A Beginner's Guide to Female Pattern Baldness: Hair Loss Causes & Treatment
Hair loss in women goes by several names and types: female pattern baldness, female pattern hair loss, or the lesser known androgenetic alopecia. The problem affects over 55% of women by the time they reach 80 years. While that might seem a long way off to most, 12% of women under the age of 30 still suffer from significant hair loss, which is not a small number.
Unfortunately, even a minor degree of hair loss has a significant psychological effect on females. Studies have shown that women place a greater value than men on their physical attractiveness, and it has a stronger link to their self-esteem. This is compounded by societal norms, which greatly emphasize the role of the hair in defining feminine beauty. In contrast, male pattern baldness or alopecia is somewhat more accepted as it is much more prevalent. Due to this discrepancy between the genders, women are more likely to suffer negative social effects as a result of hair loss.
Moreover, modern medicine has no permanent cure for female pattern baldness. Therefore, effective hair loss remedies rely on recognizing hair loss symptoms as early as possible, then using the appropriate treatments to prevent a worsening of the condition.
The term alopecia (pronounced al-o-PEE-she-uh) has its origins in the Greek word alōpekia, which means "fox mange". It's a generic name used for both men and women to indicate an absence of hair — in other words, baldness. Depending on the degree of affliction, there are several types of alopecia, a few of which are:
Alopecia areata refers to a bald spot or patch on the scalp, which may occur in a single area or multiple, separate sections. It's an autoimmune disorder that may be triggered by stress, though this has not been conclusively proven.
Alopecia totalis is an advanced form of alopecia areata, in which all of the hair on the scalp is lost.
Alopecia universalis is a very rare condition that causes the loss of all bodily hair, including even the eyebrows and eyelashes.
Another type called Androgenetic alopecia refers to hair loss caused due to androgens, which are the male sex hormones. It was earlier believed that female pattern baldness was caused due to an excess of androgens (called hyperandrogenism) in a woman's body. However, recent research has cast some doubt on this link, and therefore the term female pattern hair loss is preferred.
Female pattern baldness or female pattern hair loss is the most common cause of excessive hair fall in women. It's defined as a thinning or reduction of hair density mostly over the top and sides of the head, with a small part of the frontal hairline retained. The condition is usually first noticed as an increase in the widening of the center hair parting.
While some similarities exist for androgenetic alopecia between men and women, a few important differences are as follows:
Hair loss in women usually starts later than in men, but is generally brought to a doctor's attention earlier as women are more conscious of their hair beginning to fall out.
The hair at the front is frequently unaffected. Thinning occurs mostly at the top of the head, called the crown. In men, the front hairline also disappears.
If the hair loss is caused due to hyperandrogenism, it results in a thinning of the hair on the scalp, with a simultaneous thickening of body and facial hair.
For men, hair loss often progresses to a state of total baldness, called alopecia totalis. However, this condition is rarely seen in women.
As mentioned earlier, 12% of women will develop medically observable female pattern hair loss by the time they turn 30. This rate doubles by the age of 50, and reaches a peak of 57% at 80 years and above. On the bright side, severe female pattern baldness, which leads to an almost total lack of hair on the crown, occurs in only 1% of women.
Incidentally, the second most common cause of hair loss in women is telogen effluvium, a condition in which the hair prematurely starts to shed. Its causes, diagnosis, and treatment have been described in another blog post.
The surest way to identify female pattern baldness in the early stages is to determine the pattern of hair loss. The thinning begins in the center of the scalp and is most visible when the hair is parted at the middle. The exposed scalp usually reveals a typical pattern that resembles a Christmas fir tree (see figure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684510/figure/f2-cia-2-189/).
Another characteristic feature of female pattern hair loss is the conversion of the scalp's normal hair type, called terminal hair, into a much thinner type called vellus hair. While terminal hairs are around 0.06 mm thick, vellus hairs are only 0.03 mm or thinner. This is accompanied by a corresponding shrinkage of the individual hair follicle. Over time, this thinner hair falls off, and no new hair grows to take its place, leading to hair loss. Since this is a permanent condition, it means that female pattern hair loss cannot be reversed, only prevented from worsening. However, the follicle does not die entirely, so perhaps someday researchers might be able to find a way to regenerate the follicle and reverse hair loss altogether.
