Many women will experience some form of hair loss as they age. Female hair loss often occurs postpartum as the body reacts to the stress of delivery and hormone changes. However, as women get older, they encounter shedding that is frequently associated with stress both physical and psychological. Menopause and other imbalances that can result in an increased sensitivity to hormones that can result in the thinning of scalp hair.

Female pattern hair loss, also known as female androgenetic alopecia, is a common and perplexing clinical problem. The most common pattern of female hair loss is the thinning of hair over the top area of the scalp with the retention of the frontal hairline. The causes of female pattern hair loss are complicated, involving hereditary factors as well as individual sensitivity and susceptibility to male hormones called androgens. Genetics play a large role for hair loss in both men and women, and these traits are typically inherited from either parent. Most of the time the hormone levels are normal in the blood, but there is an end-organ sensitivity that allows an increased conversion of testosterone in to the active form called 5-hydroxy testosterone. The slow reduction in estrogen compared with the fairly constant level of testosterone results in a relatively increased impact of the androgen. Hair loss is a stressful experience for both sexes, but possibly more distressing for women. In comparison to women with normal scalp hair, women with androgenetic alopecia tend to have more social anxiety, poorer self-esteem, less of a sense of control over their lives, and a less satisfying quality of life.

Common features of female pattern hair loss include: Gradual or sudden thinning of hair. The hair becomes miniaturized as it is replaced Hair thins mainly on the top and crown of the scalp. The front hairline usually remains intact. Often a family history of thinning hair

Similar to men, female pattern hair loss is androgenetic alopecia, which is a sensitivity to the effects of male hormones on hair follicles. However, androgen processing in hair follicles appears to be different in males and females even though scalp follicles demonstrate similar metabolic pathways. Although young females have twice as much 5-α reductase in frontal hair follicles than in occipital hair follicles, levels in the former are still only half those found in young males. Aromatase converts testosterone to estradiol in both males and females, but young females have higher levels of aromatase in scalp hair follicles than their male counterparts. These differences are thought to explain the milder form of androgenetic alopecia and the sparing of the frontal hairline seen in females. Hair braiding, hot combing, chronic illness, crash dieting and nutritional alterations, metabolic and endocrine disorders, stress, environmental changes, surgical procedures, and certain drugs can also contribute to hair loss in women.

Use gentle shampoos and conditioners to cleanse the hair. After washing your hair, let it naturally air dry. Hot air dryers can often damage hair and cause it to break. Activities such as over-brushing or over-styling the hair can often lead to more hair loss. Use a large-toothed comb to minimize the risk of breaking or pulling out hair. Avoid hairstyles that pull on the hair such as buns, braids or ponytails. Cut back on hair styling products that contain alcohol, which may irritate the scalp. To improve the appearance of thinning hair, there are a variety of hairstyles that can give the appearance of more volume and fullness.

The best strategy is to consult a dermatologist when you first notice any signs of thinning hair. Only a qualified physician can dispense proper advice and medical treatments to minimize or reverse hair loss.

Minoxidil, (Rogaine) is a common over-the-counter treatment for hair loss in both men and women. It has been shown to decrease hair loss and increase hair density. Minoxidil can come in a foam or liquid form and is typically applied directly to the affected area of the scalp. Wigs and hairpieces may also be used.

A doctor may prescribe Spironolactone, which has been shown to control excess androgens in the body by blocking the testosterone receptors. Androgen-blocking birth control pills may also inhibit hair loss that is genetically patterned. Finestaride is also used for this condition by blocking an enzyme required for converting circulating testosterone to the active form in the hair follicle. This is an off-label use.

Procedures such as follicular (hair) transplants are an effective procedure for restoring hair to an area of loss. However, this procedure can be quite costly and require multiple treatment visits.