FEMALE PATTERN HAIR LOSS (FPHL)

Other names: Female thinning, Hereditary thinning in women, Female genetic hair loss, female balding, FPHL

What is female pattern hair loss (FPHL)?

  • Female pattern hair loss (also called androgenetic alopecia) is a common type of hereditary hair thinning. 
  • Although hair may become quite thin, women do not become 'bald' as in men.
  • Hair thinning starts as early as the teenage years, but usually in the twenties and thirties and is usually fully expressed by the age of 40.

How can I recognize female pattern hair loss (FPHL)?

  • Typically, a young woman in her teens, twenties or thirties gradually becomes aware that she has less hair on the top of her head than previously. 
  • She may notice that her scalp has become slightly visible now and it takes more effort to style the hair to hide the thinning. 
  • The size of the ponytail becomes smaller in diameter. 
  • While all this is happening, she may also notice that her hair becomes greasy and stringy more quickly and she shampoos more often to keep the hair looking fuller volume.
  • One of the earliest signs of androgenetic alopecia is widening of the ‘central part’ (down the middle of the scalp). The spacing between hairs gradually increases. The thinning gradually becomes diffuse and may be present all over the scalp but is usually most pronounced over the top and sides of the head. There is much variation in the diameter and length of hairs – some and thick and long while others are fine and short. This variation in size represents the gradual miniaturization of hair follicles- they become smaller and smaller.   

What causes female pattern hair loss (FHPL)?

  • The precise reasons for FPHL are not yet fully understood
  • This form of hair thinning is a normal hereditary trait that is influenced by two factors – the normal male hormone called testosterone and heredity. 
  • The influence of the normal male hormone on hair follicles that a programmed to genetically get thinner causes their 'miniaturization' over time. 
  • Smaller follicles produce hair that is finer and shorter.  The miniaturized hairs are still present and the possibility still exists to reverse this process and re-enlarge the hair follicles. This is what treatments like Minoxidil help to do. 

Does female pattern hair loss come from mother’s side or father’s side of the family?

  • Contrary to popular belief, the genetic trait can be inherited from both sides of the family – mother or father  (or both sides).
  • Affected members in the family may have varying degrees of thinning.

 How common is female pattern hair loss?

  • Female pattern hair loss is common.
  • At least 50 % of women will be affected by this type of thinning.
  • We are less aware of it in women because it tends to be milder than in men. 
  • Furthermore, women tend to be more self conscious and embarrassed by this trait and do not talk about it freely.  For all these reasons, there is much less public awareness about hereditary thinning in women.

Do women with female pattern hair loss have too much male hormone?

  • No –normal levels of the male hormone are present in most cases.
  • The difference is that the hair follicles are MUCH MORE SENSITIVE to the normal male hormone.    

Do I need any hormone tests as part of my blood work?

  • In most cases, the answer is ‘no’.
  • However, if there are certain findings on your history or hair examination  your doctor may order these tests. This includes:
    • irregular periods
    • infertility
    • excess facial hair
    • severe acne
    • milky breast discharge.

What treatments are available for female pattern hair loss?

Although there is no cure, there are several treatment options available to women with hair loss.  Feel free to discuss any of these treatments with your doctor.

  1. Minoxidil (Rogaine and others). This is the first approved treatment for promoting hair growth.  Although the effect is not very strong, if applied properly, the effect is real.  Many studies have shown that it produces a substantial increase in partially thicker and longer hairs and women whose scalps are visible will usually enjoy improved coverage of the scalp. Topical minoxidil does not completely reverse the thinning process. It must be applied twice daily for one year before judging its efficacy. Treatment must be continued.
  2. Hormonal blocking treatments – (Spironolactone, oral contraceptives and others).  In certain cases, these may be helpful.   These treatments are not effective for all women with hair loss, and your doctor  can advise if these may be helpful for you. 
  3. Hair Transplantation. Many women with female pattern hair loss can greatly improve the density of hair on top of the scalp with hair transplantation. This is an out-patient day long surgical procedure whereby hairs are removed from the back of the scalp and individually placed into the front and top of the scalp where there is thinning.  The new hairs grow out over the next 6-12 months.
  4. Laser hair treatment – Some laser devices have shown evidence of being helpful in women.
  5. Platelet rich plasma therapy – A newer treatment, PRP has shown benefit in many women.
  6. Wigs and camouflage.  Women the substantial thinning may use small hair pieces or full wigs. There is a large selection and these are safe.  Contrary to popular belief, wigs do not harm the hair in any way and do not accelerate the thinning process. Camouflaging agents are over the counter products (hair fibers, sprays) that cover areas of thinning. 

