by Alan J. Bauman, M.D.
Here’s a fact that many people probably don’t know: roughly half of all women over the age of 40 suffer from some form of hair loss.
That’s right – half. While most people tend to think of hair loss as a man’s problem, the reality is that women are almost just as likely as men to lose their hair. But wait, you say, I don’t see bald women walking around… how is this possible?
In women, genetic hair loss is “expressed” in women differently than men. While many women can experience significant hair loss—women do not typically “go bald.” That is an important factor in diagnosing and treating female pattern hair loss vs male pattern hair loss. The main difference between male and female pattern hair loss is the fact that female hair loss occurs more diffusely over the affected areas of scalp, leaving some follicles unscathed while severely miniaturizing others.
In early cases, male pattern hair loss can be diagnosed “from across the room” as hairlines recede and the traditional crown bald spot appears. This is in stark contrast to most women, where coverage is often maintained even as the quantity of hair in the affected area decreases to 50% of normal! Without a close examination or measurement, the early stages of hair loss can be underestimated, missed and perhaps dismissed, even by dermatologists. The subtle signs and symptoms of decreased ponytail volume, excessive shedding, widening part-lines, decreased frontal or temporal coverage requiring more creative hairstyling, etc. if ignored can lead to a larger cosmetic issue that is harder to address later on, if left untreated.
Genetics and other factors determine the time of onset, speed and severity of loss over time. Female hair loss can be mild or severe, and there are a variety of factors at work that determine how a woman’s hair will change over time. Hair loss can start at any age – teens, twenties, thirties, forties, and a woman’s risk skyrockets after menopause.
When men experience hair loss, some decide to deal with it by shaving it off and moving on like Bruce Willis or Vin Diesel. Unfortunately for women, there isn’t a similar socially-acceptable option. Female pattern baldness often causes a great deal of anxiety and embarrassment in women – it’s also associated with a higher risk of depression and social withdrawal as styling options become more limited and cumbersome.
There are a number of reasons why women go bald, as I’ll discuss below, but it’s important for women to realize that this condition is quite common and they’re not alone. It’s estimated that more than 30 million US women suffer from hair loss – and that’s a very conservative estimate. The real number is probably two to three times higher. Also important – there are treatments that can help! From FDA approved minoxidil to special marine-derived supplements, low level laser therapy, prostaglandin analogs, platelet-rich plasma (PRP) therapy and NeoGraft FUE microsurgical hair transplants, there are several highly effective medical treatment options available for female hair loss patients.
There are also genetic tests available that can predict a woman’s hair loss risk later in life and a scientific measuring tool called HairCheck that can help professionals accurately measure, analyze and track the amount of hair in various areas of scalp over time. This can help monitor hair loss or hair regrowth from treatments over time.
Here are five reasons why women lose their hair:
1. Genetics – There are approximately 200 genes that regulate hair growth. Just like men, women too can inherit “the hair loss gene” amongst other hair characteristics that make hair loss more significant. After puberty, the hereditary hair loss genes can take over—causing a gradual and progressive miniaturization of hair follicles. As our hair ages, the follicle function diminishes in proportion to hereditary risk.
What Can You Do? If you’re young, get tested to see if you’re at risk later in life. If you’re already experiencing hair loss, consult with a board-certified hair restoration physician right away and get a HairCheck measurement in the at-risk areas. Regardless of how far along your hair loss is, there are medical treatments that can help. A typical multi-therapy approach will utilize minoxidil, low level laser therapy and nutritional supplements – but additional measures like PRP, prostaglandin analogs and NeoGraft FUE hair transplant surgery may also be used depending on the person’s individual case.
2. Hormonal Changes – At times in a woman’s life when hormone levels change—birth control pills, childbirth, menopause, hormone replacement therapy, etc.—sometimes there’s an association with hair loss. Recent scientific studies suggest that some women may be genetically predisposed to be sensitive to androgens (even small levels), which are known trigger for hair loss in men. In addition, many physicians report that anti-androgen treatments are helpful in cases of female hair loss.
What Can You Do? Genetic testing, called HairDX, is now available from select doctors to determine if a woman may be “Highly Androgen Sensitive,” which increases her likelihood of responding to certain off-label treatments like finasteride. Other treatments like minoxidil, PRP and low level laser therapy may also be used in combination.
3. Diet – Our follicles need certain types and amount of nutrients to produce healthy hair, so women who engage in unhealthy dieting (such as crash diets) or have nutritional deficiencies – particularly in calories, protein, iron, zinc or vitamins A, B, C – are at risk of a short-term hair loss condition known as ‘telogen effluvium.’ This risk is compounded if the woman is already genetically predisposed to hair loss.
What Can You Do? Eat a healthy diet, rich with hair “super foods” like salmon, dark green vegetables, nuts, beans, poultry, whole grains, low-fat dairy, etc. Also consider taking a pharmaceutical-grade biotin supplement (like Appearex) or the marine-derived supplement Viviscal Professional, both of which support healthier hair.
4. Health – Ill health can also have an impact on a woman’s hair. Weight loss, thyroid disorders, stress and other health-related issues can also cause hair loss. Additionally, certain medications may also cause hair loss, such as: oral acne medications with retinoids, antibiotics, antifungals, antidepressants, birth control, anti-hypertensives, cholesterol-lowering drugs, immunology-suppressants, and more.
What Can You Do? Patients should never discontinue a prescribed medical treatment just because of its potential hair loss side effects. However, such patients should consult a board-certified hair restoration physician to get started on multi-therapy program that can combat these side effects, such as minoxidil, nutritionals and low level laser therapy.
5. Physical Damage – Women who wear hair extensions, braids and tight pony-tails can cause lasting physical harm to hair follicles, resulting in a type of permanent hair loss known as traction alopecia, a form of scarring alopecia. Additionally, using harsh chemicals like bleaches and dyes, blow dryers and flat irons, and combing the hair when wet puts the hair strands themselves at risk of damage and breakage.
What Can You Do? Avoid long-term use of hair extensions or use intermittently only. Over time, these are especially harmful to hair follicles and most stylists will underestimate their potential for damage until its too late. Women with weak hair should also try to scale back on the other harmful styling practices (e.g. chemical or heat straightening) as much as possible. They can also incorporate dimethicone-based hair conditioners and thermal protection conditioners to minimize damage and use nutritional supplements like biotin to help boost the strength of hair fibers.
Alan J. Bauman, M.D. Of Bauman Medical Group in Boca Raton, Fl uses innovative techniques to preserve or restore natural hair appearance. As one of the few physicians in the world board certified by the American and International Board of Hair Restoration Surgery, Dr. Bauman lectures frequently at medical conferences such as the American Academy of Anti-Aging Medicine. In recent months he has been noted as a medical expert in O, The Oprah Magazine and Men’s Health, and appeared on “The Suzanne Show” on Lifetime, ABC and NBC News in South Florida.