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Hair loss in women

Female hair loss may not be as obvious as male pattern baldness, but with one in five women facing it at some point, hair loss is a problem that's widespread, with both physical and emotional affects.   Expert Dr. Michael Reed joins in with the answers.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Female hair loss may not be as obvious as male pattern baldness, but with one in five women facing it at some point, hair loss is a problem that's widespread, with both physical and emotional affects. What causes it, and what can you do to reduce or even reverse the loss of your locks? Hair and scalp disorder expert Dr. Michael Reed, joined us with the answers.

Member question: What is the most common pattern of female hair loss: All over, the crown of the head, or the frontal hairline? Which is the easiest to treat?

Reed: The most common is for a patient to have an area behind the hairline where there is diffuse thinning extending in a so-called Christmas tree pattern toward the back of the scalp, wider in the front, and then narrowing as it goes towards the back.

The easiest type of pattern to treat is when there is a fairly small oval or round area behind an intact frontal hairline. In such a case, a fairly small hair transplantation procedure may totally correct the problem.

Medical treatment works best in women who still have adequate hair density independent of the pattern of hair loss, but their hair has become weaker, finer in texture. The reason for this is that the medical treatment available is able to make hairs courser, and by doing this in someone with thin but adequate hair in terms of density, we can achieve a great deal of improvement in hair weight or hair volume.

Member question: Is the transplanted hair not susceptible to further thinning?

Reed: The transplanted hair will live in its new location as long as it is genetically programmed to survive in its original location. This may be the lifetime of the individual or it may be less than the lifetime, but nevertheless, a long time.

Women can, over time, actually thin out in the back of their scalp as well as on the top of their head, and for this reason transplanted hair may not last as long in women as we expect it to last in men. For this reason, it is of great importance that women who have had hair transplants also use medical treatment on a regular basis to help both their transplanted hair and their nontransplanted hair survive long-term.

Member question: I am 27 years old. I have two children. I started losing my hair after my first child was born when I was 18. I have had my scalp looked over and the doctor said that it looked fine. Also I had my thyroid checked and that is fine. Do you know what could have caused this?

Reed: It is common and actually normal for women to experience hair shedding beginning two to three months after pregnancy and lasting for two to three months before subsiding. However, since approximately 50 percent of women have an underlying genetic predisposition to suffer from female pattern hair loss, it is not unusual for women to report that their hair did not return to its full glory after the shedding subsided and new hair replaced the lost hair.

The shedding process that occurs after pregnancy, and also associated with other conditions such as rapid weight loss, serious illnesses, and so forth, is called a telogen defluvium, which is defined as an increased loss (shedding) of normal resting or so-called club hairs.

In normal circumstances, without any underlying tendency for female-pattern hair loss, the condition will correct itself, but may take up to one year for full correction.

Member question: I'm a 27-year-old woman, never been pregnant, nor have I suffered from any illness or stress, yet I had very severe hair loss until a month ago (it has reduced considerably). At one point it was so bad that I have bald spots on the top of my head. Can you tell me if there is something I can do about it? Can I re-grow my hair?

Reed: Hair loss that occurs with the presence of completely bald spots is most likely an allergic form of hair loss called alopecia areata. This is the third most common cause of hair loss, affecting approximately 2 percent of the population at some point in time. The condition is often limited to one or two small spots that often appear under unusual stressful circumstances, and in many cases spontaneously resolve without treatment.

However, a number of patients affected by this disorder suffer from more severe involvement, and in some cases may lose all the hair on their head and in some cases on the entire body. These conditions are called, respectively, alopecia totalis and alopecia universalis. These conditions should be seen and treated by a dermatologist. Dermatologists are the doctors trained in the medical treatment of a wide variety of hair loss disorders.

The usual treatment for alopecia areata in its limited form is local cortisone shots that, in most cases, cause hair re-growth.

Member question: How much are the cortisone shots?

Reed: The cost of cortisone shots is quite variable. Usually there is a charge for an office consultation with the dermatologist and then an additional charge for the shots. The cost of the shots can vary, depending on location, from $25 to $75 for the procedure.

