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Hair Loss In Women

Hair Loss in Women

 

Hair loss is relatively common in women with about 30% experiencing at least some degree of thinning in their lifetime. However, because female hair loss tends to be diffuse (less hair all over) and because women often maintain their frontal hairline their hair loss may not be noticeable, particularly in its early stages.

The psychological effects of hair loss can be significant for women and many are emotionally affected, even with modest amounts of thinning. This is, in part, due to the false assumption that it is uncommon for women to lose their hair and that hair loss in women is perceived to be socially unacceptable. Both of these erroneous perceptions make dealing with hair loss particularly difficult for women.

In addition, the widely used medication Propecia is not indicated for women, so there is a misconception that medical progress in treating female hair loss is not as advanced, or that the medical community does not take the treatment of female hair loss as seriously. Lastly, because hair loss in women can so often be disguised with existing hair, many women choose to hide their hair loss from others. Not sharing their problem tends to isolate them and makes the ability to deal with their hair loss all the more difficult.

Hair loss in women is generally very gradual, with the rate accelerating during pregnancy and at menopause. It can also show seasonal variations and it is more easily affected by hormonal changes, medical conditions, and external factors.

Causes of Hair Loss in Women

Common or “hereditary” baldness in women, also called female pattern alopecia, is genetic and can come from either the mother’s or father’s side of the family. It is affected by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-alpha reductase (which is found in both women and men). However, since the diffuse pattern of hair loss typically seen in women can be caused by a number of medical conditions other than common genetic hair loss, a thorough evaluation is particularly important for female patients. If an underlying medical cause can be found and treated, the hair loss can often be reversed. Read more about the Causes of Hair Loss in Women.

Classification of Female Hair Loss

 
Ludwig Class 2: Moderate Hair Loss

The common diffuse pattern of female hair loss caused by heredity is organized by the degree of thinning. This system of classification for hair loss in women is called the Ludwig Classification. Hair loss in the Ludwig system is labeled as being mild, moderate and extensive. Read more about the Classification of Hair Loss in Women.

Diagnosis of Hair Loss in Women

The diagnosis of “female pattern” hair loss is relatively straightforward when there is a history of gradual thinning in the front and/or top of the scalp, a relative preservation of the frontal hairline, a positive family history of hair loss and the presence of miniaturization in the thinning areas. Miniaturization, the progressive decrease of the hair shaft’s diameter and length in response to hormones, can be identified using a hand-held device called a densitometer.

Besides densitometry, two other common diagnostic tests that can be performed in the physician’s office are the hair-pull (a test for shedding) and the hair pluck (a test for hair damage). If common causes are ruled out, a more thorough diagnosis is called for, which may include blood work, a biopsy, or other laboratory testing. Read more about the diagnosis of hair loss in women.

Treatment of Hair Loss in Women

Read about the treatment of hair loss in women, including medical treatment, laser therapy, hair transplantation, and camouflage treatments. Treatment of Hair Loss in Women.

Common baldness in women, also called female pattern alopecia, is genetically inherited and can come from either the mother’s or father’s side of the family. Female alopecia most commonly presents in a diffuse pattern, where hair loss occurs over the entire scalp. Less commonly, women exhibit a patterned distribution where most of the thinning occurs on the front and top of the scalp with relative sparing of the back and sides.

The type of hair loss, diffuse or patterned, has important implications for treatment. Women with diffuse hair loss are generally best treated medically, whereas women with patterned hair loss may be good candidates for hair transplant surgery. Interestingly, patterned hair loss is the most common type seen in men and accounts for why a greater proportion of men are candidates for surgery compared to women.

In women who are genetically predisposed to hair loss, both diffuse and patterned distributions are caused by the actions of two enzymes: aromatase (which is found predominantly in women) and 5-a reductase (which is found in both women and men). Diffuse hair loss is most often hereditary, but it can also be caused by underlying medical conditions, medications, and other factors; therefore, a thorough medical evaluation is an important part of the management.

In the next sections, we will take a closer look at both the mechanisms of genetically induced female hair loss as well as the medical conditions and drugs that can cause diffuse hair loss in women.

Mechanism of Genetic Hair Loss in Women

As with hair loss in men, female genetic hair loss largely stems from a complex stew of genes, hormones, and age. However, in women, there are even more players. In addition to 5-a reductase, testosterone, and dihydrotestosterone (DHT); which are also found in men’s hair loss; also present in women are the enzyme aromatase and the female hormones estrone and estradiol. So let’s break down the process that leads to common hair loss in women.

