Causes (Common Causes)

Female Pattern Hair Loss (Androgenetic Alopecia)

Genetic female pattern hair loss, long believed to be analogous to male pattern baldness with only slight differences in presentation, manifests as diffuse hair thinning across the entire scalp, while typically retaining some degree of the frontal hairline. Initially, it was widely believed that androgen hormones, similar to male pattern baldness, played a major role in driving this condition. However, current understanding reveals that androgenetic hair loss in women is not solely dictated by male hormones.

Contrary to the previous assumption, most women with Androgenetic Alopecia actually have normal hormone levels, except in cases where they are taking exogenous hormones, notably hormonal birth control. Remarkably, about 90% of women affected by Androgenetic Alopecia show normal naturally occurring (androgen) levels. Interestingly, despite the normal or low-normal hormone levels, treatments specifically targeting androgens for Androgenetic Alopecia can still prove effective.

Differences between Female Pattern Hair Loss (FPHL) and Male Pattern Hair Loss:

  1. Female pattern hair loss (FPHL) is characterized by diffuse hair thinning throughout the entire scalp, often retaining some degree of the frontal hairline. Unlike male pattern baldness, androgens have a less clear-cut role in FPHL, and blocking these hormones may not always be beneficial. In fact, increasing androgen hormones may help some women.
  2. The genetics of hair loss in women are more complex, and some women experience genetic hair loss without a strong family history of the condition.
  3. Alterations in estrogen signaling may play an important role in FPHL.
  4. In women with FPHL, the efficacy of the drug finasteride (commonly used to treat hair loss in men) cannot be predicted with the same degree of certainty as in men with androgenetic alopecia (AGA).
  5. The patterns of hair loss differ, with women experiencing central scalp hair loss (generally) while men lose hair in the temples and crown of the head.
  6. Am extremely small percentage (less than 5%) of women are suitable candidates for hair transplant surgery due to the impact of genetic hair loss on the donor area.
  7. Females have significantly lower levels of 5 alpha reductase compared to men.
  8. Women have higher aromatase levels, which convert testosterone to estradiol and estrone, reducing the conversion to dihydrotestosterone (DHT). Aromatase levels are particularly elevated in the frontal hairlines of women compared to men. These differences may explain why retention of the frontal hairline is a typical feature of FPHL but not observed in male balding.
  9. Although androgen receptor levels are higher in the frontal scalp than the occipital scalp in both men and women, the total receptor level is 40% lower in women.
  10. The lower levels of 5 alpha reductase, higher aromatase levels, and reduced androgen receptor levels in women may account for the fact that the oral medication finasteride is not as effective in women as it is in men.

It is essential to emphasize that early-onset androgenic alopecia in women, also known as female pattern hair loss, has reached epidemic proportions over the past 50 years. This concern came into the spotlight within the field of dermatology when oral contraception was introduced in the early 1960s, leading to a wider range of hormone-based contraceptives. However, by the late 1990s, early-onset female pattern baldness became a significant issue, with hormonal birth control being widely recognized as the primary drug-induced or exogenous trigger for this silent epidemic, despite not being openly discussed.

Surveys involving thousands of female patients reveal that 8 out of 10 women under 40 attribute their hair loss to hormonal contraception use or changes. Being aware of these effects is crucial for both patients and physicians. Regrettably, teenage girls and women are often not provided with full disclosure, and in many cases, they are not armed with the necessary information to make informed decisions about using hormonal birth control. If genetic hair loss is present on either side of the family, patients should be informed that both high androgen index as well as low androgen index birth control pills can trigger this condition much earlier in life.

In the 21st century, a more accurate statistic regarding female pattern baldness, mostly attributed to the early use of hormonal contraception, reveals that approximately 20% of women suffering from early onset FPHL will experience it to some degree by the age of 21. Outdated statistics are often cited on dermatology practice websites, hair loss product and service marketing materials, and even mainstream medicine digital assets.

While some online gurus and even physicians may prefer to attribute this phenomenon to environmental and lifestyle changes, it is crucial to acknowledge that factors like diet, lifestyle, and stress may have some influence on hair health, but their role in causing early onset FPHL is relatively minor compared to the impact of genetics mixed with hormonal contraception.

Therefore, understanding the link between hormonal contraception and female pattern baldness is of utmost importance for both patients and medical professionals, enabling informed decision-making and appropriate care for those affected by this condition.

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