As unfair as pattern hair loss seems to be, at least when it affects a man, society generally accepts bald men as a normal part thereof. However, balding women constitute another matter altogether. Stares and whispers often accompany such a woman as she goes about her daily tasks. "What is wrong with this poor lady?". "Is she sick?". For such women, just glancing in a mirror, previously a chance to preen, to enjoy a moment of pride, turns to gut-wrenching shame and, sometimes self-loathing.
How could the fates have dealt such a cruel blow? Even worse, sensible information about female hair loss has never been in ready supply. Even today, contradictory information is everywhere. Sometimes even a woman's own PCP is lacking in a well-rounded grasp on the various disease processes that trigger hair loss. Most depressing of all, women can fall easy prey to hucksters and scam artists promising the world and charging a mint -- but delivering little other than more disappointment.
In this and future articles, we will explore the physiologic basis undergirding hair loss in women. And we will begin to separate fact from 'noise' so that women reading this article can arm themselves with genuinely useful knowledge. So let's begin.
So to start, let's explore the biggest single question first --- "why do women lose hair"?. Here's a not-so-fun fact. Of the estimated 60 million Americans currently suffering common pattern hair loss, at least 20 million are women. Androgenetic alopecia, the most typical variant of hair loss phenotypes affecting humans, is regulated by genes, hormones and other factors. However, to date, none has been shown to be "gender-specific", meaning that it favors one sex over the other. So when a woman begins to experience thinning hair, she is undergoing a strikingly similar cascade of biologic events as those occurring in a man.
Women produce androgenic (male) hormones as well as estrongenic (female) hormones. In women, certain individuals have scalp hair that is sensitive to metabolites of androgen hormones -- and specifically 5 alpha-DHT. So there are clear and compelling similarities that tie pattern hair loss in a woman to pattern hair loss in a man. Does this mean that women are affected precisely the same as men? No. It does not. In this, the differences are as striking as the aforementioned similarities.
For one thing, women do not usually suffer from a receding hair line or a crown bald spot. Instead, the most usual progression of female pattern hair loss involves the retention of the juvenile/feminine hair line, but with marked and progressive thinning behind the anterior -- or frontal -- edge. Another difference has to do with time. Men can begin losing hair in their 20's and progress to full baldness by their 30's, or even before. Women who lose hair usually start to notice the problem at about the point they enter menopause. This is important as menopause signals a multi-faceted modulation in the level of circulating steroid hormones.
In our next installment, we will touch upon the various forms of hair loss women experience, and further on we will discuss treatment options. Finally, we will culminate with the cutting edge of hair loss research, and particularly what the future bodes for women.
