Thinning and balding are often seen as problems that only affect men.
But less than 45 percent of women will go through life with a full head of hair (1).
In this post, we’ll first introduce female pattern hair loss and its cause. We’ll then discuss the hair growth cycle, and how balding can interfere.
Finally, we’ll share hair loss treatment options that are available for women.
What Is Female Pattern Hair Loss?
You’ve likely heard of Male-Pattern Baldness, which is the most common cause of hair loss in men (2). But can women suffer from pattern hair loss? And if so, what is it?
Female Hair Loss Causes
Just like MPB, female pattern hair loss is a genetic condition in which the sufferer is sensitive to the androgen hormone DHT (3).
DHT plays a critical role in male sexual development, but it also contributes to functions within the female body (4). These include sex drive and even hair growth.
A sensitivity to this hormone, however, can trigger a process known as miniaturization.
When the follicle becomes overwhelmed with DHT, it begins to inflame. This inflammation can become chronic and, if left untreated, will result in shortening of the hair strand.
If this process is allowed to continue for too long, the follicle will eventually die from lack of blood flow. It’s at this point that hair regrowth is impossible.
The good news is that female pattern hair loss is easy to spot. And if you treat it in the earliest stages, you have a good chance of regrowing what you’ve lost.
The Stages of Female Pattern Hair Loss
If male-pattern baldness and female pattern hair loss have the same cause, then what’s the difference between them?
The difference lies solely in how the conditions present.
With MPB, the hairline will begin to recede first. The thinning and balding will then spread to the crown until only a ring of hair is left around the base of the scalp.
The presentation in women is more subtle, however.
The first signs of FPHL are often seen on the crown and/or the hair part. You’ll likely see more shedding on a regular basis, which will soon result in noticeable thinning and loss of density.
The thinning will spread throughout the scalp, but it will continue to be more noticeable at the crown.
In the latest stages, the entirety of the top of the scalp can become bald while the temples and base of the scalp are left untouched. This is an extreme case, but one which is possible.
So, what causes this difference in presentation between men and women?
The most likely answer is hair follicle sensitivity.
In men, it appears that the follicles at the fronto-temporal region of their scalp are more sensitive to DHT and its effects.
There are theories as to why this is, including mechanical tension (5).
And while many women may have greater follicular sensitivity at the crown, they may not have any marked sensitivity at all.
That’s right. Androgens can play a role in some forms of FPHL, but that’s not true for every case (6).
Other Causes of Thinning and Balding in Women
Pattern hair loss is perhaps the most well-known form of hair loss, but it’s not the only kind.
This is especially true in women.
So, what causes besides DHT sensitivity exist?
The triggers for hair loss in women can vary greatly. They may be as simple as a nutrient deficiency which can often be resolved with a supplement, or as complex as a medical condition such as Polycystic Ovary Syndrome (PCOS). In polycystic ovarian syndrome excessive androgens are thought to be the culprit resulting in hair loss.
The only way to know for sure the cause of your thinning and balding, though, is to seek out the opinion of a dermatologist.
A dermatologist can perform tests that will help to pinpoint the exact reason for your hair loss. This will lead to a more effective treatment approach.
The Hair Growth Cycle
Before we can get into the most common treatments for FPHL, it’s first important that you understand how hair grows.
The hair growth cycle is split into three distinct phases: anagen, catagen, and telogen (7).
Anagen phase is perhaps the one most often associated with the hair growth cycle. That’s because this is the only phase where active growth occurs.
During anagen, the germinal matrix within the hair follicle produces cells. These cells build up to form what’s known as the hair strand.
Eventually, the hair strand will pierce the scalp. The growth will then continue for two to six years.
Once the hair has reached its fullest length, the next phase takes place: catagen.
Catagen is the phase of rest and transition. It’s here where the follicle stops actively producing new cells and, instead, pushes the bulb of the strand from its place at the base of the follicle.
The bulb doesn’t completely detach at this point, but during this few week period the hairs do become more likely to dislodge.
The final phase is telogen, and this is where hair shedding occurs.
With the hair bulb completely detached from the follicle base, the strand can now shed from the follicle entirely. It’s at this point you’ll begin to see hair strands with a white bulb at the bottom. That means it’s a telogen hair which has entirely detached to make room for anagen growth.
If the cycle above takes place on a regular basis, then why do we always have hair?
