Professor of Dermatology in the College of Health Sciences, Bayero University, Kano State, Yusuf M-Shehu, talks to EMMANUEL OJO, about the causes and management of baldness in females, commonly called female pattern baldness
What is female pattern baldness?
Female pattern baldness is similar to what you see in males, that is, male pattern baldness. When you see the male pattern baldness, which can be referred to as normal baldness, it’s the same and we refer to it as androgenetic alopecia. Even some of it is a combination of hormonal factors in a person who is genetically predisposed and that’s why it came from the combination of two words: andro, originating from androgen, and genetic meaning that there is a genetic contribution. The unification brings about the word and then you have hair loss. So, it is seen in both males and females who have a family history of baldness, meaning that it can be genetically transferred from parents to children.
So, if the father has baldness, there is a possibility that his children, males and females will have this pattern of hair loss too, which is either male or female pattern hair loss but then, what they present is different. In males, you may have precision. The hair will start to recede from the front backward or the back; it would then reach the frontal recession and then you have complete hair loss and hair on the sides of the scalp. Now, what happens is that the hair is not completely lost. What happens is that the hair becomes thinner and thinner until you can no longer see it or it’s not vivid enough anymore and then, eventually, it’s so weak that it can easily break. However, at the initial stage, it is not like the hair is lost completely. Rather, the hair will gradually reduce in thickness and volume and that’s what we call miniaturisation.
How does it happen in the female pattern baldness?
In females, it usually starts from the centre and then goes sideways. So, what you see is the withering of the hair; it becomes thinned out. The volume starts to reduce in such a way that oftentimes you could see the scalp of a woman that had full hair from a distance. So, the volume of the hair is reduced and gradually, it could wither off completely.
Are there stages of the withering of the hair in female pattern baldness?
Of course, there are stages to that.
What are the stages?
There are stages, whereby it starts gradually and then it gets to a stage where almost all the hair on the scalp is lost. So, there is a particular grading that we call stage one. There are other stages we call stages two, stage three, and four. So, they go through that staging, and eventually, the hair goes down over a period.
Is there a particular stage or age it starts or how early can it be seen to start withering in women?
It can start as early as the early 30s but in most people, it starts after the age of 40 and that’s when you see it becoming more prominent. At the age of 60, everybody can see that because there is a substantial loss of hair and the volume must have significantly reduced.
How common is this pattern of baldness in females compared to how often it occurs in males?
Of course, it is as common as it is in male pattern baldness. The only issue is that when a lady gets older, she tends to start wearing headgear, so, you are not likely to see or observe anything. Many times, they try to park the little hair they have, so, you are not likely to notice it. However, it’s not like they go bald like the way we go. As I told you, it is withering of the hair. The hair withers out and it reduces the volume of the hair. If the strands of the hair on the scalp could be counted, if, for instance, there were supposed to be one million strands of hair on the scalp, over time, it would reduce to maybe 200,000, or something like that and that’s what I mean by the volume of hair on the scalp reducing significantly. It usually starts from the central area and withers out and it then goes outwards. That’s how the hair is lost.
What are the common signs to watch out for in females?
Just like the males, there are no symptoms at all. It doesn’t give any itch or pain on the scalp. In fact, one might not notice anything except the fact that over time, one would observe that they are losing hair or someone could call to their notice that their hair is going off. It is different from other forms of alopecia where the hair loss takes place when one is trying to comb the hair and the lost hair is seen on the comb but for this one, you don’t see it on the comb when you are combing your hair. It doesn’t occur that way. So, it is asymptomatic and you don’t see anything. It’s not something that is felt.
What causes this hair loss in females?
The same cause as it is in males or male pattern baldness. It’s a factor of the androgens and over time, usually after menopause, you know there is an increased level of androgens. These androgens cause the hair to become thinner. So, that’s the way it happens and that’s why it is termed ‘androgenetic.’ So, for a genetically predisposed person, in the presence of an increasing amount of androgens, you will have reduced volume of the hair and you will have baldness in females.
Is there a possibility for the baldness to be reversed, especially in females?
Well, what happens is that, just like it is in males, there are so many things that can be done. In the early stages, there are certain things that can be used and there are certain drugs that can be used by the patient to block the androgens from being taken to the hair, and by so doing, you arrest or delay the progression of this hair loss but invariably, oftentimes, it will continue, so, if a person doesn’t want balding, the person would have to start using some hair-growing spray, constantly, over a long period or sometimes, androgenic drugs that will block the effect of the androgens on the hair. However, once it has gotten in, the only thing one can do, especially in males, is to put a wig on or do a transplant procedure. Women can also do similar things. They can put on hair attachments, can put wigs on the scalp, or they can leave it alone.
Having made many comparisons on the similarities in baldness in women to that in men, can baldness in women also get as worse as it can be in men?
Well, it is not that prominent in females. You rarely see a lady coming with baldness on the scalp like you see in men. It is not like that. In women, you just see that the volume of hair will start reducing from what it initially used to be but actually. There is no such total balding in females just as you see in males. So, it is not as bad as what you see in males. Sometimes, you might observe that she has lost even more than 80 per cent of the volume of hair on the scalp but again, not to the extent it can be in males.
Are there risk factors with this?
There are no risk factors. The only risk factor is that if one has a family history of baldness, then it would be seen, that’s all. Apart from that, there are no risk factors that predispose a person to baldness.
Are there also complications that come with this?
There are no complications at all. If there is anything as such, then it is just cosmetics, no more, no less. One may have reduced self-esteem, and the person might also not like what the scalp looks like and would be distressed over what he or she sees. That may just be the complication, that is if you choose to call it complication, but apart from that, there are no complications. It might not necessarily lead to an inferiority complex as such but the person might not just like what it looks like and all that and that’s it. The person may also suffer criticism, low self-esteem, or reduced self-esteem or the person might even feel depressed because of the way people would be looking at the scalp. In other instances, maybe because the person is a model or a celebrity and might not like the scalp to be like that, the person might then feel down emotionally because of that. That is possibly the only complication that might come with that.
Loss of hair has been said to take place, not only on the scalp but on other parts of the body. Does that take place simultaneously with hair loss on the scalp or how are they related?
The androgenetic alopecia is only on the scalp. It doesn’t take place in other places or parts of the body. The loss of hair on the body is totally of a different cause, not the same cause of baldness as seen in androgenetic alopecia on the scalp.
How is it diagnosed?
It is just diagnosed clinically. There is nothing like a facial test or anything. Usually, the history is just taken and we look at it, its progression and that’s all.
What are the ways in which it can be treated or the situation managed?
As I said, most people leave it alone because it is just a natural part of the aging process. Some may wish, as I said, to use a wig or some may use attachments, and some may use hair-growth-promoting aids like spray or cream, I mean hair sprays that promote growth.
Are there ways to prevent this from happening?
There are no preventive measures. Just as I told you, in the early stage, if you don’t want it, you can start using hair-growth promoting sprays, I mean, sprays that promote hair growth and what it does is that it reduces the progression of hair loss or tries to arrest the progression process. There are many conditions that have to do with loss of hair either on the skin or other parts of the body. The condition that has to do with loss of hair on the skin is totally different from female or male pattern baldness. They are of different topics and have different causes altogether.