In both men and women, 5-a reductase reacts with testosterone to produce DHT, the hormone responsible for the miniaturization (shrinking) and the gradual disappearance of affected hair follicles. This explains why both men and women lose their hair. But one of the reasons why women seldom have the conspicuous bald areas that men do is because women naturally have only half the amount of 5-a reductase compared to men.

Adding to this complexity, in women, the enzyme aromatase is responsible for the formation of the female hormones, estrone, and estradiol, counteract the action of DHT. Women have higher levels of aromatase than men, especially at the frontal hairline. It is this presence of aromatase which may help explain why hair loss in women looks so different than in men, particularly with respect to the preservation of the frontal hairline. It may also explain why women have a poor response to the drug finasteride (Propecia), a medication widely used to treat hair loss in men that works by blocking the formation of DHT.

The following is a schematic chart of how the female hormones estrone and estradiol are produced and their relationship to DHT:

 

Medical Conditions That Can Cause Diffuse Hair Loss in Women

Women’s hair seems to be particularly sensitive to underlying medical conditions. Since systemic medical conditions often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed alopecia be properly evaluated by a doctor specializing in hair loss (i.e., a dermatologist).

Below is a list of medical conditions that can lead to a diffuse pattern of hair loss:

      1. Obstetric and gynecologic conditions; such as post-partum and post-menopausal states or ovarian tumors
      2. Anemia (iron deficiency)
      3. Thyroid disease
      4. Connective tissue diseases, such as Lupus
      5. Nutritional causes including crash diets, bulimia, protein/calorie deficiency, essential fatty acid or zinc deficiency, malabsorbtion, and hypervitaminosis A
      6. Stress from surgical procedures, general anesthesia, or severe emotional problems

Drugs That Can Cause Diffuse Hair Loss in Women

A relatively large number of drugs can cause “telogen effluvium,” a condition where hair is shifted into a resting stage and then several months later shed. Fortunately, this shedding is reversible if the medication is stopped, but the reaction can be confused with genetic female hair loss if not properly diagnosed. Chemotherapy and radiotherapy can cause a diffuse type of hair loss called “anagen effluvium” that can be very extensive. This hair loss is also reversible when the therapy is over, but the hair does not always return to its pre-treatment thickness.

Causes of Telogen Effluvium

      1. Blood thinners (anti-coagulants) such as warfarin and heparin
      2. Seizure medication (most commonly dilantin)
      3. Medication for gout, colchicines, and alopurinol (Xyloprim)
      4. Blood pressure medication, particularly the b-blockers (such as Inderal) or diuretics
      5. Anti-inflammatory drugs (such as prednisone)
      6. Medications that lower cholesterol and other lipids
      7. Mood altering drugs such as lithium, tri-cyclics, Elavil, Prozac
      8. Thyroid medications
      9. Oral contraceptive agents, particularly those high in progestins
      10. Miscellaneous medications, such as diet pills, high doses of Vitamin A, street drugs (cocaine)

Causes of Anagen Effluvium

      1. Chemotherapy
      2. Radiotherapy

Localized Hair Loss

A host of dermatologic conditions can cause localized hair loss in women. The pattern that they produce is usually quite different from the diffuse pattern of female genetic hair loss and is easily differentiated from it by an experienced dermatologist. Occasionally, the diagnosis is difficult to make and tests, such as a scalp biopsy are necessary.

Localized hair loss in women may be sub-divided into scarring and non-scarring types.

Non-Scarring Alopecias

Alopecia Areata is a genetic, auto-immune disease that typifies the non-scarring type. It manifests with the sudden onset of discrete, round patches of hair loss associated with normal underlying skin. It usually responds quite well to local injections of corticosteroids.


Localized hair loss can be also be caused by constant pulling on scalp hair, either through braiding, tight clips or hair systems. Traction alopecia, the medical term for this condition, often causes reversible thinning but, if the tugging on the follicles persists for an extended period of time, the hair loss can be permanent. The most common presentation is thinning, or complete hair loss, at the frontal hairline and in the temples of women who wear their hair pulled tightly back. Early traction alopecia can reverse itself by simply wearing the hair loose. A hair transplant may be needed to restore the hair that is permanently lost from sustained traction.

