Women go bald, too

The Baltimore Sun

The term "male pattern baldness" is familiar to most people. But many women, too, suffer from hair loss, says Lisa Earnest Ishii, assistant professor for facial plastic and reconstructive surgery in the Johns Hopkins School of Medicine's department of otolaryngology and neck surgery.

Everyone "sheds" or loses some hair; what do doctors consider "hair loss" that could lead to thinning of the hair or balding?

In general, hair loss greater than 100 hairs a day is considered abnormal. Otherwise, it is based upon what you see: Obviously, if you start to see the scalp showing through the hair, that is abnormal.

Does hair loss in women look the same as it does in men?

The pattern that you see in women is called female pattern balding and is not the same as in men. It is a diffuse spreading of hair loss that typically spares the front [hair] line. What bothers women is that the hair thins so that you can start to see the scalp all over the head.

There are two peaks of hair loss in women - in their 30s and in their 50s. And those who begin to lose hair in their 30s are going to have more loss in the end.

How common is hair loss in women?

The numbers that are most accepted is that [hair loss] affects 30 percent of post-menopausal women. ... There have only been three large studies of hair loss affecting women, and of those studies, the largest was 1,000 women. Part of the problem is that this is an area that hasn't received enough attention.

What causes hair loss in women?

The most common cause is female pattern baldness, which is a multifaceted problem, related to heredity and endocrinology (hormones). It is thought that it is a response to either an increase or decrease of circulating androgens (or male-type hormones such as testosterone, which women also have).

What are some other causes of hair loss?

Other factors should be considered and ruled out ... such as iron deficiency; or an under-active thyroid.

There also is something called polycystic ovary syndrome, which is a familial endocrinal disorder that can affect women in their reproductive years. Classically, these women have infertility and hair loss, as well as obesity, but the triad of symptoms is not always obvious.

Anything else?

Another important cause to consider is called telogen effluvium. This basically refers to a shift in the normal growing phase of hair follicles so that an unusually large number of hair follicles are in the resting phase.

Women can experience this kind of hair loss after pregnancy or after serious emotional distress or an illness (particularly one that caused a high fever). This kind of hair loss may not immediately follow the event - it may not happen for several months.

Auto-immune diseases can also cause patches of hair loss as can some inflammatory diseases like lupus. There are also medications that can cause hair loss. All of these things need to be considered.

How can hair loss be treated?

There are two treatments: medical and surgical. The medical treatment consists of [the drug] minoxidil. This is applied to the scalp and the primary action is to slow down the loss that is occurring.

There have been reports of new hair growth in up to 25 percent of women. The only drawback to minoxidil is that once you stop using it, it stops having its effect. So you basically have to use it forever. But it doesn't have any untoward systemic side effects. Some people have said it makes their hair greasy, and some have complained of itching, but these are minor side effects.

What about surgery?

The surgical therapy is hair transplants. Although hair transplantation has been a well-known therapy for men for the last 30 years, only recently has it been recognized as a great option for women.

It consists of taking hair follicles from one region of the scalp and moving them to where the hair is thinning. You can do this in the clinic with light anesthesia: Take a strip of the scalp and cut out every hair follicle and transplant them to an area where you want the hair to thicken.

Does the surgery leave scars?

You are left with a scar in the area where you took the hair, but it is covered by the hair remaining in that area. All you can see in the area where you have placed the new hair is pin-sized scabs. But with women, since you are typically placing the hairs where there is remaining hair, the old hairs do a good job of hiding the very small wounds. They are only visible for about a week, and then you don't see anything at all until the new hairs grow. That usually takes several months.

How expensive is the surgery?

It depends on the number of hair follicles that you are transplanting. But typically costs range from $2,000 to $8,000.

Do you need to repeat the transplantation surgery?

The woman will continue to lose hair so there may come a time when she wants to have another procedure, and if she has an adequate amount of donor hair that is fine. I have done repeat procedures on people, but most people find that with one procedure, they achieve hair that they are comfortable with.

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