Female Pattern Hair Loss

Female pattern hair loss also known as androgenetic alopecia is a common condition affecting many women. Less than 45% of women are not affected by this problem. Prevalence increases with age (12% of women aged 20 to 29 and more than 50% of women over 80 are affected by female pattern hair loss).

​

In female pattern hair loss there is a gradual hair follicule miniaturization and conversion of terminal follicles into vellus-like follicles. Unlike men the miniaturization is not uniform and intense. For this reason there are no complete balding areas except very rare cases.

​

There is a change in androgen metabolism in some women with female pattern hair loss but there is no androgen excess in all cases. Women with female pattern hair loss may have other general signs of hyperandrogenism such as hirsutism, acne, irregular menses, infertility, galactorrhea and insulin resistance, but in most cases there are no other symptoms than baldness.

​

Increased sensitivity of the hair follicles to normal androgen levels may explain the onset of baldness in some women. This indicates that unlike hair loss in men, hair loss in women may develop even in the absence of androgens.

​

The genetic inheritance of female pattern hair loss is not clear yet.

​

Women with female pattern baldness complain about gradual ans slow thinning of hair which usually affects the top of the scalp and the upper parietal areas. Unlike men, the front hairline is generally preserved and the miniaturization of the hair is not very certain.

​

However, in some women, alopecia is diffuse and involves the parietal and occipital areas of the scalp. This can cause difficulties when looking for donor areas for hair transplantation.

​

In 1977, Ludwig described the distinctive characteristics of female pattern baldness and classified it into 3 degrees of severity: Ludwig Type I, II and III (See diagram below).

​

It is important to evaluate thyroid fonction, ferritin and vitamin D levels to exclude factors that may increase hair loss before recommending medical or surgical treatment for female baldness.

​

If there are signs of high androgen levels, blood samples should preferably include total testosterone and dehydroepiandrosterone levels.

​

If medical treatment is proven insufficient, hair transplantation is alternative when hair loss becomes stable in patients over 25 years of age.

 

The evaluation criteria for hair transplant indication in female pattern baldness are:  

​

• Patients with moderate female pattern baldness (Ludwig I, see diagram below) are not ideal candidates for hair transplantation because the difference between the pre-operative and post-operative situation is difficult to appreciate.

 

• Patients with diffuse baldness including the occipital donor area are not good candidates either for surgical treatment because the efficiency will be very low considering the hair thinning and the risk of hair loss in the donor area.

​​

• Finally, the ideal patients for hair transplantation are those have significant hair loss in the frontal area and a high density hair in the occipital donor area. 

​

​