Examining Hair Thinning in Women

Women are generally more attentive to the appearance of their hair
and notice the see-through quality of thinning hair early on. Most
women with thinning hair don’t lose enough all at once to clog the
drain, so problems with styling may be the first sign of the female
genetic balding process. This is fortunate because the slow onset
of thinning allows women to adjust their styling to compensate for
their hair loss.
Most women are able to conceal thinning with a new hairstyle, up
to a point. Layering, a pulled-back style like a pony tail, or a bun
can hide thinning hair fairly well. Or women can use hair exten-
sions or other hair systems, which we discuss in Chapters 6 and 7.
Regardless of how well they may be able to hide it, hair loss is a
psychological challenge for women who fondly remember the lus-
cious, thick hair of their youth and see it coming out in bunches on
their hairbrushes. Thinning hair can make a woman feel older and
less sexy.
This section looks at genetic female pattern hair loss and other
causes of women’s hair loss.
Differentiating between
possible causes
There are a number of types of identifiable hair loss in women, and
they differ based on their causes. The cause of female hair loss is
reflected in the pattern, so doctors look to the pattern of loss to
get an idea of the cause and how to treat it.
About 10 percent of women experience the classic pattern of
genetic hair loss, which is an intact frontal hairline for the first
2
⁄3 inch or so and hair loss behind that persistent hairline. Another
recognizable pattern of genetic hair loss in women is hair loss con-
fined to the top of the head, sparing the leading frontal edge of the
hair line. Some women with genetic hair loss experience a diffuse
hair loss, which is a thinning of the hair all over the head (includ-
ing the sides and back of the head) and isn’t confined to any partic-
ular area. This is more common in postmenopausal women,
although it does show up in younger women as well.
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 (the place in the crown where hair changes direction and
produces a vortex); 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 rec-
ognized 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.
Generalized thinning isn’t always genetic, and women should
undergo a complete medical examination including a wide variety
of laboratory tests. (We touch on these tests in this chapter in the
section “Medical causes of female hair loss” and in detail in
Chapter 5.)