As unfair as pattern female hair loss seems to be, at least when it affects a man, society generally accepts bald men as a normal part of life. However, female hair loss constitute another matter altogether. Stares and whispers often accompany such a woman as she goes about her daily tasks. “What is wrong with this poor lady?”. “Is she sick?”. For such women, just glancing in a mirror, previously a chance to preen, to enjoy a moment of pride, turns to gut-wrenching shame and, sometimes self-loathing.
Female Hair Loss
How could the fates have dealt such a cruel blow? Even worse, sensible information about female hair loss has never been in ready supply. Even today, contradictory information is everywhere. Sometimes even a woman’s own PCP is lacking in a well-rounded grasp on the various disease processes that trigger hair loss. Most depressing of all, women can fall easy prey to hucksters and scam artists promising the world and charging a mint — but delivering little other than more disappointment.
In this and future articles, we will explore the physiologic basis undergirding hair loss in women. And we will begin to separate fact from ‘noise’ so that women reading this article can arm themselves with genuinely useful knowledge. So let’s begin.
Understanding Female Hair Loss
So to start, let’s explore the biggest single question first… “why do women lose hair”?. Here’s a not-so-fun fact. Of the estimated 60 million Americans currently suffering common pattern hair loss, at least 20 million are women. Androgenetic alopecia, the most typical variant of hair loss phenotypes affecting humans, is regulated by genes, hormones and other factors. However, to date, none has been shown to be “gender-specific”, meaning that it favors one sex over the other. So when a woman begins to experience thinning hair, she is undergoing a strikingly similar cascade of biologic events as those occurring in a man.
Women produce androgenic (male) hormones as well as estrongenic (female) hormones. In women, certain individuals have scalp hair that is sensitive to metabolites of androgen hormones and specifically 5 alpha-DHT. So there are clear and compelling similarities that tie pattern hair loss in a woman to pattern hair loss in a man. Does this mean that women are affected precisely the same as men? No. It does not. In this, the differences are as striking as the aforementioned similarities.
For one thing, women do not usually suffer from a receding hair line or a crown bald spot. Instead, the most usual progression of female pattern hair loss involves the retention of the juvenile/feminine hair line, but with marked and progressive thinning behind the anterior or frontal edge. Another difference has to do with time. Men can begin losing hair in their 20’s and progress to full baldness by their 30’s, or even before. Women who lose hair usually start to notice the problem at about the point they enter menopause. This is important as menopause signals a multi-faceted modulation in the level of circulating steroid hormones.
In this chapter we will focus upon the various forms of hair loss women experience, and further on we will discuss treatment options. Finally, we will culminate with an overview to explore the cutting edge of hair loss research.
Perhaps surprisingly, the most typical variant of hair loss affecting women has close concordance to common pattern hair loss in men. The primary genetic and hormonal triggers are operative in both genders. However, the progression of loss differs in women in some critically important ways.
Female Hair Loss Not Male Hair Loss
Women usually don’t experience a receding hair line. Nor do they manifest a bald spot in the crown. Instead, women gradually lose density behind their hair line so that the scalp becomes increasingly visible over time. Another key difference is that in women, hair loss may occur outside the anatomical bounds normally present in men. That is, in affected males, a zone of hair over the ears and in the posterior occipit remains vibrant and thriving, irrespective of the fact that profound hair loss may occur inside the “pattern”, i.e. across the front and top of the scalp.
Not the case in women, where hair loss can spread to include almost the entire scalp. This predicates important differences in considering treatment options. For one thing, many women find that surgical transplantation is a non-viable option because the donor and recipient areas contain approximately the same density of hair.
Another gender-based difference is that women may suffer from forms of hair loss not usually seen in men. Hair loss in women can be triggered, in part, by disruptions in thyroid function, hormonal modulations linked to menopause and other endocrine-based changes. Because women tend to grow their hair longer, they may experience a greater tendency to experience hair breakage, due to weakening of the hair strands themselves. Women who use bleach, coloring products or perm solutions also are susceptible to accelerated hair loss. Likewise, profound hair loss can occur through the use of braids, weaves, and hair pieces. This becomes a vicious circle wherein a woman becomes reliant upon the very factors that are causing even worse female hair loss.
The good news is that very often, treatment options that work well for men may also work well for women. In our next chapter we will explore the similarities and also the differences pertaining to female hair loss treatment options currently available.