Minoxidil for Hair Loss in Women

It's the only treatment FDA-approved for female pattern baldness, or androgenetic alopecia. While it's effective at stopping hair loss, women need to know about this drug's potential side effects.

Women who have female pattern baldness, or androgenetic alopecia, lose about 150 hairs a day — more than the 50-100 hairs that women without thinning hair lose daily. And unfortunately, once those hairs are lost, it takes a long time to grow them back, so getting hair loss treatment early is the best strategy.

The telltale sign of androgenetic alopecia is an overall thinning of your hair. For many women, hair loss happens on the top or the front of the head.

Fortunately, minoxidil (Rogaine) can help stop the hair loss in its tracks. In some cases, it can even help regrow new hair. But there are disadvantages to using the medication, which comes as a topical lotion or foam, especially for women.

Who May Need Minoxidil and How It Works

Minoxidil applied topically to the scalp only works if your hair loss is a result of female pattern baldness and not some other condition, says Clarissa Yang, MD, a dermatologist at Brigham and Women’s Hospital in Boston.

Normally, hair grows about half of an inch each month. Each hair grows for up to six years, then it stops growing, rests for a while, and eventually falls out and is replaced by a new hair that grows for six years. If your hair is growing normally, about 85 percent of it is growing at any given time and 15 percent of it is resting.

But if you have female pattern baldness, your hair follicles get smaller and smaller over time, Dr. Yang says. The smaller they are, the shorter the amount of time your hair grows. Eventually, when strands of hair fall out, they’re not replaced with normal new hair, but instead by thinner, finer strands of hair.

Doctors think that, among other possible causes, aging, genetics, and a change in the level of male hormones, or androgens, after menopause may be part of what brings on female pattern baldness. (That’s why female pattern baldness is also called androgenetic alopecia).

Minoxidil is the only drug which is FDA-approved to treat female pattern baldness. It works by prolonging the growth phase of the hair follicles, Yang says. It’s recommended that women use minoxidil 2%, while men can use the 5% formula.

Minoxidil: Pros

In most women, minoxidil slows down or stops hair loss. And in up to a quarter of the women who take it, minoxidil can actually encourage new hair to grow. It works best when you use it as soon as you notice that you’re losing hair, Yang says.

It’s available over the counter, so you don’t need a prescription from a doctor to get it. However, Yang encourages everyone to see a primary care doctor or a dermatologist before beginning treatment, because there could be a medical problem that’s causing the hair loss, such as thyroid dysfunction or nutritional abnormalities.

Minoxidil: Cons

There also are some disadvantages to taking minoxidil as a hair loss treatment. These include:

• It’s expensive. Buying Rogaine for women can cost about $30 for two ounces, but a generic form of minoxidil 2% costs almost half the price. It’s also something you have to continue using indefinitely because the results go away if you stop the medication, Yang says.
• It can be inconvenient. You have to apply it to the scalp two times a day.
• It can cause unwanted hair growth. Some women may experience facial hair growth when they use minoxidil. That can happen if the medication trickles down onto your face or simply as a side effect when you apply it only to your scalp. The risk is lower for women who use the 2 percent concentration of the drug, as opposed to the 5 percent concentration that’s designed for men.
• It can cause more hair loss at first. You may notice an increase in hair loss during the first two to four weeks of using minoxidil, Yang says. That happens because some of the old hairs are being pushed out by new ones, she says.
• It can take months to see results. You have to use it for at least four months — and possibly a year — before you see results. Even then, only about one in five women will have moderate hair regrowth, with a larger percentage noticing only that their hair loss seems to slow down or stop.
• It can irritate your skin. You may experience some irritation, flaking, and redness.

It’s not easy knowing you may never have the same long locks or hairstyles you had when you were younger, but minoxidil is a relatively easy, safe way to fight the loss of your hair.

Hair Loss in Women Articles

In the words of Elizabeth Steel, hair loss is miserable enough for a man: a downright catastrophe for a woman. A survey by Hairline International, the baldness support group, found that 78% of its female members no longer felt like women, 40% said their marriage had suffered and 63% had considered suicide.

Women who lose their hair often worry that they are going bald like a man, and that their hormones are becoming masculinized. In fact, patchy baldness (alopecia areata) and total baldness (alopecia totalis and alopecia universalis) are unrelated to hormones and occur equally commonly in men and women.

Thinning hair after the menopause

Like men, most women develop widening partings and thinning of the hair all over the scalp with age; this is normal. It actually starts in the teens or early 20s, and by the age of 50 over half of all women have thinning hair. After the menopause, thinning of the hair is more pronounced. Hair can also become thin at the front, similar to the male pattern. This is because the hair follicles are responding in exactly the same way as in balding men to the testosterone in the blood. All women have testosterone; this is perfectly normal. The balding does not mean that the woman has more testosterone; it simply means that the hair follicles on her scalp are oversensitive, which is probably inherited. The hair will eventually not become any worse. There is no need to worry that you will become completely bald.

Hair loss and other symptoms

A few women develop male pattern baldness with other problems such as growth of hair on the face, lumpy acne, deepening of the voice and irregular periods. In rare cases, this can mean that too much testosterone is being produced by a tumour, so it is important to see your family doctor so that appropriate tests can be done.

Causes of thinning hair in women

Thinning hair may be caused by:

• age (most old people have thinner hair than when they were young)
• heredity (some people are programmed to have thin hair, particularly as they get older)
• a hormone disorder (particularly an underactive thyroid gland)
• drugs
• iron deficiency (most likely in women who are vegetarians)
• severe mental stress (such as bereavement), 2–3 months previously
• severe physical illness of any sort, 2–3 months previously (particularly a high fever or severe infection – the hair grows again when the body has fully recovered)
• childbirth (it is common to shed a lot of hair for 1–6 months after childbirth, but it usually grows again afterwards)
• systemic lupus erythematosus (SLE, a disease affecting the connective tissue)
• damage from bleaches and relaxers, which can make the hair become ‘soapy’ in texture and break off (Afro-Caribbean hair is especially vulnerable).

Treatments for thinning hair in women

Looking after your hair. Just because your hair is thinning there is no need to avoid hairsprays, careful perming or hair dyes. These will not worsen the problem. In fact, perms and hairsprays lift the hair and disguise thinning. However, you should avoid bleaches and hair relaxers. Short, bouncy hairstyles give lift and body. It is also all right to use hair colorants on thinning hair, but darker shades may make thinning more obvious.

