Bernstein Medical Center for Hair Restoration - Causes of Hair Loss in Women

Causes of Hair Loss in Women

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New York PostAs the taboo of women’s hair loss gradually dissipates, more women than ever are seeking treatment for hair loss caused by stress, pregnancy, genetics, and a variety of other medical conditions and behavioral causes. Dr. Bernstein is quoted in an article in the New York Post identifying the upward trend of women seeking hair loss treatments.

“Approximately 40 percent of women experience some form of hair loss in their lives, and stress is the second biggest cause after genetics,” says Dr. Robert Bernstein, a professor of dermatology at Columbia University and a hair restoration specialist with a Midtown practice. “Over the last five years there had been a 50 percent increase in the number of women coming to our office to seek help.”

The article discussed four women of varying ages who sought treatment for different hair loss conditions. Among the treatments discussed are Rogaine for Women and Laser Therapy.

Read about Women’s Hair Loss
See before and after photos of Female Hair Transplant patients

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NYCityWoman.com

Dr. Bernstein was quoted in an article on NYCityWoman.com, where he spoke about the risks associated with popular hair extensions, such as weaves, wefts, and similar clip-in or add-on pieces. Extensions are a stylistic choice that allow women to dramatically change their appearance. However, their frequent use can contribute to a type of hair loss in women called traction alopecia – hair loss around the frontal hairline and temples caused by tight hairstyles pulling on the follicles.

Dr. Bernstein is quoted:

“Hair extensions can create a problem over a long period of time, as constant tugging on the hair follicles compromises their blood supply and may cause permanent thinning,” explains Robert M. Bernstein, M.D., a dermatologist in midtown Manhattan who specializes in hair loss.

Traction alopecia often causes thinning that reverses itself when the hair is worn loose, but if tugging on the hair follicles continues for an extended period of time, the hair loss can be permanent. In patients with permanent hair loss from traction alopecia, a hair transplant can typically restore the hair that is lost from sustained traction. See before and after photos of Patient BOI, Patient NBN, and Patient KAR for examples of women who had their edges restored by hair transplant surgery.

NYCitywoman.com is a website dedicated to lifestyle issues for “women on the right side of 40” — women who are smart, stylish, and eager to embrace new challenges and opportunities.

Read about Traction Alopecia
Read about the Causes of Hair Loss in Women

Before and after photos of women who had surgical hair restoration to repair thin edges:

Patient BOI
Patient NBN
Patient KAR

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Thinning Hair Nightmare - Cosmopolitan Magazine - January 2014

A patient who visited Dr. Bernstein to learn about her hair loss authored an article on her experiences which appeared in the January 2014 issue of Cosmopolitan Magazine. In an article titled, “Thinning Hair Nightmare,” the patient wrote about her struggle in coping with thinning hair, the taboo of talking about women’s hair loss, and ways in which she attempted to overcome these physical and emotional difficulties.

On visiting Bernstein Medical – Center for Hair Restoration:

I dialed up New York dermatologist and hair transplant surgeon Robert Bernstein, MD — I’d just seen him on Oprah talking about hair loss, so he had to be good — and booked an appointment.

Dr. Bernstein ordered a blood test to rule out common hair loss causes, like thyroid disorders and hormone abnormalities, and he made sure my diet and any medications weren’t to blame. Everything came back normal.

On the diagnosis of hair loss in women:

During a follow-up visit, the doc broke out a densitometer — a crazy flashlight-looking tool that measures the changes in diameter between hair — dove into my mane, resurfacing moments later with a diagnosis: mild androgenetic alopecia, aka female pattern hair loss (FPHL). “It’s the most common type of hair loss in women, affecting perhaps one-third of the adult female population,” he explained. It occurs when a woman’s hair follicles shrink in response to her body’s own hormones.

On the taboo of female hair loss:

In search of solutions, I turned to the blogosphere… While the topic of female hair loss feels taboo, here were thousands of women talking openly — not just about the physicality of the issue but also its psychological toll. […] Whenever any conversation turns to hair, I push myself to talk openly about my issue. I’m determined not to let this condition make me feel ashamed. With more than 30 million U.S. women affected by FPHL, we should find strength in our numbers.

Dr. Bernstein was the featured guest on the Doctor Oz Show, where they discussed women’s hair loss and how the subject is often, unfortunately, considered taboo.

Consultations for female hair loss patients

Video: watch Dr. Bernstein and Dr. Mehmet Oz discuss the taboo of female hair loss

View before & after hair transplant photos of some of our female patients

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Dr. Schweiger on PIX 11 - Dangers of Hair Extensions

Dr. Schweiger lends his expertise on hair loss in women and cosmetic hair extensions in a segment on PIX 11 television. The interview with Dr. Steve Salvatore focused on the pitfalls of using some types of hair extensions, or using them improperly.

Hair extensions can result in undesirable bald patches caused by traction alopecia, which is hair loss due to a constant tugging on hair follicles.

Read the transcript of the interview below:

Dr. Steve: Dr. Schweiger, there are two types of hair extensions, tell me about those. The permanent and temporary type.

Dr. Schweiger: There are permanent and temporary. The temporary are just that. They are clip-on hair extensions, they’re meant to be used for weddings, special occasions, to test out a new hair style. And they are generally the safer of the hair extensions.