The shots are given at approximately three- to four-week intervals until the hair re-grows and the condition is in remission.

Member question: Can a woman suffer from hereditary balding? For example, if a father is bald and his daughter has hair exactly like her father, will the woman go bald?

Reed: The genetics related to hair loss are more complex than most people are led to believe. It seems to most people that there is a tendency for hair loss to come through the maternal grandfather, but many times this is not the case, and in approximately 12 percent of the people there is no family history.

Hair texture and color are determined by different genes than hair loss, so a patient could have the texture of a parent who did not go bald, but they can still lose their hair like the parent who did go bald who doesn't have the same texture.

Member question: My grandmother, mother, and two aunts all have thinning hair of varying degrees. I have heard that my type of thinning is genetic. Do topical medications work well on this type of thinning (I have the Christmas tree pattern myself)?

Reed: Topical preparations are helpful in slowing the rate of hair loss in most cases and actually improving the hair quality in many cases. The only topical preparation that is available for which there is hard scientific evidence for effectiveness is topical minoxidil. Minoxidil is available generically as 2 percent and 5 percent minoxidil over-the-counter. It is also available under the brand name Rogaine. Two percent minoxidil is FDA-approved for men and women and 5 percent is approved for men. However, many women who do not respond to 2 percent also use 5 percent.

Topical minoxidil is safe and effective, however there are side effects patients should be aware of that would cause great concern if they occur unexpectedly:

It is common with the 5 percent preparation to experience more hair shedding for several weeks or several months due to release of resting hairs that are being replaced by newer, better hairs. Some women will experience temporary (and reversible) growth of unwanted fine facial hair in the forehead and temple areas. This unwanted growth can be easily removed using a depilatory, but often occurs before the benefits are seen on the top of the head. A number of patients will experience scalp irritation with the 5 percent preparation and many report that they find it oily and unpleasant to use twice a day as directed. For this reason, many physicians who specialize in hair loss will have special formulations that are less irritating and easier to use than the over-the-counter products.

Member question: Since I have stopped taking my HRT my hair has thinned even more. Is this normal?

Reed: It's normal for women in the postmenopausal and perimenopausal period to have the onset of noticeable and disturbing female-pattern hair loss. Hormone replacement therapy may slow the hair loss process in these women, although it generally will not cause hair to re-grow.

Estrogen, which is in the hormone replacement therapy, does have a protective effect on hairs and reduces the effect of male hormone, which is what causes the hairs to be lost. So if a woman with female pattern hair loss goes off HRT, it is common for her underlying female pattern hair loss to take a turn for the worse.

Member question: My 14-year-old daughter is experiencing hair loss for a second time. The first was when she was 11 years of age. Her thyroid was checked and fine. It eventually came back coarse and curly. She is now experiencing thinning again. We just had blood work done, but the results are not in. She seems to have more than normal hair on her upper lip and eyebrows. Stress level and diet have been ruled out. She has normal periods with no discomfort. Are there long-term affects with polycystic ovary syndrome or androgenic alopecia? Can you tell me how these problems are corrected?

Reed: Any 14-year-old girl with the history that I just heard should have a complete, thorough evaluation, not by just a dermatologist but an endocrinologist.

Polycystic ovarian syndrome (PCOS) is a complex disorder with many manifestations and is often very difficult to diagnose. Patients with PCOS will often have premature and severe androgenetic alopecia. The treatment for the hair loss, however, is the same for the patient, whether a diagnosis of PCOS is correct or not. Some patients will not have PCOS, but instead have premature and severe early onset female-pattern hair loss.

The main problem in treating this condition in young women is, with the exception of topical minoxidil, that all the medications that may be effective are contraindicated in a female of childbearing potential who may become pregnant. However, in the hands of hair-loss experts, so-called off-label indications for medication can be used successfully in women of childbearing potential who are definitely not going to become pregnant while on treatment. If a patient wishes to become pregnant they can go off treatment and resume it at a later time.

Member question: How do I find a doctor who specializes in hair loss? My dermatologist didn't have much to say about my problem.

