Female Pattern Hair Loss
Female Pattern Hair Loss (FPHL) has also been called “androgenic alopecia,” which is a misnomer, because there’s no proof that male hormones (androgens) have anything to do with it. It occurs mainly after menopause, rarely before, and may affect up to 75% of women over 75 years-old. It never advances to major baldness as in men. It’s mainly been studied in white women (just like the overall history of medical research).
Diagnosis is clinical, by the woman’s age, and gradual progression of hair thinning. It most commonly occurs at the very top of the head, but rarely if ever with spots of complete baldness. Sometimes the sides of the head can be involved, but the hairline in front usually remains. The scalp skin itself is completely normal. See pictures below.
There may be significant psychological impact, leading to depression. Men tend to accept hair loss with age, since we commonly see bald men in society. But even though many women experience hair loss with age, a given woman may not realize the fact, since it’s not so easily noticeable. As such, she becomes understandable distressed by her own experience, which is obvious to her.
Although specific areas may be more involved than others in the case of FPHL, the spots are not completely bald as with Alopecia Areata, and don’t exhibit the appearance of having been tugged at as with Traction Alopecia. Sometimes a woman unaware of her FPHL develops Telogen Effluvium, making the overall picture confusing. See our topic Hair Loss.
The most common treatment to be tried for FPHL is topical minoxidil solution or foam (there are various brand names). Some very important things to know:
- Hair loss may seem to increase during the first 2 months of treatment, because hairs in the resting phase (telogen) are shed as the follicles are stimulates to begin the growth phase (anagen).
- It may take four months to notice any results. Treatment should be continued for a year before deciding it doesn’t work.
- It’s important to apply the solution at least two hours before going to bed, so it can dry. Otherwise, it may trickle down the face to cause unwanted hair there.
Male Pattern Hair Loss
Men may normally start to lose hair in their late teens, but hair loss mostly begins to become noticeable in one’s 30’s or 40’s. It’s a very gradual process, such that a man may become bald so slowly over the years almost without realizing it’s been going on. Sometimes it may occur in waves.
The degree of hair loss, including complete baldness, is caused by genetic factors. In men, it progresses due to effects of hormones on the hair follicle. Over the years, a follicle’s growing phase (anagen) gets progressively shorter, such that new hairs fail to emerge.
Men begin losing hair in the front, on the sides, or at the top of the head (see chart below). These three patterns may vary as per the individual. Many men have a receding hairline of up to one inch in front, which does not progress any further. The main keys to diagnosis are:
- Very gradual progression.
- Does not occur diffusely all over at the same time; does not occur in patches of sudden hair loss
- The skin of the scalp is normal
- Often a family history of baldness
See our topic Hair Loss.
The two main treatments are oral finasteride, and topical minoxidil (solution or foam); both have various brand names. Finasteride may mainly prevent hair loss, while minoxidil promotes regrowth. Both may require several months to note an effect. Minoxidil is available over-the-counter, but not finasteride. Although sexual side effects are uncommon with the dose of finasteride used for hair loss (vs. the dose for prostate conditions), it’s important to discuss these with your medical provider before beginning treatment.