Hair Loss Patterns in women and various hair loss restoration options

There are a number of reasons for hair loss in both men and women. Diet, environment, stress, past surgeries, past experiences etc. are some of the few factors which cause hair loss. Though genetics plays a major role for hair loss (male pattern baldness), there are a number of hair loss conditions for which a number of hair loss restorations treatments are available both for men and women.

Though the underlying causes for male and female pattern hair loss are same, there is some basic difference with regards to the physiology and genetics of the condition.

Androgen metabolism and hair loss

As already discussed, it is the altered metabolism of androgen in a genetically pre-disposed male and female which plays a major role in female and male pattern hair loss. 2 steroid-metabolizing enzymes (5a-reductase and aromatase), and androgen receptor proteins (ARPs) are the major metabolites of androgen metabolism.

Women have 3 to 3.5 times less 5α-reductase (types I and II) in their hair follicles as compared to men but the levels of enzyme aromatase in their bodies is significantly higher than those in males.

The aromatase enzyme is also part of normal androgen metabolism and has a protective effect on hair follicles. It brings about the conversion of androgen to estradiol and estrone, and therefore, there is less conversion of testosterone to DHT. It is also interesting to note that aromatase level in frontal hair follicles is 50% that of occipital hair follicles. This is the reason why women with androgenetic alopecia usually retain their frontal hairline and also explains the reason for difference in pattern of balding in men and women.

Changes in the levels of hormones also affect hair production in women. After menopause, estrogen level becomes low and they become prone to the destructive effect of DHT (Dihydro Testosterone) The hair on the head start becoming thinner and no new hair is produced. The gradual thinning of the hair is also associated with decrease in the diameter of the hair. The follicles remain alive but contain only miniaturized hair, and there is always a possibility of re-growth.

The typical pattern of female pattern baldness is different from that of male pattern baldness. Though the thinning of hair is seen all over the head, the frontal hairline is maintained. Widening of the natural part is also evident. There may be a moderate loss of hair on the crown, but this rarely progresses to total or near baldness as it may in men. The female pattern baldness is depicted on a Ludwig Scale.

Hair loss in women can also occur for reasons other than female pattern baldness, including the following:

• Temporary shedding of hair (telogen effluvium)
• Breaking of hair (from such things as styling treatments and twisting or pulling of hair)
• Patchy areas of total hair loss (alopecia areata -- an immune disorder causing temporary hair loss)
• Medications
• Thyroid Diseases
• Certain skin diseases

The hair loss restoration treatments for the above are different than the Female pattern baldness which is usually diagnosed based on the appearance and pattern of hair loss and by ruling out the above mentioned causes of hair loss.

A skin biopsy or other procedures may be used to diagnose medical disorders that cause loss of hair.

The hair loss of female pattern baldness is permanent. In most cases, it is mild to moderate. It is not a medical disorder and no treatment is required if the woman is comfortable with her appearance. But thinking from a cosmetic angle it may cause anxiety and affect the personality, and most women would like to go for affordable hair loss restoration treatment.

Hair Loss Restoration Treatment for AA

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Many factors must be considered in the treatment of androgenetic alopecia. Once hair loss due to other factors is ruled out, it is important for the therapy to stratify the patients according to hair loss and androgen level. In women without hyperandrogenism( excess of androgen) the Hair Loss Restoration Treatment approach is straightforward.

For women with clinical hyperandrogenism, serum androgen testing should be done according to individual presentation before any hair loss restoration treatment is started. In cases of polycystic ovary syndrome (PCOS), regulation of menses and control of hyperinsulinemia can also serve as hair loss restoration treatment and is able to reverse FPHL (Female pattern Hail loss) to some extent. Hair loss restoration treatment s like women lifestyle alterations (balanced weight loss and exercise, stopping of hormone therapy or birth control medicines may also be sufficient to induce the reversal).

The best hair loss restoration treatment for women with androgenetic alopecia Ludwig stage I and II is minoxidil 2% solution. This is the only hair loss restoration treatment drug or medication which is approved by the United States Food and Drug Administration (FDA). A higher concentration may be tried in unresponsive patients. Minoxidil as a hair loss restoration treatment medicine has helped about 20% to 25% of the female population to grow hair. In majority of women it either slows down or is capable of hair loss restoration.

There are reports that Hair loss restoration treatment with combination therapy always gives enhanced benefits. Hair loss restoration treatment with 0.05% betamethasone dipropionate and 5% topical minoxidil are found to be superior to minoxidil alone.

If Hair loss restoration treatment with minoxidil is not effective after one year, antiandrogen therapy can be tried. The antiandrogen therapy has shown some promise as a Hair loss restoration treatment in women with hyperandrogenism Nine months or more may be required for the h air loss restoration treatment before a benefit is appreciated.

Hair loss restoration treatment with higher dose finasteride (5 mg/d) has also been shown to induce significant re-growth in a postmenopausal, non-hyperandrogenic women.

Hair loss restoration treatment with spironolactone has been proved to induce some hair growth and it is a good option for woment without hyperandrogenism. Use of this agent is contraindicated in women with renal insufficiency or hyperkalemia, and in those with a personal or family history of breast cancer.

In patients who do not respond to medical hair restoration, hair transplantation as a hair loss restoration treatment should be discussed. Counseling of patient in this regard is very important. Ludwig stage II FPHL or women with anterior hairline recession are the best candidates for the hair transplant surgery. A patient with Ludwig I FPHL is unlikely to be satisfied with the surgical hair loss restoration outcome because post-transplant hair density would not be sufficient to give a natural look. Combining surgical hair restoration and medical hair restorationalways show better results and is the best hair-loss restoration treatment available so far.

Cosmetics, hair lightening, creative styling, hair pieces and hair prostheses can also help to camouflage the defect. A partial hairpiece may also give a natural and satisfying appearance.

Hair loss restoration treatment management in women comprises a number of factors and treatments as depicted below:

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References:

1. Chantal Bolduc and Jerry Shapiro: 'Management of Androgenetic Alopecia', Am J Clin Dermatol 2000 May-Jun; 1 (3)

2. Elizabeth K. Ross, Shapiro: ‘ Management of Hair Loss’, Dermatol Clin 23 (2005) 227 – 243