Diet. Low stores of iron in the body can sometimes cause hair loss so, particularly if you are vegetarian, ask your doctor for a blood test. Iron-rich foods include lean red meat, game, offal, egg yolks, dark green leafy vegetables and pulses. Vitamin C helps your body to absorb iron. Although hair follicles need plenty of the essential amino acids – the building blocks of proteins – it is doubtful whether increasing your intake of protein or taking amino acid supplements will really help.

HRT, depending on the type, can affect the hair. If you are taking HRT containing progestogen, ask your doctor for a third-generation type of progestogen HRT, which is less similar to male hormones and may be better for women with hair loss.

Hair transplantation. If you are very distressed by thinning hair, and Regaine has not helped, you might consider hair transplantation, which can be done for women as well as men.

What Women Can Do To Stop Hair Loss

Q: I'm in my early 40s and I've noticed sudden hair loss. I'm devastated. Why is this happening and what can I do?

A: Women don't expect to lose their hair (unlike men), so when it happens it’s extraordinarily traumatic.

We normally have, on average, 100,000 hairs on our scalp. And as evinced by our changing hair lengths, roots and visits to our hairdressers, those hairs grow; in fact, 90 percent of our hair is actively growing at any given time. Hair is the second fastest growing tissue in our body after (I'd love for you to guess) … bone marrow. To keep its place on your head, your hair needs the right conditions. (Note I didn’t say conditioner.) You may find that you're unexpectedly losing hair if you impose restrictions on hair growth or if your genes are such that continued hair growth is not in your destiny.

There's a simple test you can do to help determine whether you are losing hair, it’s just thinning or you are damaging it by abusive hair products or pulling it too tight (which can occur with braiding). Pull on several strands of your hair — do they come out easily at the root? If so, it suggests that the hairs are indeed “shedding” and have gone into what we call an excess telogen phase.

To explain this telogen phenomenon, I must first go into hair physiology 101. As hair actively grows, it’s in the anagen phase. Each hair is connected to a hair shaft (or follicle), which remains in its secure position in the scalp for three to seven years before falling out and being replaced by a new follicle. Once the anagen phase naturally runs its course, there's a two-week catagen phase, in which the hair follicle dies. The hair then goes into the telogen phase for the next three months, during which time it falls out. Normally we lose 100 telogen hairs a day, but in certain cases (and this sounds like your situation), many, if not most, of the hairs go into the telogen phase. This causes alopecia (balding). The condition of overwhelming telogen loss is termed telogen effluvium; the anagen to telogen ratio has gone from its normal 90:10 to 70:30 or less. If I do the math correctly, this means you lose at least 300 hairs a day, compared to 100 hairs.

Some sort of stress or medication that started three months before you see the actual hair loss usually causes telogen effluvium. And there are many stresses that can lead to this condition. These include all major illnesses, especially if you're bedridden and/or have a high fever, surgery, childbirth (giving birth can be stressful, but the hair loss is also due to the body's reaction to a sudden loss of hormones after delivery), rapid weight loss, nutrition deficiencies (we see this more in vegetarians who don’t get enough iron or protein), or hemorrhage and subsequent anemia. Hormonal changes often have a negative effect on hair. Hair loss occurs with thyroid disorders or in instances when there is a sudden cessation or change in hormones (such as stopping the birth control pill, surgical menopause, discontinuing hormone therapy and, as I stated above, after childbirth).

Then there's the hair loss effect of taking certain medications, rather than stopping them. There is a long list of drugs associated with hair loss, but here are the most common ones (in which hair loss occurs in more than 5 percent of people taking it):

• Heparin, interferon, Accutane (for acne), Altace, certain anticonvulsant drugs such as Klonopin and valproic acid

Drugs that less commonly lead to hair loss (but can cause this side effect) include:

• Acyclovir, Lupron, Cyclosporin, certain anti-arrhythmia medications, high doses of naproxen, and antidepressants such as Paxil, Zoloft, and Effexor

You may wonder about chemotherapy drugs and their impact on hair loss. These drugs don't actually change the status of hair, because they cause hair to fall out during the anagen phase. The hair loss from chemo usually occurs 7 to 14 days after onset of treatment.

The good news is that hair loss associated with telogen effluvium is temporary, and usually the hair will grow back within six months of the initial hair loss trigger. That said, there are individuals in whom it takes years for full hair recovery, possibly due to ongoing hair loss triggers or subsequent triggers that added insult to hair injury.

I suspect that your hair loss is due to one of these hair stressors. But we should go over other causes of hair loss that are usually more gradual. The most common is female pattern hair loss (hair thinning), which can occur any time between puberty and old age. Although we associate thin hair and balding with male gender, female pattern hair loss (called androgenic alopecia) occurs in 38 percent of women. Usually the center part of the scalp goes first, though hair on the lateral sides can also start to thin. A topical 2 percent minoxidil solution applied twice a day helps treat this type of hair loss. It has been found to increase “minimal” hair growth in 50 percent of women who use it and “moderate” hair growth in 13 percent. However, you need to wait 32 weeks to see these results. For women who've waited patiently and don't see any growth, doctors can prescribe a 5 percent solution. (Please note, however, although this is quite commonly prescribed, the FDA hasn't approved this concentration for use in women.) If long-term female pattern hair loss does not respond to topical therapy, the option of hair transplantation can be considered.

Finally, some of my patients complain of what they think is “typical” male pattern hair loss. If they also have acne and hair growth on other parts of their body, I will check their male hormone levels. If they are high or they are diagnosed with a condition called PCOS, I might prescribe medications that block male hormones. One that is commonly used is the mild diuretic spironolactone.

About Hair Loss in Women

Hair loss is relatively common in women with about 30% experiencing at least some degree of thinning in their lifetime. However, because female hair loss tends to be diffuse (less hair all over) and because women often maintain their frontal hairline their hair loss may not be noticeable, particularly in its early stages.

The psychological effects of hair loss can be significant for women and many are emotionally affected, even with modest amounts of thinning. This is, in part, due to the false assumption that it is uncommon for women to lose their hair and that hair loss in women is perceived to be socially unacceptable. Both of these erroneous perceptions make dealing with hair loss particularly difficult for women.

