Female pattern baldness

Each strand of hair sits in a tiny hole in the skin called a follicle. In general, baldness occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow new hair. The follicles remain alive, which suggests that it is still possible to grow new hair.

The reason for female pattern baldness is not well understood, but may be related to:

• Aging
• Changes in the levels of androgens (hormones that can stimulate male features)
• Family history of male or female pattern baldness
• Heavy loss of blood during menstrual periods
• Certain medicines, such as estrogenic oral contraceptives

Female pattern baldness is the most common type of hair loss in women.

Female pattern baldness is usually diagnosed based on:

• Ruling out other causes of hair loss, such as thyroid disease or iron deficiency.
• The appearance and pattern of hair loss.
• Your medical history.

The health care provider will examine you for other signs of too much male hormone (androgen), such as:

• Abnormal new hair growth, such as on the face or between the belly button and pubic area
• Changes in menstrual periods and enlargement of the clitoris
• New acne

A skin biopsy of the scalp or blood tests may be used to diagnose skin disorders that cause hair loss.

Looking at the hair with a dermoscope or under a microscope may be done to check for problems with the structure of the hair shaft itself.

Female pattern baldness is usually not a sign of an underlying medical disorder.

Hair loss may affect self-esteem and cause anxiety.

Hair loss is usually permanent.

There is no known prevention for female pattern baldness.

American Academy of Dermatology Association website. Thinning hair and hair loss: could it be female pattern hair loss? www.aad.org/public/diseases/hair-loss/types/female-pattern. Updated December 13, 2022. Accessed February 22, 2024.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Diseases of the skin appendages. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 33.

Rudnicka L, Stefanato CM. Alopecias. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 5th ed. Philadelphia, PA: Elsevier; 2024:chap 69.

Sinclair R, Koh WL. Androgenetic alopecia. In: Lebwohl MG, Heymann WR, Coulson IH, Murrell DF, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 12.

Zug KA. Hair and nail diseases. In: Habif TP, Dinulos JGH, Chapman MS, Zug KA, eds. Skin Disease: Diagnosis and Treatment. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 20.

Hair thinning is different from that of male pattern baldness. In female pattern baldness:

• Hair thins mainly on the top and crown of the scalp. It usually starts with a widening through the center hair part. This pattern of hair loss is known as Christmas tree pattern.
• The front hairline remains unaffected except for normal recession, which happens to everyone as time passes.
• The hair loss rarely progresses to total or near total baldness, as it may in men.
• If the cause is increased androgens, hair on the head is thinner while hair on the face is coarser.

Itching or skin sores on the scalp are generally not seen.

Untreated, hair loss in female pattern baldness is permanent. In most cases, hair loss is mild to moderate. You do not need treatment if you are comfortable with your appearance.

MEDICINES

The only medicine approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness is minoxidil:

• It is applied to the scalp.
• For women, the 2% solution or 5% foam is recommended.
• Minoxidil may help hair grow in about 1 in 4 or 5 women. In most women, it may slow or stop hair loss.
• You must continue to use this medicine for a long time. Hair loss starts again when you stop using it. Also, the hair that it helps grow will fall out.

If minoxidil does not work, your provider may recommend other medicines or treatments, such as vitamins, spironolactone, birth control pills, ketoconazole shampoo, platelet-rich plasma therapy (PRP) injections, and laser treatments. Your provider can tell you more about these if needed.

HAIR TRANSPLANT

This procedure can be effective in females:

• Who do not respond well to medical treatment
• With no significant cosmetic improvement from their treatment

During hair transplant, tiny plugs of hair are removed from areas where hair is thicker, and placed (transplanted) in areas that are balding. Minor scarring may occur where hair is removed. There is a slight risk of skin infection. You will likely need many transplants, which can be expensive. However, the results can be excellent and permanent.

OTHER SOLUTIONS

Hair weaving, hairpieces, or a change in hairstyle can help hide hair loss and improve your appearance. This is most often the least expensive and safest way to deal with female pattern baldness.

Contact your provider if you have hair loss and it continues, especially if you also have itching, skin irritation, or other symptoms. There might be a treatable medical cause for the hair loss.