Her Hair Loss Help Rotating Header Image

androgenetic

Hair Loss in Women

Her Hair Loss Help has an outstanding Discussion Forum specifically for women with alopecia and other forms of hair lossWomen experience hair loss because of a number of reasons, such as pregnancy, stress, genetics or an illness. Another cause is Alopecia Areata, an autoimmune disorder which results in hair loss.

Women going through any type of hair loss becomes distraught about their changing appearance. Some are comfortable leading their life as someone without hair, but many seek out hair replacement studios to give them back what they have lost.

Unless you yourself have been through sudden and unexpected hair loss, it is nearly impossible to fully understand the emotions that a person must be experiencing. The process going from someone with hair, to someone losing their hair, to someone seeking hair replacement, is a sensitive and personal journey.

What is androgenetic alopecia (AGA)?

Hair loss can be very concerning to womenHereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother’s or father’s side of the family. Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties, or thirties. There is no cure, although medical treatments are available that may help some people.

Hereditary hair loss, or androgenetic alopecia, is marked by a progressive miniaturization of hair follicles, causing a shortening of the hair’s growth cycle. As the growth phase shortens, the hair becomes thinner and shorter. Eventually there is no growth at all. Because hereditary hair loss is gradual, the sooner treatment is started, the better the chances of results.

What Causes Androgenetic Areata?

Hair follicles contain androgen receptors. In the presence of androgens, genes that shorten the anagen phase are activated, and hair follicles shrink or become miniaturized. With successive anagen cycles, the follicles become smaller (leading to shorter, finer hair), and nonpigmented vellus hairs replace pigmented terminal hairs. In women, the thinning is diffuse, but more marked in the frontal and parietal regions. Even persons with severe androgenetic alopecia almost always have a thin fringe of hair frontally. The remaining hair configuration may resemble a monk’s haircut.

Women with androgenetic alopecia do not have higher levels of circulating androgens. However, they have been found to have higher levels of 5a-reductase (which converts testosterone to dihydrotestosterone), more androgen receptors, and lower levels of cytochrome P450 (which converts testosterone to estrogen).

Most women with androgenetic alopecia have normal menses, normal fertility, and normal endocrine function, including gender-appropriate levels of circulating androgens. Therefore, an extensive hormonal work-up is unnecessary. If a woman has irregular menses, abrupt hair loss, hirsutism, or acne recurrence, an endocrine evaluation is appropriate. In this situation, total testosterone, free testosterone, dehydroepiandrosterone sulfate, and prolactin levels should be obtained.

Because the hair loss in androgenetic alopecia is an aberration of the normal hair cycle, it is theoretically reversible. Advanced androgenetic alopecia, however, may not respond to treatment, because the inflammation that surrounds the bulge area of the follicle may irreparably damage the follicular stem cell.

AGA – Photo image of onset

Image photo of the onset of Androgenetic Alopecia in a female courtesy of www.aafp.org

Image photo of the onset of Androgenetic Alopecia in a female courtesy of www.aafp.org

Polycystic Ovary Syndrome

How common is PCOS?

It is currently believed that approximately 5 to 10% of women have Polycystic Ovary Syndrome (PCOS). It is the most common hormonal disorder in women of reproductive years and the leading cause in women for infertility. Since many women can have PCOS without exhibiting any symptoms, the actual number of women affected could be as much as 10% more of the population.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

What are the symptoms of PCOS?

Photo of a polycystic ovary courtesy of http://www.ovarian-cysts-pcos.com

Photo of a polycystic ovary courtesy of http://www.ovarian-cysts-pcos.com

Some of the most common symptoms include:

  • Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) Menstrual cycles can often be scant, irregular and infrequent or may also exhibit in the form of spotting throughout the month.
  • Oligo or anovulation (infrequent or absent ovulation) Women with PCOS generally produce an egg but they don’t fully mature. Instead, these immature egg sacs can create ovarian cysts.
  • Hyperandrogenism Women who have PCOS generally also have an increase in serum levels of male hormones such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
  • Infertility
  • Cystic ovaries Classic PCOS ovaries have a “string of pearls” or “pearl necklace” appearance with many cysts.
  • Enlarged ovaries Polycystic ovaries are usually 1.5 to 3 times larger than normal.
  • Chronic pelvic pain
  • Obesity or weight gain Most commonly referred to as an “apple figure”. PCOS women will generally gain weight primarily in the abdomen and waistline.
  • Insulin resistance, hyperinsulinemia, and diabetes Insulin resistance is a condition where the body’s use of insulin is inefficient.
  • Hirsutism (excess hair) Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
  • Alopecia (female-pattern baldness or thinning hair) The thinning most commonly occurs on the top of the head.
  • Acne/Oily Skin/Seborrhea
  • Acrochordons (skin tags)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

What causes PCOS?