Scarring Alopecias

Scarring hair loss can be caused by a variety of medical or dermatologic conditions such as Discoid Lupus, Lichen Planus, and infections. It can also be caused by thermal burns or local radiation therapy. Face-lift surgery may result in permanent localized hair loss that can be particularly bothersome if it occurs at the frontal hairline or around the temples. Fortunately, localized hair loss from injury or from medical problems are often amenable to hair transplantation.

Hair Loss in Women & Aging

Many of the factors that cause the rate of loss to speed up or slow down are unknown, but we do know that with age, a person’s total hair volume will decrease. This is referred to as senile alopecia. Even when there is no predisposition to genetic balding, hair across the entire scalp will thin over time resulting in the appearance of less density. The age at which these effects finally manifest themselves varies from one individual to another and is mainly related to a person’s genetic makeup.

Classification of Hair Loss in Women

As discussed in the section on the causes of hair loss in women, women’s hair loss can be classified into diffuse hair loss, localized hair loss, or patterned hair loss. It can also be divided into scarring and non-scarring types. Since the diffuse, non-scarring female hair loss caused by hereditary is so common, it has its own special classification that is based upon the degree of thinning called the Ludwig classification.

The Ludwig Classification uses three stages to describe female pattern genetic hair loss:

      • Type I (mild)
      • Type II (moderate)
      • Type III (extensive)

In all three Ludwig stages, there is hair loss on the front and top of the scalp with relative preservation of the frontal hairline. The back and sides may or may not be involved. Regardless of the extent of hair loss, only women with stable hair on the back and sides of the scalp are candidates for hair transplant surgery.

 
Type I: Early thinning that can be easily camouflaged with proper grooming. Type I patients have too little hair loss to consider surgical hair restoration.

 
Type II: Significant widening of the midline part and noticeably decreased volume. Hair transplantation may be indicated if the donor area in the back and sides of the scalp is stable.

 
Type III: A thin, see-through look on the top of the scalp. This is often associated with generalized thinning.

It is important for all women experiencing hair loss that an accurate diagnosis is made. This is particularly true when the hair loss is diffuse, as underlying medical conditions may be a contributing factor. Please refer to the diagnosis of hair loss in women page to learn about how the various types of female hair loss are evaluated. Also, watch Dr. Bernstein on the Early Show with a female hair loss patient who was treated at Bernstein Medical.

The diagnosis of “female pattern” hair loss is relatively straightforward when there is a history of gradually thinning in the front and/or top of the scalp, relative preservation of the frontal hairline, a positive family history of hair loss, and the presence of miniaturization in the thinning areas.

Miniaturization is the progressive decrease of the hair shaft’s diameter and length in response to hormones. It can be observed using a densitometer, a hand-held instrument that magnifies a small area of the scalp where the hair has been clipped to about 1mm in length. With this instrument miniaturization is easily apparent.

Normally follicular units (natural hair groups) are made of full-thickness, healthy terminal hair. With miniaturization one or more hairs within each group begin to thin. Eventually these hairs are lost.

If the hair loss is diffuse (thin all over) rather than in the typical female pattern on the front and top, the diagnosis can be more difficult. The presence of miniaturization in the areas of thinning usually confirms the diagnosis of androgenetic alopecia, however, if the diagnosis is still unclear, a number of other conditions must be ruled out. These have been listed in the section on Causes of Women’s Hair Loss.

Besides densitometry, two other common diagnostic tests that can be performed in the physician’s office are the hair-pull and hair pluck. In the hair pull, the physician grabs on to 20-30 hairs with his fingers and gently pulls on them. If five or more come out in the pull then this is suggestive of the increased shedding associated with telogen effluvium, a reversible type of female hair loss seen with stress, pregnancy, drug reactions and a variety of other conditions. Telogen effluvium generally occurs 2-3 months after a stressful event and affects 35-50% of one’s hair. Over 300 club hairs (telogen hairs that have rounded ends) may be shed per day (see Causes of Women’s Hair Loss).

In the hair pluck, 20 to 30 hairs are forcibly plucked from the scalp with a small clamp. The hair bulbs are then examined under a microscope to determine the ratio of anagen (growing) hairs to telogen (resting) hairs. Normally, at least 80% of the follicles should be in the anagen stage. A lower ratio would suggest telogen effluvium. With the hair pluck, various abnormalities of the hair shaft may be observed that can contribute to hair breakage and poor growth.

