Female "Genetic" Hair Loss

What are the features?

Female genetic hair loss is a common cause of hair loss in women. 40% of women by age 60 will have this condition.

Female genetic hair loss has many names, including "female pattern hair loss", "female androgenetic alopecia", "female balding", "female thinning", and the "female equivalent of male balding". The preferred term is female pattern hair loss or "FPHL". Women with FPHL develop hair loss in the centre of the scalp. Usually the front of the scalp is not affected. Hair thinning can also occur at the sides and the back of the scalp. This type of thinning is referred to as diffuse loss.

This type of hair loss is easily confused with other types of hair loss. Women with FPHL initially develop increased hair shedding. A common misdiagnosis at this stage is 'telogen effluvium' - causing extensive work up for things such as low iron or thyroid problems. FPHL causes shedding in the early stages.

Up close exams help confirm the diagnosis. Hair follicle miniaturization (see arrow) is an important feature - hairs that were once 70 micrometers in diameter thin to well under 40 micrometers. The abundant normal groupings of 2 and 3 hairs coming out of a single pore are no longer present - most hair follicle pores contain just 1 or 2 hair bundles.

Biopsies are not typically required for a diagnosis but rather a careful up close examination, review of the full history and review of blood tests results. Most women with FPHL have normal blood test results. Only 10-15 % have elevated androgens.

Treatments include minoxidil, hormone blocking medications, low level laser, platelet rich plasma and hair transplantation.