Hair Transplantation is not just for men with hair loss. It is a treatment for women, too. Modern techniques of hair transplantation are successful in treating typically diffuse female-pattern hair loss as well as the more familiar forms of male-pattern hair loss. A woman who becomes concerned about hair loss can discuss this option with her hair restoration specialist.
In general, Hair Transplantation is likely to result in a more satisfying outcome for a woman when there is adequate donor hair for successful transplantation. A less satisfying outcome is more likely when transplantation is a “last ditch” treatment for advanced hair loss when donor hair is in short supply.
To understand the different types of hair loss in women, and their management, it is helpful to divide it into three broad categories:
Localized hair loss may be sub-divided into scarring and non-scarring types. Alopecia Areata is a genetic, auto-immune disease that typifies the non-scarring type. It manifests itself with the sudden onset of round patches of hair loss from the scalp and sometimes eyebrows or other hair-bearing areas of the body associated with normal skin. Hair loss can be episodic and recurrent.
It can be treated with local injections of Corticosteroids. Hair Transplantation is not helpful for Alopecia Areata.
Traction Alopecia due to injury from tight braiding or corn-rowing of hair, and Trichotillomania (compulsive hair plucking) are other types of non-scarring alopecia. They are usually amenable to Hair Transplantation.
Scarring Alopecia can be caused by a variety of medical or dermatologic conditions such as Lupus and Lichen Planus, local radiation therapy, injuries, or from local medical problems. Localized hair loss that occurs around the hairline after face-lift surgery may be permanent. In all of these conditions, once the active process of alopecia have been cured, It is usually amenable to Hair Transplantation.
The most common type of hair loss in women is Patterned Hair Loss (Female Androgenetic Alopecia). It occurs in about 20% of women overall. In one study of 1,008 Caucasian women, female androgenetic alopecia was found in 3% of women aged 20-29 years, 16-17% of women aged 30-49 years, 23-25% of women aged 50-69 years, 28% of women aged 70-79 years, and 32% of women aged 80-89 years. The statistics reflect the increased incidence of female androgenetic alopecia during and after menopause
Women with this type of hair loss have a pattern similar to what we observe in men. In other words, they have thinning in front or on top of their scalp with little hair loss in the permanent zone around the sides and in the back. Thus, the balding is in a characteristic “pattern” rather than generalized form.
This type of hair loss (also called Common or “hereditary” baldness) in women appears to be related to the same major factors that cause hair loss in men: Genes, Hormones, and Age.(See Hair Loss in Men). As is men, the genes that cause hair loss can be inherited from either your mother or father. The expression of these genes is dependent on hormones called androgens, so common hair loss in women is called “Female Androgenetic Alopecia” (the same term is used for common balding in men).
There are a number of reasons to explain why hair loss in women presents differently than in men (although all of the factors are still not completely understood). Probably the most important reason is that men have a much higher level of the androgen testosterone. This is the hormone that is responsible for male sexual characteristics and, when the body converts it to Dihydrotestosterone (DHT), it becomes the main culprit in causing baldness. Fortunately, the much lower levels of testosterone in women spare them from the extensive hair loss that is often seen in men.
Testosterone is converted to DHT by the enzyme 5-Alpha Reductase that is present in higher concentrations in the balding areas of the scalp. Women have only ½ the amount of this enzyme overall as men and have even less in the crown. In addition, women have higher levels of an enzyme called Aromatase in all areas of the scalp that may block the formation of DHT. This enzyme is present in especially high concentration in the frontal hairline in women, possibly explaining why this area is fortunately resistant to balding in most females. Women with patterned hair loss are excellent candidates for Hair Transplantatiom.
The pattern of hair loss in Female Androgenetic Alopecia has some distinctive features that differentiate it from Male Pattern Baldness. In general, there are three patterns of hair loss in Female Androgenetic Alopecia:
Grade I: hair on the central scalp (top of the head).
Grade II: hair and patches of greater scalp hair loss.
Grade III: Pattern Baldness with hair loss at the front of the scalp to mid-scalp. However, it is very rare to see complete Male Pattern “cue-ball” Baldness in a woman.
A third category of hair loss in women is a Diffuse(Generalized) thinning that affects all parts of the scalp. This is the most common type of hair loss seen in females. In this situation, much of the hair remains, but the thickness of the hair shaft is smaller than normal hair. The medical term for this type of thinning is “Diffuse Un-patterned Alopecia”. These women have thinning that involves the donor area so that women with this type of hair loss are generally not good candidates for surgery. This condition may be identified with a Hair Densitometer, a special magnifying apparatus, which assesses the population of miniaturized hair in different parts of the scalp. (Miniaturization is the process by which hairs shrink in length and diameter from the effects of hormones.)