In addition, the widely used medication Propecia is not indicated for women, so there is a misconception that medical progress in treating female hair loss is not as advanced, or that the medical community does not take the treatment of female hair loss as seriously. Lastly, because hair loss in women can so often be disguised with existing hair, many women choose to hide their hair loss from others. Not sharing their problem tends to isolate them and makes the ability to deal with their hair loss all the more difficult.

Hair loss in women is generally very gradual, with the rate accelerating during pregnancy and at menopause. It can also show seasonal variations and it is more easily affected by hormonal changes, medical conditions and external factors.

Causes of Hair Loss in Women

Common or “hereditary” baldness in women, also called female pattern alopecia, is genetic and can come from either the mother’s or father’s side of the family. It is affected by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-alpha reductase (which is found in both women and men). However, since the diffuse pattern of hair loss typically seen in women can be caused by a number of medical conditions other than common genetic hair loss, a thorough evaluation is particularly important for female patients. If an underlying medical cause can be found and treated, the hair loss can often be reversed.

Classification of Female Hair Loss

The common diffuse pattern of female hair loss caused by heredity is organized by the degree of thinning. This system of classification for hair loss in women is called the Ludwig Classification. Hair loss in the Ludwig system is labeled as being mild, moderate and extensive.

Diagnosis of Hair Loss in Women

The diagnosis of “female pattern” hair loss is relatively straightforward when there is a history of gradual thinning in the front and/or top of the scalp, a relative preservation of the frontal hairline, a positive family history of hair loss and the presence of miniaturization in the thinning areas. Miniaturization, the progressive decrease of the hair shaft’s diameter and length in response to hormones, can be identified using a hand-held device called a densitometer.

Besides densitometry, two other common diagnostic tests that can be performed in the physician’s office are the hair-pull (a test for shedding) and the hair pluck (a test for hair damage). If common causes are ruled out, a more thorough diagnosis is called for, which may include blood work, a biopsy, or other laboratory testing.

Treatment of Hair Loss in Women

Hair Loss Medication

Rogaine (minoxidil), a topical hair loss medication, has a 2% solution that is approved for women. Although Propecia (finasteride), is not indicated for women, some female patients with hair loss may benefit from using the oral medication spironolactone (used mainly to control blood pressure).

Laser Therapy

Low-Level Laser Therapy (LLLT) is a treatment for hair loss based on the principle of photo-biotherapy where a laser stimulates hair follicles on the scalp producing thicker hair shafts and a fuller appearance. LLLT is most useful in patients with diffuse hair loss (the most common pattern seen in women) although the benefits are generally modest. Two commonly use forms of laser treatment for hair loss are the Laser Comb and the Laser Cap. Both products can be used at home.

Camouflage

Since women’s hair loss is typically diffuse with a persistent frontal hairline, it is generally possible for women to be able to hide their thinning with creative styling and other camouflage techniques. Using cosmetic camouflage products may also help. A number of over the counter products are now available that can make the hair look thicker. They come in a variety of forms; powders, sprays and creams. The main limitation of these products is that one must have enough hair to hold the cosmetics in place and, unless it is applied properly, it may not look natural.

Surgical Hair Restoration

The development of surgical hair transplant techniques, particularly Follicular Unit Transplantation (FUT), allows many women to have a completely natural hair restoration. When performed on a good candidate, hair transplantation can produce a dramatic change in a woman’s appearance.

5 Causes of Hair Loss in Women

At a certain point, hair loss happens to almost everyone. Here, expert insight into what’s expected, what’s excessive—and how to handle it.

It can be alarming when your brush seems to hold more hair than your scalp does. The good news is that some hair loss is to be expected (the average person loses up to 150 strands a day). If you’re shedding significantly more than that, however, any number of physiological or psychological factors could be to blame. But you don’t have to tear your (remaining) hair out. Whatever the cause, there are strategies that can help.

What’s Normal…

First a bit about your hair’s natural growth cycle: Each strand grows for several years, then enters a resting phase for three to four months before it is finally shed. Next, the follicle begins to grow a new hair, and the cycle begins again. Different strands of hair are in different phases of the growth cycle at any given time, which is why you don’t go bald every few years. As you get older, “hair can grow back in more sparsely, and the strands may be thinner than they were when you were younger,” says Doris Day, a clinical associate professor of dermatology at New York University.

...And What’s Not

If you notice your part widening, your scalp showing through at your crown, or the hair at your temples receding, you may have an issue. Here are a few possible culprits. Consult your doctor, who can help you get to the root of the problem.

Genetics

Hereditary hair loss affects approximately 30 million women in the United States, according to the American Academy of Dermatology. Female-pattern hair loss—a.k.a. androgenetic alopecia—is the most common form and causes the hair on top of the head to thin. The over-the-counter preparation Rogaine, which contains the active ingredient minoxidil, can help. Applied directly to the scalp twice a day, it “can slow or stop hair loss in most women. In some cases, it can even help regrow hair,” says Sonia Badreshia-Bansal, a clinical instructor of dermatology at the University of California, San Francisco. “But the benefits are lost when you stop using it.” A newer over-the-counter regimen from DS Laboratories—which is composed of Revita Shampoo, Revita.Cor Conditioner, and Spectral.DNC-N (a scalp treatment)—includes antioxidants and stem cells and has been shown to stimulate and maintain healthy new growth. (Prices start at $31; dslaboratories.com for salons.)

Stress

Hair loss can occur after a significant physiological strain, such as a prolonged illness or crash dieting, which may leave you deficient in iron, B12, or protein—all vital to healthy hair growth. An emotionally trying event, like a divorce, can also lead to allover thinning three to four months later, when the hairs that were forming under the scalp at the time finally make (or don’t make) their appearance. Usually the hair will grow back in a few months. If a nutrient deficiency is the cause, your doctor can help you supplement your diet.

Medication

Some oral contraceptives, antidepressants, anticoagulants, and hypertension, acne, and cholesterol medications may cause temporary patchy hair loss. Again, talk to your doctor.

Brushing or Pulling

Brushing hair too vigorously or wearing tight braids or ponytails can pull hair out in patches, a condition called traction alopecia. “The hair will grow back when the repeated tugging stops,” says Nicole Rogers, a clinical assistant professor of dermatology at Tulane University School of Medicine, in New Orleans.

The Immune System

With alopecia areata, a woman’s immune system attacks her follicles, resulting in round patches or clumpy hair loss. Cortisone injections can help.

