Why does hair thinning occur and what are the main causes of hair loss in a woman?

Author: Kenneth O. Rothaus, M.D

Whenever my patients schedule a visit for one reason, it is the norm and expected that they will usually inquire about many of their other cosmetic concerns.  We talk openly and freely about such concerns as skin laxity, lines and wrinkles, and areas that suddenly seem to have collected a little more fat than was present the year before.  The significant concern that my female patients will raise reluctantly, almost as if they are embarrassed by it, is hair loss.  The reason I first became interested in the NeoGraft technology was to help these patients.

Hair loss, a problem in woman which is much more common than most people realize, has two distinct patterns and a variety of causes.  One does not have to be a doctor to know that all people shed hair. Hair follicles go through a normal cycle of growth (anagen), shedding (catagen), dormancy (telogen) and then the cycle begins again.  It is normal to lose as few as 50 and as many as 100 hairs each day.  That is not too bad considering that our scalp holds approximately 100,000 hairs.  It is when the numbers of hairs shed exceed that 100 figure and follicles go dormant but never re-enter the growth phase that thinning of the hair becomes noticeable.

Male pattern baldness has well recognizable patterns.  There is a regression of the hair line and a thinning or loss of hair on the top of the scalp with the back and sides remaining relatively full.  Some women do develop this exact pattern of baldness (alopecia).  The more common type of hair loss in woman, however, is a diffuse thinning of the hair over the entire scalp including the back and sides.  These patients may not have any regression of their hair line accompanying the distinct thinning.

Why does this happen and what are the causes of hair loss in woman? These causes of hair loss can be broken down into several categories:

  • Male pattern Hair loss (Androgenic) results from an elevation of DHT (dihydrotestosterone) a breakdown product of testosterone. Certain hair follicles are more sensitive to the DHT resulting in hair loss and eventual atrophy of the follicle itself. The reasons for this in woman can be hereditary, hormonal imbalances, ovarian cysts, menopause or even birth control pills.
  • Stress Related Hair Loss (Telogen Effluvium) – Stressful events such as trauma, childbirth, malnutrition, severe infections or major surgery can cause hair loss. This can begin if 3 months after the precipitating episode.  This type of hair loss, fortunately, is usually totally reversible
  • Nutritional and Metabolic – Severe iron deficiency anemia, excessive intake of Vit A, Vit B deficiency and disorders of the thyroid gland (hypo- and hyperthyroidism) are two other causes for hair loss.
  • Autoimmune (alopecia areata)
  • Medication-Induced – We are all aware that certain chemotherapeutic agents can cause hair loss (anagen effluvium) but other drugs such as those used to treat high blood pressure (beta blockers), arthritis (methotrexate), bipolar disorders (lithium) and depression can also lead to hair loss. Drugs used as blood thinners and even the common nonsteroidal anti-inflammatory drugs (NSAIDs) can also induce alopecia.
  • Traumatic – Hair loss following surgery (e.g., face or brow lift surgery) and excessive or tight styling of the hair are two examples of this type of hair loss.

As a result, woman presenting to the doctor with hair loss need to be evaluated to rule out one of the treatable causes before undertaking any surgical treatment.  Topical agents such as minoxidil or certain red light laser and LED treatments can also help some woman retain their remaining follicles and perhaps even reactivate some dormant follicles.  Woman with surgically induced loss of hair or those with a male pattern of alopecia including a thinning of the hair on the top of the scalp and a regression of the hair line are excellent candidates for the Neograft follicular hair transplantation procedure.  Woman with the more common pattern of diffuse loss of hair throughout the scalp including the sides and back must be approached with more caution before considering surgery.  Transplanting a follicle from the side of the head to the top may not be in the patient’s best interest for two reasons.  If the patient is losing hair from the donor area (e.g., back and sides) as well, it obviously makes no sense to transplant a follicle that is going to stop growing and be lost.  Secondly, taking hair from a thinning area will clearly worsen the thinning appearance of that donor site.

The evaluation of the female patient with thinning hair is, thus, somewhat different than that for male patients.  Unfortunately, for the reasons previously discussed, a smaller percentage of female patients will be candidates for follicular unit hair transplantation.  The NeoGraft procedure is, however, an excellent choice for those female patients who are good candidates for hair transplantation and is the procedure of choice in my practice.

Disclaimer: The content within this site is not intended to provide diagnosis, treatment or specific medical advice. The products and claims made about specific products and treatments through this article have not been evaluated by the United States Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease. Please consult with a NeoGraft Certified Physician or other healthcare professionals regarding any medical or health-related diagnosis.

About Kenneth O. Rothaus, M.D.

Kenneth O. Rothaus, MD is a board-certified Manhattan and Westchester plastic surgeon offering cosmetic and reconstructive surgery for the face, breast, body, and skin. Educated at Yale College and Harvard Medical School, Dr. Rothaus general and plastic surgery training was at the Columbia and Cornell campuses of the New York Presbyterian Hospital. Dr. Rothaus values the wants and needs of his patients and strives to give them the best experience possible. With both a national and international practice, Dr. Rothaus has unmatched experience in a number of plastic surgery treatments and techniques. As a distinguished surgeon, husband, and parent, Dr. Rothaus has a profound appreciation for the apprehension a patient, spouse or parent may feel approaching a surgical procedure, and feels that trust and communication is of the utmost importance in developing a close doctor-patient relationship.