Hair Loss in Women

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Medical Author: Alan Rockoff, MD
Medical Editor: Frederick Hecht, MD, F.A.A.P.

Men don't like losing their hair, but women like losing theirs even less. Some women who come to consult about thinning hair look at me, smile slightly, and say: "Well, of course, on a man it's not the same." (In order to understand this response, you only have to look at my photo!)

There are many kinds of hair loss, including what we call:

• alopecia areata (patches of baldness that usually grow back);
• telogen effluvium (rapid shedding after childbirth, fever, or sudden weight loss); and
• traction alopecia (thinning from tight braids or ponytails).

All of these types of hair loss can be alarming but, fortunately, they are most often mild and temporary or reversible.

The majority of people who lose their hair, however, do it gradually and all through the scalp, with some emphasis on the frontal part. Doctors refer to this process as "androgenetic alopecia" which implies that a combination of hormones
(andro-) and heredity (genetics) is needed to develop the condition. Men lose more hair earlier and get big bald spots (this is the familiar male-pattern baldness).

Women start losing their hair later in life and almost never lose the frontal hairline, no matter how thin their hair gets (this is called female-pattern baldness.)

All of us develop thinning of our hair as we age. How thin our hair gets all depends on how much hair we start out with and the overall appearance of hair within the family. Women who still have full heads of hair often exclaim: "This is nothing--you should have seen how thick it used to be!"

Notions about baldness being inherited through the mother's family, just like stories about hats choking off follicles or long hair pulling on the roots, are just folklore. (It is known that genes influence the occurrence of male-pattern baldness, that is androgenetic alopecia, but the exact nature of these genes and how they are inherited are still not known. - Editor)

Since we can't change the families into which we were born (not that we aren't sometimes tempted), what are we to do?

• First, don't stop coloring, perming, or conditioning your hair if you like the results of these processes. Hair styles that pull tightly can cause some hair loss, but hair coloring and "chemicals" do not.
• Ask your doctor about minoxidil (the generic name for Rogaine.) This is over-the-counter and available in 2% and 5% concentrations. It's something of a nuisance to apply but it helps conserve hair and may even grow some.
• Propecia is a drug that helps men retain their hair but unfortunately has no use for women. Propecia is not safe for women of childbearing age and it just doesn't work for older women. This is unfortunate but, for the moment, this is the situation.
• Surgical procedures like hair transplants can be useful for some women as well as men to "fill in" thinned-out areas.

When women express concerns about hair loss, I sometimes say: "No matter what, you will never look like me."

Many of them somehow find that reassuring!