Anagen effluvium occurs when hair is shed in its growing phase and is characterized by large numbers of tapered or broken hairs (> 80%). It can be caused by chemotherapy or radiation and can result in extensive hair loss in women.

Chronic telogen effluvium is a condition whose diagnosis is often missed, so it is worth mentioning briefly. Chronic TE affects women age 30-60. It starts abruptly with or without an initiating factor. Chronic TE presents with diffuse thinning with accentuation at the temples – often more apparent to the patient than to others. It has a long fluctuating course and patients can lose up to 50-400 hairs/day. There is increased shedding of telogen (club) hairs with a positive hair pull. Fortunately, the condition does not lead to complete baldness. Chronic TE can be expected to resolve spontaneously in 6 months to 6-7 years.

When the cause of the hair loss is still uncertain, further diagnostic information can be obtained from a scraping and culture for fungus and a scalp biopsy (sent to the lab for regular and special tissue stains and examined under both horizontal and vertical sections). A dermatologic consultation is warranted whenever the cause of hair loss is unclear.

Laboratory Evaluation for Androgen Excess

Occasionally, when a woman presents with female pattern hair loss, increased androgen production may be a contributing factor. The following signs and symptoms suggest that specific blood tests might be appropriate to rule out underlying sources of excess androgen:

      1. Irregular periods – for an extended period of time
      2. Cystic acne – severe acne which usually leaves scars
      3. Hirsuitism – increased body hair that doesn’t normally run in your family
      4. Virilization – appearance of secondary male sex characteristics such as a deepened voice
      5. Infertility – inability to become pregnant
      6. Galactorrahea – breast secretions when not pregnant (this is due to prolactin which is not actually an androgen)

It is important that when any of these symptoms are present, or these conditions are being considered, that you are under the care of a physician, to receive a proper evaluations and correct treatment if needed. Generally a gynecologist is the specialist most helpful for these problems.

Some of the tests that your doctor might order when considering androgen excess include:

      1. Total and Free Testosterone – the hormone that is mainly responsible for male secondary sex characteristics
      2. DHEA-Sulfate – a precursor to testosterone
      3. Prolactin – the hormone that enables the breast to secrete milk

Diagnostic Tests for Other Medical Conditions

Other test that are commonly ordered to screen for underlying medical conditions include:

      1. CBC (complete blood count) – for anemia, blood loss and certain vitamin deficiencies
      2. Serum iron and iron binding capacity – for anemia
      3. T3, T4, TSH – for thyroid disease
      4. ANA – for Lupus
      5. STS – for Syphilis

Localized Hair Loss

Localized hair loss in women is distinct from the diffuse thinning seen in female pattern alopecia. The following are the more common causes of local alopecia. A dermatologist should be consulted if any of these conditions are suspected. Note: the term alopecia is synonymous with hair loss).

Alopecia Areata
Alopecia areata is recognized by the sudden appearance of discrete, round patches that are completely devoid of hair. Occasionally, the entire scalp may be involved (alopecia totalis) and even the entire body hair including the eyebrows and eyelashes (alopecia universalis). When localized, the lesions respond well to injections of cortisone. Generalized alopecia is more difficult to treat. The prognosis is better the older the age of onset. Alopecia areata can occasionally be associated with other conditions such as thyroid disease.

Traction Alopecia
Hairstyles that exert constant pull on the hair, such as “corn rows” or tightly woven braids produce a characteristic pattern called “Traction Alopecia” that can be identified by a rim of thinning or baldness along the frontal hairline and at the temples. This is easily prevented by changing one’s daily hair-care habits, but once the hair loss occurs, it may be permanent. Fortunately, this condition is easily amenable to surgery if the cause can be eliminated.

Trichotillomania
Trichotillomania is a condition seen more commonly in young females, where the person twists, tugs or pulls out her hair. This can be scalp hair, eyebrows or eyelashes. The diagnosis is made by observing short, broken hairs in the area of hair loss. The patient may deny having this habit.

Face-lift & Brow-lift Procedures
Face-lift and brow-lift procedures can result in local hair loss in the vicinity of the incision. This may present as hair loss along the frontal hairline, in the temples, or adjacent to a surgical scar. If female patients do not have genetic hair loss, and have a good donor supply, they may make excellent candidates for a hair transplant.

