Hair loss is a common condition that can affect both men and people assigned female at birth (AFAB), although it is often perceived as more prevalent in people assigned male at birth (AMAB).The self-esteem of people AFAB and overall happiness can be significantly impacted by hair loss, which is a serious problem. Even though some hair shedding or thinning is natural daily, excessive shedding or thinning can be upsetting and may be a sign of something more serious. Hormonal imbalances, genetic predisposition, underlying medical disorders, lifestyle factors, and some medications are only a few of the causes of hair loss in people AFAB.1,
To choose the best course of therapy or management, it is essential to understand the causes of hair loss. It is significant to note that while there are numerous successful interventions for hair loss in people AFAB, it is advised to speak with a healthcare provider or a dermatologist to correctly identify the underlying reason and create a personalised treatment strategy. We can provide people AFAB with the knowledge they need to handle this issue proactively, regain their confidence, and attain optimal hair health by helping them understand the causes and available treatments for hair loss.
Hair loss in people AFAB, also known as female pattern hair loss (FPHL) or female androgenetic alopecia, is a prevalent disorder that can have serious emotional and psychological repercussions. It is characterised by progressive hair thinning, mainly on the scalp's crown and frontal regions. Female hair loss is a common problem that becomes more common with age. The frequency and effects of hair loss in people AFAB have been investigated in several studies. Studies have shown that 38% of people AFAB over 70 and 6% of people AFAB under 50 experience female pattern hair loss and hair loss in people AFAB is linked to a higher risk of psychological discomforts, such as sadness and anxiety.1,2
People AFAB experience hair loss for a variety of reasons, including genetic predisposition, hormone imbalances, illnesses, certain drugs, and lifestyle choices. Topical drugs, oral medications, laser therapy, and hair transplantation are among the available treatments for female pattern hair loss. It is crucial to remember that not all treatments are appropriate for everyone, and their efficacy can vary. Consultation with a dermatologist who specialises in hair issues or a healthcare expert is necessary for anyone experiencing hair loss. They can make a precise diagnosis, point out potential underlying reasons, and suggest an appropriate course of action.4
Types of hair loss
People AFAB are susceptible to a variety of hair loss conditions.1 Here are a few typical causes of hair loss in people AFAB:
- Female pattern hair loss ( Female androgenetic alopecia): Female pattern baldness is the most prevalent kind of hair loss in people AFAB. It is characterised by a gradual thinning of the hair on the scalp, primarily in the frontal and central regions. The hair follicles shrink, resulting in finer, shorter hair. Genetic and hormonal variables, especially the actions of androgens like dihydrotestosterone (DHT) on the hair follicles, have an impact on female pattern hair loss.
- Telogen Effluvium: A break in the hair growth cycle can lead to telogen effluvium, a type of temporary hair loss. It can be caused by numerous factors, including physical or mental stress, hormonal changes (such as childbirth or menopause), nutritional deficiencies, drug usage, or underlying medical disorders.
- Alopecia Areata: This autoimmune disease causes patchy loss of hair on the scalp and other parts of the body. Hair follicles are wrongly attacked by the immune system, which drives them into a state of rest and leads to hair loss. Alopecia areata occasionally develops into alopecia totalis (total body or scalp hair loss) or alopecia universalis (complete hair loss).
- Traction alopecia: Traction alopecia is a condition that develops when the hair follicles are repeatedly, or for an extended period, under tension from tight hairstyles like braids, ponytails, or hair extensions. If the repeated pulling is not stopped, it can break off hair and eventually result in permanent hair loss.
- Trichotillomania: A psychological condition known as trichotillomania is characterised by a persistent need to pull out one's hair, which causes observable hair loss. It can cause bald spots or uneven hair loss and is frequently used as a coping method for stress or worry.
Causes of hair loss in people AFAB
Women's hair loss can be caused by a variety of things, and to properly manage the problem, it's important to understand the underlying causes.1,4 Here are some typical reasons why people AFAB experience hair loss:
- Female androgenetic alopecia, also referred to as female pattern hair loss, is the most typical reason for hair loss in people AFAB.8 Genetics and hormonal factors, particularly the presence of androgens like DHT, are known to have an impact on it.12 The hair that grows on the crown and top of the scalp often thins as a result of female pattern hair loss.
