Female Hair Loss

Hair loss in women is culturally unacceptable despite the fact that up to 40% of the female population experiences some hair loss in their lifetime.

Although not uncommon, the stigma attached to female baldness is an extremely stressful and unwelcome event. In fact, androgenic alopecia in women can be psychologically debilitating. There have been several medical studies, which have concluded that although alopecia is clearly a distressing experience for both sexes; its effect is much more problematic in women. Most women go to extremes to conceal and treat their hair loss; using a broad array of creative camouflaging and hair thickening cosmetic techniques in an attempt to mask the condition.

Women experiencing hair loss should undergo a thorough investigation by a dermatologist. The medical workup and testing for women with hair loss is very involved. The most difficult cases are women with diffuse hair loss, i.e. balding, which is not concentrated in the frontal region of the scalp. In cases of non-patterned alopecia, a dermatologist will usually recommend laboratory tests, which may include a complete blood count, iron levels, and a thyroid study. An extensive medical drug history and family hair loss history must also be obtained, and in some cases, testing for hormonal imbalances is warranted.

For those women who do not have diffuse alopecia, the diagnosis can be simplified and much more direct. This type of hair loss presents itself as thinning or complete loss at the part line of the scalp with the front hairline being unaffected. These women are classified by the Ludwig classification system. There are three categories: Ludwig I, Ludwig II, and Ludwig III. Those with a Ludwig I pattern are rarely candidates for any surgical treatment. Their loss is best managed with topical treatments. Patients with more advanced hair loss, those who are classified as Ludwig II or Ludwig Ill categories, are possible candidates for hair transplantation, if they have an adequate amount of donor density. (The donor area is the hair found in the back of the scalp). In those women who have complete balding in the mid and frontal scalp, hair transplants are a viable option. The results from these transplants can be truly outstanding.

Transplantation in women with hair loss caused by cosmetic surgery also yields excellent results. By camouflaging the scars resulting from brow lifts or facelifts these patients are able to achieve their expectations. Women who experience hair loss after undergoing a brow lift procedure lose hair behind the frontal hairline. These scars are occasionally unsightly and noticeably whiter than the surrounding scalp. Hair grafts are placed directly into the scar tissue to cover the area. Generally, one or two sessions of grafting are required.

Females who have facelifts usually do not suffer from hair loss, although in some cases, the hair in front of the ears (the sideburns) and above the ears will be lost due to the tightening and trimming of the skin. These women do very well with hair restoration. By recreating the sideburn area, the patient’s previous hairline is restored. Generally, two sessions are needed to cover the area adequately.

Female Androgenetic Alopecia Similar to Male Pattern Baldness, (MPB), women’s hair loss can take many shapes and forms; however, the causes are much more elusive. A combination of heredity, hormones, and age cause a progressive shrinking or, miniaturization of certain hair follicles. Researchers have classified some forms of female hair loss by using a guide known as the Ludwig Scale. This is a rather limited, but accurate portrayal of the loss pattern commonly seen in women. Female hair loss is particularly likely to appear at times of hormonal change, and is generally identified by overall thinning and not patches of baldness. Androgenetic alopecia is polygenic, meaning it can be inherited from the maternal or paternal sides of the family. Androgenetic alopecia is the most common form of hair loss in men and women. This type of hereditary hair loss can begin anytime after puberty and usually occurs before age forty.

Telogen effluvium Telogen effluvium is a type of hair loss, which may or may not be related to androgenetic alopecia. There are three categories of causes: physiological, injury or stress/illness related and drugs or other substances. A physiologic cause can be the early start of androgenetic alopecia and can “unmask” genetic loss. An example of a physiologic effluvium would be loss following childbirth. Also, hair loss which coincides with menopause is a common cause of telogen effluvium.

Injury and stress or illness

These include:
-Crash/liquid protein diets
-High lever
-Anorexia, eating disorders
-Iron deficiency
-Hypothyroidism, polycystic ovarian disease or other endocrinopathies
-Surgery
-Severe chronic illness
-Severe infection

Medications
Some drugs and other substances known to have hair loss side effects are:

-Anticoagulants (especially heparin)
-Anticonvulsants
-Anti Keratinizing agents (such as etretinate, tegison)
-Antithyroid medications
-Heavy metals
-Hormones (such as birth control)
-Tricyclic antidepressants
-Anti-cancer drugs
-Beta blockers

Telogen effluvium usually begins 2 to 4 months after the causative event and lasts for several months. Most of the time hair that is lost from this trigger will re-grow on its own.

Discontinued usage of medication is usually followed with hair re-growth. If within, one year the hair density is not restored, then the drug may have unmasked dormant androgenetic alopecia. Never discontinue any medication with out consulting the prescribing physician.

It is extremely important to find a qualified physician to treat hair loss. A dermatologist is usually a good start, as they specialize in treating skin diseases including problems associated with hair and hair loss. The best place for finding a board certified dermatologist is through the American Academy of Dermatology website. (www.aad.org)

Some questions you may be asked at your doctor’s appointment.

-How long have you been losing hair and when did it start?
-Is your hair falling out fully intact or is it breaking off?
-Do you have a family history of hair loss?
-Do you have a history of diabetes, thyroid problems, asthma, arthritis, lupus, vitiligo, anemia, or AddisonÕs disease?
-Are you on any medications, and if so, what are they?
-What does your normal diet consist of?
-Have you experienced sudden weight loss?
-Have you recently given birth, had a hysterectomy, or gone through menopause?
-Have you had any surgeries with general anesthesia recently?
The following blood tests can also be important in determining the cause of a female’s hair loss.

-Hormone levels (DHEA’s, Testosterone, Androstenedione, Prolactin, Follicular Stimulating Hormone)
-Serum Iron, Serum Ferritin, TIBC (Total Iron Binding capacity)
-Thyroid Stimulating Hormone (TSH)
-Complete Blood Count (CBC)

About 20% of women, 50% of pregnant women and 30% of men are iron deficient.
A ferritin level of 70 is considered healthy, but 100 is optimal.

Please Beware of treatments and promises offered through internet, radio, and television infomercials. If you have hair loss a physician should evaluate you. Do not waste time and money on unproven treatments or claims that seem too good to be true.
This information is not meant as a substitute for an appointment with a qualified physician.