Female Pattern Baldness Explained
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Akin to the more commonly known male pattern baldness, female pattern baldness is a noticeable thinning of the hair in women. Known clinically as androgenic alopecia, this condition typically affects women beginning in the early to mid-forties, but may manifest earlier in some women. Generally, women suffering from this condition experience an all-over thinning of the hair, with the most pronounced hair loss on the crown of the head or around the part of the hair. Unlike men, women suffering from female pattern baldness don't typically experience a receding hairline.
What are the Symptoms?
This condition does not occur suddenly or overnight, so a distinct progression of symptoms can generally be seen. Initially, female pattern baldness manifests as a notion that the hair no longer feels as thick as it previously was or is no longer as visibly full. Women may experience widening of the natural part in their hair, followed by a noticeable thinness that leaves portions of the scalp visible through their hair.
To diagnose this condition, a clinician or other medical professional will observe the pattern of hair loss and, taking into account prior medical history, will examine the scalp, check for indications of infection or inflammation, and potentially order blood tests if the cause of the hair loss seems unclear.
What are the Causes?
Androgenic alopecia is caused, in both sexes, by the activity of hormones known as androgens. These hormones, which play vital roles in the normal sexual development of men and the regulation of sex drive and hair growth in both men and women, are controlled by several different genes. Male and female pattern baldness is often hereditary, but can also be the result of underlying endocrine conditions, such as the presence of an androgen-secreting tumor or overproduction of androgen in the ovary, adrenal, or pituitary gland. Whatever the root cause, it is generally understood that androgenic hair loss is dependent on increased androgen activity.
Regardless of gender, androgenic hair loss is caused by the combination of the genetically determined shortening of anagen, the phase during which a hair grows, and the lengthening of time between when the hair is shed and the beginning of a new anagen phase. Essentially, the time between the shedding of the hair and the regrowth of a new hair becomes longer, meaning that the hair replacement rate slows. Additionally, the hair follicles that grow are fundamentally changed, shrinking in size to produce a shorter, thinner hair shaft. This process, known as follicular miniaturization, replaces longer, more robust terminal hairs with the thinner, non-pigmented vellus hairs, resulting in a noticeable reduction of hair volume and color.
What Treatments are Available?
Generally, medications are the most common and most cost effective treatment for female pattern baldness, although hair transplantation may also be an option for some patients.
Medications:
Minoxidil, a medication originally prescribed to treat high blood pressure, has been shown to promote minimal to moderate hair growth in female users. Commonly known by the brand name Rogaine, this drug can be effective in stimulating fine hair growth in some women. Unfortunately, minoxidil can’t fully restore lost hair density and the course of treatment generally takes 6 to 12 months to reach its peak effectiveness. To maintain hair growth, patients must continue to take this drug indefinitely.
Anti-Androgens:
Certain androgen receptor-blocking drugs like finasteride and spironolactone may benefit women who did not respond well to treatment with minoxidil. However, these drugs are currently not approved to treat female pattern baldness and case studies into their use for this condition are still ongoing. Some early case studies suggest that spironolactone may be used in addition to minoxidil to aid in hair regrowth, while those women suffering from an excess of androgen may consider taking a androgen receptor-blocking drug in combination with an oral contraceptive to combate this condition. More research is needed to determine the best use of these drugs in combating female pattern baldness.
Hair Transplants:
Known as follicular unit transplantation, hair transplants ential the removal of a small strip of scalp, typically from the back of the head, for use in filling areas where thinning has occurred. This scalp strip is divided into hundreds of tiny grafts, each composed of a clump of 1 to 4 hair follicles. The grafts are then “planted” in the thinning area by a surgeon who makes tiny slits with a blade or needle before inserting the hair clumps into these incisions. The hair transplants then grow naturally in small clusters, creating more natural looking regrowth patterns than previous large hair plug procedures.
Other Female Hair Loss
It is important to note that not all hair loss can be attributed to female pattern baldness. Other conditions that may cause significant hair loss in women include Alopecia areata, a rare autoimmune disorder that causes the immune system to attack and destroy hair follicles, and Traction alopecia, a form of hair loss caused by the frequent wearing of hairstyles that pull the hair too tightly, causing permanent damage to the follicles. Additionally, illness, such as certain infections, high fevers, and some cranial surgeries, and medication used for conditions such as cancer, can also cause hair loss. The best method of determining the specific causes and treatments for hair loss is to consult a knowledgeable physician.
The Ludwig Classification
The Ludwig Classification is a hair loss scale that helps clinicians determine the severity of each patient’s condition and the most effective treatment. The scale grades the amount of hair loss experienced from Type 1 to Type 3, with Type 3 being the most severe. Type I is generally considered a thinning of the hair around the crown or part that is minimal and easily disguised by various styling techniques or beauty products. Type 2 is considered to be significant enough thinning to decrease overall hair volume and a noticeable widening of the natural part. Type 2 hair loss is difficult to hide using styling techniques or beauty products. Type 3 is considered a diffuse, serious thinning of the hair resulting in an overly wide natural part and a generally see-through appearance on the crown of the head that allows the scalp to be seen. Using this scale as a reference makes it easier for those who are attempting to describe the severity of their hair loss to a doctor or other medical professional and get the correct treatment for their condition.
If you feel that you are suffering from any stage of female pattern baldness, or any other similar form of hair loss, it's important to consult with a physician that specializes in this area to discuss your treatment options. Dr. Epstein is Miami-based surgeon specializing in hair transplants for women and men - all genders, ages, and ethnicities. Dr. Kuka-Epstein is a plastic surgeon recognized for her FUE skills, and has the honor of acting as the Head of Research for the Foundation for Hair Restoration as well as the co-director of the Women’s Center for Hair Loss. Dr. Bared, a member of the exclusive International Alliance of Hair Restoration Surgery, is a fellowship trained facial plastic surgeon committed to natural appearing hair restoration.
