Female Pattern Baldness

Female Pattern Baldness

What is female pattern hair loss or female pattern baldness?

  • Female androgenetic alopecia has two forms:the pattern form, known as female pattern hair loss and the diffuse form characterised by overall hair loss in females.
  • Female Pattern Hair Loss (FPHL), also called female pattern alopecia is the most common cause of female hair loss. 
  • Around 40% of women by age 50 show signs of hair loss and fewer than 45% of women reach the age of 80 with a full head of hair. 
  • It is natural for hair thickness to change over time. Hair thickness at 60 is not the same as at 16 for anyone.
  • Alopecia can also be the first symptom of underlying systemic illness within the primary care setting so it’s important to discuss any hair loss with your GP. 
  • FPLH usually starts with thinning and reduced hair volume or both. 
  • It is described as occurring in a “Christmas Tree” pattern, with the part often widening towards the front.

FPHL is classified based on the Ludwig Scale and Sinclair grading. More information can be found here.

What are the symptoms of female pattern baldness?

  • Noticeable clumps of hair falling out, e.g in the hairbrush, on the pillow or clumps of hair in the shower or sink.
  • Some daily hair loss is normal about 50 to 100 hairs daily, but anything further warrants a discussion with your GP or dermatologist. 
  • Generalised thinning of hair at the hairline, temples and top of the head (patterned hair loss) with or without frontal hairline recession.
  • Less commonly, hair loss may be a symptom of several medical and psychiatric conditions including ovarian and adrenal tumours, polycystic ovarian syndrome, hair-pulling disease (trichotillomania), hypertension and coronary artery disease. 
  • This is why it’s important to mention any noticeable hair loss to your doctor, who may order blood tests and metabolic screening to rule out these conditions.

What are the risk factors for female pattern hair loss?

  • Hair loss can be genetic, related to medical conditions or fluctuating hormones and most commonly is an ageing disease.
  • Genes can be inherited from either parent or both parents and genetic testing is unreliable and not recommended 
  • Smoking, elevated fasting blood glucose levels are risk factors for FPHL   
  • FPHL tends to be more common after menopause which suggests oestrogen may be a stimulator for hair growth, however other lab experiments contradict this and suggest it may suppress hair growth.

How is Female pattern hair loss diagnosed at Aurora Dermatology?

  • Dr Parisa Arianejad (FACD, MD) is highly experienced in hair loss diagnosis and will use a Trichoscopy test (examination of the hair follicle, shaft and scalp) under a dermatoscope.
  • The hair shedding scale is used to assess hair shedding. 
  • It is used to classify the severity of hair loss for better evaluation.
  • She will also perform a special hair pull test using gentle traction which is positive when more than 10% of hairs are easily pulled out.
  • Other tests may include blood tests. Where the diagnosis is uncertain she may perform a skin biopsy
  • Assessment by a dermatologist is important as FPHL is often misdiagnosed as many other conditions including Discoid Lupus Erythematosus (an autoimmune condition),  secondary syphilis (STD), frontal fibrosing alopecia (permanent hair loss) and Trichotillomania (psychological hair pulling condition). 
  • Dr Parisa is a passionate and experienced provider of hair disease care and has a fellowship in dermatology from the Australasian College of Dermatologists. 
  • She also runs a specialised hair disease clinic at Westmead Public Hospital and is a member of the International Society of Hair Restoration Surgery, the global medical body dedicated to promoting the gold standard of medical practice and medical ethics in hair restoration.
  • Dr Parisa has also trained under world-leading hair disease professionals and treats the gamut of hair conditions – including male pattern baldness, alopecia areata, receding hairline as well as pregnancy and menopause related hair loss.

What are the treatments for female pattern hair loss?

  • There is no cure for FPHL so it is important to have realistic expectations about medical treatments.
  • Medications such as minoxidil often work, but results are unpredictable. A 2% solution is less likely than the 5% solution to cause irritation and undesirable hair growth on other parts of the body. 
  • Oral medications such as oral minoxidil and also tablets that block androgen hormones such as spironolactone, cyproterone, finasteride and flutamide are other popular treatment pathways
  • PRP is a signature treatment at Aurora Dermatology and this is where the patient’s blood is extracted, platelets are spun through a centrifuge and then injected into the scalp. However, it is not suitable for all patients. Find out more about PRP for hair loss at Aurora Dermatology here. 
  • Cosmetic camouflages include coloured hair sprays to cover thinning areas of the scalp, as well as hair-bulking fibre powder and wigs.  
  • Hair transplant surgery such as the FUE hair transplant is a safe and effective option, with more permanent and dramatic results that last for years
  • Find out more about the FUE transplant here.  
  • Low level laser therapy ( LLLT) is a treatment for hair loss that utilises low power lasers to stimulate hair follicles promoting hair growth.

What are Dr Parisa’s “top 10 fakeaways” when it comes to disguising hair loss at home?

  • Shorter hairstyles generate more volume and lift 
  • Use a zig-zag part to disguise condition and use soft layers at the top 
  • Soft or light curls add volume but avoid heat at top of the head 
  • Use wide combs rather than brushes to allow thin hair to flow through without breakage 
  • Blot wet hair with a non-friction towel rather than dry vigorously 
  • Remember that any clinical effect will take 3-6 months to be noticeable 
  • There may be increased shedding in initial phases of treatments as hair transitions to growth phase 
  • Any topical or oral treatment must be continued daily or if discontinued the effect is lost 
  • Use scarves at hats to disguise baldness and headbands around a thinning frontline are also popular ways to disguise female baldness, while a top knot can disguise crown baldness. 

“If you are experiencing hair loss, seeking help early is crucial as preventing hair loss is much easier than attempting regrowth if you start later.” 

 

*Disclaimer. Individual results may vary. All procedures have risks, so discuss the benefits of hair loss treatments and hair loss transplant with your doctor. 

Sources
Australian Journal of Clinical Practice: Female Pattern Baldness 

Female Pattern Baldness: International Society of Hair Restoration Surgery 

NetDerm Female Pattern Baldness