- Hormonal changes: People AFAB who have hormonal fluctuations may experience hair loss. Pregnancy, childbirth, menopause, and illnesses like polycystic ovary syndrome (PCOS) and thyroid disorders are among the common hormonal causes. These hormonal changes may interfere with the hair cycle, increasing shedding or decreasing hair growth.9
- Telogen effluvium: It is a typical reason for people AFAB to have temporary hair loss. It happens when there is a disruption in the hair growth cycle, which causes more hairs to go into the resting (telogen) phase and then shed. Telogen effluvium can be brought on by conditions like physical or mental stress, illness, surgery, fast weight loss, or specific drugs. Typically, the scalp has diffused hair loss.
- Autoimmune conditions like Alopecia Areata: This autoimmune disorder causes hair loss because the immune system mistakenly assaults the hair follicles. The scalp, brows, or other body hair may undergo patchy hair loss in women with alopecia areata. Alopecia areata is thought to have both hereditary and environmental causes, while the specific origin is unknown.
- Nutritional deficiencies: Hair loss in people AFAB might be attributed to inadequate consumption of vital nutrients. Iron, zinc, biotin, vitamin D, and other nutrients required for healthy hair growth can be deficient, which can damage hair follicles and cause more hair to fall out.11
- Medical disorders: People AFAB who have certain medical disorders may have hair loss. Examples include skin problems like lichen planopilaris, trichotillomania (hair-pulling disorder), autoimmune diseases like lupus, and psoriasis, scalp infections like ringworm, and trichotillomania, thyroid, and anaemia.
- Stress: Chronic Stress and other psychological problems can also result in hair loss.
- Chemotherapy: Hair loss is a side effect of chemotherapy that typically occurs two to three weeks after treatment begins. After therapy, hair normally grows back.
- Hair care habits: Harsh chemical treatments, excessive heat style, or rough brushing can harm hair and cause hair loss.
Signs and symptoms of hair loss in people AFAB
- Increased hair shedding: You might experience more hair falling out than normal while washing, combing, or styling your hair
- Hair thinning: Your hair may seem thinner, especially around the crown or parting of your head
- Widening of the part: Due to hair loss and thinning, the part in your hair may look broader than usual
- Receding hairline: Some people AFAB have a hairline recession, in which the hairline gradually recedes, revealing more of the forehead
- Sparse or patchy patches: You may notice parts of your scalp where the hair appears remarkably thin or patchy, highlighting the scalp
- Slower hair growth: Your hair may grow at a slower rate than usual, or you may find it difficult to grow it past a specific length
- Excessive hair on pillows or clothes: Throughout the day, you may notice an excessive quantity of hair on your pillows, hairbrush, or clothing
Management and treatment for hair loss in people AFAB
For mild pattern hair loss, no treatment is required. For severe hair loss, one should consult with a dermatologist to identify the underlying cause of the hair loss.3.5 Depending on the cause of hair loss, your healthcare professional may suggest the following medical treatments:6,7
- Topical minoxidil: Minoxidil is an FDA-approved over-the-counter medication which is applied to the scalp to stimulate hair growth and finasteride or spironolactone are also used to help slow down hair loss and promote regrowth
- Hormone therapy: If hormonal imbalances are contributing to your hair loss, hormone therapy may be recommended to restore balance.
- Management can be done by having a balanced diet, managing stress, avoiding hair styling and heating, taking nutritional supplements for hair and also by maintaining a healthy scalp
- Hair transplant can be done for certain cases
- Physical examination: Examination of the scalp and hair is done.
- Pull test: A pull test involves a healthcare expert gently pulling on a tiny part of the hair to assess the quantity of hair that can be readily taken out. This test is used to assess hair loss and fragility.
- Blood test
- Scalp biopsy: This is done to examine the tissue in the scalp and to understand the cause of hair loss.
- Trichoscopy: This is the examination of the scalp and hair follicles with a portable device that has magnification and illumination. It can aid in the identification of certain hair and scalp features such as hair follicle miniaturisation or symptoms of inflammation.10
- Genetics: A family history of hair loss increases the possibility of experiencing hair loss.
- Hormonal changes during pregnancy, childbirth, menopause, polycystic ovarian syndrome, etc. could trigger hair loss in people AFAB.
- Certain medical conditions like hypothyroidism, hyperthyroidism, autoimmune diseases, and scalp infections could lead to hair loss.
- Nutritional deficiencies: Women's hair loss can be exacerbated by a lack of key minerals such as iron, zinc, vitamin D, and vitamin B12.11
- Stress, whether from emotional trauma, severe surgery, or chronic disease, can cause people AFAB to have temporary hair loss.
