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Female pattern baldness

Definition

Female pattern baldness involves a typical pattern of hair loss in women, due to hormones, aging, and genes.

Alternative Names

Alopecia in women; Baldness - female; Hair loss in women; Androgenetic alopecia in women

Causes, incidence, and risk factors

A hair grows from its follicle at an average rate of about 1/2 inch per month. Each hair grows for 2 to 6 years, then rests, and then falls out. A new hair soon begins growing in its place. At any time, about 85% of the hair is growing and 15% is resting.

Baldness occurs when hair falls out and normal new hair does not grow in its place. The reason why new hair does not grow in female pattern baldness is not well understood, but it may be related to:

• Aging
• Changes in the levels of androgens (male hormones). For example, after reaching menopause, many women find that the hair on their head is thinner, while the hair on their face is coarser.
• Family history of male or female pattern baldness

Hair loss can occur in women for reasons other than female pattern baldness, including the following:

• Breaking of hair (from treatments and twisting or pulling of hair, or hair shaft abnormalities that are present from birth)
• Certain skin diseases that lead to scarring of the hair follicles
• Hormonal abnormalities, such as too much testosterone, or too much or too little thyroid hormone
• Iron deficiency
• Medications such as chemotherapy and beta blockers
• Patchy hair loss (alopecia areata)
• Syphilis
• Temporary shedding of hair (telogen effluvium) after a major illness, surgery, or pregnancy
• Vitamin deficiency (such as biotin)

Symptoms

Hair thinning is different from that of male pattern baldness. In female pattern baldness:

• Hair thins mainly on the top and crown of the scalp. It usually starts with a widening through the center hair part.
• The front hairline remains
• The hair loss rarely progresses to total or near total baldness, as it may in men

Itching or skin sores on the scalp are generally NOT seen.

Signs and tests

Female pattern baldness is usually diagnosed based on:

• Ruling out other causes of hair loss
• The appearance and pattern of hair loss
• Your medical history

The doctor will examine you for other signs of too much male hormone (androgen), such as:

• Abnormal new hair growth, such as on the face or between the belly button and pubic area.
• Changes in menstrual periods and enlargement of the clitoris
• New acne

A skin biopsy or other procedures or blood tests may be used to diagnose skin disorders that cause hair loss.

Analyzing the hair itself does not accurately diagnose nutritional or similar causes of hair loss, although it may reveal substances such as arsenic or lead.

Treatment

The hair loss in female pattern baldness is permanent, if not treated. In most cases, hair loss is mild to moderate. You do not need treatment if you are comfortable with your appearance.

The only drug or medication approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness is minoxidil, used on the scalp.

• For women, the 2% concentration is recommended.
• Minoxidil may help hair grow in 20% to 25% of women. In most women it may slow or stop hair loss.
• Treatment is expensive, because you must continue to use the medication. Hair loss starts again when you stop using minoxidil.

In women who do not respond to minoxidil, oral spironolactone may be added.

• Spironolactone may help women whose hair loss is caused by too much male hormones (androgens). This drug is not FDA-approved for female baldness.
• It can cause increased potassium levels in the blood, and cannot be used in people with kidney failure or who are pregnant.

Hair transplants remove tiny plugs of hair from areas where hair is thicker, and place them in areas that are balding. This can cause minor scarring where the hair is removed, and carries a slight risk for skin infection. Many transplantation sessions are usually needed, which can be expensive. However, the results are often excellent and permanent.

The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.

Stitching (suturing) hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp.

Hair weaving, hairpieces, or a change in hairstyle may disguise hair loss and improve your appearance. This is often the least expensive and safest way to deal with female pattern baldness.

Support Groups

Expectations (prognosis)

Female pattern baldness usually does not mean that a woman has a medical disorder. However, for many women, it may affect self-esteem or cause anxiety. The hair loss is usually permanent.

Complications

Complications are psychological stress and a loss of self-esteem due to change in appearance.

Calling your health care provider

Call your health care provider if you experience hair loss and it continues, especially if you also have itching, skin irritation, or other symptoms. There might be a treatable medical cause for the hair loss.

Prevention

There is no known prevention for female pattern baldness.

References

Habif TP. Hair diseases. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 24.

Mousney AL, Reed SW. Diagnosis and treating hair loss. Am Fam Physician. 2009;80:356-362.