Hair Restoration in Women

A man may expect to lose hair as he gets older, especially if his father, uncles, or other near relatives had male-pattern baldness. A woman does not generally expect to lose hair even if there is a history of hair loss in male or female relatives. In the United States, at least, there has been a general belief that thinning hair and baldness is a "male thing."

A woman also usually feels she must have a full head of hair to meet societal expectations. Thinning hair is acceptable only when a woman is very old.

Societal expectation run counter to reality, however. The fact is, many women do experience hair loss at young to middle age and the incidence of the most common type of female hair loss (female androgenetic alopecia) seems to be increasing [Norwood OT. Incidence of female androgenetic alopecia (female pattern baldness). Dermatol Surg 2001; 27:53-54.].

Many women today recognize the reality of hair loss and choose to do something about it by seeking hair restoration treatment or procedures. In the hands of a physician specialist in hair transplantation, most hair loss in women can be successfully treated.

What Causes Hair Loss in Women?

The most common type of hair loss in women is female androgenetic alopecia (female pattern baldness). It occurs in about 20% of American 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. [Norwood OT. Incidence of female androgenetic alopecia (female pattern baldness). Dermatol Surg 2001; 27:53-54.]. The statistics reflect the increased incidence of female androgenetic alopecia during and after menopause. See About hair loss for more information.

The underlying cause of female androgenetic alopecia is believed to be related to production of androgenetic (male) hormones and the effect of androgenetic hormones on the hair follicle—the same underlying cause responsible for male androgenetic alopecia (male pattern baldness). The pattern of hair loss in female androgenetic alopecia has some distinctive features that differentiate it from male-pattern hair loss. In general, there are three patterns of hair loss in female androgenetic alopecia:

• Grade I: Thinning hair on the central scalp (top of the head).
• Grade II: Thinning hair and patches of greater scalp hair loss.
• Grade III: Male-pattern alopecia 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.

Other causes of hair loss in women include scalp scarring from injury or an underlying disease, traction alopecia due to injury from tight braiding or corn-rowing of hair, and trichotillomania (compulsive hair plucking). See About hair loss for detailed information on these causes of hair loss.

Consultation with a Hair Restoration Doctor

A woman who is experiencing hair loss should consider consulting a hair restoration doctor. The consultation has both medical and esthetic aspects.

Medical

The focus of the medical examination is the reason for hair loss. In a healthy woman the most common reason for hair loss is female androgenetic alopecia in a Grade I, II or III pattern as described earlier. If the patient medical history and physical examination indicate no underlying medical conditions, and the hair-loss pattern is clearly that of female androgenetic alopecia, no further tests may be necessary. However, if the hair-loss pattern (1) is not clearly that of female androgenetic alopecia, or (2) suggests the possibility of an underlying medical condition, further medical tests and inquiry into personal and family medical history may be indicated. A scalp biopsy can be helpful in establishing a reason for hair loss when the reason is not immediately apparent.

While the primary reason for the medical examination is to determine the reason for hair loss, the examination may occasionally result in diagnosis of a previously unsuspected underlying disease. Hair loss can be a symptom of certain autoimmune diseases and diseases that cause overproduction of androgenic (male) hormones. An underlying disease does not necessarily preclude hair restoration. However, it may be necessary to treat the underlying condition before hair restoration can proceed.

Esthetic

The rationale for hair restoration is primarily esthetic ow a woman feels about her appearance and how she wants others to perceive her. The esthetic consultation with the physician hair restoration specialist is every bit as important as determining the reason for hair loss. The patient has esthetic goals that she hopes hair restoration can achieve. The physician helps the patient refine her goals within the context of what surgical and/or nonsurgical hair restoration can accomplish. Many questions can be raised and discussed in the esthetic consultation:

• What hair styles has the patient been using to minimize the appearance of thinning hair?
• What hair styles would the patient hope to use after hair restoration?
• Would the patient change her hair style, curl, color, etc., to get the most out of hair restoration?
• Does the patient want a "luxurious head of hair" that might require procedures such as hair weaving or hair extenders? Does the patient want to be able to swim and/or exercise heavily without worrying about her hair?
• What can hair transplantation accomplish and is transplantation an option for the patient?
• If transplantation is not an option because of scalp scarring or underlying disease, what options for hair restoration can be considered?
• Results of the medical and esthetic consultation are the primary considerations that guide the selection of a surgical or non-surgical hair restoration treatment appropriate to the patient’s needs.

Treatment of Female Hair Loss

Hair restoration treatments for women are primarily surgical, or treatments such as hair weaving or extending. Medical treatments for hair loss are largely directed at male androgenetic alopecia (See Nonsurgical hair loss treatment options for more information). A surgical treatment for female androgenetic alopecia may occasionally be combined with finasteride or minoxidil, the two products approved by the Food and Drug Administration (FDA) for non-surgical treatment of androgenetic alopecia. The physician hair restoration specialist may be able to determine whether the patient alopecia would be responsive to one of the FDA-approved drugs.