Women and Hair Loss
Hair loss is relatively common in women, more common than one would imagine. Unlike hair loss in men, the primary causes of hair loss in women are:
1) Iron Deficiency
2) Thyroid Abnormalities
3) Hormonal Imbalances or Changes
We recommend that women, especially women under the age of 40, have your primary physician test for iron deficiency, thyroid abnormalities or hormonal imbalances.
But for many women, as with men, hair loss requires a genetic predisposition. In essence, hair follicle are “pre-destined” to thin and ultimately stop generating a hair – resulting in loss.
The presentation, however, is much different than male pattern loss, and the management of women with hair loss requires significant expertise in both diagnosis and treatment. For those women in whom surgical hair restoration is indicated, special surgical skills are required to achieve the best results. It is a mistake for a surgeon to assume that hair loss in women can be treated the same way as in men.
Women generally have a diffuse thinning (less hair all over), in contrast to men who more frequently have a “patterned” type (hair loss that spares the back and sides). Women often maintain their frontal hairline, whereas men characteristically lose a significant amount of hair in the front part of their scalp from the very beginning. Hair loss in women is most often very gradual, with the rate accelerating during pregnancy and at menopause. It is more often cyclical than in men, with seasonal changes that reverse themselves, and it is more easily affected by hormonal changes, medical conditions, and external factors.
There are two simple “bedside” tests that a doctor can use to help support a diagnosis of hair loss. The first is the “hair pull” in which a finger-full of hair is gently pulled and the hairs that easily pull out are counted. The second is “densitometry” in which a small area of the scalp is clipped short and examined under magnification (usually 30x). The hair density (number of hairs per cm) can then be measured and the approximate percentage of hairs that are in a miniaturized state (and subject to being lost) can be assessed.
To understand the different types of hair loss in women, and their management, it is helpful to divide the patterns into three broad categories.
Localized Hair Loss
Hair loss commonly occurs around the hairline after facelift surgery. This may easily be corrected with hair transplantation. Traction Alopecia, the hair loss that occurs with constant tugging on the hair, may also be similarly treated. Baldness from injuries, or from local medical problems that have been cured, is also amenable to hair transplantation. In general, women in this category may be excellent candidates for hair restoration surgery.
Patterned Hair Loss
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. Women with patterned hair loss may be excellent candidates for surgical restoration.
Diffuse Hair Loss
A third category of hair loss in women is a generalized thinning that affects all parts of the scalp. This is the most common type. 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 Unpatterned Alopecia”. These women have a relatively large area that has been subjected to thinning, and the donor area is also affected. Women with this type of hair loss are generally not good candidates for surgery.