What are the Symptoms?
This condition does not occur suddenly or overnight, so a distinct progression of symptoms can generally be seen. Initially, female pattern baldness manifests as a notion that the hair no longer feels as thick as it previously was or is no longer as visibly full. Women may experience widening of the natural part in their hair, followed by a noticeable thinness that leaves portions of the scalp visible through their hair.
To diagnose this condition, a clinician or other medical professional will observe the pattern of hair loss and, taking into account prior medical history, will examine the scalp, check for indications of infection or inflammation, and potentially order blood tests if the cause of the hair loss seems unclear.
What are the Causes?
Androgenic alopecia is caused, in both sexes, by the activity of hormones known as androgens. These hormones, which play vital roles in the normal sexual development of men and the regulation of sex drive and hair growth in both men and women, are controlled by several different genes. Male and female pattern baldness is often hereditary, but can also be the result of underlying endocrine conditions, such as the presence of an androgen-secreting tumor or overproduction of androgen in the ovary, adrenal, or pituitary gland. Whatever the root cause, it is generally understood that androgenic hair loss is dependent on increased androgen activity.
Regardless of gender, androgenic hair loss is caused by the combination of the genetically determined shortening of anagen, the phase during which a hair grows, and the lengthening of time between when the hair is shed and the beginning of a new anagen phase. Essentially, the time between the shedding of the hair and the regrowth of a new hair becomes longer, meaning that the hair replacement rate slows. Additionally, the hair follicles that grow are fundamentally changed, shrinking in size to produce a shorter, thinner hair shaft. This process, known as follicular miniaturization, replaces longer, more robust terminal hairs with the thinner, non-pigmented vellus hairs, resulting in a noticeable reduction of hair volume and color.
What Treatments are Available?
Generally, medications are the most common and most cost effective treatment for female pattern baldness, although hair transplantation may also be an option for some patients.
Medications:
Minoxidil, a medication originally prescribed to treat high blood pressure, has been shown to promote minimal to moderate hair growth in female users. Commonly known by the brand name Rogaine, this drug can be effective in stimulating fine hair growth in some women. Unfortunately, minoxidil can’t fully restore lost hair density and the course of treatment generally takes 6 to 12 months to reach its peak effectiveness. To maintain hair growth, patients must continue to take this drug indefinitely.
Anti-Androgens:
Certain androgen receptor-blocking drugs like finasteride and spironolactone may benefit women who did not respond well to treatment with minoxidil. However, these drugs are currently not approved to treat female pattern baldness and case studies into their use for this condition are still ongoing. Some early case studies suggest that spironolactone may be used in addition to minoxidil to aid in hair regrowth, while those women suffering from an excess of androgen may consider taking a androgen receptor-blocking drug in combination with an oral contraceptive to combate this condition. More research is needed to determine the best use of these drugs in combating female pattern baldness.
Hair Transplants:
Known as follicular unit transplantation, hair transplants ential the removal of a small strip of scalp, typically from the back of the head, for use in filling areas where thinning has occurred. This scalp strip is divided into hundreds of tiny grafts, each composed of a clump of 1 to 4 hair follicles. The grafts are then “planted” in the thinning area by a surgeon who makes tiny slits with a blade or needle before inserting the hair clumps into these incisions. The hair transplants then grow naturally in small clusters, creating more natural looking regrowth patterns than previous large hair plug procedures.
Other Female Hair Loss
It is important to note that not all hair loss can be attributed to female pattern baldness. Other conditions that may cause significant hair loss in women include Alopecia areata, a rare autoimmune disorder that causes the immune system to attack and destroy hair follicles, and Traction alopecia, a form of hair loss caused by the frequent wearing of hairstyles that pull the hair too tightly, causing permanent damage to the follicles. Additionally, illness, such as certain infections, high fevers, and some cranial surgeries, and medication used for conditions such as cancer, can also cause hair loss. The best method of determining the specific causes and treatments for hair loss is to consult a knowledgeable physician.
The Ludwig Classification
The Ludwig Classification is a hair loss scale that helps clinicians determine the severity of each patient’s condition and the most effective treatment. The scale grades the amount of hair loss experienced from Type 1 to Type 3, with Type 3 being the most severe. Type I is generally considered a thinning of the hair around the crown or part that is minimal and easily disguised by various styling techniques or beauty products. Type 2 is considered to be significant enough thinning to decrease overall hair volume and a noticeable widening of the natural part. Type 2 hair loss is difficult to hide using styling techniques or beauty products. Type 3 is considered a diffuse, serious thinning of the hair resulting in an overly wide natural part and a generally see-through appearance on the crown of the head that allows the scalp to be seen. Using this scale as a reference makes it easier for those who are attempting to describe the severity of their hair loss to a doctor or other medical professional and get the correct treatment for their condition.
If you feel that you are suffering from any stage of female pattern baldness, or any other similar form of hair loss, it's important to consult with a physician that specializes in this area to discuss your treatment options. Dr. Epstein is Miami-based surgeon specializing in hair transplants for women and men - all genders, ages, and ethnicities. Dr. Kuka-Epstein is a plastic surgeon recognized for her FUE skills, and has the honor of acting as the Head of Research for the Foundation for Hair Restoration as well as the co-director of the Women’s Center for Hair Loss. Dr. Bared, a member of the exclusive International Alliance of Hair Restoration Surgery, is a fellowship trained facial plastic surgeon committed to natural appearing hair restoration.
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