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Your Guide to Women’s Hair Loss Part 1: It’s Complicated…

50 percent of all adults will experience hair loss – why don’t we often talk about when women experience it? 

21 million women in the USA are currently experiencing hair loss. 

To put the size of that number into perspective, 21 million is 12% of the US female population, or the entire female population of Canada. 

It's staggering. In fact, 40% of all women will experience some form of hair loss before the age of 40.

So why don’t we discuss female hair loss in depth more often?  

Many more women than you probably think experience hair loss. Close to 12% of the US female population. It’s estimated that 40% of all women will experience some form of hair loss before age 40. 

The reasons are as complex as the hair loss women experience. Yes, almost half of all women will experience hair loss at some point in their life, but it’s often not due to a single cause. Hair loss takes on many forms in women and it’s often due to a combination of factors. 

 In short, it’s complicated, and we often don’t have simple answers at the ready. One thing that is certain, it’s gratifying when women’s hair loss is taken seriously and managed appropriately. 

With that in mind, we set up today’s blog to be more of a guide to women’s hair loss. Below you’ll find the top 6 causes of hair loss in women, how to diagnose, and what treatments are available.

1. Androgenic alopecia (AGA) – affecting both men and women, it’s the most common form of hair loss and one of the best understood. Catalyzed by both a high level of DHT and DHT hair follicle sensitivity. The pattern of hair loss does differ between men and women. In women, the part line tends to get wider as the condition progresses. (Ludwig scale versus the Norwood scale). 

In women androgenic alopecia hair loss tends to be diffuse and present as a widening of the part – which can make it difficult to mask or hide. 

2. Telogen effluvium – Hair loss that is stress induced and usually temporary. The acute, rapid form is typically a response to a virus or other physical stress, but it can be chronic and diffuse as well. 

3. Cicatricial alopecia – This is a type of scarring alopecia (where the hair stem cells are destroyed, and the follicle is replaced with fibrous scar tissue) and the hallmark is an unusual hair loss pattern. When someone presents with hair loss that doesn’t quite fit with other hair loss types, I go here. Like all scarring alopecia, this ties into the immune system. A biopsy can be an important step in determining treatment options and whether the inflammation is ‘active’ or ‘burned out’. When considering transplant surgery, we never want to operate when there’s active inflammatio.. Afterwards, once the underlying condition is under control, we’re good to go. With scarring alopecia, the hair loss is permanent, so a transplant might be your only option for improvement.  

4. Alopecia areata – Another immune system-based hair loss condition where your body’s defense system attacks the hair follicle. There are degrees of alopecia areata, such as single patches, totalis (lots of patches with fusion), universalis (all over the body – what Dr. Linkov has). A hallmark is that hairs have an exclamation shape. Because the follicle is not destroyed, hair regrowth is possible (once inflammation is under control). A relatively new kind of treatment, Jak inhibitors, can help get the immune system under control. 

5. Frontal fibrosing alopeciaTypically we don’t see a change in women’s hairline like we do with men – hair loss for women tends to be at the central part and/or more diffuse. When the hairline does shift, this condition jumps to the front of the line as a candidate. It’s another inflammation-based, scarring hair loss and tends to accompany hair loss of the eyebrow tail. It’s something we really have to look out for when considering an eyebrow transplant, especially if there’s active inflammation. Because it’s a scarring form, the hair loss is permanent. 

 We don’t often see hair loss at the hairline in women, and when it’s present it can indicate a very specific condition – frontal fibrosing alopecia. For women considering an eyebrow transplant, it’s an important condition to be aware of. 

Interestingly, this condition has been on the rise, and it’s been hypothesized that increased sunscreen use might be responsible. More research is needed and it’s far from conclusive – don’t stop your sunscreen use yet! 

6. Traction alopecia – is hair loss caused from wearing hair in too tight of a hairstyle and we usually see it at the hairline where hair is pulled the most. Hair extensions, tight braids, ponytails… Continuous tension on hair causes stress that can make it fall out, and though it often grows back, that’s not a guarantee. It can scar down, especially where the trauma is continuous and unrelenting.

 

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 Finding the Patterns

To properly diagnose hair loss in women, we need an accurate health history. Some of the health factors that can affect hair loss might surprise you.  

Wouldn’t it be easy if all we had to do was identify the hair loss and treat it? Because women’s hair loss can be so complicated and multifaceted (some hair loss causes are unique to female biology) it’s really critical to take (and give) an accurate health history. 

Is there any hair loss in the family? – either side, as we now know multiple genes and alleles are involved. Does the patient know when their hair loss began? Was it acute or something they became aware of over time? Where did it occur – in the front, back? Diffuse? Did the hair loss also affect the eyebrows or other hair on the body? Were there other symptoms, such as burning, itching, or pain? What about the nails, are they pitted? What haircare products were they using

Also, has the patient tried previous medical therapies? Perhaps even a transplant? How did they react?

When we say hair loss for women is multifaceted and complicated, we’re not being coy. There are many factors at play, which makes getting a good medical history a crucial step. Nutrition, viruses, infections, emotional stress, chemical agents, medications, hormonal fluctuations, and autoimmune conditions can all profoundly influence hair growth (and loss) for women. 

Some of these are temporary, but again that depends on the individual. Having the patient get to know their own hair loss and recognize their own personal patterns – including the triggers – is a very important step.  

If you are experiencing hair loss and want to explore affordable hair loss therapy, visit Feel Confident to find out about your options. Don’t let your hair loss define you.

 

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Written by
Kristi Charish
Edited by
Dr. Gary Linkov
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.

 

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