Female Hair Loss: Causes, Tablets, and Treatments

Hair loss in women, also known as alopecia, can be a distressing experience, significantly impacting self-esteem and overall quality of life. While it's less socially acceptable for women than for men, it's important to understand that hair loss is a common issue, particularly among postmenopausal women, where as many as two-thirds experience hair thinning or bald spots. This article will explore the various causes of hair loss in women, with a focus on androgenetic alopecia (female pattern hair loss), and discuss available treatment options, including tablets and other therapies.

Understanding Female Pattern Hair Loss (Androgenetic Alopecia)

Androgenetic alopecia (AGA) is the most prevalent type of hair loss in both men and women. In women, it manifests as a gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head, while the front hairline usually remains unaffected except for normal recession. This pattern of hair loss is sometimes referred to as a "Christmas tree pattern." Unlike men, women rarely progress to total or near-total baldness.

Causes of Androgenetic Alopecia

The exact reasons for female pattern baldness are not completely understood, but several factors are known to play a role:

• Genetics: A family history of male or female pattern baldness increases the risk of developing AGA. The condition may be inherited and involve several different genes.
• Hormones: As the name suggests, androgenetic alopecia involves the action of hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sex drive and regulation of hair growth. AGA is likely related to increased androgen activity. Changes in the levels of androgens (hormones that can stimulate male features)
• Age: Hair loss typically increases around menopause. Almost every woman eventually develops some degree of female pattern hair loss. It can start any time after the onset of puberty, but women tend to first notice it around menopause, when hair loss typically increases.
• Other Factors: Heavy loss of blood during menstrual periods, Certain medicines, such as estrogenic oral contraceptives

Diagnosis

Female pattern baldness is usually diagnosed based on the appearance and pattern of hair loss, medical history, and by ruling out other causes of hair loss, such as thyroid disease or iron deficiency:

• Ruling out other causes of hair loss, such as thyroid disease or iron deficiency.
• The appearance and pattern of hair loss.
• Your medical history.

A clinician diagnoses female pattern hair loss by taking a medical history and examining the scalp. She or he will observe the pattern of hair loss, check for signs of inflammation or infection, and possibly order blood tests to investigate other possible causes of hair loss, including hyperthyroidism, hypothyroidism, and iron deficiency.

Read also: Do You Need Iron Tablets? Find Out Here

Other Potential Causes of Hair Loss in Women

While androgenetic alopecia is the most common cause, it's crucial to consider other potential factors contributing to hair loss in women:

• Telogen Effluvium: This is a nonscarring, noninflammatory alopecia of relatively sudden onset, with similar incidences between sexes and age groups. It occurs when large numbers of hairs enter the telogen phase and fall out three to five months after a physiologic or emotional stressor. The list of inciting factors is extensive and includes severe chronic illnesses, pregnancy, surgery, high fever, malnutrition, severe infections, and endocrine disorders.
• Alopecia Areata: This is an acute, patchy alopecia that affects up to 2% of the population with no difference between sexes. The etiology is unknown, but the pathogenesis is likely autoimmune.
• Tinea Capitis: This is a dermatophyte infection of the hair shaft and follicles that primarily affects children.
• Trichotillomania: This is an impulse-control disorder where patients consciously or unconsciously pull, twist, or twirl their hair.
• Trichorrhexis Nodosa: This occurs when hairs break secondary to trauma or because of fragile hair.
• Anagen Effluvium: This is abnormal diffuse hair loss (usually abrupt) during the anagen phase due to an event that impairs the mitotic or metabolic activity of the hair follicle, most commonly chemotherapy.
• Medical Conditions: Thyroid disorders, diabetes, and autoimmune diseases can contribute to hair loss.
• Medications: Blood thinners, statins, and anti-hypertensives are some medications that may lead to hair loss.
• Nutritional Deficiencies: Deficiencies in protein, iron, vitamin B12, and calcium have been linked to hair loss.
• Stress: Significant physical or emotional stress can trigger temporary hair loss.

Treatment Options for Female Hair Loss

Treatment for female hair loss depends on the underlying cause and may involve a combination of approaches.

Medications

• Topical Minoxidil: This is the only medicine approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness. It is available over-the-counter in 2% and 5% solutions or foam. Minoxidil elicits its greatest effect at the vertex and frontal regions of the scalp where it is known to slow the rate of hair loss by prolonging the anagen phase and promote hair regrowth by increasing both hair diameter and density. Minoxidil may help hair grow in about 1 in 4 or 5 women. In most women, it may slow or stop hair loss. You must continue to use this medicine for a long time. Hair loss starts again when you stop using it. Also, the hair that it helps grow will fall out.
• Oral Finasteride: While not approved for use in women and assigned to pregnancy category X, finasteride is approved for the treatment of male pattern baldness since 1997. It is available in 1 mg and 5 mg tablets, of which the lower dose is indicated for male pattern baldness.
• Oral Dutasteride: Although not FDA-approved, dutasteride has shown superior efficacy both in blocking DHT and promoting hair growth compared to finasteride.
• Oral Minoxidil: Although not FDA‐approved and not nearly as popular as finasteride, multiple studies were conducted to evaluate oral minoxidil for treating both male and female patients with AGA. The drug is available as a 2.5 mg tablet, and it can be cut in halves or quarters to achieve optimal safe dosing for the treatment of AGA.
• Spironolactone (Aldactone): This diuretic drug has anti-androgen properties and may be prescribed for women who don't respond to minoxidil, especially those with polycystic ovary syndrome (PCOS). This medication is especially helpful for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens. Doctors will usually prescribe spironolactone together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.)
• Flutamide: This is an oral antiandrogen medication rarely used in practice due to the risk of hepatic injury and has a Black box warning of hepatic failure.
• Cyproterone Acetate (CA): This is an oral antiandrogen medication associated with weight gain, breast tenderness, and decreased libido and is not available in the United States.
• Ketoconazole Shampoo: Your provider may recommend ketoconazole shampoo.
• Corticosteroids: These medications are used to treat people with alopecia areata, lichen planopilaris, and discoid lupus erythematosus. These immune system suppressors can counteract the effects of an autoimmune disease, allowing hair to grow. Steroids are available as topical solutions or injections, and all require a prescription.