Tinea Capitis
Tinea Capitis is a fungal infection of the scalp. It presents as irregular, red and scaly patches and/or small bald patches with broken hairs. The diagnosis is made by scraping a small piece of scale from the scalp and obtaining a bit of hair for testing. The specimens are sent for special fungal stains and cultures.

Pseudopalade
Pseudopalade is a non-specific scarring alopecia that generally starts on the top of the scalp and extends into the surrounding hair bearing areas with finger-like extensions. The areas look smooth and white due to the scarring and loss of hair follicles.

Lichen Plano-pilaris
Lichen Plano-pilaris is an inflammatory condition of the scalp that presents with redness, scale and localized areas of hair loss. There is a characteristic scaling at the edge of each balding patch.

Discoid Lupus Erythematosus (DLE)
Discoid Lupus Erythematosus (DLE) is the localized form of Systemic Lupus Erythematosus (SLE), a potentially serious autoimmune disease. The localized form presents with red, scaly, pigmented patches of scarred skin. The localized form of the disease is mostly a cosmetic problem, but patients must be evaluated for the systemic disease as well with specific blood tests such as an ANA. SLE can cause diffuse (generalized) hair loss and both the local and systemic forms of the disease may cause sensitivity to the sun.

Hair Loss Medication

Rogaine (minoxidil), a topical hair loss medication, has a 2% solution that is approved for women. Although Propecia (finasteride), is not indicated for women, some female patients with hair loss may benefit from using the oral medication spironolactone (used mainly to control blood pressure). Oral contraceptives higher in estrogen can stimulate hair growth. Viviscal is a dietary supplement purported to boost hair growth in men and women.

Laser Therapy

Low-Level Laser Therapy (LLLT) is a treatment for hair loss based on the principle of photo-biotherapy where a laser stimulates hair follicles on the scalp producing thicker hair shafts and a fuller appearance. LLLT is most useful in patients with diffuse hair loss (the most common pattern seen in women) although the benefits are generally modest. Two commonly use forms of laser treatment for hair loss are the Laser Comb and the Laser Cap. Both products can be used at home.

    Surgical Hair Restoration

    The development of surgical hair transplant techniques, particularly Follicular Unit Transplantation (FUT), allows many women to have a completely natural hair restoration. When performed on a good candidate, hair transplantation can produce a dramatic change in a woman’s appearance.

     

    Hair Loss in Women FAQ

     

    The doctors answer frequently asked questions about hair loss in women.

     

    Q: Why am I Losing My Hair?

    A: There can be many causes for women to lose their hair. Unlike men, where it is more commonly a hereditary cause, women can have many underlying factors. Thyroid conditions, auto-immune disease, stress, hormonal imbalance, pregnancy, anemia (iron deficiency), crash dieting, and many other conditions can cause hair loss in women. Some of this hair loss can be reversed by correcting the underlying cause. If there is a genetic component, and a woman is a candidate, hair restoration surgery may be considered. Read more about the causes of hair loss in women or visit us for a comprehensive diagnostic evaluation of your hair loss.

     

     

    Q: What is Telogen Effluvium?

    A: Telogen effluvium is a condition that can be easily confused with genetic female hair loss if it is misdiagnosed. Telogen effluvium, is a condition where hair is pushed into its resting phase and then several months later is shed. This can be caused by several medications and many different medical conditions. Fortunately, telogen effluvium is usually reversible. View the hair loss glossary for definitions of important hair loss terms.

     

     

    Q: Is Women’s Hair Loss Different from Men’s?

    A: The most common type of hair loss in women occurs in a diffuse pattern. Thinning occurs “all over the scalp” rather than in a localized area. Diffuse hair loss is most often hereditary, but it can also be caused by underlying medical conditions or other factors. This is in contrast to male pattern baldness which is general hereditary and in a definitive pattern, balding from the top of the scalp and slowly having the pattern increase until there is only a circumference of hair around the scalp. Read more about the causes, classification, and diagnosis of hair loss in women.

     

    Answers to frequently asked questions about hair loss in women.

     

    What is Female Androgenetic Alopecia?

    Q: What is female androgenetic alopecia?