The exact cause of PCOS is unknown. However, there are studies that may lead us to believe that there may be a genetic link. Just as one may have a genetic predisposition to diabetes, one might also have a disposition to PCOS.

Photo trichogram findings in women with AGA

Phototrichogram findings in women with androgenetic alopecia.
Department of Dermatology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.

Background/purpose: Androgenetic alopecia (AGA) in women is characterized by diffuse thinning in the frontal and parietal areas of the scalp; preservation of the frontal hairline is norm. Hair over the occipital scalp is preserved. The purpose of this work was to investigate the findings of phototrichogram (PTG) of the affected and the spared areas in women with AGA and to compare them with those of healthy subjects.

Methods: Twenty-two controls and 60 untreated women with AGA (32 with Ludwig I, 28 with Ludwig II) were included in this study. Hair density, percentages of thin hair, and non-growing hair were estimated both on the midscalp and on the occiput by using PTG with digital camera attached to a dermoscope.

Results: In the control group, hair density was higher on the midscalp than the occiput. In AGA groups, hair density was lower on the midscalp than the occiput and percentages of thin hair and non-growing hair were higher on the midscalp than the occiput. These findings were more prominent in Ludwig II group. In the occiput there were findings mimicking the changes seen on the midscalp. These were less striking than those seen on the midscalp yet the difference between the control and Ludwig II group was statistically significant.

Conclusion: We concluded that the hair is not equally distributed on the scalp, the occiput may be affected in females with AGA and further studies are necessary to support these findings.

PMID: 17026665 [PubMed – in process]

Ludwig Scale of Hair Loss for Women

courtesy of www.dermalogix.net

courtesy of www.dermalogix.net

Photo of AGA in younger woman

Photo image of young woman with diagnosis of androgenetic alopecia (female pattern baldness) courtesy of www.trichologists.org.uk

Photo image of young woman with diagnosis of androgenetic alopecia (female pattern baldness) courtesy of www.trichologists.org.uk

Photo image of middle aged woman with AGA

Photo image of middle aged woman with female pattern baldness.  Courtesy of www.trichologists.org.uk

Photo image of middle aged woman with female pattern baldness. Courtesy of www.trichologists.org.uk

How can I cope with the effects of AGA?


Living with hair loss can be hard, especially in a culture that views hair as a sign of youth and good health. Even so, most people with alopecia areata are well-adjusted, contented people living full lives.

The key to coping is valuing yourself for who you are, not for how much hair you have or don’t have. Many people learning to cope with alopecia areata find it helpful to talk with other people who are dealing with the same problems. More than four million people nationwide have this disease at some point in their lives, so you are not alone. We have a number of women who live with alopecias of all kinds a daily basis in our Online Community who can help through message boards and support groups.

Another way to cope with the disease is to minimize its effects on your appearance. A wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.

For women, attractive scarves can hide patchy hair loss; jewelry and clothing can distract attention from patchy hair; and proper makeup can camouflage the effects of lost facial hair. If you would like to learn more about camouflaging the cosmetic aspects of androgenetic alopecia, ask your doctor or members of your local support group to recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.

How will androgenetic alopecia affect my life?

The comforting news is that androgenetic alopecia is not a painful disease and does not make people feel sick physically. It is not contagious, and people who have the disease are generally healthy otherwise. It does not reduce life expectancy and it should not interfere with the ability to achieve such life goals as going to school, working, marrying, raising a family, playing sports, and exercising.

The emotional aspects of living with hair loss, however, can be challenging. Many people cope by learning as much as they can about the disease; speaking with others who are facing the same problem; and, if necessary, seeking counseling to help build a positive self-image. HerHairLossHelp.com offers a wonderful Online Community of women who suffer from alopecia and other hair loss afflictions that can help women who suffer from hair loss cope with their everyday activities. Having a community of women, who are all going through various stages of hair loss, offers other women an empathetic person to turn to when dealing with emotional difficulties because of their hair loss. Visit the HerHairLossHelp.com Forum to learn more!

