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Androgenetic Alopecia in Women - Causes and Treatments

Female pattern hair loss can be difficult to identify. While men’s hair loss seems to get more attention, women’s hair loss has more causes than men’s. Women’s hair loss is caused by hormonal changes during pregnancy, childbirth, postpartum, polycystic ovarian syndrome (PCOS), and menopause.

Hair loss conditions such as alopecia areata and scarring or traction alopecia affect both men and women, but women have a higher prevalence of both. Female pattern hair loss, also known as androgenetic alopecia, manifests differently than male pattern hair loss, so treatment is also different.

Pattern hair loss manifests differently in men than in women, but they do share some characteristics. Both men and women experience pattern hair loss, which is defined by normal hair shedding, then regrowth, but regrowth that is progressively thinner. In addition to progressive thinning, pattern hair loss reduces the number of hair growth cycles, which can cause a delay in the regrowth of shed hair.

What are the Early Symptoms of Baldness?

Pattern hair loss in men is characterized by thinning and recession at the hairline and temples, widening of the crown, and thinning at the mid-scalp, whereas female pattern hair loss is characterized by thinning throughout the scalp. A widening of the hair part, which can sometimes resemble a “Christmas Tree pattern”, is one of the symptoms of female pattern hair loss.

Female pattern hair loss can be more difficult to detect because longer hairstyles can conceal diffuse thinning, particularly in its early stages. When female pattern hair loss is in its early stages and is difficult to diagnose, a microscopic scalp examination can be performed to identify thinning hair. Thinning hair can be compared to other native hair or areas of the scalp where hair is genetically resistant to hair thinning, such as the sides of the head or the lower back of the head.

What Causes Hair Loss in Women?

With so many possible causes of hair loss in women, other causes must be ruled out before treatment for pattern hair loss can begin. Telogen effluvium, or temporary hair loss caused by severe stress, is common in both men and women. This type of hair loss does not require treatment because shed hair grows back after the severe stress event has passed, but it can occur simultaneously with pattern hair loss. Hair shedding is more common in women than in men because women have more causes of shedding.

Changes in hormone levels can cause hair loss during pregnancy, childbirth, and postpartum. Hormonal changes or imbalances that cause hair loss can be treated with hormone therapy, or in some cases, the levels can be left to stabilize on their own.

PCOS, or polycystic ovarian syndrome, can also cause hair thinning and can occur at the same time with female pattern hair loss. PCOS is frequently treated with hormone therapy, which is typically the contraceptive pill, to regulate periods and block excessive testosterone production. With our TrichoStem Hair Regeneration treatment, we treat PCOS cases on a case-to-case basis.

Alopecia areata and other scarring conditions are also causes of female hair loss. Alopecia areata is an autoimmune disease in which the immune system attacks hair follicles, resulting in bald patches. While our TrichoStem Hair Regeneration treatment (non-surgical hair transplant alternative) can treat hair loss and stimulate hair growth, it cannot treat the autoimmune disorder that attacks the follicles.
Lichen planopilaris is a rare scarring condition that causes patchy hair loss and scaling of the scalp skin. It primarily affects women under the age of 30. Differentiating conditions such as lichen planopilaris and alopecia areata from female pattern hair loss may require scalp biopsies before treatment for pattern hair loss can proceed.

Traction alopecia is another scarring condition that can result in permanent hair loss and is more common in women. Traction alopecia is caused by constant tension on hair follicles, which is most commonly caused by excessively tight hairstyles such as ponytails and braids. Since traction alopecia injures and has a high risk of permanently damaging the hair follicle, hair transplantation is frequently the only treatment available to restore hair to the affected area.

Another type of scarring hair loss that can result in permanent hair loss is central centrifugal cicatricial alopecia or CCCA. The exact cause of CCCA is unknown, but several factors, including those found in other types of hair loss, such as fungal infections, tight hairstyles, and autoimmune disorders may play a role. While CCCA can affect people of any race or gender, the majority of cases involve middle-aged African-American women. While the TrichoStem Hair Regeneration treatment is primarily used to treat pattern hair loss, on a case-by-case basis, we have successfully treated CCCA with concurrent female pattern hair loss.

Aging and menopause are important factors to consider when it comes to female pattern hair loss. Pattern hair loss affects approximately 30% of women under the age of 50. However, after the age of 50, this figure rises to 50% of women experiencing pattern hair loss. The decrease in estrogen production before or during menopause, known as perimenopause, affects hair growth and thickness and can occur concurrently with female pattern hair loss. Supplemental estrogen can help with hair growth and thickness in these cases, as well as treatment for female pattern hair loss.

Is Minoxidil a Good Hair Loss Treatment for Women?

There are few treatment options for women who experience pattern hair loss. Women frequently use minoxidil 2%, which is available over-the-counter. Minoxidil does not thicken thinning hair, it only delays hair from its natural shedding cycle, causing more hair to appear on the head. Minoxidil hair growth is typically limited to fine hair growth that does not grow long.

Minoxidil solution is not a long-term solution because its effectiveness fades over time, and hair that has been delayed from shedding can suddenly shed if the drug is stopped, as the shedding of fine hairs is stimulated to grow. The testosterone blocker spironolactone is frequently prescribed to women with pattern hair loss, but high testosterone levels are not linked to female pattern hair loss, as women with normal testosterone levels can also experience female pattern hair loss.

Hair transplants are generally not recommended for women who have diffuse female pattern hair loss. This is because thinning native hair grows closely together, and using a sharp implanter to transplant hair will likely pierce through nearby native hair follicles, causing permanent damage and loss of these follicles through collateral loss.

How Do I Get Treatment for Female Pattern Baldness?

Since 2011, our TrichoStem Hair Regeneration treatment has shown as an effective stand-alone treatment for female pattern hair loss. Over 99% of our female pattern hair loss patients see a visible improvement in hair thickness, scalp coverage, and increased hair growth from dormant hair follicles that are still viable but previously not growing.

The main component of TrichoStem Hair Regeneration is extracellular matrix by ACell, which is activated by platelet-rich plasma, or PRP. Unlike PRP alone which requires multiple treatment sessions for limited, short-term hair benefits, most TrichoStem Hair Regeneration patients require only one to two treatment sessions, which can last 3-5 years, or even longer.

Patients with advanced hair loss receive a second treatment session 15 to 24 months after the first to thicken fine hair growth stimulated by the first treatment. Our pattern hair loss patients no longer need to use minoxidil, and can stop taking spironolactone after receiving our injection treatment. Patients who have pattern hair loss, as well as concurrent hair loss conditions such as PCOS or menopause, may benefit from hormone therapy in addition to the injection treatment.

While there are more potential causes of hair loss in women than in men, female pattern hair loss still accounts for approximately 95 percent of total hair loss cases; however, concurrent hair loss conditions can occur at the same time. Before assuming that female pattern hair loss is occurring, a proper diagnosis is required to determine whether it is being misdiagnosed for other causes of hair loss.

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