    A: Female androgenetic alopecia, also called female pattern hair loss, is caused by the shrinking of susceptible hair follicles in response to normal levels of hormones (androgens). It is the most common type of hair loss in women, affecting perhaps 1/3 of the adult female population. It is seen as a general thinning over the entire scalp, but can also present in a more localized pattern i.e. just limited to the front and top. The condition is characterized by a gradual thinning and shortening (miniaturization) of individual hair follicles, rather than their complete loss and, although the condition tends to be progressive, it rarely leads to complete baldness.

     

    Is A Hair Transplant For Women Different Or More Difficult Than One For Men?

    Q: Is the hair transplant for women different from the one for men? Anything easier? Anything more difficult?

    A: Women’s hairlines are far more complex than men’s as the hair in a women’s hairline often creates subtle swirls and directional changes. These must be mimicked in the surgical design for the hair transplant to look natural.

    In women, we are more often working in and around existing hair, as most women that seek hair transplantation are thinning rather than bald. This slows down the graft insertion steps and makes the procedure take a bit longer compared to men.

     

    Why Is Hair Loss In Women Harder To Treat With A Hair Transplant Than Hair Loss In Men?

    Q: Why is hair loss in women harder to treat with hair transplants than hair loss in men?

    A: The majority of women present with diffuse hair loss (i.e. thinning all over) rather than the patterned hair loss seen in men (where the hair loss is localized to the front and top of the scalp).

    Diffuse thinning presents two problems for a potential hair transplant candidate.

    The first is that there is no permanent area where the hair can be taken from. If hair is taken from an area that is thinning, the transplanted hair will continue to thin after the procedure, since moving it doesn’t make it more permanent.

    The second problem is that since the areas to be transplanted are thin, rather than completely bald, the existing hair in the area of the hair transplant is at some risk to shedding as a result of the procedure.

    When women have a more defined pattern (i.e. more localized thinning on the front part of the scalp with a stable back and sides), they can make excellent candidates for surgery. This pattern occurs in about 20% of women. A small percentage of men have diffuse thinning and are, therefore, poor candidates for a hair restoration surgery as well.

     

    What are the Most Common Causes of Hair Loss in Women?

    Q: What are the most common causes of hair loss in women other than genes?

    A: The most common causes for localized hair loss in women are traction (due to tight braiding) and alopecia areata (an autoimmune disease that produces smooth round patches of hair loss).

    Other than genetic (hereditary) thinning; generalized hair loss is most commonly caused by medications, anemia, and thyroid disease.

     

    Is Female Pattern Hair Loss Common?

    Q: How common is female pattern hair loss?

    A: It is very common. It affects about 40% of women.

     

    How Do You Treat General Thinning in Women ?

    Q: I’ve been losing my hair just around the front of my scalp for years, but now it’s bad enough that I need to wear a wig to hide the top and back. Do you transplant women?

    A: If you have thinning in such a broad area, most likely your donor area is also thin and you would not be a good candidate for surgery.

    An examination can determine this and also determine if there is some other cause of your hair loss other than genetics.

     

    Can a Woman be a Candidate for a Hair Transplant?

    Q: I am female and thinning can I be a candidate for a Follicular Unit Hair Transplant?

    A: If it turns out that you have female pattern hair loss, you may be a candidate a hair transplant, but would need to be evaluated by a doctor who specializes in surgical hair restoration.

    In the evaluation, you should have your degree of hair loss assessed and donor supply measured, using an instrument called a densitometer, to be certain that you have enough permanent donor hair to meet your desired goals. 

    Are Women Less Likely to be Candidates for a Hair Transplant?

    Q: I heard that a smaller per cent of women are candidates for hair transplants compared to men. Is this true?

    A: Yes, that is true. Women more commonly have diffuse hair loss where the thinning is all over the scalp. This means that the donor area (the back and sides of the scalp) are thinning as well.

    If the donor area is not stable, then there is no point in doing a hair transplant, since the transplanted hair will continue to fall out. Remember, the transplanted hair is no better than the area where is comes from.

    On the other hand, women with stable donor areas can be great candidates for surgical hair restoration. The stability of the donor area can be assessed using a procedure called densitometry and should be part of the hair loss evaluation when you see your physician.

     

    How do You Treat Early Hair Loss in Women?

    Q: I am a 33 year old women and am just starting to thin on the top of my scalp behind my frontal hairline. What should I do? Should I have a hair transplant?

