A different pattern to female baldness

LaVerne Walker was only 32 when she noticed the small bald spot right in the absolute middle of her hair. “It looked like someone took a lawnmower and left a little patch,” she says.

That small spot grew into an obsession. She found herself thinking about the fact that tall people could look down on her and see it. She would compulsively put her hands in her hair, and made her husband check every night to make sure the patch wasn’t growing.

When she noticed another bald spot a few months ago, she couldn’t stand it any longer and scheduled an appointment with a dermatologist.

“I’m a woman!” says the Washington, D.C.-area cosmetology student. “You see men losing hair, you think sometimes it looks distinguished -- but not on a woman.”

Hair loss is far more visible in men -- but in fact, nearly 40% of women lose substantial amounts of hair after menopause, and 10% to 15% experience thinning in their 30s.

The pattern of loss is different from that of men: Women don’t usually develop bald spots the way men do. Instead, their hair tends to thin out all over.

“It’s rare to see a woman lose all their hair, but they can thin dramatically,” said Dr. Ronald Moy, clinical professor of dermatology at the UCLA medical center.

The reason for such thinning is mostly a mystery.

Some scientists think that female hair loss, like male-pattern hair loss, is related to the testosterone level and the level of one of its byproducts, DHT. Although testosterone is a male hormone, women generally have small amounts of it too -- and when estrogen levels decline, testosterone becomes more abundant in proportion.

Testosterone can certainly cause women to lose hair under special circumstances. Female athletes sometimes take testosterone to bulk up their muscles -- and often find they start shedding hair as well.

Women who develop rare cancers that produce testosterone can also experience hair loss.

But in these cases, women tend to lose hair in the male pattern -- bald spots along the hairline and top of the head -- not in the diffuse hair loss pattern that’s more typical of their sex. And many women with hair loss have normal hormone profiles.

Genes appear to play a role in female-pattern hair loss, just as with baldness in men. And other factors, such as diet -- or even hairstyles -- contribute too.

“In women, hair loss is a tricky business. The changes are usually more subtle, and there are lots of other things that might be going on,” said Dr. Claire Haycox, clinical associate professor of medicine at the University of Washington in Seattle.

Nutrition, for example, plays a greater role in women’s hair loss than in men’s. If the body’s stores of iron, called ferritin, start to get low, a woman’s hair will stop growing or can even fall out. “When the ferritins become depleted, women cannot grow adequate hair, or they grow crummy hair,” Haycox says. But once the iron levels are back to normal, “the shedding stops; the hair regrows -- they do wonderfully.”

Hair loss plagues black women even more than other women, possibly because of harsh hair treatments. Chemical hair relaxers, hot combing and styles that put tension on the hair can lead to patchy balding known as traction alopecia, or another condition known as central centrifugal cicatricial alopecia.

Whatever the cause, hair loss for women can be much more upsetting than for men, says Dr. Valerie Callender, a cosmetic surgeon in the Washington, D.C., area. “In men, it can be accepted; they can shave off their hair like Michael Jordan. But in women, it’s a sign of being less feminine,” she says.

Just as with male-pattern baldness, there are treatments that can help women’s diffuse hair loss, up to a point. Minoxidil (Rogaine), the only FDA-approved drug for female hair loss, can often give good results, says Dr. George Cotsarelis, associate professor of dermatology at the University of Pennsylvania School of Medicine.

Finasteride was not thought to work in women, but a study published in March in the Archives of Dermatology reported improvements in 23 of 37 women who took the drug, at higher doses than those for men, for a year. (The women in the study also took birth control pills because the drug can cause defects in male fetuses.)

More extreme cases of female-pattern hair loss can be treated with hair transplantation. That is the only solution for women with central centrifugal cicatricial alopecia, who develop scars in the balding areas. At that point, the hair follicles are actually gone, Callender says, so minoxidil doesn’t work.

Hair transplants are trickier in women than in men because there aren’t clean bald spots to target, just diffuse thin hair. “You have to go in between existing follicles without destroying those follicles,” Callender says.

And transplants are especially difficult for cases of central centrifugal cicatricial alopecia. “The scalp is scarred,” Callender says. “It has less blood vessels -- the follicles are fighting to survive.”

Technical advances mean that surgeons today can successfully transplant hair into the scar tissue of these patients, and burn victims also. What they can’t do is erase all signs of hair loss, because they don’t yet have enough follicles to work with.

Women have to focus on restoring hair in a specific area.

This can certainly help if there’s a particular spot that a patient is self-conscious about, says Dr. Craig Ziering, a cosmetic surgeon in Beverly Hills. “It’s by honing in on an aesthetic unit that you can make that positive change,” he says.

Janice Stegeman of Las Vegas says her hair began thinning in front about four or five years ago. She and her hairdresser tried different things, such as gluing in hairpieces. Nothing helped.

“I tried that Rogaine stuff,” the 57-year-old schoolteacher says, “and it seemed to be getting worse and worse.”

Her confidence suffered. “I felt like even the kids in my classes were staring right there at that bald spot,” she says.

Stegeman consulted Ziering, and he transplanted some hair to the thinning spot.

“They took the hair from the back of my head where it was fullest, and then they put 2,705 little holes in my head, up there where I was bald, and they put each little hair in those little holes,” she says.

Today, she says, “I have hair and I feel really good about it.” And her friends have noticed. “They’ll come up and say, ‘I can’t believe how much hair you have!’ ”