Short-Term Solutions

Regardless of what type of hair loss you are experiencing, volumizing hair products can make it less noticeable. The newest generation, applied before blow-drying, coats strands with polymers that can make them appear fuller. Try John Frieda Luminous Volume Blow-Out Spray ($10 at drugstores).

Types of Hair Loss

Hair loss, also called alopecia, is a disorder caused by an interruption in the body’s cycle of hair production. Hair loss can occur anywhere on the body, but most commonly affects the scalp. On average, the scalp has 100,000 hairs that cycle through periods of growing, resting, falling out, and regenerating.

A hair growth cycle consists of three phases. During the anagen phase, hair grows actively. This phase may last for years. During the catagen phase, hair stops growing and separates from its follicle, which is the structure beneath the skin that holds the hair in place. The catagen phase lasts about 10 days. During the telogen phase, the follicle rests for two or three months, and then the hair falls out. The next anagen phase begins as a new hair grows in the same follicle. Most people lose 50 to 100 hairs per day as part of this natural cycle.

If this cycle is disrupted, or if a hair follicle is damaged, hair may begin to fall out more quickly than it is regenerated, leading to symptoms such as a receding hairline, hair falling out in patches, or overall thinning.

Hair loss may be linked to a person’s genetics, although many medical and behavioral conditions may interrupt the growth cycle and cause hair loss. At NYU Langone, dermatologists specialize in hair and scalp disorders and can identify the type of hair loss, as well as its cause.

Androgenetic Alopecia

Androgenetic alopecia is the most common type of hair loss, affecting more than 50 million men and 30 million women in the United States. Commonly known as male pattern hair loss or female pattern hair loss, androgenetic alopecia is hereditary but can be managed with medication or surgery.

Male Pattern Hair Loss

In men, hair loss can begin any time after puberty and progress over the course of years or decades. It starts above the temples and continues around the perimeter and the top of the head, often leaving a ring of hair along the bottom of the scalp. Many men with male pattern hair loss eventually become bald.

Female Pattern Hair Loss

In women, hair slowly thins all over the scalp, but the hairline usually doesn’t recede. Many women experience this type of hair loss as a natural part of aging, although hair loss may begin any time after puberty. Female pattern hair loss can cause hair to thin dramatically, but only rarely does it lead to baldness.

Telogen Effluvium

Telogen effluvium, a type of hair loss, occurs when large numbers of follicles on the scalp enter the resting phase of the hair growth cycle, called telogen, but the next growth phase doesn’t begin. This causes hair to fall out all over the scalp without new hair growth.

Telogen effluvium does not generally lead to complete baldness, although you may lose 300 to 500 hairs per day, and hair may appear thin, especially at the crown and temples.

A medical event or condition, such as a thyroid imbalance, childbirth, surgery, or a fever, typically triggers this type of hair loss. Telogen effluvium may also occur as a result of a vitamin or mineral deficiency—iron deficiency is a common cause of hair loss in women—or the use of certain medications, such as isotretinoin, prescribed for acne, or warfarin, a blood thinner. Starting or stopping oral contraceptives (birth control pills) may also cause this type of hair loss.

Telogen effluvium usually begins three months after a medical event. If the triggering event is temporary—for example, if you recover from an illness or stop taking the medication causing the hair loss—your hair may grow back after six months. Telogen effluvium is considered chronic if hair loss lasts longer than six months.

For reasons that are unclear to doctors, this type of hair loss may last for years in some people. If hair doesn’t regrow on its own, our dermatologists can offer medication that can help.

Anagen Effluvium

Anagen effluvium is rapid hair loss resulting from medical treatment, such as chemotherapy. These potent and fast-acting medications kill cancer cells, but they may also shut down hair follicle production in the scalp and other parts of the body. After chemotherapy ends, hair usually grows back on its own. Dermatologists can offer medication to help hair grow back more quickly.

Alopecia Areata

Alopecia areata is an autoimmune condition, which means the body’s immune system attacks healthy tissues, including the hair follicles. This causes hair to fall out and prevents new hair from growing.

This condition can affect adults and children, and hair loss can begin suddenly and without warning. Hair from the scalp typically falls out in small patches and is not painful. Hair in other parts of the body, including the eyebrows and eyelashes, may also fall out. Over time, this disease may lead to alopecia totalis, or complete hair loss.

Dermatologists treat alopecia areata with medication that may help hair regrow. If you are interested in talking with other people who have alopecia areata, NYU Langone hosts a monthly support group for people with this condition.

Tinea Capitis

Tinea capitis, also called scalp ringworm, is a fungal infection of the scalp that’s a common cause of hair loss in children. This condition causes hair to fall out in patches, sometimes circular, leading to bald spots that may get bigger over time.

The affected areas often look red or scaly, and the scalp may be itchy. Sores or blisters that ooze pus can also develop on the scalp. A child with the condition may have swollen glands in the back of the neck or a low-grade fever as a result of the immune system fighting the infection.

Dermatologists can prescribe an antifungal medication taken by mouth to eliminate the fungus. If tinea capitis is diagnosed and treated early, most children have excellent hair regrowth.

Cicatricial Alopecia

Cicatricial alopecia, also known as scarring alopecia, is a rare type of hair loss in which inflammation destroys hair follicles and causes scar tissue to form in their place. After scar tissue forms, hair doesn’t regrow.

Hair loss may begin so slowly that symptoms aren’t noticeable, or hair may start to fall out all at once. Other symptoms include severe itching, swelling, and red or white lesions on the scalp that may resemble a rash. This type of hair loss can occur at any age and affects men and women.

Treatment depends on the type of cicatricial alopecia causing your symptoms. Our doctors have years of experience treating people with cicatricial alopecia and can recommend a variety of treatments to help you. Types of cicatricial alopecia include:

Lichen Planopilaris

Lichen planopilaris, a type of alopecia, occurs when a common skin condition, called lichen planus, affects the scalp. Lichen planopilaris may cause a dry, flaky rash to appear on the skin that causes hair on the scalp to fall out in clumps. The scalp may also become red, irritated, and covered in small white or red itchy, painful, or burning bumps.

Lichen planopilaris is not common and affects more women than men. A doctor may prescribe medication to stop the hair loss.

