Female Pattern Baldness: Causes, Stages & Treatment Options

Approximately half of all women will experience hair loss by the time they’re 80 [1]. From stress to diet, there are many causes of hair loss in women — but the number one cause is female pattern baldness [2].

Both female pattern baldness and male pattern baldness are types of androgenetic alopecia. But while male pattern baldness is much more common, women are also susceptible to genetic hair loss. Find out if you’re at risk from female pattern baldness, why it happens, and what you can do to treat hair loss in women.

What is female pattern baldness?

Female pattern baldness is a type of hereditary hair loss affecting women. Unlike male pattern hair loss, which is typically limited to the temples and crown, female pattern baldness usually causes an even spread of hair loss across the scalp. This can result in a widening parting, and eventually a general thinning of hair across the head.

This type of hair loss happens when your hair follicles react to your hormones. The exact nature of the relationship between hormones, hair follicles, and genes is still being studied, but experts agree that these are the key determining factors for female pattern baldness [3].

What causes female pattern baldness?

Most cases of female pattern baldness are thought to be caused by genetics. While the exact genetic coding that leads to this condition is still unclear, research suggests that the aromatase gene, which is responsible for converting various androgens to oestrogen (typically testosterone to estradiol) within the hair follicles, may play a part in female pattern hair loss [4] [5].

Hormones — especially androgens, which are responsible for the development of male sex characteristics — also play an unlikely role in female hair loss. Women produce testosterone (albeit in lower quantities than men) which metabolises to produce DHT. DHT binds to androgen receptors in the hair follicles, causing them to shrink and stop producing hair.

Women produce less testosterone and therefore have lower levels of DHT, which may explain why women are less prone to pattern baldness than men. However, there’s no doubt that female hair loss affects a significant number of people. But are some women more at risk than others?

Who is at risk?

All women are susceptible to female pattern baldness, though it’s usually more likely to occur in those with a family history of baldness, and post-menopausal women. This may be due to the reduction in oestrogen that occurs after the menopause; higher levels of oestrogen have been linked to hair retention and growth [6].

There are other factors that can put women at higher risk of developing female pattern hair loss. These include:

• Smoking [3]
• Sun exposure [3]
• UV exposure of more than 16 hours per week [3]
• Hypothyroidism (i.e. an underactive thyroid) [7]

How is female pattern baldness diagnosed?

Trichologists can determine the cause of your hair loss by asking questions about your health and lifestyle, and examining your hair and scalp. Lifestyle questions will focus on your diet, medical conditions, mental health, and general health. These should alert your trichologist to any underlying conditions that may be causing your hair loss, such as an eating disorder, high stress levels, or autoimmune conditions.

Sometimes hair loss is down to poor hair washing techniques and a damaging styling routine. If your trichologist doesn’t identify any underlying conditions or lifestyle factors, they can then examine your scalp for signs of female pattern hair loss.

Stages of female pattern baldness

Female pattern baldness tends to progress in a similar way for all women, and is usually categorised into 3 distinct stages. The Ludwig scale shows these stages:

Image credit: Classifications of Patterned Hair Loss: A Review

The stages of female pattern baldness are:

1. Type I: thinning on top of the head, particularly around the parting. Certain hairstyles can conceal this hair loss.
2. Type II: the scalp starts to become visible through the hair as hair loss progresses. The parting is noticeably wider than in women who don’t have significant hair loss.
3. Type III: extensive diffuse hair loss makes the scalp clearly visible. The person may be fully bald in the areas affected by female pattern hair loss (although hair growth may be healthy at the sides and back of the head).

Is female pattern hair loss permanent?

Unlike most other types of hair loss, like stress- or diet-related hair loss, female pattern baldness is permanent. The condition can’t be reversed — once the follicles have been damaged, they can no longer produce hair. The permanent nature of this type of hair loss can cause significant distress, with some women reporting relationship and career problems stemming from their hair loss [3].

However, certain treatments can slow or stop female pattern hair loss. Drugs like Minoxidil have been approved to treat hair loss in women. There’s also evidence to suggest that anti-androgen treatments such as cyproterone acetate and spironolactone can reduce hair loss, in addition to treating conditions like polycystic ovary syndrome, hypertension, and heart failure [8].

Is female pattern baldness inherited?

Yes. Evidence suggests that a family history of baldness can increase your risk of developing the condition. One study found that almost 85% of people with female pattern hair loss reported a family history of the condition [1].

Celebrities like Kayla Itsines have revealed female pattern baldness runs in her family. Learn more about Kayla’s condition and other female celebrities with hair loss.

