be healthy

Christine Haran

Medical reviewer:

Danielle Petersel, MD

Medically Reviewed On: December 17, 2003

Published on: December 17, 2003

Although many men are distressed when they start losing their hair, they don’t have to look far to find examples of bald men who are considered successful, youthful and handsome. Andre Agassi, Bruce Willis, Michael Jordan, Vin Diesel, the list goes on and suggests that baldness can be sexy. However, balding women are hard pressed to find same “bald is beautiful” message.

"It’s totally acceptable for a man to be bald," says Dr. Brad Limmer, a dermatologist specializing in hair transplantation who has a private practice in San Antonio, Texas. "It’s not for a woman. So much emphasis and value is place on a woman’s head of hair; it’s hard to even compare the impact on men and women."

People tend not to associate pattern baldness, also known as genetic hair loss, with women, but it is just as common, though the timing and pattern of hair loss is different. While men tend to start losing hair in the 30s and 40s, thinning begins in the 40s or 50s in women. And while men tend to lose hair in the front and at the top of the head, women’s hair thins diffusely throughout the scalp. Luckily total baldness is very rare in women.

Psychological Impact
Studies have linked pattern baldness in both men and women not only to dissatisfaction with one’s appearance, but also to lowered self-esteem and other measures of self-worth. A 1999 study published in the Journal of Women’s Health and Gender-Based Medicine found that hair loss in women was associated with self-consciousness, jealousy and a feeling of powerlessness. The research also indicates that women tend to be more upset than men by their hair loss. A 1992 study in the Journal of the American Academy of Dermatology that compared the psychological impact of hair loss found that women had a more negative body image and were less able to adapt to the loss.

Causes
Despite the negative impact of their hair loss on their lives, women have been reluctant to seek treatment. But that trend seems to be turning around. "It was always very hush-hush, so women did not talk about it with anyone other than their hairdresser," Limmer says. "But today, more and more women are seeking treatment. Five years ago, 1 in 25 to 30 of my patients was a woman, now it’s 1 in every 12 patients."

After genetic pattern baldness, telogen effluvium is the most common cause of hair loss in women. It is a temporary hair loss in which a higher than normal percentage of hair shifts into a shedding phase. Telogen effuvium can occur after pregnancy or when a woman goes on or off birth control pills. It can also take place after an emotionally traumatizing event such as the loss of a loved one and during a crash diet, which may cause nutritional deficiencies that effect hair growth.

Sometimes, hair loss is due to an underlying medical condition such as lupus, polycystic ovary syndrome, a thyroid problem, anemia or hormonal imbalances. Hair loss can also be a side effect of medication such as ibuprofen, antidepressants, hypertension drugs, anticoagulants and chemotherapy.

“Also African-American women may be more likely to experience hair loss”, says Dr. Robert True, a dermatologist specializing in hair restoration who is in private practice in New York City. True attributes the higher rate of hair loss to a combination of genetic and styling issues. According to True, hair extensions and tight braiding as well as chemicals used to relax hair can damage hair follicles.

Treatment
Once a doctor establishes that the cause of the hair loss is genetic, women can consider treatment. Minoxidil (Rogaine) is the only medical therapy available to women; it’s been found to help them maintain the hair they still have. The 2 percent minoxidil formula is marketed specifically to women, and the 5 percent formula is marketed to men. Most hair loss specialists, however, recommend that women with significant hair loss use the 5 percent formula, though they need to be cautious about keeping the minoxidil off their face in order to avoid unwanted facial hair. Hair transplantation is also available to many women with pattern baldness. Older transplantation techniques were not appropriate for most women because the transplanted hair damaged hair follicles in the recipient area. As Limmer explains, this was a problem in women because, unlike men, they usually have hair in their balding zone. With today’s techniques, however, hair transplants surgeons can place grafts around the remaining hair.

So although women today continue to struggle with hair loss, more treatments are available to them. As with other conditions affecting women, it’s time for hair loss to come out of the closet—so women can openly seek a diagnosis and weigh their treatment options.