Female pattern baldness

Causes

A hair grows from its follicle at an average rate of about 1/2 inch per month. Each hair grows for 2 to 6 years, then rests, and then falls out. A new hair soon begins growing in its place.

Baldness occurs when hair falls out and normal new hair does not grow in its place. The reason for female pattern baldness is not well understood, but it may be related to:

• Aging
• Changes in the levels of androgens (male hormones). For example, after reaching menopause, many women find that the hair on their head is thinner, while the hair on their face is coarser.
• Family history of male or female pattern baldness

Hair loss can occur in women for reasons other than female pattern baldness, including the following:

• Breaking of hair (from treatments and twisting or pulling of hair, or hair shaft abnormalities that are present from birth)
• Certain skin diseases that lead to scarring of the hair follicles
• Certain autoimmune diseases
• Hormone problems, such as too much testosterone, or too much or too little thyroid hormone
• Too little iron
• Too little vitamin B (biotin) or other vitamin deficiency
• Medications such as chemotherapy and beta blockers
• Patchy hair loss (alopecia areata)
• Syphilis, a sexually transmitted infection
• Temporary shedding of hair after a major illness, surgery, or pregnancy

Symptoms

Hair thinning is different from that of male pattern baldness. In female pattern baldness:

• Hair thins mainly on the top and crown of the scalp. It usually starts with a widening through the center hair part.
• The front hairline remains
• The hair loss rarely progresses to total or near total baldness, as it may in men

Itching or skin sores on the scalp are generally NOT seen.

Exams and Tests

Female pattern baldness is usually diagnosed based on:

• Ruling out other causes of hair loss
• The appearance and pattern of hair loss
• Your medical history

The doctor will examine you for other signs of too much male hormone (androgen), such as:

• Abnormal new hair growth, such as on the face or between the belly button and pubic area.
• Changes in menstrual periods and enlargement of the clitoris
• New acne

A skin biopsy or other procedures or blood tests may be used to diagnose skin disorders that cause hair loss.

Looking at the hair under a microsope may be done to check for arsenic or lead. Looking at the hair this way does not accurately diagnose nutritional problems.

Treatment

The hair loss in female pattern baldness is permanent, if not treated. In most cases, hair loss is mild to moderate. You do not need treatment if you are comfortable with your appearance.

MEDICATION

The only medication approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness is minoxidil. It is applied to the scalp.

• For women, the 2% concentration is recommended.
• Minoxidil may help hair grow in about 1 in 4 or 5 of women. In most women it may slow or stop hair loss.
• You must continue to use this medicine for a long time. Hair loss starts again when you stop using it.

If minoxidil does not work, your doctor may recommend a medicine called spironolactone, taken by mouth:

• Spironolactone may help if your hair loss is caused by too much androgen, a male hormone.
• The drug is not FDA-approved for female baldness.
• It can cause increased potassium levels in the blood. It should not be used in women with kidney failure or who are pregnant.

HAIR TRANSPLANTS

Hair transplants remove tiny plugs of hair from areas where hair is thicker, and place them in areas that are balding. This can cause minor scarring where the hair is removed, and carries a slight risk for skin infection. You will likely need many transplants. This can be expensive. However, the results are often excellent and permanent.

The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.

Stitching (suturing) hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp.

Hair weaving, hairpieces, or a change in hairstyle may disguise hair loss and improve your appearance. This is often the least expensive and safest way to deal with female pattern baldness.

Outlook (Prognosis)

Female pattern baldness is usually not a sign of an underlying medical disorder.

Some women say it the baldness affects their self-esteem and may cause anxiety.

Hair loss is usually permanent.

When to Contact a Medical Professional

Call your doctor or nurse if you have hair loss and it continues, especially if you also have itching, skin irritation, or other symptoms. There might be a treatable medical cause for the hair loss.

Prevention

There is no known prevention for female pattern baldness.

Alternative Names

Alopecia in women; Baldness - female; Hair loss in women; Androgenetic alopecia in women

References

Habif TP. Hair diseases. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 24.

Mousney AL, Reed SW. Diagnosis and treating hair loss. Am Fam Physician. 2009;80:356-362.

Update Date: 1/26/2012

Updated by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.