The impact of female pattern baldness

Thick, healthy locks are an inherent part of the classic feminine look. As a result, female pattern baldness can have a serious impact on women’s mental health. In one study, 52% of women experiencing female hair loss said the condition was very-to-extremely upsetting, reporting anxiety, low self-esteem, and negative body image [9]. Sexual function can also be diminished, with desire, arousal, and satisfaction all being potentially associated with this type of hair loss [10].

Where male pattern baldness is often accepted as a normal part of ageing, many women consider female pattern hair loss to be unusual [9]. As a result, they may avoid social situations, windy weather, or other environments that can expose their hair loss. This contributes to a sense of isolation and powerlessness, reducing women’s confidence and general wellbeing.

Because female pattern hair loss impacts so many areas of women’s lives, it’s essential to address the issue. While the condition is permanent, many treatments minimise the effects — so affected women may want to seek out effective hair loss prevention treatments.

Female pattern baldness treatments

Many treatments are available for women experiencing pattern hair loss, including medication, alternative therapies, and surgical interventions. Here are some of the most popular treatments for female pattern baldness.

Minoxidil

Minoxidil is one of the most successful hair loss prevention drugs on the market. This topical solution is applied to the scalp, increasing blood flow to the hair follicles. Research shows it can reduce hair loss in people experiencing female pattern baldness. [11]

While Minoxidil is a successful solution to hair loss, it’s been known to cause excessive facial and/or body hair growth in women [12]. You may be able to mitigate this by using low strength (2%) Minoxidil treatments. Be aware of this (and other side effects like Minoxidil-related hair colour changes) when using any hair loss treatment.

Alternative therapies

Also known as LLLT, low-level laser therapy is a hair loss treatment that involves focusing low-level lasers to the scalp. While it’s not known exactly how this treatment triggers hair regrowth, studies show it to be a safe, effective way to reduce the effects of genetic hair loss [13].

Vitamin therapy is another option for those experiencing mild hair loss. Vitamins are vital for strong, healthy hair — and while the jury’s still out on supplements, IV vitamin therapy may be beneficial [14]. By administering vitamins through an IV drip, the body can absorb up to 100% of the nutritional value — creating healthier hair.

Learn more about whether vitamins are good for hair growth.

Hair transplants

If your hair loss has advanced beyond type 1 on the Ludwig scale, a female hair transplant may be the best hair restoration option.

Modern hair transplant methods are safe, successful, and give you natural-looking results. FUE transplant surgery is an excellent option for women, since it leaves virtually no scarring, and has a faster recovery time than FUT. However, many women also choose FUT, since it’s cheaper, and long hair can cover the scar.

More than 12% of hair transplants worldwide are performed on women — so if you’re suffering from female pattern baldness, this is an excellent way to restore your hair [15].

Before and after — female hair transplant

Trichologists often recommend hair transplants in conjunction with hair loss prevention treatments. A trichologist will be able to help you find the right course of treatment to tackle your hair loss.

New hair loss treatments have recently become available to treat other hair loss conditions. Learn more about the FDA’s recent approval of Olumiant for alopecia areata.

What to do if you’re worried about female pattern baldness

If you think you might be experiencing female pattern hair loss, the first step is to get a diagnosis. There are many reasons for female hair thinning, as well as temporary and/or reversible hair loss in women, so it’s important to find out what’s actually causing you to lose hair. Book a consultation with a qualified trichologist to get a free hair and scalp exam and determine the cause of your hair loss.

Your trichologist can then help you establish a treatment plan that involves minimising your hair loss, and, if necessary, booking a hair transplant procedure to restore your hair — giving you natural, healthy tresses. Learn more about hair transplants for women.

Sources:

1. Female Pattern Hair Loss: A Retrospective Study in a Tertiary Referral Center
2. Female pattern hair loss: current treatment concepts
3. Australian Journal of General Practice | Female pattern hair loss
4. Genetics and other factors in the aetiology of female pattern hair loss
5. Gene-wide association study between the aromatase gene (CYP19A1) and female pattern hair loss
6. Hormonal therapy in female pattern hair loss
7. Hormone studies in females with androgenic hair loss
8. Female pattern alopecia: current perspectives
9. Review of quality of life studies in women with alopecia
10. Female sexual dysfunction in androgenetic alopecia: Case-control study
11. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss
12. Hypertrichosis in females applying minoxidil topical solution and in normal controls
13. Low-Level Laser (Light) Therapy (LLLT) for Treatment of Hair Loss
14. A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair
15. 2022 ISHRS Practice Census Results