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Hair Thinning vs. Hair Loss

John Simmonds

Posted on February 19 2018

Hair Thinning vs. Hair Loss

Types of Hair Loss & Pattern Thinning

Perimenopausal women frequently experience pattern thinning that’s usually worse in the front of the thinning area, about 2 to 3 inches behind the hairline. Over time, it progresses as far back as the swirl (posterior skull vertex); the thinning areas may spare the sides and back of the head. For perimenopausal women, thinning tends to be diagnosed in the 30s or 40s. It is present but less frequent with women in the 20s. The good news is that once the thinning is recognized in these women it is generally stable over time and does not show the progressive nature of the male balding patterns, at least until they reach menopause.

On the other hand, an advanced presentation of uniform hair loss, called diffuse unpatterned alopecia (DUPA), leads doctors to narrow the type of hair loss down to a few distinct possibilities, including female genetic hair loss or senile alopecia (this refers to old age rather than cognitive dysfunction).

Generalized thinning isn’t always genetic, and women should undergo a complete medical examination including a wide variety of laboratory tests including hormone and basic blood panels.

Genetic hair loss in women

In women, there’s a distinct relationship between mother, sisters, aunts, and grandmothers when it comes to thinning hair patterns. When we take a careful history from women with thinning hair, far more than half of the women we interview with balding or thinning have female relatives with a similar problem. When one recognizes this in the family history, we generally ask these women to inquire on the course of the family balding patterns from a timeline perspective.

Genetic hair loss is relatively uncommon in women and is generally referred to as female pattern hair loss or female androgenetic alopecia. In women with this condition, the common pattern differs than that of men. Whereas the pattern in men follows the Norwood classi fication, the postmenopausal pattern in women is characterized by diffuse thinning starting just behind a normal hairline and extending to and beyond the swirl.

Unlike men, adult women with typical female postmenopausal androgenetic alopecia often have signi ficant levels of miniaturization (decreased hair shaft thickness in some hairs and loss of hairs within the follicular unit) in the back and side of the scalp.

How and Why Hair Loss Happens

Miniaturization causes hair shafts to become thinner over time before falling out, and the higher degree of miniaturization present indicates an unstable hair loss process throughout the scalp.

In some women, the genetic pattern of hair loss is associated with an increase in male sex hormones (androsterone, testosterone, and DHT), but in most cases of genetic hair loss, it occurs when the sex hormone levels are normal.

Compared to men, the mechanism of balding in women is less well understood because their hair loss isn’t as directly related to the presence of DHT. The enzyme aromatase appears to have a role in causing female hair loss and may partially explain the different pattern when compared to men. The loss of estrogens in postmenopausal women means that the protection against female genetic alopecia is reduced, therefore leading to thinning.

Women who develop pattern balding later in life also have a genetic component to their hair loss, but the association is less strong. The changes in hormones that occur around menopause are an obvious contributing factor.

Some women develop pattern balding in a distribution that is similar to men. These patients are better classi fied using something called “the Norwood classi fication system”. Because these women have hair loss mainly limited to the front and top of the scalp that doesn’t affect the back and sides, they may be candidates for hair transplant surgery. About 15% of women have this patterned balding.

Medical causes of female hair loss

Apart from genetics, female hair loss can stem from a variety of medical causes. This section looks at those causes, from the general to the more speci fic, including postpartum and menopausal hair loss.

Underlying medical conditions

In women, many medical conditions may cause hair loss, including the following:

  • Thyroid disease

  • Anemia (referred to as “blood deficiency” in Chinese medicine. )

  • Iron de ficiency (also referred to as “blood de ficiency” in Chinese medicine.)

  • Weight loss induced by severe dieting or eating disorders

  • Medication use (particularly oral contraceptives, beta-blockers, vitamin A, thyroid drugs, tranquilizers and sedatives, Coumadin, and prednisone)

  • A variety of autoimmune diseases
    As a woman experiencing hair loss, you should first be evaluated by a dermatologist to make sure that

    no underlying skin conditions are contributing to the hair loss. They may require a treatment different and may require a biopsy to rule out the presence of certain skin diseases like diffuse alopecia areata. Your family doctor can do the required blood tests for the various diseases that may be present.

    Blood tests check the following common contributors to female hair loss and can help rule out some identi fiable medical conditions:

  • ANA (antinuclear antibody): Used to test for lupus or other autoimmune diseases. This test is either positive or negative and further testing may be required if the initial screening tests are positive.

  • Iron: Levels serum iron, TIBC (total iron binding capacity), and ferritin de ficiencies in iron.

  • Estradiol: This sex hormone indicates the status of ovarian output.

  • FSH (follicle-stimulating hormone): This sex hormone indicates the status of ovarian output. This hormone reflects the status of a woman’s ability to ovulate.

  • LH (luteinizing hormone): This is a sex hormone that indicates the stage of ovarian output a woman may be at in her overall aging process. When she ovulates, this hormone stimulates the production of eggs.