The vast majority of the follicles on your scalp are in anagen phase at any given time (8).
So in a healthy scalp, only 100 to 150 hairs per day should naturally shed.
Unfortunately, this isn’t the case for men and women with androgenetic alopecia.
This is because the genetic hair loss condition affects all phases of the hair growth cycle.
As mentioned above, anagen phase naturally lasts two to six years. The exact length of anagen phase will vary depending on genetic factors, as well as physical factors such as overall health.
In men and women with AGA, the anagen phase of growth is shortened.
The phase will continue to shorten on each cycle until, eventually, the hair strand no longer makes its way to the scalp.
This will also push the follicle into telogen phase earlier and earlier, which leads to more shedding.
The vicious cycle continues until the follicle has died.
Hair Loss Treatments for Women
It seems that the vast majority of hair loss treatments are targeted at men. However, there are quite a few which can be used by women with great success.
Let’s take a look at some of the most popular options for you to consider.
As we mentioned above, the delivery of blood to your hair follicles is critical for healthy hair growth. But miniaturization interferes, and this is a likely cause of shedding and hair loss in those with AGA.
You should work to treat the underlying cause of hair loss if you hope to see long-term results. But there are solutions which aim to treat miniaturization specifically, and one of them is minoxidil.
Minoxidil, often referred to as Rogaine, is a hair loss topical solution that’s used by men and women alike.
The drug was initially developed as an oral tablet for hypertension, also known as high blood pressure (9). This means the drug is effective at dilating the blood vessels so as to improve blood pressure levels.
But an unintended side effect of the drug which was discovered during initial trials was hair growth.
One of the first small-scale studies on the subject showed that “three of five patients with androgenic alopecia using 5% minoxidil for 12 months noted hair regrowth, ranging from minimally observable hair to an appreciable restoration of larger, pigmented, terminal hair in one patient (10).”
An increase in blood flow to the scalp isn’t the only reason for its hair-growing benefits, though.
And, as a side note, minoxidil is also the only FDA-approved medication for the treatment of female pattern hair loss.
While minoxidil may be approved for use by women, there are many women with FPHL who rely on another hair loss treatment – finasteride.
Finasteride, more commonly known by its brand name of Propecia, is a prescription medication for the treatment of androgenetic alopecia.
The drug was initially developed as a treatment for Benign Prostatic Hyperplasia (BPH) (15). This is a condition where the prostate is enlarged due to the presence of the androgen hormone DHT.
It makes sense, then, that finasteride would also prove helpful in the treatment of AGA.
But one question still remains:
Can finasteride be a successful treatment for women with female pattern hair loss?
Scientific studies on this topic are few and far between, but they do exist. And, overwhelmingly, they indicate that finasteride can be an option for women.
One study study was published in 2013 (16).
The study consisted of 40 post-menopausal women with pattern balding.
According to the results, “22 patients referred significant improvement, 12 moderate improvement, and 6 no improvement” after six months of treatment.
Even more telling, these improvements were sustained for the entire 18-month study.
You may have noticed that this study in particular was performed on post-menopausal women. And there’s a reason.
As an inhibitor of the enzyme 5-alpha-reductase, finasteride is known to significantly reduce DHT levels. And while that seems to be beneficial to those with AGA, it’s not so good for a developing male fetus.
DHT plays a critical role in sexual development and, as such, 5-alpha-reductase inhibitors aren’t considered safe for women who are pregnant.
This is why the majority of studies on the topic are performed on post-menopausal women, or women who are on a reliable form of birth control.
In the vast majority of first- and second-world countries, there is very little risk of malnutrition in most of the population.
There are those subsections of the population that are more prone to malnutrition than others, though, and that includes women.
Nutrients such as iron and calcium are necessary for a lot of important cellular processes. But conditions such as menorrhagia, anemia, and hypoparathyroidism can cause an imbalance of these important nutrients.
Older women, too, may have difficulty absorbing nutrients as they age (17).
If the progression of your hair loss is due to a nutrient deficiency, then the easiest solution is a nutritional supplement.
It’s certainly possible to ensure that you’re consuming the right amount of nutrients for your needs on a daily basis. But you may find it helpful to take a multivitamin to fill in any gaps.
Your doctor may also perform a blood test to detect – and treat – any underlying deficiencies.