How is Androgenetic Areata (AGA) treated?

Only 2 proven, food and drug administration (FDA) approved medications are currently available for treatment of androgenetic alopecia: minoxidil and finasteride.

  • Minoxidil (5%): Rogaine: Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The solution, applied twice daily, has been shown to promote hair growth in both adults and children, and may be used on the scalp, brow, and beard areas. With regular and proper use of the solution, new hair growth appears in about 12 weeks.

    Although the method of action is essentially unknown, minoxidil appears to lengthen the duration of the anagen phase, and it may increase the blood supply to the follicle. Regrowth is more pronounced at the vertex than in the frontal areas and is not noted for at least 4 months. Continuing topical treatment with the drug is necessary indefinitely because discontinuation of treatment produces a rapid reversion to the pretreatment balding pattern.

    Patients who respond best to this drug are those who have a recent onset of androgenetic alopecia and small areas of hair loss. The drug is marketed as a 2% or a 5% solution, with the 5% solution being somewhat more effective. A recent 48-week study compared the 2 strengths in men. Findings indicated that 45% more regrowth occurred with the 5% compared with the 2% solution. In general, women respond better to topical minoxidil than men. The increase in effectiveness of the 5% solution was not evident for women in the FDA-controlled studies. Subsequent studies have shown at best a modest advantage to the higher concentration in women. In addition, the occurrence of facial hair growth appears to be increased with the use of the higher-concentration formulation.

  • Finasteride: Propecia: Finasteride is given orally and is a 5 alpha-reductase type 2 inhibitor. It is not an antiandrogen. The drug can be used only in men because it can produce ambiguous genitalia in a developing male fetus. Finasteride has been shown to diminish the progression of androgenetic alopecia in males who are treated, and, in many patients, it has stimulated new regrowth.

    Although it affects vertex balding more than frontal hair loss, the medication has been shown to increase regrowth in the frontal area as well. Finasteride must be continued indefinitely because discontinuation results in gradual progression of the disorder. A study in postmenopausal women indicated no beneficial effect of the medication in treating female androgenetic alopecia.

  • Exogenous Estrogen: In the past, exogenous estrogen was used to treat androgenetic alopecia. This treatment is used less often now, because minoxidil is more effective. In fertile women with androgenetic alopecia who request oral contraception, it is important to select a pill containing the least androgenic progestin, such as norgestimate (in Ortho-Cyclen, Ortho Tri-Cyclen), norethindrone (in Ovcon 35), desogestrel (in Mircette), or ethynodiol diacetate (in Demulen, Zovia).
  • Hair Transplantation: Hair transplants involve removing healthy hair follicles from one area of the scalp and transplanting them to the bald areas. Surgical treatment of androgenetic alopecia has been successfully performed for the past 4 decades. Although the cosmetic results are often satisfactory, the main problem is covering the bald area with donor plugs (or follicles) sufficient in number to be effective. Micrografting produces a more natural appearance than the old technique of transplanting plugs. Patients with less than 40 follicular units/cm2 in their donor areas are poor candidates for the procedure. Scalp reduction has been attempted to decrease the size of the scalp to be covered by transplanted hair. However, the scars produced by the reduction technique often spread and become more noticeable with time.

    Hair weaving techniques are available, and, together with hairpieces, they offer the patient a prosthetic method of coverage.

  • Spironolactone: Aldactone: This drug is a weak competitive inhibitor of androgen binding to androgen receptors. It also decreases the synthesis of testosterone. For these reasons, orally administered spironolactone has been tried in the treatment of androgenetic alopecia, although questions remain about its usefulness. Spironolactone can be beneficial in women who also have hirsuitism. However, the FDA has not labeled this drug for the treatment of androgenetic alopecia.

Who is most likely to get AGA?

Men and women should look at both sides of their family tree for relatives with hereditary hair loss. The condition can be inherited from their mother, their father, or from both parents.

In the United States, 30 million women—or one in four—experience hereditary hair loss. Less frequent causes for hair loss in women include stress, illness, medication, diet, and pregnancy. But 70 percent of women with thinning hair can attribute it to hereditary hair loss.

Race neither increases nor decreases a person’s likelihood of experiencing hereditary hair loss. Hereditary hair loss affects all ethnicities.