What is it?

It is the most common form of hair loss affecting men and women. In female pattern hair loss there is more diffuse thinning over the crown and unlike male pattern hair loss, the hairline is usually preserved. Miniaturization of hair is characteristic of pattern hair loss. Permanent loss of these miniaturized hairs occurs when the condition is left untreated.

What is the cause?

Genetic factors, male hormones (androgens) and increasing age may be important contributing factors in the development of female pattern hair loss. In men, testosterone is converted to dihydrotestosterone via the enzyme 5-α reductase in the scalp. Dihydrotestosterone acts on the hair follicle causing miniaturization of the hair. In a small number of women, the hair loss may reflect increased male hormone production from a range of medical and endocrine conditions.

How will it affect me?

Female pattern hair loss can affect a person’s self esteem and confidence. This can result in significant psychological stress.

How is the diagnosis made?

Your doctor will make an assessment based on history and clinical examination. In women, blood tests are usually required to exclude other causes of hair loss.

What are the treatment options for female pattern hair loss?

Topical minoxidil has been proven to be effective in the treatment of female pattern hair loss. It controls the progression of hair loss and stimulates hair regrowth.

How does minoxidil work, and what are its side effects?

Topical minoxidil is applied twice a day to the affected areas of the scalp. Minoxidil prolongs the growing phase of the hair cycle and thickens the hair. Side effects include scalp irritation and dandruff. Infrequently, hair loss may be paradoxically increased in the first few months of use because hairs from the previous phase of the hair cycle may be shed before new ones grow in. This increased hair loss is usually transient and self-limiting. Some patients may experience increased hair growth on unwanted areas (eg. Forehead, cheeks) if minoxidil application is not precise enough.

What are the other treatment options available? 

When indicated, an oral medication with anti androgen properties such as spironolactone, bicalutamide, finasteride or dutasteride may be used. However, these medications may not be suitable for all individuals. Their use is off-label in female pattern hair loss. Frequent blood monitoring is required for someone on spironolactone. Premenopausal women on antiandrogens need to be on strict contraception as these medications may be harmful to a male fetus. Women with androgen excess may benefit from hormonal therapy. 

Low-dose oral minoxidil may be an option for patients who find topical minoxidil messy, inconvenient or irritating. As it may affect your blood pressure, oral minoxidil may cause tiredness, dizziness, ankle swelling and growth of hairs on unwanted areas. 

Low level light therapy (LLLT) has been used to help with hair loss. This requires the purchase of an LLLT device for home use. However, success rates may vary between individuals. 

Surgical options include hair transplantation and scalp reduction. For patients with advanced female pattern hair loss, cosmetic aids like tinted powder/spray, hair pieces, and wigs may be suitable alternatives.

When can I see results? 

Female Hair loss usually stabilizes after three to six months of therapy. Hair growth may be appreciated in some patients six months to two years later.

How long is treatment necessary? 

Treatment for male and female pattern hair loss is life-long. If treatment is stopped, hair loss recurs three to six months later. Hair that was previously gained may also be lost.

Can treatment reverse complete balding? 

Current medical therapy does not reverse complete balding. Therefore, early therapy before permanent hair loss occurs is advised. Be wary of untested treatments and technologies that are currently marketed for hair loss. When in doubt, seek the advice of a dermatologist.