  • Free testosterone: May help the doctor understand a woman’s ability to convert testosterone into estrogen. Most testosterone is bound to proteins in the blood and the free testosterone is easily converted into estrogen.

  • SHBG (sex hormone binding globulin): Level indicates the status of male hormones.

  • TSH (thyroid-stimulating hormone): Level indicates the pres- ence of hyperthyroidism or hypothyroidism.

  • Total testosterone: Largely bound to proteins in the blood.
    It’s important to note that even after a medical condition has been corrected, your hair loss may 
    still persist perhaps because of a “switch” in your genetic makeup that’s turned on when the medical insult occurs. After the hair loss starts, it may be difficult to turn off this switch. The hope is that your hair loss will slow down after your medical condition is treated or cured and any deficiency of your overall hormone balance is corrected.

    Baby blues: Postpartum hair loss

    Pregnancy alters a woman’s overall hormone configuration in many different ways. When hormones change, hair becomes a target organ for change in some (but not all) women because the rapid growth of the hair cells reflects changes in the overall hormonal environment in the woman’s body.

    When you’re pregnant, your production of the sex hormone estrogen increases, which prolongs the growth (anagen) phase of the hair cycle. During pregnancy, many women are delighted to discover that their hair is thicker and more lush. After the baby is born, however, estrogen levels drop and more hair lapses into the resting (telogen) phase. Consequently, your growing hair may fall out, and because the resting cycle lasts two to six months, it may take time to see the hair return to its growth phase.

    Because hair grows at about 1 2 inch per month and doesn’t start growing again until the rest cycle is complete, it can take up to a year for you to get your “old” hair back. In that period, you may think you’re going bald; don’t worry, you aren’t. In nursing moms, the resting period can take longer than a year, and it may take more than a year for hair growth to return to previous levels.

Anemia and hypothyroidism also can contribute to postpartum hair loss.

Menopause and hair loss

Over 50% of women going through the hormone fluctuations associated with menopause experience signi ficant hair loss. The drop in estrogen levels in postmenopausal women may put the hair in a prolonged resting phase; this phase is particularly important for those women who have inherited female genetic hair loss. Unfortunately, doctors don’t really understand the mechanisms by which the withdrawal of estrogen causes hair loss in women, but they know that it occurs. Women who lose estrogen support have many changes in their bodies, of which hair is only one. There are books written on the use of hormone supplements for managing menopausal changes in the body, and this book is not meant to deal with these complex issues.

The Side Effects of Medications Leading to Hair Loss

Some medications can do more than cure what ails you: They can cause you to lose hair. The list of drugs that may cause hair loss is huge, but here are a few of the more common ones:

  • Acne medications, such as isotretinoin (Accutane)

  • Antiin flammatory drugs, such as naproxen (Naprox), indomethacine (Indocin), and naproxen (Naprosyn)

  • Antidepressants, such as paroxetine (Paxil), fluoxetine hydrochloride (Prozac), and sertraline hydrochloride (Zoloft)

  • Beta blockers, such as nadolol (Corgard), propanolol (Inderal), metoprolol (Lopressor), and atenolol (Tenormin)

  • Birth control pills

  • Blood thinners, such as warfarin sodium (Coumadin) and heparin

  • Cholesterol-lowering drugs, such as gem fibrozil (Lopid)

  • Gout medications, such as allopurinol (Lopurin or Zyloprim)

  • Seizure medications, such as trimethadione (Tridone)

  • Ulcer medications, such as famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac)

  • ADHD medications like Ritalin and Adderal.

    Hair Loss with Chemotherapy

    Chemotherapy is the treatment of disease with powerful drugs meant to kill rapidly growing cancerous cells. Because the drugs are so potent, chemotherapy has many side effects, one of which is hair loss. Chemotherapy targets not just cancer cells but all rapidly growing cells, including hair follicle cells, which is why chemotherapy often causes severe hair loss.

    Not all chemotherapy drugs cause hair loss; your doctor will tell you if the drug or drugs you’re taking have this side effect. Some newer chemotherapy drugs are made to speci fically target certain cells and spare your hair.

    Still, if you’re receiving chemotherapy, it’s likely that all your hair in the actively growing phase will fall out. Because 90% of hair is in this phase of the hair growth cycle at any given time, essentially all your hair may fall out during treatment. Different drugs cause different hair loss patterns; with paclitaxel (Taxol), the loss is sudden, while cyclophosphamide (Cytoxin) causes hair to thin but not fall out altogether.

    The good news is that your hair usually starts to grow back within six to eight weeks after you stop treatment. You may ask your doctor about topical minoxidil, which has been shown to accelerate the regrowth of hair by almost two months. When your hair does grow back, it may initially be curlier and have a different texture, but it should return to its old self within a year.

    Hair systems: coloring and “ fixing” (The healthy head of hair has no comparison in looks) When your hair is healthy and luscious you stand out from the crowd, no question about that.