Science of Female Pattern Baldness
Pattern Hair loss is the term used to describe a genetic predisposition to hair loss. When pattern hair loss affects females, it is called Female Pattern Hair Loss (FPHL) which is caused by androgenetic alopecia (AGA). The genetic component is strong, and makes the hair sensitive to hormonal changes, particularly estrogen and male sex hormones.
Most women suffer with some level of female pattern hair loss, and 2/3rds of cases occur after menopause. By age 50, 50% of women report hair loss or thinning hair. As we age hair density and diameter change. The risk of FPHL increases when there is a family history of hair loss. FPHL is also associated with endocrine disorders.
Female pattern hair loss causes significant psychological and social anguish including stress, depression and anxiety, as well as dissatisfaction with appearance, body image distress and low self-esteem.
What causes female pattern hair loss?
FPHL is caused by a combination of genetics and male sex hormones. The genetics of FPHL are less strong than in males, and the role genetics play is less clear. We do know that FPHL is caused by three factors, genetics, age and hormones.
Until recently, medicine presumed that the cause of FPHL was genetic in origin. However recent studies show significant differences between the causes of male pattern baldness and FPHL.
Women do experience higher levels of testosterone in the blood as they age; and estrogen decreases during menopause but the conversion of testosterone to DHT is not evident.
Other research suggests that women have higher levels of an enzyme called aromatase which is responsible for the formation of the female hormone estradiol, which decreases DHT formation. This may help explain why the pattern in women is different than in men. It may also explain why women have a poor response to the drug finasteride. At this time, what we know is that FPHL is multifactorial and genetically predetermined with both hormone and non-hormone causes. We also know that there is an alteration of the hair cycle that causes a gradual reduction in the growth phase and an increase in the time between hair is shed and new hair grows.
FPHL usually occurs alone. However, other hormone-related conditions like menopause can occur at the same time.
What is the pattern in FPHL?
Women with FPHL experience a pattern of diffuse thinning of the hair at the scalp, that is usually limited to the front, temples and vertex (the crown) areas where the follicles are hormone sensitive due to a genetic predisposition. However, some women have diffuse hair loss all over the head. The hair loss may accelerate for a few months, and then stabilize for a few months due to the normal cycle of hair and hormones.
Why the pattern is different in men is likely due to men having much higher levels of testosterone, and more of the enzyme that converts testosterone to DHT. Women also have higher concentrations of an enzyme called aromatase that can help to block the conversion of testosterone to DHT.
What are the symptoms of FPHL?
The first sign of FPHL is when the scalp becomes more obvious and is seen as a widening of the central part of the hair. Sometimes a woman will notice that her ponytail diameter is smaller. FPHL progresses to overall thinning without treatment. However, most women do not go bald or lose all their hair. Rather, as they age, new hairs grow in finer and thinner, evidence of shrinking hair follicles. Eventually the follicle stops growing hair.
Who is affected by FPHL?
FPHL usually begins in susceptible women between the ages of 40 and 60, but can begin earlier. It is most common after menopause because of a decline in production of estrogen which is protective of the hair follicles. FPHL is responsible for 95% of all cases of female pattern baldness, and affects more than 30 million American women.
Is FPHL reversible?
FPHL is a permanent condition, and cannot be reversed. But when the miniaturized hairs are still present, treatments may be able to slow the process.
All hair loss is not the same. Early diagnosis and treatment of FPHL are effective to avoid progression of hair loss.
If you are beginning to lose your hair, see an expert at Powell Cosmetic Surgery and Medical Hair Restoration in Cardiff, CA. Get a correct diagnosis and learn about your options.
- American Academy of Dermatology www.aad.org
- Fabbrocini, G, Female Pattern Hair loss: A clinical, Pathophysiologic and therapeutic review. International Journal of Women’s Dermatology https://doi.org/10.1016/j.ijwd.2018.05.001
- Ioannides D, Tosti A (eds): Alopecias – Practical Evaluation and Management. Curr Probl Dermatol. Basel, Karger, 2015, vol 47, pp 45-54
- Davis DS, Callende VD, Review of quality of life studies in women with alopecia.
- Int J Womens Dermatol. 2018 Jan 9;4(1):18-22. doi: 10.1016/j.ijwd.2017.11.007. eCollection 2018 Mar.