If left untreated, female pattern hair loss will continue to progressively worsen over time. However, the rate of hair fall may vary significantly. The condition will first be observed as an increased shedding of hair that continues for three months or so. The hair loss may then return to normal levels, only to resume after a few months. This start-stop cycle will repeat at unpredictable intervals, causing further psychological distress to the affected women.
While the Ludwig Scale developed in 1977 has traditionally been used to grade the level of female pattern baldness, the Sinclair Scale developed in 2006 offers a better way of detecting alopecia symptoms in the early stages. A biopsy of the scalp performed by a dermatologist is the best way to determine whether the hair loss is due to female pattern hair loss or androgenetic alopecia. In addition, tests may be conducted to determine whether a thyroid condition or nutritional deficiency exists.
As noted previously, hair loss due to androgenetic alopecia cannot be reversed, only stopped. Furthermore, if female pattern hair loss is left untreated, it will eventually lead to a total absence of hair over the crown. Now let's take a look at the factors affecting female pattern hair loss.
1. Medication-Induced Androgenetic Alopecia
Androgenetic alopecia in women could be caused due to taking oral contraceptive pills, testosterone medication, or anabolic steroids. It's best to consult a physician or dermatologist to check if the hair loss is being caused as a side effect of some medication.
2. Hormonal Factors For Androgenetic Alopecia
When it comes to hormones, the link between female pattern baldness and hyperandrogenism has not been conclusively established. While one study found that 40% of women who suffered hair loss had a higher than normal level of male hormones, another study determined that only about 10% of female hair loss patients showed symptoms of androgenetic alopecia.
A very specific symptom of hyperandrogenism is that facial or body hair will tend to get coarser. If hyperandrogenism is detected, the dermatologist will generally look for other symptoms such as excessive hair growth on the body, irregular menstrual periods, or an outbreak of acne. This might indicate an underlying cause for the hyperandrogenism, such as Polycystic Ovary Syndrome (PCOS). In such cases, treating the PCOS will cause the body's hormone levels to return to normal.
3. Genetic Considerations In Female Pattern Baldness
From a genetic viewpoint, female pattern hair loss can be inherited from either parent. However, the extent to which is factor is responsible has not been determined by scientists. Researchers are currently trying to identify the genes that regulate the hair growth and shedding cycle. Once a method has been found to activate these genes, regeneration of new growth and reversal of permanent hair loss may well be achieved in the not too distant future.
Hair loss in women differs from many other diseases in that it has detrimental effects on the psychological well-being of those afflicted with it. It's rather self-evident that excessive hair fall causes far greater distress in women than men. Surveys carried out by beauty magazines show that the state of a woman's hair is central to the perception of her beauty, with over 50% stating that if their hair looks bad, then nothing else can make them feel that they look good.
Society also plays a critical role in the perception of hair and beauty. Our culture is filled with stories of the fair maiden with the long, flowing, golden locks (remember Rapunzel?). While men show a far greater predisposition to baldness, their distress is cushioned by societal acceptance of the condition. In stark contrast, there's a stigma attached to female pattern baldness due to a lack of awareness and the relatively lower occurrence of the condition. Studies have shown that only 28% of men are "extremely upset" due to hair loss, as compared to 52% of women. This emotional distress can lead to social withdrawal, low self-esteem, and interference with daily life.
A small percentage of women are content with being reassured that their hair fall isn't a symptom of more serious disease. However, other women afflicted with female pattern hair loss attempt various coping mechanisms to deal with the emotional trauma. In an effort to reassure themselves of their self-image, some might display signs of obsessively checking how their hair looks in a mirror or photographs. Others may try to conceal the condition from even close relatives and friends, going so far as to wear wigs, hats, or extensions to hide the progress of the disease. In some cases, women may choose to compensate for the loss of hair by making up for it in other departments, such as an excessive fixation on dressing up well. In all such cases, women who show signs of acute distress should be encouraged to seek psychological counseling as part of the treatment process.
To help combat the stress and anxiety caused by hair loss, you can make use of a variety of supplements and ayurvedic herbs that have been scientifically shown to reduce stress levels and ease anxiety. These supplements have been covered in greater detail in our blog post on telogen effluvium. In addition, a future article will deal exclusively with various treatment options and remedies to eliminate stress, so watch this space!
The root cause of female pattern hair loss has not been fully understood, and neither have the drugs that are used to treat it. Most of them have been found through trial and error, and the exact mechanism of their action is still undergoing extensive research. Non-medicinal options are also available, such as hair extensions, wigs, and camouflaging products. However, each of these has its limitations, as well as being cumbersome to use. Finally, a permanent but expensive solution is available in the form of surgical hair transplantation. Let's take a look at each of the treatment options in a little more detail.
