Female Hair Loss

When a female develops hair loss it can be devastating and have a profound effect on her overall well-being. Many women will say it is the worst thing they can imagine happening to them.

Unfortunately, it is very common for women to approach their general practitioners only to leave feeling no better and often dismissed.

This is because general practitioners will see a woman who may look as though she still has a reasonable head of hair but the patient knows it is changing, the fear being what may happen in the future if the existing problem is not dealt with.

There are hundreds of different types of hair loss, some extremely rare, some extremely common and easily resolved.

The common types of hair loss are often due to the following:

• Dietary deficiency
• Illness
• Autoimmunity
• Hormonal change (pregnancy, menopause)
• Hormonal dysfunction (thyroid, sex hormones)
• Diabetes
• Extreme diets
• Iron deficiency
• Scarring skin disease
• Certain contraception plus hormone replacement therapies

The most important factor in helping a patient with hair loss is obtaining an accurate diagnosis. This can only be achieved by obtaining the full picture: the patient’s medical and family history, the manner in which the hair loss is presenting, the appearance of the hair loss, other hair changes occurring and, of course, specific blood tests.

The type of hair loss can only be determined by taking all these factors into account.

Hair loss can also be completely temporary and can spontaneously improve without any treatment, just reassurance.

Sometimes it is impossible to categorically state the cause of a hair loss other than natural changes which can occur in a high percentage of women over time, often decades.

There are very few women in their 8th or 9th decade who have the same density and texture they had in their 2nd and 3rd decades. However, they do not progress to balding as commonly as males.

Hormones

Hormones are chemical messengers in the body which regulate and control cells and organs.

This is a series of finely tuned complex systems which sometimes can become out of sync and imbalance resulting in signs and symptoms in the body which alert us to something changing or going wrong.

Thyroid Hormones

The thyroid is an important endocrine gland that essentially regulates our metabolism and influences the effects of several other (non- thyroid) hormones.

The thyroid gland can become overactive or underactive and one of the first symptoms can be diffuse hair shedding. When the gland becomes underactive, over a period of time the hair can become increasingly dry and brittle. Individual hairs then become much finer and shorter across the vertex (top of head). This can have a very similar appearance to genetic hair loss and adequate blood testing is required to eliminate this as a possible cause.

Sex Hormones

Both sexes have estrogens (female hormones) and androgens (male hormones). At puberty the levels increase to induce sexual maturity in both the male and female. This process is very complex and involves many different hormones to effect many different responses.

In simplistic terms the male hormones induce body hair growth, facial hair growth, muscle development, voice deepening, and testicular development. The female hormones induce breast development, egg production and menstruation. Provided the levels of these hormones are balanced, the male and female body will be healthy and productive.

However, it is the activity of the male hormones (androgens) that cause hereditary (or androgenetic) hair loss in both males and females. A potent androgen called dihydrotestosterone is converted from testosterone in both sexes. It is this androgen which is then able to bind on hormone receptors on follicle cells and cause the follicles to diminish over a period of time.

This only happens in hair follicles genetically predisposed to this effect and in women generally this is less so than in males.

The conversion to DHT in women is caused by the activity of an enzyme called aromatase whereas in men the enzyme is called 5 alpha reductase enzyme. Males generally experience greater effect of this conversion because they have naturally greater conversion.

Nowadays, female and male androgenetic hair loss can be managed effectively in a good percentage of sufferers provided the correct and appropriate treatment is determined from thorough consultation. Age is irrelevant; it is the degree of hair loss that determines treatment regimes.

Hormone Dysfunction

Many women can experience hormone dysfunction as a result of numerous illnesses or syndromes, as can some men. In these cases, comprehensive hormonal blood tests are required to establish whether additional hormone replacement is required. In women with a disease such as Polycystic Ovarian Syndrome it is sometimes necessary to introduce oral anti-androgen treatment, change their contraceptive pill or hormone replacement therapy. This is because certain formulations of OCP or HRT contain progestogens (synthetic progesterone) which are testosterone analogue agents. In other words are potentially androgenic in nature and can worsen hair loss.

The most commonly prescribed OCP formulations and HRT formulations that should be avoided are formulations that contain:

• Norethisterone
• Levonorgestrel
• Norgestimate
• Norgestrel

For patients with hormonal dysfunction it is essential these hormones are rebalanced and any agents contributing to the problem are identified and replaced with more suitable options.

Scarring Alopecias

These types of hair loss are particularly distressing as the follicles are progressively destroyed leading to permanent hair loss.

Sadly, many patients remain undiagnosed and elect to try treatments for androgenetic hair loss which, of course, will not help prevent the disease from progressing as such treatment is not appropriate for these problems.

The priority is to prevent further follicular destruction and this can only be achieved by very specific prescription-only medication.

These diseases can be autoimmune in nature or sometimes bacterial. The different types require a different approach so diagnosis, once again, is all important.