    A: There are a number of things that you should consider that can be effective in early hair loss. These include minoxidil (Rogaine), laser therapy, and using cosmetics specifically made to make the hair appear fuller. Lightening or streaking the hair, as well as parting the hair off to the side, will also make the hair appear fuller.

    If a surgical hair restoration is performed too early and there is still a lot of existing hair in the area, the hair transplant may actually accelerate hair loss. Surgery should not be performed prematurely.

    Also, it is important that the doctor check the stability of the donor area, using densitometry, to make sure that the procedure is even possible. For those women who are good candidates, and if it is done at the appropriate time, a follicular unit hair transplant is a great procedure that can produce really natural results.

     

    Can Hair Loss in Women be Caused by Pregnancy, Prozac, or Hyperactive Thyroid?

    Q: I had a baby 12 weeks ago and have recently been diagnosed with a hyperactive thyroid, although only slightly. I was also taking Prozac for 7-10 days. I am 27 and have been experiencing a significant amount of hair loss from all over my scalp. What are the chances that this would be permanent?

    A: Based upon your history, you have three possible reasons for having a type of hair loss called telogen effluvium; thyroid disease, medication induced (Prozac) and pregnancy.

    Telogen effluvium is diagnosed by a hair pull test and observing club hairs under the microscope. It is generally a reversible condition, regardless of the cause. Telogen effluvium most often occurs 2-3 months after the inducing event, so your pregnancy is the most likely cause. Prozac would less likely be the problem since you have only been on it for a short time. Besides causing Telogen effluvium, thyroid disease can also alter your hair characteristics, which can make your hair appear thinner.

    Other causes of hair loss, such as genetic female pattern hair alopecia, must be ruled out. Please see the Hair Loss in Women page on the Bernstein Medical – Center for Hair Restoration website for more information.

     

    Can a Hair Transplant Restore Frontal Hair Loss in Women?

    Q: Although I read that women are supposedly protected from hair loss in the frontal hairline by the enzyme aromatase that is exactly where I am losing hair. My hairline has receded and I have developed a widow’s peak. What can be causing this, and how can I fix it? It seems to have been happening gradually for a few years.

    A: Less than 10% of female hair loss is in a frontal pattern that is similar to the pattern of genetic hair loss seen in men.

    Women with this pattern can often be good candidates for hair transplant surgery, particularly if the donor area is stable. View our Women’s Hair Transplant Gallery for some examples of the kind of results we can achieve for women at Bernstein Medical – Center for Hair Restoration.

     

    Can Hair Loss in Women Come from Hair Dye?

    Q: I am a 48 year old woman. Since I have used a new hair dye, I seem to be going bald. Is this possible?

    A: Dying hair is a very common practice and hair loss in women who are 48 years old is also very common. The fact that the two have occurred together does not necessarily imply that there is a cause and effect relationship.

    Women who are already losing hair often go to a great deal of effort to disguise this fact with dying, bleaching, and perming. These procedures, particularly if too aggressive, or done too frequently, can cause weakening and increased fragility of the hair shaft and increased hair breakage may result. This is more common if the hair is already fine in texture. This breakage is frequently interpreted as “hair loss” and it certainly does result in a significant loss of hair bulk, although the follicle itself is not damaged.

    When there is a relationship between hair dye and hair loss in women, it is usually an inflammatory/allergic or irritant reaction. If severe, there may be an actual burn. In these cases, there would be a history of redness and swelling. An inflammatory reaction could cause hair loss but it would be unusual to damage follicles enough to produce scarring – although this occasionally does occur. A scalp biopsy is often helpful to sort out these cases.

     

    Can Women Experience Hair Loss from Hormone Replacement Therapy with Testosterone?

    Q: Dr. Bernstein, a lot of older women are taking testosterone to restore libido, but are they going to suffer hair loss as a consequence?

    A: They can. In women there is a delicate balance between the androgens, i.e. testosterone and estrogens. Estrogen is protective to some degree against hair loss in women, which is why most women don’t experience such severe hair loss as do men.

    When a woman takes testosterone supplements it upsets that balance and can cause hair loss. However, hair loss in post-menopausal women is usually due to age related changes. Typically, the hair decreases in size in a genetically determined progression that seems not to be directly related to changes in the levels of hormones.

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