How can I recognize female pattern hair loss (FPHL)?

  • Typically, a young woman in her teens, twenties or thirties gradually becomes aware that she has less hair on the top of her head than previously. 
  • She may notice that her scalp has become slightly visible now and it takes more effort to style the hair to hide the thinning. 
  • The size of the ponytail becomes smaller in diameter. 
  • While all this is happening, she may also notice that her hair becomes greasy and stringy more quickly and she shampoos more often to keep the hair looking fuller volume.
  • One of the earliest signs of androgenetic alopecia is widening of the ‘central part’ (down the middle of the scalp). The spacing between hairs gradually increases. The thinning gradually becomes diffuse and may be present all over the scalp but is usually most pronounced over the top and sides of the head. There is much variation in the diameter and length of hairs – some and thick and long while others are fine and short. This variation in size represents the gradual miniaturization of hair follicles- they become smaller and smaller.   

What causes female pattern hair loss (FHPL)?

  • The precise reasons for FPHL are not yet fully understood
  • This form of hair thinning is a normal hereditary trait that is influenced by two factors – the normal male hormone called testosterone and heredity. 
  • The influence of the normal male hormone on hair follicles that a programmed to genetically get thinner causes their 'miniaturization' over time. 
  • Smaller follicles produce hair that is finer and shorter.  The miniaturized hairs are still present and the possibility still exists to reverse this process and re-enlarge the hair follicles. This is what treatments like Minoxidil help to do. 

Does female pattern hair loss come from mother’s side or father’s side of the family?

  • Contrary to popular belief, the genetic trait can be inherited from both sides of the family – mother or father  (or both sides).
  • Affected members in the family may have varying degrees of thinning.

 How common is female pattern hair loss?

  • Female pattern hair loss is common.
  • At least 50 % of women will be affected by this type of thinning.
  • We are less aware of it in women because it tends to be milder than in men. 
  • Furthermore, women tend to be more self conscious and embarrassed by this trait and do not talk about it freely.  For all these reasons, there is much less public awareness about hereditary thinning in women.

Do women with female pattern hair loss have too much male hormone?

  • No –normal levels of the male hormone are present in most cases.
  • The difference is that the hair follicles are MUCH MORE SENSITIVE to the normal male hormone.    

Do I need any hormone tests as part of my blood work?

  • In most cases, the answer is ‘no’.
  • However, if there are certain findings on your history or hair examination  your doctor may order these tests. This includes:
    • irregular periods
    • infertility
    • excess facial hair
    • severe acne
    • milky breast discharge.

What treatments are available for female pattern hair loss?

Although there is no cure, there are several treatment options available to women with hair loss.  Feel free to discuss any of these treatments with your doctor.

  1. Minoxidil (Rogaine and others). This is the first approved treatment for promoting hair growth.  Although the effect is not very strong, if applied properly, the effect is real.  Many studies have shown that it produces a substantial increase in partially thicker and longer hairs and women whose scalps are visible will usually enjoy improved coverage of the scalp. Topical minoxidil does not completely reverse the thinning process. It must be applied twice daily for one year before judging its efficacy. Treatment must be continued.
  2. Hormonal blocking treatments – (Spironolactone, oral contraceptives and others).  In certain cases, these may be helpful.   These treatments are not effective for all women with hair loss, and your doctor  can advise if these may be helpful for you. 
  3. Hair Transplantation. Many women with female pattern hair loss can greatly improve the density of hair on top of the scalp with hair transplantation. This is an out-patient day long surgical procedure whereby hairs are removed from the back of the scalp and individually placed into the front and top of the scalp where there is thinning.  The new hairs grow out over the next 6-12 months.
  4. Laser hair treatment – Some laser devices have shown evidence of being helpful in women.
  5. Platelet rich plasma therapy – A newer treatment, PRP has shown benefit in many women.
  6. Wigs and camouflage.  Women the substantial thinning may use small hair pieces or full wigs. There is a large selection and these are safe.  Contrary to popular belief, wigs do not harm the hair in any way and do not accelerate the thinning process. Camouflaging agents are over the counter products (hair fibers, sprays) that cover areas of thinning. 


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