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Female Pattern Baldness: Causes and Treatments

Female pattern baldness (also known as female pattern hair loss or androgenetic alopecia in women) is a female version of hereditary hair loss. It is the most common form of hair loss in women, affecting to some degree up to 50% of females over 65. This type of hair loss is genetically predetermined and incurable at the moment, though factors such as age and levels of androgens (male sex hormones) may help determine when it occurs and how extensive it may become. It can be controlled with medication(s) and (sometimes also) with hair transplantation. The main distinguishing characteristic of female pattern hair loss is its diffuse balding pattern, affecting the entire scalp, not just the top of the scalp as in men.

Causes of Female Pattern Baldness

Heredity, age and hormonal changes during menopause are the main factors determining the incidence of this condition. Although female pattern baldness occurs in women of all races, it is most common in Caucasian women and least common in Native American and Asian women. The chief cause of androgenetic alopecia in women is susceptibility of some hair follicles to the harmful effects of dihydrotestosterone (DHT), a metabolite of the male hormone testosterone. Female bodies also produce male hormones and with passing years, as estrogen production declines (estrogens naturally counteract the effects of male hormones), there are excess amounts of DHT available to cause damage to the susceptible hair follicles. The result is shrinking hair follicles, hair miniaturization and eventual hair loss.

Signs of Female Pattern Baldness

Unlike male pattern baldness, female hair loss is less apparent because it occurs as diffuse balding around the whole scalp and is, therefore, more difficult to recognize in the early stages. The first visible sign is usually a widening of the part but once you notice it, a significant hair loss has already occurred.

Diagnosing Female Pattern Baldness

Densitometer will be used to determine the presence of miniaturized follicles and to assess the extent of their miniaturization. A skin biopsy or other procedures, such as blood tests, may be used to diagnose medical conditions that can cause balding, e.g. hyperthyroidism and vitamin B or iron deficiency, or that may be confused with female pattern baldness, e.g. alopecia areata or telogen effluvium. The Ludwig scale is commonly used to determine the degree of female hair loss.

Treating Female Pattern Baldness

Women have fewer options for treating hair loss than men as they cannot use finasteride (Propecia), which could cause damage to the male fetus in their body. Furthermore, studies have shown that finasteride is not effective against female pattern baldness. To make matters yet more difficult, many females are not suitable candidates for hair surgery.

Minoxidil. The only treatment approved by the FDA to specifically treat female pattern baldness is minoxidil 2% solution (Rogaine for women). In contrast, men can use 5% minoxidil solutions. The reason why women cannot use stronger, more powerful solutions are the side effects of minoxidil, especially undesired facial hair growth and growth of hair on other parts of the body. Other possible side effects include skin irritation and itching, swelling of the feet and irregular or fast heartbeat. Nevertheless, some doctors recommend female hair loss sufferers to use 5% minoxidil foam (Rogain foam), which is more effective at stimulating hair growth (it was designed for male hair loss) than 2% solution but has fewer side effects than liquid preparations.

Spironolactone (Aldactone) is a diuretic (used to treat high blood pressure) with anti-androgenic properties. Because of these anti-androgenic properties, it is sometimes prescribed off-label to treat hirsutism, acne and hair loss in women. Like finasteride, it blocks the conversion of testosterone in DHT but, in addition to that, it also binds to the androgen receptor sites in the hair follicles where it competes with DHT. Therefore, it is a very strong anti-androgen. Potential side effects of this medication include dizziness, drowsiness, diarrhea, upset stomach, light-headedness, nausea, vomiting and headache.

Hair transplant surgery is for many female hair loss sufferers not a viable treatment option because of their diffuse balding pattern and resulting difficulty to identify hair follicles on their scalp that would remain resistant to the harmful effects of DHT. Studies show that when hair follicles in balding men are attacked by DHT, those that are sensitive to DHT attacks will gradually lose all their hairs whereas those that are resistant to DHT will remain intact. In contrast, in women with female pattern baldness most follicles on their scalp will be affected by DHT but affected follicles seldom lose all their hairs (there are between one and four hairs growing out of each hair follicle but mostly two or three). This also explains diffuse balding in women.