Women who lose their hair often worry that they are going bald like a man, and that their hormones are becoming masculinized. In fact, patchy baldness (alopecia areata) and total baldness (alopecia totalis and alopecia universalis) are unrelated to hormones and occur equally commonly in men and women.
Thinning Hair after the Menopause
Like men, most women develop widening partings and thinning of the hair all over the scalp with age; this is normal. It actually starts in the teens or early 20s, and by the age of 50 over half of all women have thinning hair. After the menopause, thinning of the hair is more pronounced. Hair can also become thin at the front, similar to the male pattern. This is because the hair follicles are responding in exactly the same way as in balding men to the testosterone in the blood. All women have testosterone; this is perfectly normal. The balding does not mean that the woman has more testosterone; it simply means that the hair follicles on her scalp are oversensitive, which is probably inherited. The hair will eventually not become any worse. There is no need to worry that you will become completely bald.
Hair Loss and Other Symptoms
A few women develop male pattern baldness with other problems such as growth of hair on the face, lumpy acne, deepening of the voice and irregular periods. In rare cases, this can mean that too much testosterone is being produced by a tumour, so it is important to see your family doctor so that appropriate tests can be done. However, polycystic ovary syndrome (PCOS) can cause these symptoms and is much more common than a virilising tumour.
Causes of Thinning Hair in Women
Thinning hair may be caused by:
- age (most old people have thinner hair than when they were young)
- heredity (some people are programmed to have thin hair, particularly as they get older)
- a hormone disorder (particularly an underactive thyroid gland)
- iron deficiency (most likely in women who are vegetarians)
- severe mental stress (such as bereavement), 2–3 months previously
- severe physical illness of any sort, 2–3 months previously (particularly a high fever or severe infection – the hair grows again when the body has fully recovered)
- childbirth (it is common to shed a lot of hair for 1–6 months after childbirth, but it usually grows again afterwards)
- systemic lupus erythematosus (SLE, a disease affecting the connective tissue)
- damage from bleaches and relaxers, which can make the hair become ‘soapy’ in texture and break off (Afro-Caribbean hair is especially vulnerable).
Treatments for Thinning Hair in Women
Looking after your hair. Just because your hair is thinning there is no need to avoid hairsprays, careful perming or hair dyes. These will not worsen the problem. In fact, perms and hairsprays lift the hair and disguise thinning. However, you should avoid bleaches and hair relaxers. Short, bouncy hairstyles give lift and body. It is also all right to use hair colorants on thinning hair, but darker shades may make thinning more obvious.
Diet. Low stores of iron in the body can sometimes cause hair loss so, particularly if you are vegetarian, ask your doctor for a blood test. Iron-rich foods include lean red meat, game, offal, egg yolks, dark green leafy vegetables and pulses. Vitamin C helps your body to absorb iron. Although hair follicles need plenty of the essential amino acids – the building blocks of proteins – it is doubtful whether increasing your intake of protein or taking amino acid supplements will really help.
Minoxidil lotion produces slight hair regrowth in about 50% of women with thinning hair, and moderate regrowth in 13% (after 32 weeks of treatment) (New England Journal of Medicine 2007;357:1620–1630). Only the 5% strength is suitable for women. A few women (about 1 in 20) using minoxidil lotion notice hairiness of the face, even though the lotion is only applied to the scalp. Hairiness occurs on the cheeks, above the eyebrows and sometimes on the upper lip and chin. The reason for this is not known; perhaps the minoxidil lotion is carried in the blood from the scalp to the face, or maybe it is rubbed off onto a pillow that is in contact with the face while sleeping. If minoxidil lotion is continued, facial hairiness usually lessens over a year; if the drug is stopped, it goes away within 1–6 months.
Oestrogens used to be prescribed for women with hair loss, but no proper research has been done to find out whether or not they worked at all. They are seldom prescribed now because minoxidil lotion is more effective.
HRT, depending on the type, can affect the hair. If you are taking HRT containing progestogen, ask your doctor for a third-generation type of progestogen HRT, which is less similar to male hormones and may be better for women with hair loss.
Drug treatment. If you have male pattern baldness (receding at the front and balding on the crown), you need to see your family doctor for some tests. Male pattern baldness is treated with minoxidil lotion or cyproterone acetate (as in polycystic ovary syndrome). Another drug, spironolactone, is a common treatment now and is used daily for this condition (British Journal of Dermatology 2005;152:466–473). The drug finasteride (used for male baldness) is used for women only in special cases; it could affect the developing baby if a woman became pregnant while taking it (British Journal of Dermatology 2005;152:466–473).
Hair transplantation. If you are very distressed by thinning hair, and minoxidil lotion has not helped, you might consider hair transplantation, which can be done for women as well as men.
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Ahmed Kazmi
Last updated: October 2020