Pattern Hair Loss in Women

Pattern hair loss is the most common non-scaring cause of hair loss in both men and women. The American Academy of Dermatology estimates that 30,000,000 women are affected in the US alone, this is probably a conservative number that underestimates the actual number since it is far easier for women to camouflage hair loss. The term Female Pattern Hair Loss is preferred over Androgenetic Alopecia because the latter is synonymous with male pattern baldness (MPB). MPB is manifest with distinct patterns described by Hamilton in 1941, later revised and expanded upon by Dr. Norwood in 1975.

Ludwig described the Female Pattern Hair Loss in 1977. Female Pattern Hair Loss (FPHL) is a broad term, which encompasses many possible causes. FBHL usually occurs post-pubescent or after hormonal changes such as post-menopause or after discontinuing birth control pills. This pattern hair loss usually spares the hairline and manifests with thinning in the frontal, and mid-scalp areas Ludwig I and II. Ludwig III is the most severe pattern in which the thinning on the top is most severe and it also thins in the back or occipital area. Fortunately, the Ludwig III is rare occurring in only 1 in 7 patients.

In summary, whereas the patterns in men result in progressive thinning and can advance to severe baldness, in women it is usually a thinning in frontal and mid-scalp areas. Women usually do not progress to complete baldness, which usually makes it easier for them to mask the thinning with comb over hair styling. The differences in the patterns of expression of hair loss in the two sexes is due to the presence of the enzyme Aromatase in the frontal scalp of women which converts male androgens into estrogen and its derivatives.

Dr. Olsen in 1994, coined the term “Christmas’s Tree Pattern “ to describe the appearance of Female Pattern Hair Loss. The image to the right shows this pattern in a female client. She stipulated that it has frontal accentuation, usually sparing the hairline.

The treatment of Female Pattern Hair Loss is both medical and surgical. The medical treatment includes Spironolactone, and Rogaine. The Spironolactone has weak anti-androgen action hence it needs to be used at higher dosages and for a prolonged time. The dosage should be 100-200 mg per day. Caution needs to be employed that if the woman is fertile birth control needs to be used because of the potential feminization of male fetus. Also the monitoring of the serum potassium (K+) needs to done monthly since Spironolactone is a K + sparing diuretic. Rogaine 5% should be used twice per day for the first 6 months then once per day. This regimen ensures a more rapid response and it is much easier to be compliant with a once per day regimen. The use of 5% Rogaine carries a greater risk of the growth of facial hair.

The best results are obtained with the surgical treatment in the appropriate patients, which employs the use of ultra-refined follicular unit transplantation. The follicular unit transplantation (FUT) can be used to maximize the density in strategic areas to facilitate hair styling options. The FUT can also restore the hairline in those women with male pattern recessions.

To learn more, please see Dr. Arocha's Presentation on Hair Loss in Women.

Unlike traditional methods of hair restoration, such as extensions, weaves and wigs, the Arocha Hair Restoration method uses your own natural hair for an undetectable and lasting solution for natural hair restoration.

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