- Medications and treatments: As a side effect, several medicines, such as antidepressants, anticoagulants, and chemotherapy therapies, can cause hair loss.
How can I prevent hair loss in people AFAB?
Here are some general hair loss prevention strategies for people AFAB like eating a well-balanced diet, avoiding severe hairstyles and treatments, and avoiding rigorous towel drying and vigorous brushing, which can harm the hair root and cause breakage. Protect your hair from sun and heat damage, minimise stress, stop smoking and drinking alcohol, and use mild hair care products to massage your scalp on a regular basis.
How common is hair loss in people AFAB?
According to the American Academy of Dermatology (AAD), about 40% of people AFAB experience visible hair loss by the age of 40.
When should I see a doctor?
Consult your doctor if you observe abrupt or patchy hair loss, or if you notice greater hair loss than normal when combing or washing your hair. Sudden hair loss might indicate an underlying medical problem that must be treated.
Hair loss in people AFAB, commonly known as female pattern baldness or androgenetic alopecia, is a prevalent disorder characterised by hair thinning and volume loss. A multitude of reasons can contribute to it, including genetics, hormonal changes, ageing, medical disorders, and lifestyle choices. People AFAB may notice hair loss all over their heads or in specific locations. Their self-esteem and quality of life might suffer as a result of the condition's emotional and psychological effects. Medication, topical treatments, laser therapy, and hair transplantation are among treatment possibilities; success varies based on the underlying reason and individual reaction.
- Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol [Internet]. 2018 Jun 19 [cited 2023 Nov 2];4(4):203–11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322157/
- Birch MP, Messenger JF, Messenger AG. Hair density, hair diameter and the prevalence of female pattern hair loss. Br J Dermatol [Internet]. 2001 Feb [cited 2023 Nov 3];144(2):297–304. Available from: https://academic.oup.com/bjd/article/144/2/297/6690834
- Price VH, Roberts JL, Hordinsky M, Olsen EA, Savin R, Bergfeld W, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. Journal of the American Academy of Dermatology [Internet]. 2000 Nov [cited 2023 Nov 2];43(5):768–76. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0190962200643530
- Bhat YJ, Saqib NU, Latif I, Hassan I. Female pattern hair loss—an update. Indian Dermatol Online J [Internet]. 2020 Jul 13 [cited 2023 Nov 2];11(4):493–501. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413422/
- Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low‐dose oral minoxidil and spironolactone. Int J Dermatology [Internet]. 2018 Jan [cited 2023 Nov 2];57(1):104–9. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ijd.13838
- Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. Journal of the American Academy of Dermatology [Internet]. 2011 Dec [cited 2023 Nov 2];65(6):1126-1134.e2. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0190962210018116
- Fischer TW, Trüeb RM, Hänggi G, Innocenti M, Elsner P. Topical melatonin for treatment of androgenetic alopecia. International Journal of Trichology [Internet]. 2012 Oct 1 [cited 2023 Jun 27];4(4):236. Available from: https://www.ijtrichology.com/article.asp?issn=0974-7753;year=2012;volume=4;issue=4;spage=236;epage=245;aulast=Fischer;type=0
- Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. JDDG: Journal der Deutschen Dermatologischen Gesellschaft [Internet]. 2011 Oct [cited 2023 Jun 27];9:S1–57. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1610-0379.2011.07802.x
- Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, et al. Postmenopausal hormone therapy: an endocrine society scientific statement. J Clin Endocrinol Metab [Internet]. 2010 Jul 1 [cited 2023 Jun 27];95(7 Suppl 1):s1–66. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287288/
- Rushton DH, Westgate GE, Van Neste DJ. Following historical “tracks” of hair follicle miniaturisation in patterned hair loss: Are elastin bodies the forgotten aetiology? Exp Dermatol [Internet]. 2022 Feb [cited 2023 Jun 27];31(2):102–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290669/
- Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The role of vitamins and minerals in hair loss: a review. Dermatol Ther (Heidelb) [Internet]. 2018 Dec 13 [cited 2023 Jun 27];9(1):51–70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380979/
- Olsen EA, Messenger AG, Shapiro J, Bergfeld WF, Hordinsky MK, Roberts JL, et al. Evaluation and treatment of male and female pattern hair loss. Journal of the American Academy of Dermatology [Internet]. 2005 Feb [cited 2023 Nov 2];52(2):301–11. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0190962204010588