Because diffuse hair loss can be caused by a variety of conditions other than “hereditary balding”, (see below) women who are losing their hair should be evaluated by a physician who is experienced with these problems. Most important, they should know when a medical evaluation is appropriate and whether medical or surgical treatments will offer the greatest benefit.
Like men, most women develop widening partings and thinning of the hair all over the scalp, with age; this is normal. It actually starts in the teens or early twenties, and by the age of 50 over half of all women have thinning hair. After the menopause, thinning of the hair is more pronounced. Hair can also become thin at the front, similar to the male pattern. This is because the hair follicles are responding in exactly the same way as in balding men to the testosterone in the blood. All women have testosterone; this is perfectly normal. The balding does not mean that the woman has more testosterone; it simply means that the hair follicles on her scalp are over-sensitive, probably inherited. The hair will eventually not become any worse. There is no need to worry that you will become completely bald.
A few women develop male pattern baldness with other problems such as growth of hair on the face, lumpy acne, deepening of the voice and irregular periods. In rare cases, this can mean that too much testosterone is being produced by a tumour, so it is important to see your family doctor so that appropriate tests can be done.
The decision of when to perform a laboratory evaluation in women experiencing hair loss must be made on an individual basis by your physician. We briefly describe some of the situations where your doctor may order lab. tests and what they might be. It is important to stress that this is just an overview for your general information. When a physician orders laboratory tests he/she bases it upon specific clinical information and this can only be determined by the doctor who evaluates you.
The following signs and symptoms suggest that specific blood tests might be appropriate to rule out underlying sources of excess androgen:
Irregular periods – for an extended period of time, Cystic acne – severe acne which usually leaves scars, Hirsuitism – increased body hair that doesn’t normally run in your family, Virilization – appearance of secondary male sex characteristics such as a deepened voice, Infertility – inability to become pregnant, and Galactorrahea – breast secretions when not pregnant (this is due to prolactin which is not actually an androgen).
Some of the tests that your doctor might order in these situations include the following:
Total and Free Testosterone – the hormone that is mainly responsible for male secondary sex characteristics, DHEA-Sulfate – a precursor to testosterone, and Prolactin – the hormone that enables the breast to secrete milk.
Other test that are commonly ordered for underlying medical conditions include:
CBC (complete blood count) – for Anemia, Serum iron (and TIBC) – for Anemia, T3, T4, TSH – for Thyroid disease, ANA – for Lupus, and STS – for Syphilis
Just because your hair is thinning there is no need to avoid hairsprays, careful perming or hair dyes. These will not worsen the problem. In fact, perms and hairsprays lift the hair and disguise thinning. However, you should avoid bleaches and hair relaxers. Short, bouncy hairstyles give lift and body. It is also all right to use hair colorants on thinning hair, but darker shades may make thinning more obvious.
Low stores of iron in the body can sometimes cause hair loss so, particularly if you are vegetarian, ask your doctor for a blood test. Iron-rich foods include lean red meat, game, offal, egg yolks, and dark green leafy vegetables. Vitamin C helps your body to absorb iron. Although hair follicles need plenty of the essential amino acids – the building blocks of proteins – it is doubtful whether increasing your intake of protein or taking amino acid supplements will really help.
Regaine (minoxidil): It produces some improvement in about 50% of women with thinning hair. Only the 2% strength is suitable for women. A few women (about 1 in 20) using Regaine notice hairiness of the face, even though the lotion is only applied to the scalp. Hairiness occurs on the cheeks, above the eyebrows and sometimes on the upper lip and chin. The reason for this is not known: perhaps the Regaine is carried in the blood from the scalp to the face, or maybe it is rubbed off onto a pillow that is in contact with the face while sleeping. If Regaine is continued, facial hairiness usually lessens over a year; if the drug is stopped, it goes away within 1–6 months.
Oestrogens used to be prescribed for women with hair loss, but no proper research has been done to find out whether or not they worked at all. They are seldom prescribed now because Regaine is more effective.
Hormone Replacement Therapy (HRT), depending on the type, can affect the hair. If you are taking HRT containing progestogen, ask your doctor for a ‘third generation’ type of progestogen HRT, which is less similar to male hormones and may be better for women with hair loss.
Cyproterone acetate and Spironolactone, are sometimes used for wemen with thinning hair. The drug finasteride (used for male baldness) is not used for women, because it does not work in women. Also, it could affect the developing baby if a woman became pregnant while taking it.
If you are very distressed by thinning hair, and medical treatments have not helped, you might consider Hair Transplantation, which can be done for women as well as men.