Although it doesn’t receive the same levels of attention as its male equivalent, female hair loss is actually very common, affecting nearly 1 in 5 women in the UK. Dealing with the physical and psychological impact of hair loss can be an extremely distressing experience for many women, which is compounded by the lack of understanding of the changes occurring with their hair. To help shed light on the different types of hair loss, their causes and the most effective treatments, we have turned to the expertise of leading hair transplant surgeon Dr. Greg Williams.

What is female pattern hair loss and how does it differ to male pattern hair loss?

Like male pattern hair loss (MPHL), female pattern hair loss (FPHL) is a genetic condition. In some women, there is receding of the temples which gives a masculine appearance to the hairline. However, most cases involve thinning on the top and sides of the scalp often with the hairline retained. The exact cause of FPHL is not yet known but it is likely that only a minority of cases are due to male hormones, or androgenetic alopecia, which is the aetiology behind MPHL.

Is female pattern hair loss the same as telogen effluvium?

No, telogen effluvium is generalized shedding of the hair. In the acute form, this usually occurs about 3-4 months after a physical, physiological, or emotional trauma to the individual. It is often self-limiting and recovers. An example is post-pregnancy hair loss. There is a chronic form which can be more long-lasting and difficult to diagnose.

What are the primary causes of hair loss in women?

Hair loss in women can be complex and require extensive investigation. It can be due to hormonal imbalances, nutritional deficiencies, illness, dermatological conditions, and medications, but the commonest causes is a genetic predisposition. Tight braids and hairstyles can cause a form of hair loss called traction alopecia, which is commonly found in the frontal hairlines of black women.

When should a woman become concerned and seek medical advice?

Whenever a woman thinks her hair is thinning out she should seek expert advice. General practitioners are often not very helpful in this area and it is better to seek the services of a private dermatologist who specializes specifically in hair loss even though they can be expensive. Women who think the quality of their hair is deteriorating or who have scalp problems could consider first seeing a trichologist (a non-doctor who is trained in scalp and hair health) which is likely to be a less costly consultation.

In your experience, which hair practices cause the most damage to women’s hair?

Heat-related styling and chemical colouring practices can damage the hair and cause breakage but are unlikely to affect the actual amount of hair on the scalp. However, hair loss can be caused by long-standing use of tight braids and hairstyles such as pulling the hair back in very tight ponytails

Can all types of hair loss be reversed?

No, it is rare for hair loss, other than that due to nutritional deficiencies or telogen effluvium, to be reversible. However, it can be possible in some cases to stop or slow down hair loss with treatment.

What treatment options are available to women?

The only licensed medication for hair loss is topical minoxidil, however, there are oral medications that can be prescribed off-license by doctors who specialize in dealing with FPHL. All of these will have a side effect profile to be considered and discussed with the doctor. Where there is a visible, but minor degree of hair loss, camouflage products, hair colouring and hairstyles can be used to hide the thinning. Moderate to advanced cases of FPHL may be suitable for hair transplantation providing there is sufficient donor hair to be transplanted. Low-level light therapy (LLLT) and Platelet Rich Plasma (PRP) are emerging treatment options that have widespread anecdotal support for efficacy but there is still limited researched proof of benefit. Very advanced cases might require the use of hairpieces or wigs.

For women going through the menopause, what advice can you offer to minimize hair loss?

Women going through the menopause should expect to see a deterioration in hair volume and length. This is normal but causes significant emotional distress to many women at a time when there are often other psychological issues to contend with. If hair loss is significant then women can seek the services of an endocrinologist to ensure that male and female hormone balance is appropriate.

Which supplements or nutritional tips can you recommend to support general hair health?

If there are specific nutritional deficiencies such as iron, zinc and Vitamin D, which can be determined by blood tests, then these should be corrected. Other than that, maintenance of a healthy lifestyle with good nutrition, hydration, exercise, rest and avoiding smoking will contribute to healthy hair. Taking multivitamins regularly may address any undetected dietary deficiencies. In terms of hair supplements, there is little research evidence for efficacy but Viviscal has a large cohort of loyal followers who believe this product is beneficial for hair and nail health.

To book a consultation with Dr. Greg Williams, please contact the Farjo Hair Institute

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Dr. Greg Williams
Greg Williams is the only member of the BAAPS who performs hair transplant surgery on a full-time basis. He has over a decade of experience in hair restoration not only for genetic male and female hair loss, but also for reconstruction post trauma and burns. Greg is the current President of the British Association of Hair Restoration Surgery and was awarded the ‘Fellow’ status by the International Society of Hair Restoration Surgery which recognises senior Hair Transplant Surgeons around the world. He regularly lectures at aesthetic conferences and is part of the faculty at the UCL’s Plastic Surgery MSc program. He also participates in hair related research, collaborating with Imperial College, Queen Mary University London, and Guys and St Thomas’ Hospital.