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Woman's Hair Loss

Hair Loss in Women, What Causes This?

Hereditary or otherwise known as common baldness in women seems to be related to the same major factors that cause hair loss in men:

  • Hormones
  • Age
  • Genes

As with men, the genes that are responsible for woman's hair loss can be inherited from either the father or mother. The expression of these genes is dependent on hormones called androgens, so common hair loss in women is called "Androgenetic Alopecia" (this is the same term used for common balding in men).

There are is a large number of reasons to explain why hair loss in women presents itself differently than in men (although all of the factors are still not completely understood). Probably one of the most important reason for this is that men have a much higher level of the androgen testosterone. This is the hormone that is responsible for male sexual characteristics and, when the body converts it to DHT, it becomes the main culprit in causing baldness. Fortunately, these Hlower levels of testosterone in women spare them from the hair loss that is most often seen in men.

Testosterone is converted to DHT by the enzyme 5-alpha reductase that is present in higher concentrations in the balding areas of the scalp. Women have only half of the amount of this enzyme overall as men do and have even less in the crown. In addition to this, women have higher levels of an enzyme called aromatase in all areas of the scalp that may block the formation of DHT. This enzyme is present in especially high concentration in the frontal hairline in women, possibly explaining why this area is often resistant to balding in most women.

As we age, some normal degree of hair loss occurs in many of us so total hair volume will likely decrease over time in both sexes. Hair loss associated with genetic balding is also dependent upon time to express itself. Woman's hair loss occurs at different rates and at different periods in one's life with increased loss often occurring during periods of hormonal change, such as pregnancy and menopause.

Other Causes of Hair Loss in Women

A large number of "non-androgenetic" factors may be responsible for hair loss in women. Women's hair can to be particularly sensitive to underlying medical conditions. Since a variety of problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is imperative that women with undiagnosed hair loss, those of the diffuse or "un-patterned" type, endure an extensive examination.

Of the many medical conditions that can cause hair loss, the most common of these are:

  • anemia
  • other endocrine problems (especially those that produce excess androgens)
  • gynecological conditions - such as ovarian tumors
  • surgical procedures and general anesthesia
  • connective tissue disease (such as Lupus)
  • severe emotional stress
  • thyroid disease
  • rapid weight loss or crash diets that are not nutritionally balanced

It is also important to review the use of medications that may cause hair loss. The more common medications are:

  • blood pressure medication (such as beta-blockers or water pills)
  • "mood" medication such as lithium, Prozac, or tri-cyclic antidepressants
  • medication for gout, such as Zyloprim
  • anti-inflammatory drugs such as cortisone
  • vitamin A or tryptophan in high doses
  • street drugs (such as cocaine)
  • oral contraceptives
  • thyroid medication
  • blood thinners such as heparin or coumadin
  • cholesterol lowering medication

Laboratory Evaluation in Women

The decision of when to conduct a laboratory evaluation in women experiencing hair loss must be made on an case-by-case basis by a physician. In this section we briefly describe some of the medical situations where the doctor may order lab tests and what they might be. It is important to mention that this is just a review for your general information. When a physician orders lab tests he/she bases it upon specific medical information and this can only be determined by the doctor who evaluates you.

The following symptoms suggest that blood tests might be appropriate to rule out underlying sources of excess androgen:

  • Virilization - appearance of secondary male sex characteristics such as a deepened voice
  • Infertility - inability to become pregnant
  • Galactorrahea - breast secretions when not pregnant (this is due to prolactin which is not actually an androgen)
  • Irregular periods - for an extended period of time
  • Cystic acne - severe acne which usually leaves scars
  • Hirsuitism - increased body hair that doesn't normally run in your family

Some of the laboratory tests that your physician might order in these situations include the following:

  • Total and Free Testosterone - the hormone that is mainly responsible for male secondary sex characteristics
  • DHEA-Sulfate - a precursor to testosterone
  • Prolactin - the hormone that enables the breast to secrete milk

Other tests that are commonly ordered for underlying medical conditions include: