Female Pattern Hair Loss

Female pattern hair loss - sometimes referred to as androgenetic alopecia - is a very common condition. Whilst it mostly affects women after menopause, it can affect much younger women too.

It can be very traumatic for those of us who experience it - after all, our hair makes us feel feminine and beautiful, so losing it can be stressful. 

On this page, I'll look closer at this condition - its causes, symptoms, potential treatments and approaches for coping. Please do let me know if you have any experiences you'd like to share on this page.


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Please note: This information is not to be seen as medical advice. It is very important to contact a medical professional to discuss your hair loss.

What is Female Pattern Hair Loss?

Female pattern hair loss is the gradual thinning of hair over time.

As mentioned above, it is often referred to as androgenetic alopecia or androgenic alopecia. Some refer to it as female pattern baldness.

However, many experts feel that none of these terms are strictly correct.

The 'andro' part of the words 'androgenetic' and 'androgenic'  refers to androgens - hormones that can influence hair growth.

Yet not all female pattern hair loss is connected to an excess of androgens, as was once believed. 

The 'genetic' or 'genic' part of the word refers to genes, implying that female pattern hair loss is always triggered by genetics (ie inherited from a family member). Sometimes, it is - but not always. 

And the term 'baldness' indicates total loss of hair, which is extremely rare with female pattern hair loss.

Given that these terms are misleading, then, many medical professionals prefer to use the term 'female pattern hair loss'. So that's the term I'll use throughout this article.

Symptoms

With female pattern hair loss, the thinning usually occurs all over the head, not in patches. And it doesn't usually affect the hairline. 

It hardly ever progresses to complete baldness - in most cases the loss is mild to moderate. But it can progress far enough to be noticeable. And - unfortunately - the loss tends to be permanent.

The condition creeps up very gradually.

It can start with the appearance of thinner, shorter hairs, which are eventually shed and not replaced. This tends to happen more on the crown and the top of the head.

If you have noticed a slightly wider part and that your hair just 'feels' thinner, female pattern hair loss may be to blame.

Usually, there is no itching associated with female pattern hair loss, although some women do say that they feel a burning sensation, particularly when brushing their hair or changing their part.

The shedding can stop and start, with the hair loss seeming worse at some times than others.

Who is at risk of female pattern hair loss? What causes it?

Female pattern hair loss affects around 30 million women in the US and around 50% of women over the age of 65. According to DermNet in New Zealand, by the age of 80 less than 45% of women have a full head of hair.

Female pattern hair loss usually strikes when a woman is in her 50s or 60s (late onset), but it can start as early as the teens to early twenties (early onset).

Unfortunately, the cause isn't clearly understood by medical experts - indeed, there seem to be various forms of pattern hair loss caused by a variety of possible influences, both genetic and hormonal.

This makes it very difficult to predict who might be affected.

As mentioned earlier, androgens play a part in some cases.

If you have an increased level of androgens in your hair follicles, the cycle of hair growth can be shortened. This leads to the growth of thinner, shorter hairs and a delay in new growth once hairs are shed. The hair follicle shrinks over time, and eventually new hairs will not grow at all.

The follicle doesn't die, though, so there is the possibility that hair could grow again given the right stimulus. For some women this is minoxidil (read more in treatments, below).

Genes may also play a part...

... and if your mother or father experienced pattern hair loss, then your risk of doing so is higher.

Even estrogen levels can be a factor.

Female pattern hair loss is more common after menopause, which might suggest that falling estrogen levels trigger the shedding. In complete contradiction of this, however, are some laboratory experiments that indicate that estrogen may suppress hair growth.

The age of onset of female pattern hair loss may be related to the cause.

Women suffering from early onset hair loss (teens to twenties) tend to have more male family members with male pattern baldness. Male pattern baldness has been proven to be related to androgen levels. Women with early onset hair loss often have other signs of high androgen levels OR a greater sensitivity to androgen.

These signs include

  • a history of hirsutism (unwanted hair growth, such as excessive facial hair)
  • irregular periods
  • persistent adult acne

Most women with female pattern hair loss who are subsequently found to have high levels of androgens in their blood tend to experience the symptoms shown above.

If you do not have any of these symptoms, then it seems far less likely that androgens are to blame for your early onset hair loss.

For older women (40s and upwards), the symptoms of excessive androgens related to hair loss are less likely and many sources suggest that menopause causes a decrease in blood androgens. So the potential cause of hair loss become even less clear!

How is female pattern hair loss diagnosed?

When you first visit your doctor regarding your hair loss, he/she will usually carry out a series of tests to rule out other causes, such as thyroid problems or low iron.

He will look at the appearance of your hair loss - to see if it is 'patchy', for example - which is inconsistent with female pattern hair loss, or if it seems to follow the 'pattern' typically seen with this condition.

He may ask you questions about how you wear your hair, to determine whether or not your hair loss might be caused by traction alopecia

He will look at your medical history, which might reveal a genetic disposition to hair loss. He may also look for signs that your androgen levels are high, such as hair in unusual places (such as the face or lower abdomen), acne, or changes in your menstruation.

Tests for hair loss may include blood tests, skin biopsies, or microscopic examination of the hair.

What's the prognosis?

The progression of female pattern hair loss tends to be slow for most women. For those with early onset hair loss, things may (sadly) progress a bit more quickly.

It's rare for all the hair to be lost, but in many cases the loss does become noticeable.

How is female pattern hair loss treated?

There are a few treatment options available, but they only tend to work modestly well, and even then they don't work for everyone.

There are also an awful lot of products on the market that claim to treat the problem, but most are ineffective... not to mention expensive!

Of course, any products that claim to be able to fix this problem is going to be tempting to those of us who've experienced the trauma of hair loss - but it's very important to do your research and not be drawn into wasting money on 'remedies' that will never work.

Medications 

Some of the treatments your doctor may suggest include

  • Minoxidil. Better known by the brand name 'Rogaine', minoxidil may help regrow hair in some women and will more often slow down or stop hair loss in others. It works best if started before the hair loss has progressed very far, which is why it's important to seek an early diagnosis from your doctor. Minoxidil must be applied daily, for life.
    You can read more about minoxidil (Rogaine) here

  • Spironolactone.  Also known by the brand name Aldactone, this drug is somewhat effective in women whose hair loss is caused by excessive androgens. It can, however, cause side effects, some serious.

  • Flutamide. Like spironolactone, this drug blocks the effects of androgens on the body, but can also produce serious side effects.
  • Cimetidine. More commonly known under its brand name Tagamet, cimetidine is mainly used to treat heartburn. But it also has an anti androgenic effect and can be used to treat hair loss where excess androgens are to blame.

  • Finasteride. This is useful for women with high testosterone levels. However, it is not widely recommended for women because it can cause foetal abnormalities in pregnancy. For women unable to use finasteride, saw palmetto might make a good alternative (read more here). 

  • Cyproterone acetate. Used as a birth control pill in the UK (Dianette), this is another drug used to block the effects of excess androgens. It does cause some side effects, including tender breasts and mood changes, but many women take it with no issues at all. That being said, it can (rarely) lead to blood clots.

Your doctor will probably recommend that you continue with your treatment for at least 6 months, to allow him/her to properly assess the results. Don't be tempted to simply stop your medication if you feel that you are not seeing results quickly enough.

Other treatments

Hair transplant

This involves taking tiny plugs of hair from areas where it is thick and placing them in thin areas. 

The good news is that it is very effective and the results are permanent.

The bad news? It's expensive!

To assess whether or not this option might be suitable for you, you would need to speak to a transplant surgeon.

Hair pieces

Depending on the severity of the hair loss and exactly where it is, hair pieces or weaves can be useful for disguising thin patches. BUT - your existing hair needs to be strong enough and you shouldn't wear the hair piece or weave for too long in the same place. This is because you might run the risk of further hair loss caused by traction alopecia.

A new look

Alternatively, try a simple change of hairstyle. If your hair is thin in the middle, something as simple as putting your part on the side can make a big difference. Or try forming a zig-zag part - it takes a little practice but it's very effective!

Have a chat with your stylist as he/she may be able to come up with a cut that makes the most of the hair you have and disguises the thin bits!

'Make up' for the hair

Fill-in powders and thickening fibers are great - they really help to hide the hair loss by preventing your scalp from being as visible. You can see some of the more popular ones here

Platelet rich plasma therapy

This involves taking blood, then separating it with a machine into its different components. The blood platelets are then treated and injected into your scalp, which is believed to help stimulate the follicles to trigger hair growth. However, more research into this treatment is needed and there seems to be little scientific evidence available of its success.

Laser treatment

This seems quite limited in its effectiveness, although some people claim to have achieved good results. You can read more about laser therapy here.

Hair loss shampoos

These are not effective for female pattern hair loss, despite their claims. Most hair loss shampoos work by strengthening existing hair and promoting a healthy scalp. Whilst this is beneficial, it's important to to keep your expectations realistic, especially with some of the more expensive products!