Discoid Lupus Erythematosus

Discoid lupus erythematosus is a type of cutaneous lupus, an autoimmune disease that affects the skin. It can lead to inflamed sores and scarring on the ears, face, and scalp. Hair loss is one symptom of the disease. When scar tissue forms on the scalp, hair can no longer grow in that area.

Folliculitis Decalvans

Hair loss caused by folliculitis decalvans, an inflammatory disorder that leads to the destruction of hair follicles, is often accompanied by redness, swelling, and lesions on the scalp that may be itchy or contain pus, known as pustules. This type of hair loss is not reversible, but dermatologists can offer medication to control symptoms and, in some instances, stop the progression of hair loss.

Dissecting Cellulitis of the Scalp

Dissecting cellulitis of the scalp, a rare condition, causes pustules or lumps to form on the scalp. This condition may also cause scar tissue to develop, destroying hair follicles and causing hair loss. Medications may help control symptoms.

Frontal Fibrosing Alopecia

Frontal fibrosing alopecia typically occurs in a receding hairline pattern and may also result in hair loss in the eyebrows and underarms. Frontal fibrosing alopecia most commonly affects postmenopausal women. Certain medications can manage symptoms and stop the progression of the disease. The cause is unknown.

Central Centrifugal Cicatricial Alopecia

Central centrifugal cicatricial alopecia may occur as a result of hair products or styling techniques that damage hair follicles. The use of hair relaxers, blow dryers, curling irons, and hair extensions can cause central centrifugal cicatricial alopecia, as can the process of creating a permanent wave, or a “perm.”

The frequent application of oils, gels, or pomades can also cause this condition, which may be reversible if you stop using these hair products or styling techniques. Our dermatologists may recommend taking medication to help hair grow back.

Hair Shaft Abnormalities

Several types of hair shaft abnormalities can lead to hair loss. These conditions cause strands of hair to thin and weaken, making them vulnerable to breaking. The hair loss doesn’t occur in the follicle but as a result of a break somewhere along the hair shaft, which is the visible part of a hair strand. This can result in overall thinning, as well as in many small, brittle hairs.

Making simple changes to the way you style and treat your hair can reverse some hair shaft abnormalities. Other conditions may require medical intervention. Types of hair shaft abnormalities include:

Loose Anagen Syndrome

Loose anagen syndrome, which most commonly presents in young children, occurs when hair that is not firmly rooted in the follicle can be pulled out easily. Most of the time, hair falls out after it has reached an arbitrary maximum length. Children with loose anagen syndrome often cannot grow hair beyond a relatively short length. The condition more commonly affects girls with blond or brown hair.

In people who have loose anagen syndrome, hair can fall out easily—even when it’s growing. For example, hair loss may accelerate overnight because of the friction of a pillow. The cause of loose anagen syndrome is unknown, though it may be related to a disorder in the hair growth cycle that prevents hair from staying in the follicle.

There are few reliable treatments, but the condition tends to improve greatly with puberty, and some medications may result in fuller hair.

Trichotillomania

People with trichotillomania pull their hair out and find it difficult to stop. This results in hair loss on the scalp or elsewhere on the body. Hair often returns if the behavior is stopped, but hair loss can be permanent if the pulling continues for many years.

The best treatment for this condition may be psychotherapy, which might include talking with a counselor about causes of stress and why you feel the urge to pull your hair. Our doctors can refer you to a psychotherapist who specializes in this condition.

Traction Alopecia

Some hairstyles, including tight ponytails and braids, pull hair away from the scalp with such force that hair strands are damaged and fall out. Unless the hairstyle is changed, traction alopecia may lead to thinning hair or bald spots. Most of the time, hair regrows after you alter the hairstyle.

Hypotrichosis

Hypotrichosis is a rare genetic condition in which very little hair grows on the scalp and body. Babies born with this condition may have typical hair growth at first; however, their hair falls out a few months later and is replaced with sparse hair.

Many people with hypotrichosis are bald by age 25. There are few treatment options for this condition, but some medications may help to thicken or regrow hair.

Natural Treatments for Hair Loss in Women

Finding clumps of hair in your brush can be traumatic, whatever your age, but it’s not unusual — statistics show that hair loss affects about 30 million women in the U.S. alone.

There are a variety of possible causes behind hair loss. Pattern baldness or permanent hair loss is simply the result of genetics. Increased hair shedding or temporary hair loss can result from poor nutrition, genetics, imbalanced hormones, medications such as chemotherapy, radiation treatment, infections and chronic stress to name a few. Certain illnesses and diseases — like anemia, low thyroid hormone levels, lupus and some cancers — can also cause hair loss or hair shedding. In most of these cases, hair loss is not permanent.

Dropping weight too quickly, following fad diets or eating extremely few carbohydrates, can also cause imbalances in the body that result in increased hair shedding. Following a healthy weight-loss program can prevent this from happening. The Hormone Diet, which is balanced in protein, carbohydrates and healthy fats, may help to prevent such nutritional deficiencies.

The first step to determining the treatment for hair loss is to identify the cause behind it. Even the pattern of hair loss can help to establish the root source. For example, women may lose hair from the crown of the head — similar to male pattern baldness — with an elevation of testosterone levels, whereas nutritional deficiencies may cause generalized hair loss over the whole head.

Recommended blood tests

In all cases of hair loss, it’s important to ensure that the following blood tests are completed by your doctor:

1. TSH, free T3, free T4 and thyroid antibodies

These are tested to assess thyroid gland function. All of them should be completed to properly diagnose a thyroid condition that may result in excessive hair loss. (Note: Optimally, your TSH should be less than 2.5.)

2. Ferritin

This is the storage form of iron. Low iron (<70) is a very common cause of hair loss.

3. Vitamin B12 and folic acid

Low levels of either of these nutrients may cause hair loss.

4. Copper and zinc

Excess copper relative to zinc could result in hair loss.

5. Dihydrotestosterone

High levels of this hormone are related to hair loss in both men and women.

6. Progesterone and estradiol

Low levels of estrogen can cause an increase in hair loss.

7. DHEAs and cortisol

High levels of cortisol or low DHEAs may contribute to hair loss.

8. Free and total testosterone

High levels of testosterone in women could accelerate hair loss.

9. Biotin

A deficiency of biotin can cause progressive hair loss.