1. Medications: Androgen-Independent & Androgen-Dependent
Medicinal treatments for female pattern baldness are limited, and the drugs' effects take several months to a year to kick in. Moreover, the medication needs to be administered for the rest of the patient's life, since it only acts as a preventative measure. Allopathic drugs for female pattern hair loss can be divided into two types: androgen-independent and androgen-dependent. Of course, it goes without saying that all of these drugs should only be taken under strict medical supervision.
Minoxidil (pronounced meh-nox-eh-dil) is the only drug that has been approved by the FDA specifically for treating female pattern hair loss. All other medications were originally approved for other diseases, then found in clinical studies to prevent hair loss as a beneficial side-effect. It takes nearly a year for the results to show, and may even temporarily increase hair loss for the first few weeks of use. After regular application on the scalp, it prevents further hair fall in most women, and even causes limited regrowth in around 20% of users. If treatment stops though, all of the regrown hair will fall out within four months, and hair loss will resume at the pre-medication rate.
A common side-effect of minoxidil is that it may cause irritation of the scalp, leading to redness and itching. Furthermore, it's not to be given to pregnant women or breastfeeding mothers, as it may be harmful to the fetus or infants.
Androgen-Dependent: Spironolactone, Cyproterone Acetate, Flutamide, Dutasteride, & Finasteride
These drugs are essentially anti-androgens, and therefore used to treat cases of androgenetic alopecia. They were originally developed for other purposes such as a diuretic, contraceptive, or treating prostrate cancer, and so have not been specifically approved by the FDA to treat female pattern baldness. However, due to their action of suppressing male hormones, they're also prescribed for treating hair loss caused by hyperandrogenism. As in the case of minoxidil, the drugs need to be regularly taken for upto a year to show results, and stopping the treatment will cause the hair fall to resume with full force.
As powerful anti-androgens, the side-effects of these drugs include breast tenderness, fluctuating libido, menstrual irregularities, depression, weight gain, gastrointestinal issues, fatigue, negative effects on blood pressure and electrolyte levels, and liver dysfunction. Depending on the specific drug used, regular tests may have to be carried out, especially for liver and blood health. In most cases though, the side-effects will diminish over time.
More importantly, anti-androgens have been conclusively shown to cause deformities in the fetus. Therefore, these medications are always combined with contraceptive pills to ensure that the female patient doesn't become pregnant.
2. Alternative Herbs & Oils: Omega-3, Rosemary, & Aloe Vera
If all of these side-effects of allopathic drugs sound worrisome, perhaps you might find alternative medicinal treatments more effective. Certain natural foods such as fish oils, rosemary, and aloe vera have been shown in some studies to significantly reduce hair loss, and their 100% natural origin makes it much easier for your body to accept.
Omega-3 fatty acids boost hair thickening, provide nourishment, and reduce inflammation of the hair follicles. In one study, 120 women with female pattern hair loss were given a daily dose of omega-3 for a period of six months, with photographs taken to evaluate the change in hair density. Compared to the control group, 87% of the patients who received the omega-3 supplement showed an improvement in hair density, 90% reported a reduction in hair loss, and 86% had a measurable increase in hair thickness.
Those who take blood-thinning medications such as aspirin should first consult their doctor, as omega-3 could increase their chances of hemorrhaging. For the rest though, stock up on this superfood by eating walnuts, hemp seeds, white fish, natto, tuna, mackerel, salmon, eggs, and sardines. If you want to avoid animal foods, you might prefer to take a vegan omega-3 supplement instead.
Rosemary Essence Oil
Applying rosemary oil over the scalp has been demonstrated in one study to be an effective treatment for androgenetic alopecia. The experiment divided hair loss patients into two groups. One group used rosemary oil on the scalp, while the control group used a 2% minoxidil solution. After six months, it was seen that both groups showed significant improvements in the symptoms. However, the rosemary group experienced none of the negative side-effects that minoxidil caused. Therefore, rosemary oil can potentially be used as a safe, natural hair loss remedy.
