Although hair loss is not generally thought to be a problem for women it is widespread. This, together with the lack of social acceptability of women with hair loss is a source of some concern. Although in recent years acceptance of hair loss as a consequence of medical treatments e.g. cancer chemotherapy has increased, a social stigma is often attached to balding women.
Hair loss in women is different from that in men. There are at least two major causes.
Genetic hair loss
It is apparent to even the casual observer that a number of women lose hair dramatically in their post-menopausal years. This is because sexual characteristics are controlled by the balance of sex hormones. Both male and females normally have male and female hormones, males will have more male hormones and females will have more female - but they all have both types. Even Arnold Schwarzenegger makes considerable quantities of oestrogen! post-menopause the levels of female hormones fall, in some women (not all) this means that the balance of hormones can tip towards a more male level. This doesn't mean to say that the person is any less female. It simply means that some body systems are more likely to change their behaviour. Hair is probably one of the most easily affected. After the menopause susceptible women may lose the protective effects of the female hormones. The hair follicles in women have patterns of sensitivity to androgens just as men do. The female patterns are different to men in detail but usually involve the front of the scalp, just like males.
Genetic hair loss in women can occur before menopause. The balance of hormones can vary between individuals, by chance some are nearer to a male balance and, for reasons that are unknown, can fall below the level. These women may experience hair loss, some will experience hirsuitism (excess hair in a male pattern e.g. beard area). Those with hair loss will notice that their partings are getting wider and that the loss is patterned i.e. only in some areas.
G.p.'s are becoming sympathetic but, as ever, it can be a difficult experience for women. Those post-menopausal, who are concerned by their loss should consider hormone replacement therapy (HRT). Not all women will be suitable for, or desire HRT, but it is a method to restore hair growth. Those pre-menopausal with hair loss occurring in a specific pattern, with widening of the partings should definitely consult their G.p. There are some medical conditions which may be responsible and these need to be ruled out. The options then are limited. One possibility is to consider hormone replacement in the form of the contraceptive pill. this may work for some women. Again there are sound medical reasons and personal ethical considerations why this may not be possible.
Anti-androgen therapy may be a possibility. Rather than trying to restore the balance of male/female hormones by adding female this method attempts to reduce the male levels. Anti-androgens can have side-effects and have variable success rates. Their use should only be considered under close medical supervision.
Minoxidil is a drug found to affect hair growth but which has limited success in men. However, Minoxidil, sometimes in combination with other treatments is proving useful in women with genetic hair loss. The responses noted in women are better than those found in men. Minoxidil came off prescription in August 1995 and is thus available for sale over the counter. Treatment is topical and daily and if the treatment is stopped the hair loss may begin again. Some scalp irritation and drying can occur. A months supply will sell for around 25. At this price you really need to think if it is working for you. Stopping the treatment, if it is working, will lead to a re-instatement of the hair loss. Although it has proved very safe in extensive trials minoxidil can affect blood pressure - if in doubt consult your G.p. first. Follow the application instructions carefully to avoid scalp problems - don't use too much, more is not necessarily better!
Non-genetic hair loss
As mentioned above it is not generally accepted, or indeed obvious, that hair loss is a problem for women. Unpublished data (Norris, Rushton and Dover) suggests that a significant number of women feel they have less hair than they used to. Women between puberty and the menopause show what appears to be a distinct form of hair loss. This involves a diffuse loss over the entire scalp. The partings do not significantly widen. The most obvious signs are an increase in hairs shed, usually noticed in the brush, sink or shower. Women with long hair may notice that the amount of hair they can gather into a ponytail or clip up is reduced.
Why isn't this recognised For a number of reasons; the process is slow and insidious, the loss isn't in patches and is less obvious, there is a lack of awareness that it isn't normal and that it is reversible.
Males and females before puberty are broadly similar in their nutritional needs. Following puberty the sexes diverge in their requirements. During their menstrual years women are often suffering nutritional deficiencies, even with a rich western diet.
The governments COMA report supports this view. The reports by the Ministry of Agriculture Fisheries and Food show that women are not receiving the levels of several minerals and nutrients recommended.
Taken from table 3.3 "The Dietary and Nutritional Survey of British Adults-Further Analysis" HMSO:
|Women age 19-50|
|Item||Units||RNI||% below RNI|
|Vitamin A||micro g||600||31|
|Vitamin B6||micro g||1.2||22|
|RNI=Reference Nutrient Intake|
The figures for males, in nearly all cases are dramatically less i.e. there are fewer males receiving less than the RNI. In a few cases (notably fibre and potassium) the male levels are two-thirds of the female levels other values are much lower. Females are, by this measure, not receiving what the government considers adequate levels of these vitamins and minerals. The figures for the lower reference nutrient intake LRNI show that significant numbers of women do not get even the lowest levels of intake recommended.
Taken from tables 3.5, 3.6 "The Dietary and Nutritional Survey of British Adults-Further Analysis" HMSO:
|Women age 19-50||Men age 19-50|
|Item||Units||LRNI*||% Women below LRNI||% Men below LRNI|
|* Lower Reference Nutrient Intake; only female LRNI shown, calculations based on male or female LRNI, as appropriate|
So a quarter of all women don't receive even the lowest recommended levels of Iron and potassium. For women over 51 years the % below the LRNI for iron drops to 1.
During their menstrual years women are losing iron at a faster rate than men, yet their dietary intake is (on a % basis) lower. This doesn't mean to say that they are anaemic. Anaemia is a severe condition but the body will divert resources to essential systems, so available iron will be used for blood supply, this may leave other processes lacking in iron. Iron is particularly hard to absorb and as an element is quite toxic. It is clear that 30% of British women would benefit from higher iron intake, as well as other minerals, vitamins and fibre. As many women are turning to a vegetarian diet it is probable that the situation for iron intake may get worse and women should consider supplementation for general health. Hair loss is associated with poor nutrition. Women who improve their diets often find that their hair volume increases and the shedding decreases. The largest group of women with excess hair fall, when investigated, can be demonstrated to be deficient in nutrient intake. This form of hair loss is treatable and the treatment is quite cheap, by better diet and or supplementation. See Baldness for Supplementation
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