Helpful supplements to prevent hair loss

A balanced diet can help prevent or reverse hair loss when it’s cause by nutritional deficiencies, but supplements can also be useful. The principal nutrients involved in healthy hair growth are vitamin A, certain B vitamins, biotin, vitamin C, copper, iron and zinc. Sufficient protein and water intake are also important.

1. Iron: This mineral’s main job is to carry oxygen in the hemoglobin of red blood cells. Iron deficiency can lead to a condition called anemia and to possible hair loss or increased hair shedding. Anemia can be easily diagnosed with a blood test and is characterized by fatigue, weakness and general poor health. The recommended daily intake for iron is 18 mg (which increases during pregnancy and breastfeeding).

2. Zinc: Dandruff and hair loss are both conditions associated with zinc deficiency. Zinc is a mineral that promotes cell reproduction and tissue growth and repair. It also functions in the maintenance of the oil-secreting glands attached to hair follicles. Aim for 15 mg per day.

3. Vitamin B6, B12, folic acid and biotin: All of these B vitamins are essential to the creation of red blood cells or the hemoglobin (iron-containing) portion of red blood cells. Hemoglobin’s main function is to carry oxygen from the lungs to tissues in the body, including the hair. Healthy and strong hair requires a constant supply of blood and oxygen. A deficiency of these B vitamins can cause reduced blood and oxygen supply to the hair, leading to increased hair shedding, damaged hair and slow regrowth. Although uncommon, sometimes a biotin deficiency can also contribute to hair loss.

4. Vitamin C: A vitamin-C deficiency can make hair more likely to split and break. This usually only occurs with severe deficiency and can be reversed when vitamin C intake is increased.

Vitamin C is essential for producing collagen, a connective tissue that gives structure by holding tissues in the body together, including the tissue in hair. I recommend 60 mg/day for the average adult. People who smoke need double that amount. Many of my patients take 1,000 mg of vitamin C two to four times daily.

Patterned Hair Loss

Patterned hair loss is a progressive hair loss that occurs in a specific pattern. The pattern in men is different to the pattern in women. Men develop recession at the temples, thinning and eventually a bald spot on the top of the head (vertex scalp), then ultimately total baldness over the entire crown. Hair above the ears and at the back of the head is relatively spared.

In contrast, women develop diffuse thinning over the entire scalp that is most pronounced over the crown. Baldness is only seen in a minority of women (less than five per cent).

Patterned baldness is the most common cause of hair loss in both men and women, and is the result of genetic and hormonal factors. Hereditary baldness is so common that it is considered to be a normal part of the ageing process.

All men and women will be affected by patterned hair loss at some stage in their lives. While the majority of men have developed temporal recession by their mid 20s and noticeable balding by their mid 50s, for most women, hair loss is mild and only occurs later in life. However, when hair loss is premature or severe, it can cause distress. A range of treatments is available to slow or reduce hair loss, and stimulate partial regrowth

How hair grows

The human body is completely covered with hair follicles, except on the palms of the hands, soles of the feet and lips. Most follicles are tiny, and many of the hairs they produce do not grow long enough to emerge out from the pore.

Hair is made from a protein called keratin. The only living part of the hair is the root (sometimes known as the bulb), which is attached to the base of the follicle. The follicle supplies oxygen and nutrients to the root, and lubricates the hair shaft with an oily substance called sebum.

Hair is in a constant cycle of growth, rest and renewal. On the scalp, there are approximately 100,000 hair follicles. Over the course of three years, every one of these follicles will produce a hair that grows, rests, falls out and then regrows. That means that every 1,000 days, you shed 100,000 hairs. This equates to 100 hairs shed every day. 

As long as the new hair that grows from that follicle is the same as the one it replaces, the hair density will remain constant. In patterned hair loss, hormones affect the follicle, making it smaller and the new hair becomes shorter and finer than the one it replaces. Eventually, the new hairs are so short and fine they become invisible and the scalp becomes bald. 

Causes of hair loss

It is likely that several genes determine susceptibility to baldness. Some of these genes come from your mother’s side and some from your father’s side of the family. Identical twins lose hair at the same age, at the same rate and in the same pattern. This indicates that genetic factors are more important than environmental factors in causing hair loss.

Androgenetic hair loss is caused by androgen hormones (produced in different amounts by both men and women) that affect the hair follicles in people with a genetic susceptibility. 

Some people think that stress, diet, wearing hats, frequent washing and drinking alcohol are causes of hair loss, but researchers have found no link between any of these activities and patterned hair loss. There is some uncertainty about smoking cigarettes and hair loss, but the evidence is not strong.

Male pattern baldness (androgenic alopecia)

While there are a number of treatments available for male pattern baldness, there is no cure. Treatments include minoxidil, and finasteride. Minoxidil lotion is available over the counter from pharmacies, but finasteride tablets are only available on prescription from your doctor. Cosmetic options include camouflage sprays, wigs and hair transplant surgery.

Hair loss in women (androgenetic alopecia)

Hair loss in women produces scattered thinning over the top of the scalp rather than a bald spot. Patterned hair loss occurs in over 55 per cent of women as they age. For most women, the hair loss is subtle, but about 20 per cent of women develop moderate or severe hair loss.

A number of treatments are available for female pattern hair loss, including topical minoxidil lotion (not recommended for pregnant or breastfeeding women), and tablets such as spironolactone, which have antiandrogen properties (they lower the levels of male hormones). These are available on prescription and require a doctor’s supervision. 

Causes of Hair Loss in Women

Alopecia Areata

This form of hair loss is an “autoimmune” disease, meaning the body causes inflammation around the hair follicle preventing it from growing.  Most often it presents as a coin shaped lesion or discrete patches of hair loss with sharp borders. Less commonly it can be more diffuse. Women with Alopecia Areata can have hair loss in other areas beside the scalp, including eyelashes and eyebrows.

Androgenic (Andro-genetic) Alopecia

This is the most common cause of hair thinning and loss in women. It is also known as Female Pattern Hair Loss, or FPHL. Up to 50 % of women have some degree of this in their lifetime. It certainly is more common as women age, particularly after menopause, but it can start as early as the teenage years. We know that it tends to run in families but sometimes there is no family history. Inheritance can be from either the mother’s or father’s family. We know that hormones play a role in this type of hair loss, especially the “androgenic” hormones such as testosterone. The hair loss is typically more pronounced in the frontal areas of the scalp. Over time the hair shaft gets thinner in a process known as “miniaturization.” Eventually if not treated, the affected hair will continue to get smaller and disappear completely.

