What is female pattern hair loss? Causes, diagnosis and treatment approach

What is female pattern hair loss?

Female pattern hair loss is a slow thinning of the hair over many years that follows a particular pattern. In medicine, it is considered the female form of androgenetic alopecia (hair loss linked to an inherited predisposition). It is one of the most common causes of long-term hair thinning in women. It can start at any age after puberty, and it becomes more common with age, especially after menopause.

Unlike in men, the front hairline often stays where it is, and instead of a clearly bare area, the thinning spreads over a wide area at the crown and around the part. Many women notice it because their part gets wider, their ponytail gets thinner or more of their scalp shows under bright light. In some women, the thinning is more noticeable at the front and widens toward the forehead along the part; in others, the hairline recedes at the temples, similar to the male pattern.

At times, more hairs than usual may fall out, but the main change is that the hairs become thinner; it is rare for the scalp to become completely bare. You can find the scales used to describe the degree of thinning in our article on the Norwood and Ludwig scales.

Why does the hair thin?

Hair roots, or follicles, work in a cycle: they produce a hair for a while, then rest and shed it, and then grow a new one. In female pattern hair loss, the growth phase of this cycle gets shorter and shorter. As the cycles repeat, the follicle shrinks and produces finer, shorter, lighter-colored hairs. This process is called miniaturization. We cover the phases of the cycle in our article on the hair growth cycle.

Thick and fine hairs grow side by side in the same area; as the number of fine hairs increases, more of the scalp shows. When thinning is advanced and has gone on for a long time, some follicles may stop producing a visible hair.

It is more common in women who have a family history of similar thinning. The predisposition is thought to involve more than one gene and to come from either the mother or the father; in women, however, the role of genetics is not as well understood as it is in men. In men, the role of androgens (male hormones, which women also have at lower levels) is well known; in women, the picture is more complex. Some women have signs of excess androgens, but in most women with female pattern hair loss, androgen levels in the blood are within the normal range. That is why, in women, the term “female pattern hair loss” is often preferred over “androgenetic alopecia.”

What do we not know yet?

There is no test that can show in advance how quickly a woman’s thinning will progress or where it will stop. What starts the process in women with normal androgen levels is still being researched. It is also debated how much iron deficiency contributes to this thinning, and below what level iron stores start to matter for hair.

What does the doctor look into?

In women, hair thinning does not always have a single cause; another condition may accompany female pattern hair loss or look like it. That is why the doctor looks at your hair and scalp and asks about your history: When did the hair loss start? Does anyone in your family have similar thinning? In recent months, have you given birth, had an illness with a fever, had surgery or lost weight quickly? Have you started or stopped a medication? How regular are your periods?

The doctor who examines you decides which tests are needed based on your history and the examination findings; there is no single list for everyone. We do not recommend getting tests done on your own and then taking medication or supplements based on the results; for example, if you are not iron deficient, iron supplements are not expected to benefit your hair. For widespread shedding that starts after giving birth or an illness, see our article on telogen effluvium.

Trichoscopy helps with the diagnosis; in female pattern hair loss, it shows marked differences in thickness between hairs in the same area. The diagnosis is often made from your history and the examination; a biopsy usually comes into consideration if the picture is not clear. We recommend seeing a dermatologist about the cause and diagnosis of your hair loss; we do not diagnose from photos or messages.

The general approach to treatment

Because female pattern hair loss is a long-term condition, the aim of treatment is often to slow the thinning and preserve as much of the existing hair as possible; the response to treatment varies from person to person. If an accompanying condition such as iron deficiency or a thyroid problem has been found, treating it also becomes part of the plan. The following is general information; your doctor decides which option is suitable for you.

• Medications applied to the scalp: The most widely studied medication for female pattern hair loss is minoxidil. It is thought to extend the growth phase and help the shrinking follicle produce thicker hairs. Its effect can only be judged after several months, and once the medication is stopped, the gains are gradually lost. Side effects such as scalp irritation or unwanted hair growth on the face can occur.
• Oral medications: In some women, especially if there are signs of excess androgens, medications that reduce the effect of androgens on the hair follicle (antiandrogens) may be considered.
• Supporting procedures: The evidence on the effect of methods such as PRP (plasma prepared from a person’s own blood) and low-level light therapy in female pattern hair loss is limited.
• Ways to improve the look: A suitable haircut, changing where you part your hair, or products that reduce the color contrast between the hair and the scalp can make thinning less noticeable.

If you are pregnant, planning a pregnancy or breastfeeding, tell your doctor: some of these medications are not used during these times, and with others, you need to use contraception while taking them. Do not start any medication on your own, and do not change a treatment you are using without talking to your doctor first; suitability, possible side effects and how long to use it are determined by your doctor’s assessment.

Who might a hair transplant be an option for?

In a hair transplant, we usually take grafts (the natural groups of hair follicles that we transplant) from the back and sides of the head, that is, the donor area, and place them in the thinning area. This approach relies on the follicles in the donor area being less prone to hair loss. In female pattern hair loss, however, thinning is not always limited to the top of the head; in some women, it also spreads to the back and sides. Grafts taken from a donor area like this may also thin over time where they are transplanted. We explain why the donor area matters so much in our article on the donor area and donor dominance.

That is why a hair transplant is not suitable for every woman with female pattern hair loss. We usually consider a transplant when all of the following apply:

• The hair in the donor area has not been affected by thinning
• The thinning is concentrated in a particular area, such as the part, the front or the crown
• The hair loss has been stable for some time
• The cause of the hair loss is understood, and any accompanying conditions have been addressed
• Your expectations match what your donor area can provide

In women, the number of grafts that can be taken from the donor area is often limited, and we usually place the grafts between existing hairs. Expecting a transplant to bring back the hair density you once had is often not realistic. In the weeks after the procedure, some of the transplanted hair or the hair around it may fall out temporarily; this is called shock loss. Surrounding hairs that had already thinned may not always grow back.

A transplant also does not stop the hair from thinning in areas that were not transplanted, so your doctor may recommend continuing medical treatment alongside the transplant. You can find out how we plan transplants for women on our hair transplant for women page.

What do we do during the examination?

During the examination, we talk about when the hair loss started and how it has progressed, and we look at your hair and scalp together. We assess where the thinning is and how widespread it is, as well as the hair density in the donor area and whether there are any signs of thinning there. We would also like to see any previous test results you have and the medications you take.

If the cause of the hair loss is not yet clear, or if there is a finding that suggests another condition, we recommend an assessment by a dermatologist before we discuss a transplant. We talk openly about the option of a transplant after that assessment.

Which signs mean you should see a doctor without waiting?

See a doctor if your hair is falling out noticeably within a short time or in patches, if you have itching, burning, pain or redness on your scalp, or if you have noticed irregular periods, acne or increased hair growth on your face or body along with the hair loss.

Whether you are suitable for a hair transplant is determined during the examination, and results vary from person to person.