The Trichological Society - Hairloss in women

HAIR LOSS IN WOMEN

Women may suffer hair losses for many reasons.
Some are temporary and hair may be expected to return (with treatment or spontaneously) viz:
Alopecia areata, annorexia/ bulimia, chemotherapy, crash dieting, exzema, dermatoses, ferritin /iron insufficiency, physical damage, post natal, pyrexia, radiotherapy, stressful circumstances etc.

Other conditions may cause permanent hair loss viz:
Androgen activity, (genetic factors, menapause, polycystic ovarian syndrome), scarring diseases, thyroidism etc.

Each of these conditions is the subject of a paper on this portal (refer to scalp & hair diseases).

This paper deals with

ANDROGENETIC & ANDROGENIC ALOPECIAS IN WOMEN
Current expert opinion expressed herein may change as medical research continues.

ANDROGENETIC ALOPECIA
(Androgen-related hair loss)

Permanent hair-loss caused by the action of androgens on genetically susceptible follicles.

Androgenetic alopecia is non-reversible genetically determined hair loss. Androgen presence is necessary for its progression. It is genetically either:
i) dominant - a single gene is inherited.
ii) polygenic - a number of genes are inherited.

In women, Androgenetic Alopecia is the cause of hereditary hair thinning/baldness. AA is a multi-factorial condition in which follicular exposure to androgens (testosterone, androsteinedione and dihydrotestosterone (DHT) causes progressive miniaturisation together with reduced anagen (hair growing) phase. Some persons may experience near baldness eventually.

How the condition differs from that in the male:
i) The progression is slower - possibly due to a level of 'follicular protection' afforded by estrogen.
ii) Hairloss is diffuse and does not conform to the traditional patterns of loss in males.
iii) Hairloss may worsen following menopause with the development of baldness especially at the vertices.
iv) In men the condition is due to genetic predisposition and is usually age related.
v) In women the condition can present at any time associated with underlying medical conditions. viz: polycystic ovarian syndrome, thyroid disorders, anaemia, chronic illness, use of certain medications.

Expert opinion currently doubts that the condition in females is the same as that in males.

Correct diagnosis is essential, and may require blood tests, or scalp biopsy.

ANDROGENIC ALOPECIA
(Androgen-related hair loss)

WOMEN

Androgenic Alopecia in women is hair loss caused by follicular miniaturisation associated with endocrine changes and increased androgen presence. Accompanying factors may include: Polycystic ovarian syndrome, virilisation (and hirsutism), irregular menstruation, infertility, acne, seborrhoea oleosa and hirsutism.
Hair loss is more severe and the onset may ocurr earlier than with Androgenetic Alopecia (which it may mimic).
Androgenic Alopecia in women warrants endocrinological investigation.

Menopausal Alopecia (androgenic alopecia) is associated with hormone changes. As oestrogen reduces hair-follicles become vulnerable to the effects of androgen exposure. Anti-androgen therapy as with androgenetic alopecia above may reduce further hair loss, but is currently unlikely to initiate the return of the lost hair.

Things to do
Until recently, no effective treatments have been available for certain alopecias in women.
Current options however may include the following drugs which may limit hair loss:
Systemic anti-androgen drugs e.g.
Spironolactone: Aldactone® Spiroctan®, Diatensec®.
Cyproterone acetate (Androcur®) Diane® or
Flutamide (Eulexin®).

Minoxidil: Regaine®
Finasteride: Propecia®is not currently indicated in women. However 5-alpha-reductase inhibitors (which prevent testosterone conversion and subsequent baldness in men) are currently being considered for female use. This may bring renewed possibilities in the treatment of this distressing disorder

Surgical Hair Restoration (transplantation techniques)
Counselling