Scarring Alopecia

This is a rare type of hair loss, which is due to inflammation around the hair follicle. There often are areas with white scales surrounding an area of inflammation, which then leads to scarring in that area. The hair follicles are actually destroyed and disappear. This is most common in African American women.

Telogen Effluvium

Telogen Effluvium is a common and temporary cause of hair loss. It usually presents as a diffuse hair loss, meaning coming from all parts of the scalp. Most commonly a woman will see increased shedding of hair. This can be caused by pregnancy, rapid weight loss, protein deficiency, emotional stress, physical illness, surgery, trauma, and some medications. Fortunately, it is usually reversible and complete regrowth occurs in about a year.

Traction Alopecia

This type of hair loss occurs from pulling the hair too tightly over prolonged periods of time. This commonly occurs with use of dread locks, or tight ponytails. The constant pulling puts pressure on the hair follicle and can lead to permanent loss.

Women Thinning Hair

As part of the natural growth cycle females lose on average 50 to 100 hair strands each day, but what happens when they stop regrowing back?

While it is generally accepted that men lose their hair as they age, it is not often recognised that female hair loss is almost as common with an estimated 40% of women making up thinning hair sufferers, many suffering their hair loss in silence.

How Does Hair Grow?

To best understand why females suffer hair loss it is important to understand how it grows.

The Anagen phase is the growth period for a hair follicle and can last anywhere from 2-5 years. This is followed shortly afterwards by the Catagen phase, a short 1-2 week transitional stage which signals the end of the active growth of the hair follicle. The final stage is known as the Telogen phase, a period where the hair follicle ‘rests’ for 3-6 weeks until a new hair shaft grows and pushes out the old hair, signalling a return to the Anagen phase to repeat the process again.

Why do Females Lose their Hair?

Female hair loss is caused when the balance between shedding of the hair follicle and regrowth is disturbed, this is created through either a shorter Anagen phase or an increase in the number of hair follicles in the Telogen Phase. There are many factors that can contribute to hair loss in women including genetics, stress and medical conditions.

Common Reasons Why Women Lose Hair

Androgenic Alopecia

Androgenic alopecia is the most common form of hair loss for women and affects about 50% of women over the age of 40 and up to 75% of women over the age of 65. For women Androgenic Alopecia is due to the action of Androgens, male hormones that are typically present in only small quantities in women. Their increased presence in women can be heredity or be created by numerous other factors including the onset of menopause, the taking of high androgen index birth control pills and pregnancy.

Androgenic Alopecia in women can be best characterised by the minaturisation of the hair follicle and a general thinning on all areas of the scalp.

Telogen Effluvium

Telogen Effluvium is characterised by the thinning of hair resulting from the early entry of the hair follicle from the Anagen phase (growth stage) into the Telogen phase (resting phase). For women it Is a common form of hair lose and is usually a reaction to stress on the body’s physical or hormonal systems, or as a reaction to medication.

For women Telogen Effluvium can occur at any age and the onset can happen quickly, however under normal circumstances it will get better on its own within about six months, although for a few people it can become a chronic problem.

Traction Alopecia

Traction Alopecia is a form of alopecia, or gradual hair loss that is caused by localised trauma to the hair follicles. This trauma is often associated with women who frequently wear their hair in a particularly tight style like ponytails, pigtails or braids. It can also be caused through hairstyles like dreadlocks and extensions which can create the same effect. Typically for women affected by Traction Alopecia the hair loss occurs around the hair line, primarily the temples and the sides of the head, and if detected early enough the hair will regrow.

Alopecia Areata

Alopecia Areata is one of the main causes of female hair-loss and is due to an autoimmune disease which effects more than 2 percent of the population. Alopecia Areata is caused when white blood cells attach and attack the hair follicles, with the result being the suppression or even stopping of hair growth.

Understanding and Restoring Women's Hair Loss

Many female hair loss patterns can be classified using the Ludwig classification system. The Ludwig system divides progressive female hair loss into three stages, as illustrated below. The photograph above demonstrates a female with an advanced Ludwig I or early Ludwig II pattern, who may progress to a Ludwig III. 

There are two basic categories for women who seek help with hair restoration - 1) those with a stable or localized hair loss problem; and 2) those with a diffuse or progressive hair loss disorder.

Women with stable or localized hair loss typically make excellent candidates for surgical hair restoration.  Good surgical candidates include women with: 1) a naturally high hairline; 2) age-related hairline recession; 3) hair loss resulting from facelift surgery; 4) traction-related hair loss (tight braids, extensions, weaves); and 5) hair loss resulting from trauma, infection or chemical damage (e.g. perms).  Patients in this group generally have excellent donor hair reserves capable of allowing a full restoration in the affected area. 

Women with diffuse or progressive hair loss patterns are generally considered risky candidates for surgery.  As many as one in four women will experience some degree of age-related diffuse thinning.  Unlike male pattern baldness which has a well-recognized genetic basis, diffuse female hair loss is much more complicated and can have many causes.  Although some in this category make reasonable surgical candidates, the majority of those with a diffuse hair loss pattern cannot be corrected by surgical intervention.  Unfortunately, diffuse patterns often extend into the donor region so as to deplete the very reserves that are needed for restoration.  Proper diagnosis and careful patient selection is mandatory for women with diffuse loss so as to prevent unwarranted surgery and to maximize the benefits of non-surgical therapy.

It is necessary to identify the cause of the hair loss for all female patients prior to considering hair transplantation.  Hair loss arising from many medical conditions can be corrected without surgery.  Evaluation by a non-surgical hair loss expert is the best first step for diagnosing the problem.  A scalp biopsy or blood tests may be required to help find a treatable cause.  Medical management for treatable disorders may include a prescribed medication to help stop hair loss and possibly restore some of the previously lost hair.  Upon completion of the medical evaluation, the non-surgical hair loss expert will provide a recommendation as to whether or not surgical hair transplantation is a viable option for cosmetic improvement.  Once cleared for surgery, the patient and surgeon will determine if the goals for enhancement can be met.  Fortunately, women declared to be good candidates for hair restoration generally achieve results that rival those of men.