Considerations for Oral Therapies

Oral therapies are often the easiest treatment options for patients with progressing and moderate AGA, but certainly have more potential side effects than topical agents.

Finasteride: As a well‐studied and widely used medication, finasteride has been approved for the treatment of male pattern baldness since 1997. It is available in 1 mg and 5 mg tablets, of which the lower dose is indicated for male pattern baldness. It is not approved for use in women and is assigned to pregnancy category X due to risk of causing ambiguous genitalia in a male fetus. Clinicians should exercise caution when treating AGA patients with finasteride due to the risk of sexual side effects.

Dutasteride: Due to dutasteride's large molecular size, it is difficult to formulate and deliver as a topical agent. However, its large size and lipophilic nature contribute to it remaining on the scalp and preventing systemic absorption.

Read also: Lasting Hair Graft Results

Oral Minoxidil: Multiple studies were conducted to evaluate oral minoxidil for treating both male and female patients with AGA. The drug is available as a 2.5 mg tablet, and it can be cut in halves or quarters to achieve optimal safe dosing for the treatment of AGA. Oral minoxidil's side effects, however, are typically dose‐dependent and reversible with discontinuation of the drug.

Spironolactone: Although labeled for the treatment of cardiovascular diseases, spironolactone has been widely used as a treatment for female pattern hair loss due to its antiandrogenic properties. Although well‐tolerated and has been on the market for decades, the side effects of spironolactone include electrolyte imbalance, worsening of renal function, and hypotension.

Flutamide: Flutamide carries a risk of hepatic injury and has a Black box warning of hepatic failure. Flutamide is an oral antiandrogen medication rarely used in practice.

Cyproterone Acetate: CA is not available in the United States, but has been used in other countries. Cyproterone acetate is associated with weight gain, breast tenderness, and decreased libido.

Other Treatments

• Low-Level Laser Therapy (LLLT): LLLT is typically administered through home‐use devices that are available in the forms of combs, helmets, and caps.
• Light-Emitting Diode (LED) Devices: These devices may emit a small band of wavelengths and can be self-administered at home and controlled by a mobile application to also record daily compliance.
• Platelet-Rich Plasma (PRP) Injections: During the procedure, approximately 10-30 mL of blood are drawn from the patient's vein and centrifuged for 10 min in order to separate the plasma from red blood cells. The platelet-rich plasma, containing numerous growth factors, is then injected into the deep dermis or subcutaneous tissue at a volume of 4-8 mL per session.
• Hair Transplant: This procedure can be effective in females who do not respond well to medical treatment and with no significant cosmetic improvement from their treatment. During hair transplant, tiny plugs of hair are removed from areas where hair is thicker, and placed (transplanted) in areas that are balding.
• Hair Weaving, Hairpieces, or Hairstyle Changes: These can help hide hair loss and improve your appearance.
• Biotin Supplements: This B vitamin helps your body produce keratin: a protein that’s important for healthy skin, hair, and nails.
• Zinc Supplements: The mineral zinc is essential to keratin.
• Vitamin D Supplements: Research shows a strong link between low levels of vitamin D and hair loss.
• Saw Palmetto: Extracted from palm trees, this supplement seems to work similarly to finasteride-at least according to early research.

Lifestyle and Home Remedies

You might want to try various hair care methods to find one that makes you feel better about how you look. For example, use styling products that add volume, color your hair, choose a hairstyle that makes a widening part less noticeable. Use wigs or extensions, or shave your head. Talk with a hair stylist for ideas.

Read also: Customizing Your Hair Oil Blend

The Importance of Early Diagnosis and Treatment

Early diagnosis and initiation of treatment are desirable as these treatments are more effective at arresting progression of hair loss than stimulating regrowth.

Coping with Hair Loss

Hair loss can affect self-esteem and cause anxiety. It's important to acknowledge these feelings and seek support if needed. Consider talking to a therapist or joining a support group to address emotional difficulties.

In a 1993 Glamour magazine survey, over half of the women stated “if my hair looks good, I look attractive no matter what I’m wearing or how I look otherwise,” and “if my hair isn’t right, nothing else can make me feel that I look good” (Etcoff 1999). While hair loss can be distressing for males, a social acceptance and understanding of this phenomenon generally allows normal psychosocial functioning. In contrast, FPHL is not expected and less understood by society generating feelings of confusion and distress for the woman. A study has shown that 52% of women were very-to-extremely upset by their hair loss, compared with 28% of men (Cash 1992; Cash et al 1993).

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