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For Women

Female Hair Loss

Mistakenly thought to be a strictly male disease, women actually make up forty percent of American hair loss sufferers. Hair loss in women can be absolutely devastating for the sufferer’s self-image and emotional well-being.

Unfortunately, society has forced women to suffer in silence. It is considered far more acceptable for men to go through the same hair loss process. Even more unfortunately, the medical community also treats the issue of women’s hair loss as if it were nonexistent. Since hair loss doesn’t appear to be life threatening, most physicians pay little attention to women’s complaints about hair loss and essentially tell their patients that "it’s no big deal", and that "you’ll just have to live with it."

Of course what these physicians don’t seem to realize is that the psychological damage caused by hair loss and feeling unattractive can be just as devastating as any serious disease, and in fact, can take an emotional toll that directly affects physical health.

Types of Hair Loss in Woman

Telogen Effluvium continued

About six weeks to three months after the stressful event, the shedding phenomenon called telogen effluvium may begin. It is possible to lose handfuls of hair at a time when in full-blown telogen effluvium.

For most who suffer with this, complete remission is probable as long as severely stressful events can be avoided. For some women, however, telogen effluvium is a mysterious chronic disorder and can persist for months or even years without any true understanding of the triggering factors or stressors.

Anagen Effluvium

Anagen effluvium occurs after any insult to the hair follicle that impairs its cellular-level mitotic or metabolic activity. This hair loss is commonly associated with chemotherapy. Since chemotherapy targets rapidly dividingcancer cells, your body’s other rapidly dividing cells — such as hair follicles in the growing (anagen) phase — are also greatly affected. Soon after chemotherapy begins, approximately 90% or more of hairs in the anagen phase can fall out.

The characteristic finding in anagen effluvium is the tapered fracture of the hair shafts. The hair shaft narrows as a result of damage to the matrix. Eventually, the shaft fractures at the site of narrowing and causes the loss of hair.

Alopecia Areata

An inappropriate inflammatory reaction is behind alopecia areata. A person’s own immune system attacks the roots of hair follicles. Symptoms include patchy shedding of hair, which sometimes develops quite suddenly. About 70% of patients recover their hair within two years, whether or not they receive treatment.

Traction Alopecia

This condition is caused by localized trauma to the hair follicles from tight hairstyles that pull at the hair over time. If the condition is detected early enough, the hair will regrow. Braiding, cornrows, tight ponytails, and extensions are the most common styling causes of traction alopecia.

About six weeks to three months after the stressful event, the shedding phenomenon called telogen effluvium may begin. It is possible to lose handfuls of hair at a time when in full-blown telogen effluvium.

For most who suffer with this, complete remission is probable as long as severely stressful events can be avoided. For some women, however, telogen effluvium is a mysterious chronic disorder and can persist for months or even years without any true understanding of the triggering factors or stressors.

Anagen Effluvium

Anagen effluvium occurs after any insult to the hair follicle that impairs its cellular-level mitotic or metabolic activity. This hair loss is commonly associated with chemotherapy. Since chemotherapy targets rapidly dividingcancer cells, your body’s other rapidly dividing cells — such as hair follicles in the growing (anagen) phase — are also greatly affected. Soon after chemotherapy begins, approximately 90% or more of hairs in the anagen phase can fall out.

The characteristic finding in anagen effluvium is the tapered fracture of the hair shafts. The hair shaft narrows as a result of damage to the matrix. Eventually, the shaft fractures at the site of narrowing and causes the loss of hair.

Alopecia Areata

An inappropriate inflammatory reaction is behind alopecia areata. A person’s own immune system attacks the roots of hair follicles. Symptoms include patchy shedding of hair, which sometimes develops quite suddenly. About 70% of patients recover their hair within two years, whether or not they receive treatment.

Traction Alopecia

This condition is caused by localized trauma to the hair follicles from tight hairstyles that pull at the hair over time. If the condition is detected early enough, the hair will regrow. Braiding, cornrows, tight ponytails, and extensions are the most common styling causes of traction alopecia.