FEMALE HAIR LOSS DISORDERS - SURGICAL CANDIDATES

• Women born with a high hairline
• Age-related hairline recession
• Hair loss resulting from facelift surgery
• Traction-related hair loss (tight braids, extensions, weaves)
• Hair loss from trauma, infection or chemical damage (perms, dyes, straighteners)

FEMALE HAIRLINE RESTORATION

Women bothered by an excessively high hairline or those with age-related frontal hairline recessions often make excellent candidates for surgical restoration.  A high hairline or deep recessions can create an aged or masculine look.  Women seeking improvement for these situations may benefit from a procedure which lowers the hairline and fills deep recessions.  A custom-tailored approach is used to match hairline shape with facial characteristics so as to fully accentuate natural female beauty.  Women with high hairlines generally have an abundant supply of donor hair which allows for a complete restoration.

REPAIR OF FACELIFT AND BROWLIFT DEFORMITIES WITH HAIR TRANSPLANTATION

Visible scarring, hairline distortion and sideburn distortion are complications that occasionally follow facelift and browlift surgery.  These problems are easily repaired using ultra-refined follicular unit transplantation.  Transplanted hair can help camouflage even the worst facelift or browlift scars.  Camouflage is possible whether these scars be located around the ears, in front of the hairline or within the hairline.  Follicular unit grafts are implanted directly into and around any problematic scar so as to create a seamless transition between the facial skin and the scarred area.  Hairlines and sideburns that have been moved into unnatural positions or shapes from aggressive facelift or browlift procedures techniques can also be repaired with ultra-refined grafting techniques (Facelift Repair).

HAIR LOSS RELATED TO TRACTION, TRAUMA, INFECTION AND CHEMICALS

Patients with hair loss from traction (e.g. braids, extensions, weaves), trauma, infection and chemicals (e.g. perms, dyes, straighteners) generally make very good candidates for surgical restoration.  As long as adequate donor reserves remain intact, a full restoration can be accomplished to thicken areas thinned by any of these hair loss processes.

FEMALE HAIR LOSS DISORDERS - NON-SURGICAL CANDIDATES

Pregnancy-related hair loss - Hormonal and stress-related hair loss is common following pregnancy.  Post-partum hair loss is usually temporary and often reverses several months following its onset.  Hair shedding commonly stops and healthy hair growth resumes once the hormonal fluctuations of pregnancy has returned to normal.  Occasionally this type of hair loss is permanent.

Thyroid dysfunction - Disorders of the thyroid gland can lead to hair loss. Thyroid dysfunction and the resultant hair loss are more common in women as compared to men.

Iron deficiency - Iron deficiency is more common in women and may be the cause of unexplained hair loss.  Diagnosis can be made with a  blood test.  Dietary iron supplements are recommended as a treatment for iron deficiency-related hair loss. 

Estrogen - Estrogen levels lower with age. Approximately one-third of women experience significant hair loss after menopause. Hormonal replacement may help post-menopausal thinning.

Stress - Stress is a well-recognized cause for hair loss.  Divorce, loss of employment, and death of a loved one come to mind as factors which can lead to stress-related hair loss.  This type of hair loss can resolve once the stress has been controlled.

Vitamin supplements/medication side-effects - Many medications contribute to hair loss and thinning.  Dietary supplements can also influence hair loss as they can contain high doses of vitamins and herbs that interfere with hair growth. Medications should be reviewed with your physician to determine if they are the cause of your hair loss.

Home Remedies For Hair Loss In Women

You could lose at least 100 of your 100,000 scalp hairs each day So you shouldn’t be alarmed if this is the case with you. Usually, the lost hair is replaced by a new hair from the same hair follicle, located just below the scalp’s surface. Luckily we have some great home remedies for hair loss in women to speed up growth.

Preventing Hair loss in women is possible, make sure you are consuming a good amount of vegetable and fruits, try to stay away from chemicals that might damage your hair, and add some vitamins to our daily intake. Furthermore, be assured that now-a-days there are good treatments to control it as well.

Women also lose more hair as they age. Many experience a generalized thinning of the hair or a “widened part” in the center of the scalp after menopause. This is called female pattern baldness.

Premature hair loss or thinning can also be due to a wide variety of other causes. Most women lose quite a bit of hair in the two to three months after they deliver a baby, and this can continue for up to six months. One and a half to three months after severe stress, operation, infection, or high fever, a person may also lose a lot of hair. Likewise, two to three months after crash dieting with insufficient protein intake, hair may come out in handfuls.

As with male pattern baldness, hormonal changes and genetic predisposition are to blame. Although they do not usually lose as much hair as men do, women are also constantly searching for a cure for this distressing problem. All in all, more than two-thirds of all men and women have some type of hair loss or thinning during their lifetime.

Many prescription drugs can cause reversible hair loss. Cancer patients treated with certain chemotherapeutic drugs may lose up to 90 percent of their scalp hair, but it eventually returns after their treatment is finished. Birth control pills that contain high levels of progestin also can cause hair loss.

Other possible causes of hair loss include trauma; syphilis; tumors; thyroid disease; connective tissue diseases; bacterial, fungal, or herpes infections of the scalp; improper hair care with tight hairstyles, overbrushing, or overuse of dyes and permanents; and, in women, too-high levels of male hormones.

Many different nutrient deficiencies result in hair loss, including deficiencies of vitamins A, B6, B12, folic acid, biotin, vitamin C, copper, iron, and zinc. Hair loss can be a sign of vitamin A toxicity as well as deficiency. Vitamins B6, B12, folic acid, copper, and iron are necessary for the normal formation of red blood cells that supply oxygen to the hair shaft.

Copper also functions in the formation of hair pigmentation, so copper deficiency can also cause color changes in the hair. With vitamin-C deficiency, the hair splits and breaks easily, resulting in dry, kinky, tangled hair. Silica also is important for hair growth and strength. Vitamin E is also necessary for good scalp and hair follicle health.

There is also an immune problem known as alopecia areata, in which the hair suddenly comes out in totally smooth, round patches. This condition can cause a lot of pyschological stress. A person with alopecia areata can also lose hair from his or her eyelashes, eyebrows, beard, and the other hairy areas of the body.

Because a full head of hair is associated with virility, youth, and attractiveness, hair loss and thinning can have a huge negative psychological impact on a person. If you start losing more hair than normal, a dermatologist will try to identify the cause by taking a complete history doing blood tests, and examining your hair visually, under the microscope, with hair analysis, and, perhaps, with a scalp biopsy.