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Hair
Loss in Women
1) Localized hair
loss
2) Patterned hair
loss(Female
Androgenetic
Alopecia)
3) Diffuse hair loss
A)Causes of diffuse
hair loss in ladies
B)Medical treatments
for thinning hair in
women
Hair Transplantation
is not just for men
with hair loss. It
is a treatment for
women, too. Modern
techniques of hair
transplantation are
successful in
treating typically
diffuse
female-pattern hair
loss as well as the
more familiar forms
of male-pattern hair
loss. A woman who
becomes concerned
about hair loss can
discuss this option
with her hair
restoration
specialist.
In general, Hair
Transplantation is
likely to result in
a more satisfying
outcome for a woman
when there is
adequate donor hair
for successful
transplantation. A
less satisfying
outcome is more
likely when
transplantation is a
"last ditch"
treatment for
advanced hair loss
when donor hair is
in short supply.
To understand the
different types of
hair loss in women,
and their
management, it is
helpful to divide it
into three broad
categories:
1) Localized hair
loss
Localized hair loss
may be sub-divided
into scarring and
non-scarring types.
Alopecia Areata is a
genetic, auto-immune
disease that
typifies the
non-scarring type.
It manifests itself
with the sudden
onset of round
patches of hair loss
from the scalp and
sometimes eyebrows
or other
hair-bearing areas
of the body
associated with
normal skin. Hair
loss can be episodic
and recurrent.
It can be treated
with local
injections of
Corticosteroids.
Hair Transplantation
is not helpful for
Alopecia Areata.
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2 Patches of
Alopecia
Areata |
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More severe
form of
Alopecia
Areata |
Traction Alopecia
due to injury from
tight braiding or
corn-rowing of hair,
and Trichotillomania
(compulsive hair
plucking) are other
types of
non-scarring
alopecia. They are
usually amenable to
Hair
Transplantation.
Trichotillomania
Scarring Alopecia
can be caused by a
variety of medical
or dermatologic
conditions such as
Lupus and Lichen
Planus, local
radiation therapy,
injuries, or from
local medical
problems. Localized
hair loss that
occurs around the
hairline after
face-lift surgery
may be permanent. In
all of these
conditions, once the
active process of
alopecia have been
cured, It is usually
amenable to Hair
Transplantation.
Scarring Alopecia
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2) Patterned hair loss(Female
Androgenetic
Alopecia)
The most common type
of hair loss in
women is Patterned
Hair Loss (Female
Androgenetic
Alopecia). It occurs
in about 20% of
women overall. In
one study of 1,008
Caucasian women,
female androgenetic
alopecia was found
in 3% of women aged
20-29 years, 16-17%
of women aged 30-49
years, 23-25% of
women aged 50-69
years, 28% of women
aged 70-79 years,
and 32% of women
aged 80-89 years.
The statistics
reflect the
increased incidence
of female
androgenetic
alopecia during and
after menopause
Women with this type
of hair loss have a
pattern similar to
what we observe in
men. In other words,
they have thinning
in front or on top
of their scalp with
little hair loss in
the permanent zone
around the sides and
in the back. Thus,
the balding is in a
characteristic
"pattern" rather
than generalized
form.
This type of hair
loss (also called
Common or
"hereditary"
baldness) in women
appears to be
related to the same
major factors that
cause hair loss in
men:
Genes,
Hormones,
and
Age.(See
Hair Loss in Men).
As is men, the genes
that cause hair loss
can be inherited
from either your
mother or father.
The expression of
these genes is
dependent on
hormones called
androgens, so
common hair loss in
women is called
"Female Androgenetic
Alopecia"
(the same term
is used for common
balding in
men).
There are a number
of reasons to
explain why hair
loss in women
presents differently
than in men
(although all of the
factors are still
not completely
understood).
Probably the most
important reason is
that men have a much
higher level of the
androgen
testosterone. This
is the hormone that
is responsible for
male sexual
characteristics and,
when the body
converts it to
Dihydrotestosterone
(DHT), it becomes
the main culprit in
causing baldness.
Fortunately, the
much lower levels of
testosterone in
women spare them
from the extensive
hair loss that is
often seen in men.
Testosterone is
converted to DHT by
the enzyme 5-Alpha
Reductase that is
present in higher
concentrations in
the balding areas of
the scalp. Women
have only ½ the
amount of this
enzyme overall as
men and have even
less in the crown.
