.
Patterns of female androgenic alopecia can vary considerably in appearance. Patterns that may occur include:
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Diffuse thinning of hair over the entire scalp, often with more noticeable thinning toward the back of the scalp.
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Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp but not involving the frontal hairline.
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Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp, involving and sometimes breaching the frontal hairline.
Unlike the case for men, thinning scalp hair in women due to androgenic alopecia does not uniformly grow smaller in diameter (miniaturize). Women with hair loss due to androgenic alopecia tend to have miniaturizing hairs of variable diameter over all affected areas of the scalp. While miniaturizing hairs are a feature of androgenic alopecia, miniaturization may also be associated with other causes and is not in itself a diagnostic feature of androgenic alopecia. In post-menopausal women, for example, hair may begin to miniaturize and become difficult to style.
It is important to note that female pattern hair loss can begin as early as the late teens to early 20s in women who have experienced early puberty. If left untreated, this hair loss associated with early puberty can progress to more advanced hair loss if it is left untreated. Non-Pattern Causes of Hair loss in Women:
In women more often than in men, hair loss may be due to conditions other than androgenetic alopecia. Some of the most common of these causes are:
Trichotillomania — compulsive hair pulling, Hair loss due to trichotillomania is typically patchy, as compulsive hair pullers tend to concentrate the pulling in selected areas. Hair loss due to this cause cannot be treated effectively until the psychological or emotional reasons for trichotillomania are effectively addressed.
Alopecia areata — a possibly autoimmune disorder that causes patchy hair loss that can range from diffuse thinning to extensive areas of baldness with "islands" of retained hair. Medical examination is necessary to establish a diagnosis.
Triangular alopecia — loss of hair in the temporal areas that sometimes begins in childhood. Hair loss may be complete, or a few fine, thin-diameter hairs may remain. The cause of triangular alopecia is not known, but the condition can be treated medically or surgically.
Scarring alopecia — hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top of the scalp and occurs predominantly in women. The condition frequently occurs in women and is believed to be associated with persistent tight braiding or "corn-rowing" of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring.
Telogen effluvium — a common type of hair loss caused when a large percentage of scalp hairs are shifted into "shedding" phase. The causes of telogen effluvium may be hormonal, nutritional, drug-associated, or stress-associated. Loose-anagen syndrome—a condition occurring primarily in fair-haired persons in which scalp hair sits loosely in hair follicles and is easily extracted by combing or pulling. The condition may appear in childhood, and may improve as the person ages.
If you are a woman with thinning or lost scalp hair, your first necessary step is to have the condition correctly diagnosed by a physician. After a diagnosis is made, the physician will recommend an approach to effective medical or surgical treatment.
Ludwig Classification of Female Pattern Baldness 
A woman who is experiencing hair loss should consider consulting a doctor. The consultation has both medical and esthetic aspects.
Medical
The focus of the medical examination is the reason for hair loss. In a healthy woman the most common reason for hair loss is female androgenetic alopecia in a Grade I, II or III pattern as described earlier. If the patient's medical history and physical examination indicate no underlying medical conditions, and the hair-loss pattern is clearly that of female androgenetic alopecia, no further tests may be necessary. However, if the hair-loss pattern (1) is not clearly that of female androgenetic alopecia, or (2) suggests the possibility of an underlying medical condition, further medical tests and inquiry into personal and family medical history may be indicated. A scalp biopsy can be helpful in establishing a reason for hair loss when the reason is not immediately apparent.
While the primary reason for the medical examination is to determine the reason for hair loss, the examination may occasionally result in diagnosis of a previously unsuspected underlying disease. Hair loss can be a symptom of certain autoimmune diseases and diseases that cause overproduction of androgenic (male) hormones. An underlying disease does not necessarily preclude hair restoration. However, it may be necessary to treat the underlying condition before hair restoration can proceed.
Esthetic
The rationale for hair restoration is primarily esthetic—how a woman feels about her appearance and how she wants others to perceive her. The esthetic consultation with the physician is every bit as important as determining the reason for hair loss. The patient has esthetic goals that she hopes hair restoration can achieve. The physician helps the patient refine her goals within the context of what surgical and/or nonsurgical hair restoration can accomplish. Many questions can be raised and discussed in the esthetic consultation:
- What hair styles has the patient been using to minimize the appearance of thinning hair?
- What hair styles would the patient hope to use after hair restoration?
- Would the patient change her hair style, curl, color, etc., to get the most out of hair restoration?
- Does the patient want a "luxurious head of hair" that might require procedures such as hair weaving or hair extenders? Does the patient want to be able to swim and/or exercise heavily without worrying about her hair?
- What can hair transplantation accomplish and is transplantation an option for the patient?
- If transplantation is not an option because of scalp scarring or underlying disease, what options for hair restoration can be considered?
Results of the medical and esthetic consultation are the primary considerations that guide the selection of a surgical or non-surgical hair restoration treatment appropriate to the patient's needs.
Treatment of Female Hair Loss
Hair restoration treatments for women are primarily surgical, or treatments such as hair weaving or extending. Medical treatments for hair loss are largely directed at male androgenetic alopecia
Surgical treatment for female androgenetic alopecia may occasionally be combined with medication. |