Reed: It's not unusual for patients to have a difficult time finding a doctor who has expertise and interest in treating hair loss. Most general dermatologists, although trained in treatment of hair loss, find it difficult to spend the time that is required for a proper consultation, especially in women. However, most dermatologists know the doctors in their region who are experts in hair loss and can make the appropriate referral to the patient who needs more expertise.

You also can call the American Academy of Dermatology in Evanston, Ill. and ask for a referral in your geographic region.

In addition, most dermatologists who specialize in hair loss are affiliated with an academic institution, so a patient may call the teaching hospital in their region and contact the department of dermatology for a referral.

Member question: I curl my hair to add volume and then tease it. I use hairspray to cover up the balding areas to make sure my hairs stay in place. Is this making the balding areas worse?

Reed: Probably not. The only type of hair manipulation that contributes significantly to hair loss is the use of hair control measures that pull on the hair on the level of the scalp: Very tight rollers, very severe and tight ponytail styles, and most severe would be braiding or corn rowing on the scalp, which is a common practice among women with spiral/helical hair textures, especially women of African American backgrounds.

The use of styles that chronically pull on the hair can not only make female hair pattern worse, but can also cause another type of hair loss called traction alopecia, which is a form of permanent hair loss where the hairs are replaced by scar tissue and is therefore irreversible.

Member question: My hair stylist told me that many of his clients with thinning hair have used prenatal vitamins and it is working. Is this OK to do?

Reed: I have no objection to the use of multivitamins, including prenatal vitamins, in an attempt to help treat hair loss. However, there is no convincing scientific data that vitamins and other forms of nutritional therapy have the ability to re-grow hair. Patients need counseling on diet, vitamins, nutrition, and herbal treatments when they come to the hair-loss specialist. It is too simplistic to blow them off, to say nothing works, because that is saying more than we really know.

If a patient asks me to advise them regarding vitamins and herbal treatments, I will tell them to take a multivitamin with zinc, biotin and saw palmetto. However, I will usually advise this as a supplement to whatever medical or surgical treatment is scientifically valid and proven as treatment for their hair-loss disorder.

I advise patients the most important item in this area is to maintain a stable body weight and to never lose weight by dieting alone, but always by a combination of proper diet with slow weight loss and regular (daily) aerobic exercise. The worst thing for the hair is rapid fluctuations in nutritional and other daily habits.

The ideal general diet for the hair loss patient is a high protein, reduced fat, and low but not no, carbohydrate diet. A high-carbohydrate diet causes rapid fluctuations in blood insulin levels that, in turn, cause fluctuations in hormonal levels, which is not good for hair follicles.

Member question: What is the latest about hair cloning? Will it be a reality, and if so, when will it be available?

Reed: At the most recent meeting of the International Hair Restoration Society there were a number of presentations on the subject of so-called follicular neogenesis. This is not true cloning, but rather an attempt to take hair follicles from the donor site, where they are genetically blessed, and in the lab isolate the stem cells and clone the stem cells in tissue culture, followed by re-implantation of these cells into the balding areas where these cells will cause the formation of new hair follicles that can last a lifetime.

This is still science fiction, unfortunately, since no one has been able to successfully clone the stem cells and re-implant them with any predictable and reproducible success. However, science fiction today will become scientific fact tomorrow, and I predict that within five to 10 years this problem will be solved and we will enter a new era where balding may become history.

Moderator: Do you have any final words for us, Dr. Reed?

Reed: Don't wait for cloning or gene therapy to get treatment for hair loss. Good treatment is available now. In most patients with hereditary hair loss we can dramatically slow or arrest a balding, thinning process, and in many cases greatly improve the hair. Medical and surgical treatment combined is producing excellent results in both men and women. In my practice more than 50% of the patients undergoing modern hair transplantation are women and the results are very gratifying.

Moderator: Thanks to Dr. Michael Reed, for being with us today. For more information on women and hair loss, or other women's health issues, visit our message boards, where you can post questions for health professionals and find support and information from fellow WebMD members.

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