What is Alopecia?
Alopecia is simply the medical term for hair loss. Female alopecia is both common and distressing.
How I Came to Treat Alopecia
In formal medical training, few physicians hear a word about androgenic alopecia, yet it affects 20% of women up to the forties and even more after that. I become interested in alopecia when I saw how distressing it is to women who have it. Though many of my physician colleagues do not think alopecia is worth medical attention, I disagree. Any bodily change which causes so much unhappiness is worth the effort to diagnose and treat.
Alopecia falls in between specialties. Hair is part of the skin so is included in dermatology. Yet the cause of the most common form, androgenic alopecia, is internal: the actions of hormones which are the focus of a different specialty – endocrinology. Yet few endocrinologists are trained to diagnose or treat hair loss in women. This is unfortunately because bridging the gap between specialties has made it possible to apply new knowledge about hormones to understanding and treating androgenic alopecia.
The ignorance among health professionals about the all too common and distressing condition of alopecia is truly astounding. Many doctors cannot even recognize alopecia. This is terrible for the person seeking help. Being told nothing can be done is bad enough, but not being believed is even worse. Often when I see a woman for alopecia on her first visit, she is surprised when I acknowledge that she has a problem, since so many doctors have told her nothing is wrong. Yet I cannot remember ever seeing a woman worried about alopecia who did not actually have it. With some the loss was very mild, but it was never simply their imagination. After all, each of us knows our body better than anyone else. So here are the first things that need to be said: female hair loss is real, it is distressing to all women who have it, and it can be treated!.
Why am I Losing My Hair?
Alopecia is a general term and can refer to hair loss from any cause. Indeed many diseases can cause hair loss but most are quite rare. Only two are common: alopecia areata which is due to the immune system attacking the hair follicles and androgenic alopecia, which is hormonal.
Androgenic alopecia is extremely common. A reasonable estimate is 20% of women prior to menopause and up to 40% after that. In early stages it so mild as to escape notice by others but most affected women are only too aware that it is happening. A common abbreviation is AGA. Sometimes it is referred to as “androgenetic alopecia” to emphasize the genetic component but I do not like this term because some women with androgenic alopecia do not have it in their family.
As the name implies, androgenic alopecia is due to the effect of androgens, the family of hormones which includes testosterone. One effect of testosterone is to inactivate hair follicles on the scalp. Oddly, it makes follicles on the face and body more active. It’s not fair but the same hormone takes hair away from where it is wanted and puts it where it is not wanted. Yet this is the unfortunate truth about what testosterone does to hair follicles. These effects are very obvious and familiar in men. The much higher testosterone levels give us less hair on the scalp and more on the body than women.
As if this were not enough, testosterone also makes the skin more oily, which in turn can trigger acne. Many women with AGA have only the alopecia but some also have other unwanted effects of testosterone – hirsutism, that is, increased facial and body hair (Hormones and Unwanted Hair) and oily skin or acne. These can be part of PCOS (polycystic ovary syndrome) (PCOSupport The Polycystic Ovarian Syndrome Association Web Site) but many women with AGA have only the alopecia without any other hormonal changes.
In my practice I’ve seen women who have been told they have PCOS but only have androgenic alopecia. But then, I’ve seen some with alopecia whose PCOS had not been diagnosed. A woman with alopecia who is overweight and/or has irregular periods, should get checked to see if she has PCOS because then additional treatments may be helpful.
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