Dr. Nedic in A2 Magazine – Getting to the root of hair loss in women….

Getting to the Root of Hair Loss in Women…

While it’s usually seen as a male affliction, hair loss in women is a frequent condition – and affects more than 40% of hair loss sufferers.

Hair grows in three different cycles: anagen, catagen, and telogen. About 90% of the hair is in the anagen (or growth phase), which lasts between two-eight years.

The catagen (or transition phase) typically lasts two-three weeks, during which the hair follicle shrinks. In the telogen cycle (which lasts around two-four months), the hair rests. Hair grows around 6 inches a year and a person loses an average of between 50 to 100 strands a day. Men’s hair tends to recede from the forehead (or the crown of the head), while women tend to notice thinning on the top third to one half of the scalp.

Sometimes their frontal line stays intact – and in other conditions can get affected. Women may see a part in the middle that is gradually becoming wider, or they see more of their scalp than normal when their hair is pulled back.

There are many types of women hair loss and identifying the exact cause will lead to an accurate treatment:

Involutional alopecia (or ageing) is a natural condition which generally happens over the age of 50, in which the hair gradually thins. More hair follicles enter the resting phase, and the remaining hairs become shorter and fewer. This condition can be postponed with antiageing treatments.

Androgenic alopecia (or female patterned baldness) is a very common condition which needs much attention in order to be diagnosed and treated properly. Androgenic alopecia in women is related to the Androgenic disorder, which is a hereditarily determined one and involves the AR variant (located in the Xq12 chromosome). It’s often associated with Polycystic Ovarian Syndrome and Hirsutisam.

Increased levels of androgens in hair follicles can lead to a shorter cycle of hair growth, with the growth of shorter and thinner strands of hair. Additionally, there is a delay in the growth of new hair to replace the strands that are shed. In the case of androgenic alopecia in women (depending on the polymorphism of this variant), we either have increased DHT (dehidro-testosteronean androgen affecting follicles) or increased sensitivity to DHT.

Women normally notice their hair becoming shorter and thinner from 30-40 years, and it’s diffusely on the entire scalp. Diagnosing this condition needs DNA testing and early treatment before hair follicles become atrophic.The best treatment would be to block the enzyme II 5-reductase, which is responsible for the production of DHT (the way it’s used in males). However, this treatment is not approved in females. Using Minoxidil at a lower concentration with beta-sitosterol would be a better solution in diagnosed cases.

Telogen effluvium is the temporary hair thinning over the scalp, which is due to the changes in the growth cycle of hair. A large number of hairs enter the resting phase at the same time, causing hair shedding and subsequent thinning which is perceived as hair loss. Possible causes include:

• Surgery
• General anesthesia
• Change in medication
• Childbirth
• High fever and flu
• Extreme psychological stress and
• Extreme weight loss

Women with telogen effluvium typically notice hair loss between six weeks to three months after the stressful event. Sometimes they notice a handful of hair. The majority of patients have normal blood results, and only a look into their history can help find a possible cause. This temporary hair thinning usually disappears if the stressful event does not continue. In some cases, hair shedding and thinning continues, so some ongoing causes must be identified to combat the hair loss. There are a variety of causes, namely:

HORMONAL

Hypo and hyperthyroidism, high cortisol, low progesterone, testosterone imbalance with high DHT production, altered hormone ratios, conventional HRT, contraception pill, prednisone and steroids

NUTRITION

Low protein intake, low vitamin B (especially B12), high vitamin A, low iron, low biotin, and folic acid, low Zn

MEDICATION

Cholesterol-lowering drugs, BP medication, anticoagulants, antidepressants, epileptic medication, isotretinoin, etc

TOXICITY

Environmental toxicity and physical damage of the follicles by harsh hair products and procedures

DIAGNOSIS & TREATMENT

To successfully diagnose hair loss in women; a detailed history, blood tests, and  DNA testing must first be undertaken.

Treatment then includes addressing an underlying condition medically (for example: if there is frontal thinning in peri-menopausal women with low progesterone, then adding a bioidentical progesterone will cure the condition.) In some cases where the underlying condition remains uncertain, we use general hair loss vitamin enhancement with combinations of Biotin, Niacin, Vitamin B5, B6, B12, PABA, Inositol, Vitamin C and essential fatty acids. Aesthetic procedures such as mesotherapy with specially designed vitamin cocktails for hair loss and LED therapy are also used.