Female Pattern Hair Loss

Well hey guys, this week I’m going to be talking about female pattern hair loss. The medical term for this is Androgenetic Alopecia. If you’re new here, welcome. My name is Susan and I’m a dermatologist. I write on skincare reviews and skincare Q&A so if this type of content interests you, I really encourage you to stay tuned for more. Female pattern hair loss is a distinct type of hair loss that occurs in women, also known as Androgenetic Alopecia. Fairly recently I want to say the popular Fitness Instagrammer Kayla, BBG community. If you guys are familiar with her, she made it very public that she herself suffers from this condition which I thought was very brave of her to to come out and use her platform to to give a voice to this condition. Because many women struggle with female pattern hair loss and it can be incredibly devastating and have huge psychological impact, so I applaud her for her very public coming out and speaking about it, and raising some awareness as to this condition. You know in fact about 40% of women, which is a pretty large percentage of women will show some degree of female pattern hair loss by the time they’re in their 50s. Less than 45% of women actually reached the age of 80 with the full head of hair that they once had. Now a female pattern hair loss there’s diffuse thinning of the hair on the top of the head and it’s due a combination of both the Androgenetic Alopecia as well as an increased amount of hair shedding, that sort of are occurring simultaneously. In female pattern hair loss or Androgenetic Alopecia in women, there’s actually a combination of both increased hair shedding as well as an increased sensitivity of the hairs to some of the hormones that are normally present in all of us, resulting in those hairs that are sensitive becoming baby hairs very early and I’ll talk a little bit more about that. So as I mentioned, one part of female pattern hair loss is an increased amount of hair shedding, but it needs to be distinguished from hair loss due exclusively to an increased amount of shedding or Telogen Effluvium or actually Androgenetic Alopecia. So that is why it is very important, if you’re suffering from hair loss, to seek evaluation and management by your healthcare provider to kind of help distinguish between if you are a woman who is suffering from chronic hair shedding exclusively or you’re somebody who has Androgenetic Alopecia and what you have a combination of the hair shedding as well as hair loss due to sensitivity of the hair due to the hormones that are circulating in our blood. Hence it’s very important to seek evaluation in management because it needs to needs to be differentiated.

Unlike the male counterpart or male pattern baldness, in female pattern hair loss the hair loss distribution is different okay. Women don’t lose the hair from the center part of their head – what happens in women actually is rather than experiencing a receding hairline and balding from the center of the scalp, women actually experience a widening of the central part of the hair. That is where their hair loss starts to begin. It’s almost like if you parted your hair down the middle, that line starts to get progressively wider and wider okay. That’s how it presents in women. You know, I get many questions what causes this. Does it have something to do with my hormones. So first of all female pattern hair loss, like it’s male counterpart, does in fact have a strong genetic predisposition. The genetics of female pattern hair loss are an area of active research and something that is ongoing but suffice to say it’s polygenetic, meaning a combination of probably several genes going on and we haven’t clarified everything yet, but at this time there’s no genetic test that could predict if you’re going to develop this condition later on in life. Part of what happens in female pattern hair loss is not only an increased amount of actual shedding of hair but a sensitivity of the hair itself to hormones, and how hormones govern the hair cycle. So many people ask me, well do I have abnormal blood hormones or should I you know be worried that I’ve got too much testosterone. The overwhelming majority of women who suffer from this condition have normal male hormone levels or androgens, testosterone, dihydrotestosterone. Those levels in the overwhelming majority of women suffering from this condition are in fact normal. Likewise, the role of estrogen, the female sex hormone, it’s rollin in female pattern hair loss is not entirely understood either, but female pattern hair loss tends to present and be more common after menopause, suggesting that maybe the female estrogens which are higher before menopause have a role in stimulating hair growth.

