On seeing a bald man walk past, most of us wouldn't take a second glance. But would this be the case if a bald woman walked past? It is doubtful. Hair loss - although distressing - is generally more accepted in men, despite women accounting for 40% of all hair loss sufferers in the US. In this Spotlight, we look at the main causes of hair loss in women, the emotional toll it can take and why research is lagging behind in treatment for female hair loss.
The most common cause of hair loss in both men and women is androgenetic alopecia, also referred to as male or female pattern baldness.
A hereditary condition, androgenetic alopecia is believed to be caused by dihydrotestosterone (DHT), which derives from the male hormone testosterone.
An enzyme called Type 2 5-alpha reductase - present in the oil glands of hair follicles, the skin organs that produce hair - helps convert testosterone to DHT. This derivative then binds to and shrinks hair follicles, killing healthy hair.
Because men have higher testosterone levels than women, they are likely to produce higher DHT levels, leading to increased hair loss. As such, men with androgenetic alopecia often experience a receding hairline which can progress to partial or complete baldness, while women tend to experience hair thinning on the top and sides of the scalp.
"Hair thinning in female pattern baldness is different from that of male pattern baldness in that the frontal hairline remains unaffected except for normal recession, which happens to everyone as time passes, and hair loss rarely progresses to total or near total baldness, as it may in men," Dr. Marc Glashofer, a dermatologist and fellow of the American Academy of Dermatology, explained to Medical News Today.
But androgenetic alopecia is not the only cause of hair loss in women.
What are the other common causes of hair loss in women?
Telogen effluvium is a form of hair loss that can develop when the body is put through extreme stress, such as child birth, malnutrition or major surgery.
The condition involves a sudden shift from hair growth or resting phases to the hair shedding phase, known as telogen. This can occur within 6 weeks to 3 months after a stressful experience.
According to Dr. Shani Francis, also a fellow of the American Academy of Dermatology and director of the Hair Disorders Center of Excellence at Northshore University HealthSystem in Illinois, telogen effluvium is much more common in women than men. "It is the typical 'shedding' that happens after childbirth in some women," she told us.
She added that some triggers of the condition - such as iron deficiency and changes in medication - are more likely to occur in women. "These triggers typically affect women more than men due to menstruation, the most common cause of iron deficiency in women, and the high prevalence of birth control use - some women change birth control quite frequently," she explained.
Traction alopecia is another form of hair loss that is more likely to occur in women. It is triggered by trauma to the hair follicles, most commonly through hair styling that continuously pulls at them - such as braiding, tight ponytails and hair extensions. "This type of hair loss is primarily seen in African-American patients," said Dr. Glashofer.
Another common cause of hair loss in both men and women is alopecia areata - an autoimmune disease that affects around 2% of the US population. The condition can be inherited; around 1 in 5 people who suffer from alopecia areata have a family member with the disorder.
It occurs when the immune system mistakenly attacks the cells in hair follicles, leading to hair loss on the scalp and other areas of the body. In alopecia areata, hair most commonly falls out in small patches. In some cases, however, the condition can lead to complete baldness.
Specific medical conditions - such as anemia and thyroid disorders - and the use of certain medications can also lead to hair loss.
The severe emotional impact of hair loss for women
It goes without saying that hair loss - regardless of gender - can be devastating. It can dent a person's self-esteem and negatively affect their overall quality of life.
"Studies on the psychosocial impact of hair loss have found patients' self-esteem, body image and self-confidence to be negatively impacted," Dr. Francis told MNT. "Known psychosocial complications include depression, low self-esteem, altered self-image and less frequent and enjoyable social engagement."
It seems experts are in agreement, however, that women are significantly more likely to suffer emotionally as a result of hair loss.
"Hair loss in a woman is so emotionally devastating that it can trigger a wide range of social and emotional issues that can negatively impact healthy daily living and overall quality of life. I have heard of women that retreat from social situations, have diminished work performance, and even alter their healthy living - avoiding exercise, overeating, not treating other medical illnesses - due to their hair loss," said Dr. Francis.
But why do women see a greater emotional impact from hair loss than men? According to Dr. Glashofer, it is down to society's perception of beauty. "Society unjustly puts an inordinate amount of pressure on beauty and a great deal of this comes from perceptions of hair," he told us.
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