Then there are permanent hair extensions, and there are different types. One permanent type you actually sew into the hair.

Dr. Steve: So you sew it into the existing hair, not the scalp, but the existing hair.

Dr. Schweiger: Exactly, into the hair.

And the other types are either glued or they use metal clamps to put it into the hair and they stay in for anywhere from 1 month to 3 months at a time.

Dr. Steve: So what are the problems that you have with the… I mean, obviously the clip-on ones are probably fine, right? But these other ones, the more permanent ones, what are the problems you run into.

Dr. Schweiger: The main problem that we’re seeing in patients is what’s called traction alopecia. And traction alopecia can come from tight braids or tight hair extensions and it leads to hair loss. Alopecia is just the medical term for hair loss. We’re seeing young patients who are using these products to look better, actually ending up with bald patches and looking worse.

[……]

Dr. Steve: So, obviously you think that the temporary ones are better. What’s the treatment for something like that.

Dr. Schweiger: The first thing, [which] is obvious, is take out the hair extensions. And then go see your doctor to assess the damage. Oftentimes, time will grow back the hair, if not, we can use injections of cortisone. The last line is hair transplant surgery, which a lot of people don’t know is an option. With a hair transplant, we take out a long strip of hair in the back of the scalp, and we dissect it into slivers, then into individual hairs. Then, actually, place them in the balding area to bring back the hair.

Dr. Steve: And the good thing about that is it’s not the old transplants of the past that look like little cornrows. It really does look great. Dr. Schweiger and Chioma, thanks so much for coming. Really appreciate it.

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Dr. Schweiger on Good Morning America

Dr. Schweiger, our resident expert on hair loss in women, was featured in a segment about hair extensions on “Good Morning America” and ABC News online.

While many women extoll the cosmetic virtues of hair extensions — they are designed to add to the length and fullness of one’s hair — many others have realized the potential for extensions to cause hair loss.

Dr. Schweiger:

“We have patients who are in their early 20s come in after wearing hair extensions for six months or one year, and they actually have bald spots,” Dr. Eric Schweiger, a New York City dermatologist, told “Good Morning America.”

Some of the hair loss can be attributed to traction alopecia, which is localized hair loss that occurs with constant tugging on the follicles. However some of the problems occur due to underlying medical conditions, like anemia. Regardless the underlying cause, when someone is exposed to prolonged tension and weight from cosmetic enhancements, temporary or permanent areas of balding can occur. In some cases hair may grow back in those areas, but for individuals with permanent hair loss from extensions, hair transplantation may be the best treatment. In those cases, a visit to a hair restoration physician is the first step towards treating or repairing your hair loss.

This risk of damage to the hair is why it is important to use caution and care with extensions, as well as to have an understanding of potential issues the extensions might cause.

Dr. Schweiger on understanding these risks:

“It’s very important that people out there know the risks of hair extensions before they get them done,” said Dr. Schweiger. “If you’re going to do any extensions, just use them for a few hours and take them out. That’s the safest way.”

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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.

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Q: My hair loss resembles the grade I female hair loss scale, but none of the male hair loss patterns. It has been relatively stable for the past five years and only recently has it begun to progress further. I began both Propecia and Rogaine two months ago, but the hair loss still continues at the same pace. I’m really worried. Does a hair transplant work in such a diffuse hair loss? — D.D., Park Slope, Brooklyn

A: If your hair loss is diffuse only on top, then a hair transplant will be effective. This condition is called Diffuse Patterned Alopecia or DPA.

If the diffuse pattern of hair loss affects the back and sides as well, then surgical hair restoration should be avoided. In this case (called Diffuse Unpatterned Alopecia or DUPA) the donor area is not permanent and the transplanted hair will continue to thin over time.

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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.

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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.

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Q: Dr. Bernstein, a lot of older women are taking testosterone to restore libido, but are they going to experience 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.

For more information, please see the Causes of Hair Loss in Women page on the Bernstein Medical – Center for Hair Restoration website.

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Q: I know that I am going to be bald because my father is bald and I am losing my hair just like him. What actually causes this kind of hair loss? — J.P., Paradise Valley, Arizona

A: Although there are many different causes, the overwhelming number of people that have hair loss have what is referred to as “patterned hair loss” or “androgenetic alopecia.”

In men, it is due to a hormone called DHT, which is a by-product of testosterone produced by the action of the enzyme 5-alpha reductase. This enzyme is inhibited by the hair loss medication Propecia. See the causes of hair loss in men page on the Bernstein Medical – Center for Hair Restoration website for more information.

In women, the mechanism is a little bit more complex as another enzyme, aromatase, is involved in the metabolic pathway. See the causes of hair loss in women page on the Bernstein Medical – Center for Hair Restoration website for more information.

We know that the inheritance comes from both the mother’s and father’s side, although the actual genes causing hair loss in men and women have not yet been identified. Statistically, the inheritance from the maternal side appears to be a bit stronger, but the reason for this is unknown.

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Q: Why do some people have a full head of hair into their seventies or eighties and others start to go bald in their late teens or early twenties?

A: The cause is genetic and this poly-genetic trait can be inherited from the mother’s side, the father’s side, or both.

There is an old wives’ tale that it is inherited only from the mother’s parents. Although the inheritance can come from either side, it is actually greater from the mother’s side – but only slightly.

Read about Hair Loss Genetics

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