So, which nutrient and mineral deficiencies are the most likely to be causing your hair loss? A few of the most common include (18):
As suggested by the conclusions of a 2013 research article (and by the name of the article itself), “iron plays a certain role in patterned hair loss (19).”
But what role does it play exactly?
While hair itself is made up of dead skin cells (among other things), the act of producing hair is one that requires constant blood flow.
When the blood flow is cut off, or there is not enough oxygen within the blood, the result can be slowed hair growth.
Where does iron come in?
Iron is a mineral with a very important role, and that is to carry oxygen in the hemoglobin of red blood cells throughout the body.
People with an iron deficiency (also known as anemia) have too little iron in their blood. This leads to a poor interchange of oxygen which can cause problems in the long term.
One such problem? Hair loss (20).
Fortunately, low iron levels are quite easy to detect. And they’re even easier to treat.
With an increase in iron-rich foods, or the addition of an iron supplement to your daily routine, you can increase your blood’s iron levels so as to ensure healthy blood-oxygen levels throughout your body.
Biotin is a nutrient with one major role in the human body: to convert food into energy (21).
It does so by catabolizing amino acids or, in other words, breaking down proteins so as to turn them into new proteins.
And one new protein that may be formed as a result of biotin’s catabolizing activities? Keratin.
If you remember from high school biology, keratin is a structural protein that’s found in the hair, skin, and nails.
In fact, the majority of hair’s structure is made up of keratin (22).
An inadequate intake of biotin can mean that your body is unable to catabolize amino acids as it should. This may result in poor structural integrity of the hair (i.e. breakage and split ends), and slower growth.
The best natural sources of biotin include organ meats, eggs, seeds, nuts, and sweet potatoes (23). You can also find biotin as a health supplement, or as part of a hair supplement formulation.
The role of zinc within the human body appears to be in cell proliferation and growth (24).
It may also play a role in hormone regulation, though the link here isn’t quite so clear cut.
So, how do we know that zinc lends itself to healthy hair growth?
The results of a study published in 2016 shed light on the benefits of zinc supplementation in women with PCOS (25).
As the research indicates, a zinc supplement decreased instances of both alopecia (hair loss) and hirsutism (excess body hair).
The supplement also reduced levels of high-sensitivity C-reactive protein (hs-CRP), which is an indicator of vascular inflammation (26).
This doesn’t mean that zinc is the answer to your hair loss woes. But if your zinc levels are noticeably low, then supplementation may provide a much needed boost to your hair.
In addition to the three nutrients mentioned above, you should also be sure to include plenty of niacin, vitamins A, B, C, and D, and fatty acids in your diet.
Of course, the best way to ensure proper nutrient intake is through a varied diet. For example, lean meats, leafy green vegetables, fruits, and nuts and seeds.
But it’s also okay if you need a bit of a boost from daily supplements.
When in doubt, it’s best to speak with your doctor.
A common hair loss “treatment” for men, hair transplantation, is quickly becoming more popular for women suffering from the same condition.
But what is this procedure, and how does it work?
Just as the name implies, a hair transplant is a procedure where hair follicles are harvested from one area of the scalp (the donor site) and transplanted to another area (the recipient site).
The goal is to essentially replace the poorly performing hair follicles with ones that are functioning.
There are many techniques used in hair transplants, including Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). You can learn more about those here.
Is hair transplantation right for you?
The answer will vary.
Unlike what some people will have you believe, a hair transplant is not a cure.
While hair transplants can be an effective way to treat areas of significant hair loss, it’s possible for the hair loss to return if the underlying problem is not treated.
That’s why you should work closely with your dermatologist to find a solution that works for you.
Even if you are an “ideal candidate,” though, you should go in with realistic expectations.
If you’re a Class III on the Ludwig hair loss scale, it’s very unlikely that a transplant can return your scalp to its pre-hair loss glory.
But if you know what to expect, and if you work with a skilled dermatologist, then you’ll likely be happy with the results.
Hair loss in women can be a complex condition.
In many instances, female pattern hair loss is caused by the same sensitivity to DHT as seen in male-pattern baldness.
But in other cases, the cause may be unrelated to hormones and instead due to illness, nutrient deficiency, or medication.
Whatever the cause, though, there’s one thing that’s certain: there are hair growth treatments available for women.
Do you have questions about the information we’ve shared above? Be sure to leave a comment below.
*This article was reviewed by Dr. Anil Simhadri.