Female Pattern Baldness

Female pattern baldness involves a typical pattern of hair loss in women. It is caused by hormones, aging, and genetic predisposition.

What causes female pattern baldness and who is at risk?

Hair grows about an inch every couple of months. Each hair grows for 2 to 4 years, remains at that length for a short period, then falls out. A new hair soon begins growing in its place. At any one time, about 85% of the hair on your head is in the growing phase and 15% is in the resting phase.

Baldness occurs when hair falls out but new hair does not grow in its place. The cause of failure to grow new hair in female pattern baldness is not well understood, but it is associated with genetic predisposition, aging, and levels of hormones (particularly androgens, the male sex hormones).

Changes in the levels of androgens can affect hair production. For example, after the hormonal changes that occur during menopause, many women find that the hair on their head has become thinner while facial hair has become coarser.

Female pattern baldness is generally permanent hair loss.

Hair loss can occur in women for reasons other than female pattern baldness, including the following:

  • Temporary shedding of hair that may occur after surgery, pregnancy or after a major illness. (telogen effluvium).
  • Breaking of hair (from such things as styling treatments and twisting or pulling of hair)
  • Patchy areas of total hair loss (alopecia areata - an immune disorder causing temporary hair loss)
  • After chemotherapy and from some other medications
  • Certain skin conditions
  • Hormonal imbalance (excess testosterone or thyroid hormone imbalance)
  • Iron or vitamin deficiency
  • Diseases like diabetes or lupus

Hair loss due to these reasons is usually reversible is identified and dealt with correctly.

Symptoms of female pattern baldness

  • Thinning of hair over the entire head; front-line hair remains. (Hair thinning is different from that of male pattern baldness)
  • Hair loss at the crown or hairline, mild to moderate
  • Hair loss rarely progresses to total or near total baldness, as in men.

The typical pattern of female pattern baldness is different from that of male pattern baldness. The hair thins all over the head, but the frontal hairline is maintained. There may be a moderate loss of hair on the crown, but this rarely progresses to total or near baldness as it may in men.

Diagnosis of female pattern baldness

Female pattern baldness is usually diagnosed based on the appearance and pattern of hair loss and by ruling out other causes of hair loss.

A skin biopsy or other procedures may be used to diagnose medical disorders that cause loss of hair.

Hair analysis is not accurate for diagnosing nutritional or similar causes of hair loss, although it may reveal substances such as arsenic or lead.

Your doctor should also check for other causes such as too much male hormones (androgens) or imbalance of other hormones.

Treatment options

The hair loss that results from female pattern baldness is permanent and there is no known preventative. In most cases, it is mild to moderate. No treatment is required if the person is comfortable with her appearance.

Minoxidil applied topically, is the only medicine approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness.

Brand Name Generic Name
Rogaine minoxidil 2%

Minoxidil 2% (not 5%) is recommended for use in women. Minoxidil may help hair to grow in 20% to 25% of the female population, and in the majority it may slow or stop the loss of hair. Treatment is expensive, however. Hair loss recurs when minoxidil's use is stopped.

Spironolactone may used in women who do not respond to minoxidil. It may help some women who experience hair loss due to excess androgens. Spironolactone is not FDA approved for female pattern baldness. It can increase potassium levels in the blood so should not be used in people with renal failure or during pregnancy.

Brand Name Generic Name
Aldactone spironolactone

Oral contraceptives are sometimes effective in treating female pattern hair loss due to hyperandrogenemia.

Hair transplants consist of the removal of tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring in the donor areas and carries a modest risk for skin infection. The procedure usually requires multiple transplantation sessions and may be expensive. Results, however, are often excellent and permanent.

Suturing of hair pieces to the scalp is not recommended as it can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.

Hair weaving, hairpieces, or change of hairstyle may disguise hair loss and improve cosmetic appearance. This is often the least expensive and safest method of treating female pattern baldness.

Prognosis

Hair loss in women can be serious and could cause complications such as psychological stress and loss of self-esteem due to change in appearance, as this pattern of hair loss is permanent. It is more acceptable for men to go through hair loss.

See your doctor if:

Hair loss occurs and persists. There might be a treatable medical cause for the loss of hair.

Also if you feel female pattern baldness is present and you want to treat the hair loss; or if hair loss is accompanied by itching, skin irritation, or other symptoms.

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