Hair Loss in Women

I’m losing more hair than usual when I comb, brush and shampoo. Am I Going to Lose All of My Hair? What Can I Do to Stop Losing Hair?
Early signs of hair loss are difficult to interpret in women. In men, the most likely cause of hair loss is androgenetic alopecia, also called male-pattern hair loss. While androgenetic alopecia, an inherited condition, can also be a cause of hair loss in women it does not follow the patterns characteristic of androgenetic alopecia in men. Female-pattern hair loss rarely progresses to the extensive balding characteristic of the most advanced patterns of hair loss in men. Thus, although androgenetic alopecia is a frequent cause of hair loss in women it is one of a number of causes to be considered. Some investigators believe that although male and female pattern hair loss both have genetic causes, different genes may be involved or the functioning of the hair-loss genes may be different in men and women. Conditions other than androgenetic alopecia are frequent causes of hair loss in women. These conditions include:

• Hypo- and hyperthyroidism—hair loss may be an early sign of thyroid dysfunction, and may be halted or reversed when thyroid dysfunction is adequately treated;
• Polycystic ovary syndrome—an inherited dysfunctional condition affecting the ovaries that occurs in about 10% of women in reproductive years;
• Hormonal changes associated with pregnancy—hair loss associated with pregnancy is self-limiting and temporary, usually resolving within months after delivery; and,
• Hormonal changes associated with menopause—hair loss may begin with onset of menopause and may be slowed with adequate medical management of menopause symptoms.

Hair breakage can mimic hair thinning and make a woman believe she is losing hair. Common causes of hair breakage include over-treatment with hair straighteners, hair relaxers, permanent waving and frequent hair dyeing. Hair loss, or the appearance of hair loss, may occur as a result of facial plastic surgery that changes the configuration of the hairline. Hair transplantation is a successful solution to repairing hairline changes resulting from cosmetic surgery. Hair styling that features corn-rowing or tight braiding can result in the condition called traction hair loss. Constant traction on hair follicles by tightly braided hair can damage hair follicles and eventually cause permanent hair loss if tissue damage causes scarring of the scalp. Hair loss may be halted or limited if tight braiding is abandoned as a hair style. Otherwise unexplained hair loss may be due to conditions such as alopecia areata and telogen effluvium that require medical diagnosis. If hair loss is limited to one defined area of the scalp, a trial of minoxidil (Rogaine) may be worthwhile. If hair loss continues, consultation with a physician hair restoration specialist may be considered. Consultation can determine (1) the cause of hair loss, and (2) the best approach to treating hair loss.
I have very visible hair loss that is progressive and makes me look older than my years. What can I do to stop hair loss and regain a full head of hair?
The degree of hair loss that is considered “very visible” and “unacceptable” varies from person to person. Studies have shown that about 80% of premenopausal women who look for hair loss will discover some degree of thinning hair. At what point the hair loss becomes “unacceptable” is an individual assessment for each person. Some women will accept hair loss as a condition of aging. Others will demand that hair loss be halted or reversed. Hair loss patterns in women are typically different from those in men. Hair loss in women tends to be more diffuse than hair loss in men, but more typically male patterns do occur in some women. The more characteristic female pattern is diffuse thinning over a considerable area of scalp, or diffuse thinning in a “Christmas tree” pattern over the central scalp. An advanced form of diffuse hair thinning is called diffuse unpatterned alopecia (DUPA) that involves the entire scalp. A woman’s hair loss that is visible, progressive and unacceptable to the woman should be evaluated by a physician hair restoration specialist to determine (1) the cause of hair loss, and (2) whether hair loss can be halted or an acceptable appearance restored by medical or surgical treatment. Hair transplantation is almost always the surgical treatment of choice for a woman. The procedure has a high rate of success in women and the great majority of women are very satisfied with the results. However, not all women are good candidates for hair transplantation. Factors that most frequently rule out hair transplantation for a woman are:

• Because of diffuse thinning over a large area of scalp, there is not enough donor hair to carry out acceptable hair transplantation, or
•  A patient has unrealistic expectations that hair transplantation can completely restore her pre-thinning appearance of hair fullness and density, rejecting any significant improvement that is less than 100% restoration of pre-thinning appearance.

Before committing to a treatment plan, a woman should be satisfied that all relevant questions have been addressed regarding procedures, likely outcomes and cost. Both patient and physician should be confident that all other causes of hair loss have been ruled out before hair transplantation is undertaken.