Diet

A nutritious diet is essential for healthy hair. Good iron levels are particularly important. Learn more about which foods are best for your hair here. 

Omega fatty acids

I've listed these nutrients separately as there's some interesting scientific research which has shown that they really may increase hair density in women with female pattern hair loss. Read more about this research here. 

Tips to protect your hair and scalp

  • When your hair is thinner, your scalp is much more vulnerable to sun damage. Take care to protect it with a suitable covering.
  • Prevent breakage of your existing hair by using a wide tooth comb when it's tangled. 
  • Try sleeping on a silk or satin pillowcase, which will be much more gentle on your hair than cotton.
  • Don't rub your hair with a towel - try blotting it with a T-shirt instead.

Dealing with female pattern hair loss

There's no doubt about it - losing your hair is very difficult to deal with. 

What makes it worse for some of us is the lack of understanding - the idea that we should cheer up because  'there are worse things that can happen'. Or the attitude (especially from some doctors) that we should 'expect' to lose hair as we get older.

Whilst that's true to a certain extent, many of us are being told that WAY before an age where we should really be expecting to lose hair. What's more, the degree of hair loss that some doctors dismiss as 'insignificant' often feels rather more significant to those of us experiencing it!

Sadly, though, the true cause of female pattern hair loss remains largely a mystery to the medical profession and whilst there may be treatments that may help some women, there is no guaranteed cure.

We then have to decide how to deal with the problem, particularly if we have tried various treatment options without success. Or if we simply don't want to consider medication at all.

Acceptance

The road to acceptance is a long and difficult one, but for many women the decision to accept the situation can bring peace, and a real sense of relief.

For some, it may mean a decision to entirely give up attempts to hide or disguise thin or balding patches, and to simply live with them.

For others, it may mean turning to a wig. And this doesn't have to be quite as bad as it sounds!

The (many) benefits of wearing a wig

A visitor to this site - Joy - wrote me a message that she gave me permission to share with you here.

I found her words encouraging, and the idea of wearing a wig much easier to come to terms with. I hope that you will too.

I was diagnosed with female pattern hair loss in 2005, after several years of losing hair on and off. I was losing hair in the middle, from behind my hair line, and I was frantic to stop it.

I tried everything - prescription drugs, Rogaine, supplements, you name it. And nothing worked for me.

One day I decided I'd had enough. I didn't want any more medications. The drugs I was on tended to cause side effects anyway, giving me even more problems to worry about. And I was tired of spending hours on the internet, hunting for the magic solution to my problem, spending money on one useless lotion after another.

So I decided to accept that I'd lost my hair. It wasn't going to grow back. And I might lose more.

Then I decided to plan how I was going to handle that.

Well, I decided to buy a wig. And I can honestly say I haven't looked back.

Since that day, I've bought lots, in different styles and colors. Sure, people know I wear a wig - they also know that many pop starts and actresses wear wigs and hairpieces too.

The motto these days seems to be, 'If you haven't got it, fake it!'. Well, that's just what I'm doing.

There are so many advantages to wearing a wig!

My hair ALWAYS looks good. I don't have to spend hours washing, drying and styling it. The time I spend getting ready to go out has more than halved. I feel GOOD!

Just in case you're wondering, yes, I'm married. And no, my husband hasn't seen me without my wig. And that's just it - no one needs to see you without it unless you want them to!

You can swim with a wig on and you can wear it during 'romantic interludes' too! If you have some hair left, I find the best way of securing it is with toupee clips sewn in the front and back.

Deciding to wear a wig is a big step and a difficult one. But if you're like me and you've had enough of the merry go round of drugs and failed treatments, then I recommend embracing the decision so that you can get back to enjoying your life... and forgetting all about your hair.


I have received other messages from women who have found living with a wig far less traumatic than they'd feared. Like Joy, many had even learned to enjoy it.

If this is something you're considering - or if you're anxious or depressed about your hair loss - considering seeking a support group in your area, or check out alopeciaworld.com, which is fantastic.

Discuss your options with other wig wearers - you don't have to go for a full wig and may be able to take advantage of something like a lace hair system, which simply covers the area that's thinning.

Difficult though it may seem, it's so important to try to keep a healthy perspective on your hair loss. Try to focus on the positive things in your life, enjoy them, be thankful, and above all remember that you are so much more than your hair.

Please Share Your Experiences

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Sources

US National Library of Medicine 

MedlinePlus

American Hair Loss Association

British Association of Dermatology

North American Hair Research Society

The Trichological Society

National Health Service


› Female Pattern Hair Loss

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