Diagnostic Tests

Hormone levels (DHEAs, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone)

  • Serum iron
  • Serum ferritin
  • Total iron binding capacity (TIBC)
  • Thyroid stimulating hormone (T3, T4, TSH)
  • VDRL (a screening test for syphilis)
  • Complete blood count (CBC)

Scalp biopsy 

A small section of scalp usually 4mm in diameter is removed and examined under a microscope to help determine the cause of hair loss.

Hair pull 

The hair pull test is a simple diagnostic test in which the physician lightly pulls a small amount of hair ( approx. 100 simultaneously) in order to determine if there is excessive loss. Normal range is one to three hairs per pull.

Densitometry 

The densitometer is a handheld magnification device which is used check for miniaturization of the hair shaft.

Treatment

Minoxidil 2% Topical Treatment

Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil experienced excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth. The amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.

Women with diffuse androgenetic alopecia can use minoxidil and it actually seems to be more effective for women compared to men. The makers of minoxidil recommend women only use the 2% concentration of minoxidil and not 5%. The makers of minoxidil have not received FDA approval for promoting 5% minoxidil or minoxidil extra strength for use by women. Many dermatologists do prescribe minoxidil 5% for women with androgenetic alopecia if used under their supervision. Some small clinical trials have been conducted on 5% minoxidil for androgenetic alopecia in women showing that indeed the 5% solution is significantly more effective in both retaining and regrowing hair than the 2 % solution.

In clinical studies of mostly white women aged 18-45 years with mild to moderate degrees of hair loss, the following response to minoxidil was reported: 19% of women reported moderate hair growth after using minoxidil for 8 months (19% had moderate regrowth; 40% had minimal regrowth). This compares with 7% of women reporting moderate hair regrowth after using the placebo, the liquid without the active ingredient in it, for 8 months (7% had moderate regrowth, 33% had minimal regrowth).

Estrogen/Progesterone

Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for androgenetic alopecia for women in menopause or whose estrogen and/or progesterone are lacking for other reasons.

Nizoral/Ketoconazole

Available as a topical treatment by prescription, Ketoconazole is currently used as an antifungal agent in the treatment of fungal infections. It also has anti-androgenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs (in women, the ovaries). Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1 percent version is now available over-the-counter, but it may not be as effective as the 2 percent prescription strength. There are no significant side effects.

Propecia/Proscar

The drug finasteride inhibits the enzyme 5-alpha reductase, thereby inhibiting the production of prostate-harming, follicle killing DHT. It was first marketed to treat the prostate under the brand name Proscar in 5 mg pills. In 1998, a 1 mg version with the brand name Propecia entered the market as the first pill approved by the FDA for men’s hair loss. It works quite well for most men in both preventing hair loss and triggering regrowth, and it may work for some women, although women must not take it if they are pregnant and must not get pregnant while on the drug because of the risk of birth defects in a male fetus. Less than 2 percent of men experience transient sexual side effects including erectile and libido difficulties. In women these side effects do not occur.

Degree of Hair Loss

There are two widely known female hair loss density scales used by most hair loss specialists: The Ludwig Scale and the Savin Scale. For all intents and purposes, they are identical except that the Savin Scale also measures overall thinning.

As you will see in these illustrations, eight crown density images reflect a range from no hair loss to severe hair loss. Density 8 is rarely seen in clinical practice. One example of frontal anterior recession is also illustrated (again, it’s not too common), and one example of general diffuse thinning, lateral view, is shown.

  •  University of Pavia - Dr. Wissam Adada - Hair Transplant Surgeon
  •  Università Degli Studi di Padova - Dr. Wissam Adada - Hair Transplant Surgeon
  • Harvard Medical School - Harvard University - Dr. Wissam Adada - Hair Transplant Surgeon
  • American University of Beirut - Dr. Wissam Adada - Hair Transplant Surgeon