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
Dr. Shah using densitometer to diagnose 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
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). Read more in the section on Hair Loss Medication.
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. Read more in the section on Low-Level Laser Therapy (LLLT).
Since women’s hair loss is typically diffuse with a persistent frontal hairline, it is generally possible for women to be able to hide their thinning with creative styling and other camouflage techniques. Using cosmetic camouflage products may also help. A number of over the counter products are now available that can make the hair look thicker. They come in a variety of forms; powders, sprays and creams. The main limitation of these products is that one must have enough hair to hold the cosmetics in place and, unless it is applied properly, it may not look natural. Read more about Cosmetic Camouflage.
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. See the results below of a hair transplant in one of Bernstein Medical – Center for Hair Restoration’s female patients.
Bernstein Medical Hair Transplant Patient
Before (left) and After (right)
See more before and after hair transplant photos of some of our female patients.
Note: It is particularly important for any women considering a surgical solution, to have a careful physical examination to make sure that the diagnosis is correct and to determine that they have an adequate donor hair supply. For those women in whom surgical hair restoration is indicated, special surgical skills are required to achieve optimal results. It is a mistake for a surgeon to assume that hair loss in women can be treated the same way it is in men.
For women who have unwanted body or facial hair, Dr. Bernstein’s wife Shizuka is the owner of Shizuka New York; a well-known Manhattan day spa located adjacent to Rockefeller Center at 7 West 51st Street, New York, NY. The Spa offers full skin care services and hair removal.
Read answers to many frequently asked questions on hair loss in women.