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Pattern Hair Loss In Women

Androgenetic alopecia, AGA, also known as common pattern hair loss affects approximately 20 million American women. AGA in women is triggered by similar processes to those causing pattern hair loss in men. In both genders, the onset of AGA may occur in early adulthood, though females tend to present signs and symptoms somewhat later than males.

Recent studies suggest that women with some markers of insulin resistance are at significantly increased risk of female AGA. Moreover, a paternal history of hair loss may be a strong predictor of female AGA.

Female pattern hair loss has also been linked with both hyperandrogenism and hirsutism. Most recently, female pattern hairloss has also been linked with polycystic ovarian syndrome, PCOS, though epidemiological documentation of this association is, as yet, not statistically compelling. Nevertheless, the association between PCOS and insulin resistance is well documented.

What actually triggers pattern hair loss in women?

From a susceptibility standpoint, the inheritance pattern in female pattern hairloss is polygenic, and the onset and incidence of the disorder closely parallels that observed in males. The disorder begins in susceptible hair follicles, where dihydrotestosterone, DHT, binds androgen receptor forming a molecular trigger that sets the process of hair loss in motion.

The 5 alpha dihydrotestosterone hormone-receptor complex translocates to the cell nucleus of susceptible hair follicles, initiating a gene activation program that starts the gradual transformation of large terminal follicles to miniaturized follicles. This process occurs within a genetically pre-determined anatomical region, or pattern of the scalp. The hair outside of this pattern remains unaffected. This is why the disorder is called pattern hair loss.

Strikingly, both females and males diagnosed with pattern hair loss have higher levels of 5-Alpha-Reductase, 5AR, in frontal hair follicles compared to occipital, back of the scalp behind the ears,. Other predisposing factors such as differential cytochrome P450 levels in susceptible versus non-susceptible hair follicles are less well clearly worked out, but may have contributory relevance as well.

The diagnosis of AGA in women is supported by a pattern of increased thinning over the frontal/parietal scalp with greater density over the occipital scalp, a retention of the juvenile hairline, and the presence of miniaturized hairs in the effected zone of loss. Most women with AGA have normal menses and pregnancies. Extensive hormonal testing is usually not indicated unless signs & symptoms of androgen excess are present such as hirsutism, severe unresponsive cystic acne, virilization, or galactorrhea.

In most cases, the differential diagnosis of AGA is made based on the patient’s history and clinical presentation. Typical differentials include alopecia areata, trichotillomania, and less commonly hair loss associated with disorders such as lupus erythematosis, scabies and other skin manifesting disease processes. Scalp biopsy and lab assay may be useful in elucidating a non-pattern hair loss etiology but, in such cases, should generally only follow an initial clinical evaluation by a qualified treating physician.

Treatment Options

From a treatment perspective, the mono-therapeutic interventions against female pattern hair loss include topical minoxidil, oral spironalactone, oral flutamide and other drugs. Surgical hair restoration can sometimes be an option, however care must be excercised as, in certain persons, the pattern of loss may sometimes extend across much of the entire scalp, rendering hair transplantation less than clinically effective. Recently, botanically derived substances, such as HairGenesis, have also come under investigation as agents potentially useful against the disorder.

One of the most commonly suggested causes of hair loss in both men and women is a genetic defect. The fact it may be inherited means it is not your fault when your hair thins and falls out and, perhaps more importantly, the condition is not necessarily something that can be cured. Of course, there is some evidence that hair loss does run in families, but there is more evidence that our lifestyles and medical decisions can be even more important factors in deciding who loses hair and how quickly. We will ignore the cultural effect of changing hairstyles where too much traction in pulling the hair back into a ponytail or comparable style may accelerate hair loss, the effect of a general anesthetic for surgery (curiously, many who undergo gastric bypass surgery often lose the most hair), increased levels of anxiety and stress, and both chemo- and radiotherapy for cancer. The most consistent cause surrounds the level of different hormones in the body.

In women, for example, the level of estrogen drops during and after pregnancy, and during the menopause. This has been directly linked to both the thinning of hair and its loss from the scalp. Some women also lose hair as a reaction to particular oral contraceptives. For obvious reasons, the level of hormones naturally occurring in the male body tends to be more stable. But, in both genders, thyroid problems can affect the production of hormones and produce early baldness in men. Similarly, for a number of reasons, the levels of the hormones may be affected artificially. The most consistent causes stem from the use of steroids which are commonly used for a variety of strictly medical, e.g. to control asthma, and other purposes, e.g. as supplements to promote growth and for strength while weight training. As an adverse side effect, many weight loss products affect the thyroid and hair suffers. Finally, it is not just athletes who discover some diet and other supplements affect the level of testosterone in their bodies. Many who take “natural” dietary and nutritional supplements find out the hard way that some “natural” chemicals affect hair growth and retention.

This should give you pause for thought. Because there are many possible causes of hair loss, you should not guess what is affecting you and self-medicate. The research evidence shows the majority of people are completely unaware that their own lifestyles or the drugs prescribed to them by physicians may be responsible. Always get a formal diagnosis from your regular healthcare professional. If he or she confirms your hair loss is an adverse side effect of drugs or supplements you are using, the remedies will be clear. But, if male pattern baldness is confirmed, propecia is the tried and tested response (albeit not for Olympic athletes like Zach Lund who were banned from competition if they took this drug). Because this drug was developed some time ago, you will now find both the branded and generic propecia (also called finasteride) freely available from most of the online pharmacies. This will save you some serious money while enabling you to both slow hair loss and often encourage some regrowth. However, two small facts should be borne in mind. Propecia works best when it is taken early in the cycle of hair loss. Secondly, hair loss restarts once you stop taking the drug.