Is It Female Pattern Baldness, Or Normal Hair Loss?

What causes female pattern hair loss?

Why does it happen? Although the reasons are not well understood, it may be related to such things as aging, changes in hormone levels (specifically the male hormone androgen) or a family history of male or female pattern baldness.

Diagnosis is usually based on your medical history, ruling out other causes of hair loss (like thyroid problems or recent surgery) and the actual appearance and pattern of the hair loss. Sadly, there’s no way to prevent it.

Unlike some men who embrace their bald heads, with the attitude that “bald is the new sexy,” hair loss in women is generally not welcomed kindly. Though it rarely progresses to total or near total baldness in women, it can be quite disconcerting and affect self-esteem.

Female pattern hair loss (FPHL) В has a strong genetic predisposition. The mode of inheritance is polygenic, indicating that there are many genes that contribute to FPHL, and these genes could be inherited from either parent, or both. Genetic testing to assess risk of balding is currently not recommended, as it is unreliable.

Currently, it is not clear if androgens (male sex hormones) play a role in FPHL, although androgens have a clear role in male pattern baldness. The majority of women with FPHL have normal levels of androgens in their bloodstream. Due to this uncertain relationship, the term FPHL is preferred to ‘female androgenetic alopecia’.

The role of oestrogen is uncertain. FPHL is more common after the menopause suggesting oestrogens may be stimulatory for hair growth. But laboratory experiments have also suggested oestrogens may suppress hair growth.

What treatments are available?

Treatments are available for FPHL although there is no cure. It is important to manage expectations when seeking treatment, as the aim is to slow or stop the progression of hair loss rather than to promote hair regrowth. However, some women do experience hair regrowth with treatment. Results are variable and it is not possible to predict who may or may not benefit from treatment.

A Cochrane systematic review published in 2012 concluded that minoxidil solution was effective for FPHL. Minoxidil is available as 2% and 5% solutions; the stronger preparation is more likely to irritate and may cause undesirable hair growth unintentionally on areas other than the scalp.

Hormonal treatment, i.e. oral medications that block the effects of androgens (e.g. spironolactone, cyproterone, finasteride and flutamide) is also often tried.

Once started, treatment needs to continue for at least six months before the benefits can be assessed, and it is important not to stop treatment without discussing it with your doctor first. Long term treatment is usually necessary to sustain the benefits.

Cosmetic camouflages include coloured hair sprays to cover thinning areas on the scalp, hair bulking fibre powder, and hair wigs. Hair transplantation for FPHL is becoming more popular although not everyone is suitable for this procedure.

Low level laser therapy is of unproven benefit in pattern balding but one device has been approved by the FDA for marketing. Further studies are required to determine the magnitude of the benefit, if any.

Like so many treatments, there are some caveats:

  • It’s best to start at the first sign of hair loss.
  • There may be a temporary increase in hair loss for the first two to eight weeks, which stops when your hair begins to regrow.
  • It may irritate your scalp.
  • You need to use it continuously for one year before knowing how well it will work for you. It may help hair growth in one in four or five women; in most women it may slow or stop hair loss.
  • You must use it every day. If you stop, the hairs that grew during its use will fall out within three to four months.

If minoxidil doesn’t work, there are other medications—approved by the FDA to treat other conditions but not female pattern hair loss—that doctors may prescribe. Among them:

  • Spironolactone (a diuretic)
  • Cimetidine
  • Birth control pills
  • Ketoconazole
  • Finasteride
  • Flutamide
  • Ordutasteride

The FDA has approved lasers, which emit a low level of laser light to treat hair loss at home. Available in the form of combs, helmets and other devices, they may help stimulate new hair growth and have been shown by some studies to be effective.

If you seek other nonmedical solutions—which are often less expensive and the safest way to deal with the issue—look into hair weaving, hairpieces or a change in your hairstyle to help hide the evidence. Other treatments being studied or used, but not proven effective, include:

  • Platelet-rich plasma therapy
  • Supplements, like biotin and folic acid
  • Combination of specific omega-3 fatty acids, omega-6 fatty acids and antioxidants


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