We are born with all of the hairs that we’re ever going to make on our head, at the time of birth. We have all that we’re going to ever make. The hairs on our head grow approximately one centimeter a month for a period of three years. Then after the growing phase they regress during a period of time known as catagen, and following catagen the hair involutes and is dormant. However the hair follicle is still alive and ticking and it subsequently begins generating a new hair that will grow for three years. When it generates the new hair it pushes the old hair out in the old hair sheds. That cycle continues throughout your lifetime. Now unlike cats and dogs, we don’t shed all of our hair at one time. We shed different proportions of our hair. Our hairs are all in different phases of this continuous cycle, but as I mentioned, in female pattern hair loss, there is an increased amount of hair shedding. So what that means is that a larger proportion of the hairs enter the resting and then subsequent shedding phase, okay. So an increased number of hairs undergo shedding and then what also happens is that, as the hair is shedding, more and more of the hairs, rather than generating a new thick coarse terminal hair, they start to become presumably sensitive to your hormones and they don’t quite kick off the next cycle right, and they turn into a baby hair and miniaturize, and as they turn into that baby hair and miniaturize, eventually the hair appears thinner and thinner and a bald patch appears.

Now many people ask me how long does this hair shedding and balding last. When is it gonna stop? Well as I said, female pattern hair loss most often begins after menopause, however it can occur at any age. The hair loss process is not constant, it occurs in bursts and it is not uncommon to have an accelerated face of hair loss for about three to six months. A period of stability lasting about six to 18 months, and without any intervention these bursts of shedding and miniaturization of the hair can occur for decades. Dishearteningly so, our society places a great deal of value in having this youthful appearance. So much so that in women in men suffering from pattern hair loss or pattern baldness, it can be incredibly devastating to one’s emotional and well-being. There are studies showing that this can impact one’s self-esteem and they are fostered by this heightened importance that our society has on having this youthful appearance. So do know that you’re not alone but you should see a healthcare provider for evaluation and management. Part of the evaluation process should include checking the thyroid to make sure it’s functional, and female and male sex hormones. So part of the workup of hair loss does include blood testing to check for female and male hormone levels as well as thyroid function, but the majority of women who have this condition do not have abnormal hormone levels. However a subset of women with female pattern hair loss also have acne and these symptoms combined with perhaps a history of irregular menses are characteristic of something called polycystic ovarian syndrome. So then what treatments are available for this? Well there’s no cure for female pattern hair loss yeah unfortunately and the aim of most treatment options is to slow the rate of hair loss and prolong the rate of hair growth.

One of the most common modalities to do this is a application of a product or application of a drug called minoxidil, sold over the counter here in the United States by the brand name Rogaine. This is usually arecommended intervention. There are also some medications by mouth that might be tried that can offset any abnormal sensitivity of the hair to hormones, and these include Spironolactone and in some cases maybe a birth control pill. Probably the treatment combination that has the most data to support the the best outcome is a combination of using Rogaine or Minoxidil along with Spironolactone, but if that’s something that has been offered to you, one thing also to understand and in terms of managing your expectations is that once this combination is started it typically takes about six months to see any improvement. So you know don’t don’t pursue it for a few weeks and then bail because you don’t suddenly notice any improvement. Don’t bail on it because it takes some time to work.

There are also a variety of cosmetic camouflages sold over the counter and hair pieces and there are a variety of hair sprays that kind of act as bulking agents if you will. They just kind of coat the hairs that you have with little fibers to make them appear thicker. and the hair density to appear improved and once the hair loss has stabilized, hair transplant is an option in women as well as in men, so that’s another potential intervention. I also get questions about laser treatment for hair loss. Studies have shown that that is not actually helpful so that currently is not really a recommended treatment. My number one tip is to first stop to see a healthcare provider for evaluation and management. A dermatologist may be necessary to further workup the nature of your hair loss. Blood tests may be needed, and sometimes a skin biopsy of the scalp can be helpful. So don’t try to self-diagnose this and self-treat it. See a healthcare provider first and foremost and discuss these treatment options with them when the time is right.

It’s important to seek reliable information as there are a lot of bogus claims on the Internet, so you know, just be careful what you read. You know, all sorts of elegant things applied to the scalp that people will try to sell you. Buyer beware. But if you are a woman battling a female pattern hair loss, I really encourage you to check out a book called Bad Hair Day, a guide to female pattern hair loss. It’s by the author Francesca Collins, it is incredibly well written and it contains good information and helpful tips and I think it’s a good read. I recommended to other dermatologists to their patients so it’s a good resource it was published in 2005, so you know science is constantly changing and being updated but I think that it’s a great resource. Stay tuned for my upcoming review on Rogaine and different treatment options for for hair loss. If you found this information useful, I encourage you to leave a comment below, and thank you for reading.

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