In addition, women
have higher levels
of an enzyme called
Aromatase in all
areas of the scalp
that may block the
formation of DHT.
This enzyme is
present in
especially high
concentration in the
frontal hairline in
women, possibly
explaining why this
area is fortunately
resistant to balding
in most females.
Women with patterned
hair loss are
excellent candidates
for Hair
Transplantatiom.
The pattern of hair
loss in Female
Androgenetic
Alopecia has some
distinctive features
that differentiate
it from Male Pattern
Baldness. In
general, there are
three patterns of
hair loss in Female
Androgenetic
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 Baldness
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.
(a) Hamilton's
grading for
androgenetic
alopecia.
(b) Ludwig's pattern
of hair loss in
females.
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3) Diffuse hair loss
A third category of
hair loss in women
is a
Diffuse(Generalized)
thinning that
affects all parts of
the scalp. This is
the most common type
of hair loss seen in
females. In this
situation, much of
the hair remains,
but the thickness of
the hair shaft is
smaller than normal
hair. The medical
term for this type
of thinning is
"Diffuse
Un-patterned
Alopecia". These
women have thinning
that involves the
donor area so that
women with this type
of hair loss are
generally not good
candidates for
surgery. This
condition may be
identified with a
Hair Densitometer, a
special magnifying
apparatus, which
assesses the
population of
miniaturized hair in
different parts of
the scalp.
(Miniaturization is
the process by which
hairs shrink in
length and diameter
from the effects of
hormones.)
Because diffuse hair
loss can be caused
by a variety of
conditions other
than "hereditary
balding", (see
below) women who are
losing their hair
should be evaluated
by a physician who
is experienced with
these problems. Most
important, they
should know when a
medical evaluation
is appropriate and
whether medical or
surgical treatments
will offer the
greatest benefit.
Like men, most women
develop widening
partings and
thinning of the hair
all over the scalp,
with age; this is
normal. It actually
starts in the teens
or early twenties,
and by the age of 50
over half of all
women have thinning
hair. After the
menopause, thinning
of the hair is more
pronounced. Hair can
also become thin at
the front, similar
to the male pattern.
This is because the
hair follicles are
responding in
exactly the same way
as in balding men to
the testosterone in
the blood. All women
have testosterone;
this is perfectly
normal. The balding
does not mean that
the woman has more
testosterone; it
simply means that
the hair follicles
on her scalp are
over-sensitive,
probably inherited.
The hair will
eventually not
become any worse.
There is no need to
worry that you will
become completely
bald.
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A few women develop
male pattern
baldness with other
problems such as
growth of hair on
the face, lumpy
acne, deepening of
the voice and
irregular periods.
In rare cases, this
can mean that too
much testosterone is
being produced by a
tumour, so it is
important to see
your family doctor
so that appropriate
tests can be done.
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A) Causes of diffuse
hair loss in ladies
-
Age (most old
people have
thinner hair
than when they
were young).
-
Heredity (some
people are
programmed to
have thin hair,
particularly as
they get older).
-
Hormone
disorders
(particularly
thyroid
dysfunctions and
other endocrine
problems that
produce excess
androgens)
-
Drugs. Oral
contraceptives,
thyroid
medication,
blood pressure
medication (such
as beta-blockers
or water pills),
"mood"
medication such
as lithium,
Prozac, or
tri-cyclic
antidepressants,
blood thinners
such as heparin
or coumadin,
cholesterol
lowering
medication,
medication for
gout, such as
Zyloprim,
anti-inflammatory
drugs such as
cortisone,
vitamin A or
tryptophan in
high doses, and
street drugs
(such as
cocaine)
-
Anemia such as,
Iron deficiency
(most likely in
women who are
vegetarians).
-
Severe mental
stress (such as
bereavement),
2–3 months
previously.
-
Severe physical
illness of any
sort 2–3 months
previously
(particularly a
high fever or
-
severe infection
– the hair grows
again when the
body has fully
recovered).
Childbirth (it
is common to
shed a lot of
hair for 1–6
months after
childbirth, but
this usually
grows again
afterwards).
-
Systemic lupus
erythematosus (SLE:
a disease
affecting the
connective
tissue).