Aloe Vera Juice Or Gel
The anti-bacterial, healing, and nourishing effects of aloe vera have been known for centuries in traditional systems of medicine. It soothes and conditions the scalp, reduces inflammation, promotes skin healing, protects against UV damage, eliminates dandruff, and releases antioxidants into the skin. A study conducted on rats found that applying aloe vera gel not only heal wounds quickly, but also boosted hair growth in the affected region. Its enzymes have been shown to remove dead cells and encourage the regeneration of tissue around the hair follicles.
Aloe vera can be applied as a gel on the scalp, and a recommended dose of half a cup of aloe vera juice can be drunk twice a day. It has absolutely no side-effects, and is a great way to promote overall well-being.
3. Non-Medicinal Options: Hairstyling, Surgical Methods, & Experimental Treatments
If female pattern hair loss is detected at an early stage, further progression can be stopped before any noticeable hair fall takes place. However, for women with mild to moderate loss, some concealment methods may be required along with the treatment regime. Furthermore, patients with severe hair loss may seek surgical intervention to improve the appearance of the scalp, or if they want a permanent solution to the problem. Let's look at the various options in brief:
Hairstyling & Camouflaging Products
For mild hair loss, women can visit a hairstylist to obtain the appearance of volume by adopting a shorter style, concealing the wide central parting by using a side or staggered part, using curls to provide hair with greater bounce, and using hairsprays to prevent breakage. Using a wide-toothed comb and drying the hair by blotting instead of rubbing it are recommended for thin hair.
If a greater degree of concealment is required, camouflaging products are available for women who suffer from moderate hair loss. They can cover the exposed scalp and add hair volume. Spray-on thickeners, alopecia masking lotion, hair building fibers, and topical shading are examples of camouflaging treatments that are resistant to water and yet easy to remove.
Another concealment option is to use hair extensions or wigs, depending on the degree of hair loss. However, hair extensions should not be applied to brittle hair in order to prevent breakage, and some users may experience scalp irritation with wigs. It's upto the individual user to find a solution that best fits her needs.
Hair Transplantation & Scalp Reduction
For women who have extensive hair loss, hair transplants offer a permanent solution. However, not everyone is eligible for this procedure. Only those who have a high density of hair in the unaffected areas at the sides and back of the head will have enough donor implants to cover the bald areas on the crown. Tiny plugs of hair are removed from the high-density areas, then transplanted onto the area with sparse growth. Multiple sessions are required to achieve this, and there's usually a gap of six months between each session to ensure that the graft has been successful. Though there is some minor risk of scarring or infection, the procedure has advanced enough that the results are almost always excellent. Of course, this comes at a rather steep price, so it's not an option that's open to all.
Another related option is scalp reduction, in which the bald areas of the scalp are cut away and the remaining scalp "pulled" closer together in order to make the hair growth appear denser. However, its efficacy diminishes in the long term, there's a potential for much more scarring, and multiple such procedures will have to be performed. As a result, this option is far less popular than hair transplantation.
Experimental Treatments: Lasers, Platelet-Rich Plasma Therapy, & Stem Cells
Lasers that grow hair? We can't blame you for thinking it sounds like it's taken right out of a science-fiction novel. However, laser combs and helmets have been approved by the FDA as a home remedy for female pattern hair loss. Manufacturers claim that these devices emit a low-level laser light that reportedly stimulates the hair follicles. However, this has yet to be conclusively proven.
Another experimental treatment uses your own blood to extract platelets from blood plasma, which are then injected into the scalp. This is believed to regenerate the hair follicles, although no hard evidence yet exists for its effectiveness.
Finally, stem cell research and gene therapy are two areas at the cutting edge of scientific research that hold great potential for a permanent cure and reversal of female pattern baldness in decades to come.
Female pattern hair loss is a common condition that has not yet been fully understood. Its treatment takes a long time to show even minor results, and causes great psychological distress to afflicted women, especially due to society's negative attitudes towards baldness in women. Using feedback in the form of regular scalp photographs is a good way to reassure patients that the treatment is working, even though the changes may be subtle. There are a wide variety of causes and treatments, which might need to be combined with psychological counseling during the initial months. Patience is the key to successfully combating the condition, given the large time lag between the medication and its effect, and this needs to be borne in mind by those undergoing the treatment.
While conventional hair loss remedies do exist, natural herbs, oils, and supplements may provide an equivalent degree of relief without any unpleasant side-effects, and offer an avenue worth exploring. As further research uncovers more evidence of their benefits, as well as the promise of a permanent cure via gene therapy, it remains to be seen what the future holds for these areas of medicine.
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