Women and Hair Loss

Bernard Nusbaum, M.D.

Miami, Florida

Since the early eighties, I’ve been transplanting female patients and have found them to be very satisfied patients. With the advancements in microsurgery, women have taken a renewed interest in the procedure. We estimate that 20 percent of the female population in North America, or 20 million women, suffers from hair thinning. Because women have expectation to have a full head of hair for life and don’t associate thinning with their gender, they suffer in silence, most often relying on creative combing, and don’t seek a professional resolution to their problem. Also, women’s thinning doesn’t appear as acute as their male counterparts because they rarely go completely bald and also don’t usually lose hair at the hairline because they have increased levels of Aromatase in that area, an enzyme that converts male hormones to estrogen.

To determine the cause of women’s hair loss requires more of a medical workup than for men. We have to make sure thyroid function is normal, test for iron deficiency and measure iron stores in the body. Women with thinning hair, may report menstrual irregularities, hair growth in body areas associated with males, severe acne or rapidly receding temples. Usually those symptoms may indicate abnormal levels of male hormones and a simple blood test is required. An appropriately trained physician like the Family Doctor, OB-GYN or an Endocrinologist should direct the treatment of women with hormonal problems.

When we diagnose the thinning problem as hereditary of female patter hair loss, various treatments may include:

1. Making sure there is sufficient protein intake.
2. Supplementing the diet with Biotin, identified as a supplement that encourages hair growth.
3. Recommending the use of Minoxidil, sold as Rogaine at drugstores. Women should know they will experience excess shedding during the initial 2 months, before the hair thickens with treatment.
4. Possibly prescribing hormonal replacement treatments (in the post-menopausal patient) or an oral contraceptive pill dominated by the estrogens component. Birth Control pills have estrogens and progestins, the latter of which acts similar to male hormones and makes hair loss worse. When selecting a birth control pill for women with hair loss, one should be selected containing a predominance of the estrogen hormone. We have also found that a diuretic, called Spironolactone, blocks the action of some male hormones.
5. Hair transplantation can replace hair lost from female pattern hair loss or thorough cosmetic surgery procedures, particularly forehead and facelifts. Because hair follicles grow in scar tissue, scalp scars and sideburns can be filled. Also the hairline can be thickened or lowered and in selected cases. Eyebrow transplantation can be achieved.

Women with thinning hair are encouraged to have permanents, experiments with hair color, use hairspray and try different hairstyles to camouflage their thinning hair. While some of these treatments may cause hair breakage, they don’t influence the root and therefore, cannot cause permanent hair thinning or hair loss.