-
Damage from
bleaches and
relaxers, which
can damage the
hair so that it
becomes ‘soapy’
in texture and
breaks off
(Afro-Carribean
hair is
especially
vulnerable).
-
Gynecological
conditions -
such as ovarian
tumors
-
surgical
procedures and
general
anesthesia
-
Rapid weight
loss
-
Crash diets that
are not
nutritionally
balanced
The decision of when
to perform a
laboratory
evaluation in women
experiencing hair
loss must be made on
an individual basis
by your physician.
We briefly describe
some of the
situations where
your doctor may
order lab. tests and
what they might be.
It is important to
stress that this is
just an overview for
your general
information. When a
physician orders
laboratory tests
he/she bases it upon
specific clinical
information and this
can only be
determined by the
doctor who evaluates
you.
The following signs
and symptoms suggest
that specific blood
tests might be
appropriate to rule
out underlying
sources of excess
androgen:
Irregular periods -
for an extended
period of time,
Cystic acne - severe
acne which usually
leaves scars,
Hirsuitism -
increased body hair
that doesn't
normally run in your
family, Virilization
- appearance of
secondary male sex
characteristics such
as a deepened voice,
Infertility -
inability to become
pregnant, and
Galactorrahea -
breast secretions
when not pregnant
(this is due to
prolactin which is
not actually an
androgen).
Some of the tests
that your doctor
might order in these
situations include
the following:
Total and Free
Testosterone - the
hormone that is
mainly responsible
for male secondary
sex characteristics,
DHEA-Sulfate - a
precursor to
testosterone, and
Prolactin - the
hormone that enables
the breast to
secrete milk.
Other test that are
commonly ordered for
underlying medical
conditions include:
CBC (complete blood
count) - for Anemia,
Serum iron (and TIBC)
- for Anemia, T3,
T4, TSH - for
Thyroid disease, ANA
- for Lupus, and STS
- for Syphilis.
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B) Medical treatments
for thinning hair in
women
Just because your
hair is thinning
there is no need to
avoid hairsprays,
careful perming or
hair dyes. These
will not worsen the
problem. In fact,
perms and hairsprays
lift the hair and
disguise thinning.
However, you should
avoid bleaches and
hair relaxers.
Short, bouncy
hairstyles give lift
and body. It is also
all right to use
hair colorants on
thinning hair, but
darker shades may
make thinning more
obvious.
Low stores of iron
in the body can
sometimes cause hair
loss so,
particularly if you
are vegetarian, ask
your doctor for a
blood test.
Iron-rich foods
include lean red
meat, game, offal,
egg yolks, and dark
green leafy
vegetables. Vitamin
C helps your body to
absorb iron.
Although hair
follicles need
plenty of the
essential amino
acids - the building
blocks of proteins -
it is doubtful
whether increasing
your intake of
protein or taking
amino acid
supplements will
really help.
Regaine (minoxidil):
It produces some
improvement in about
50% of women with
thinning hair. Only
the 2% strength is
suitable for women.
A few women (about 1
in 20) using Regaine
notice hairiness of
the face, even
though the lotion is
only applied to the
scalp. Hairiness
occurs on the
cheeks, above the
eyebrows and
sometimes on the
upper lip and chin.
The reason for this
is not known:
perhaps the Regaine
is carried in the
blood from the scalp
to the face, or
maybe it is rubbed
off onto a pillow
that is in contact
with the face while
sleeping. If Regaine
is continued, facial
hairiness usually
lessens over a year;
if the drug is
stopped, it goes
away within 1–6
months.
Oestrogens used to
be prescribed for
women with hair
loss, but no proper
research has been
done to find out
whether or not they
worked at all. They
are seldom
prescribed now
because Regaine is
more effective.
Hormone Replacement
Therapy (HRT),
depending on the
type, can affect the
hair. If you are
taking HRT
containing
progestogen, ask
your doctor for a
‘third generation’
type of progestogen
HRT, which is less
similar to male
hormones and may be
better for women
with hair loss.
Cyproterone acetate
and Spironolactone,
are sometimes used
for wemen with
thinning hair. The
drug finasteride
(used for male
baldness) is not
used for women,
because it does not
work in women. Also,
it could affect the
developing baby if a
woman became
pregnant while
taking it.
If you are very
distressed by
thinning hair, and
medical treatments
have not helped, you
might consider
Hair Transplantation,
which can be done
for women as well as
men.
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