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The idea of hair loss may be off-putting to both genders alike, but for women, female pattern hair loss may be particularly unsettling - and entirely unexpected - despite the fact that as many as 40 percent of American hair loss sufferers are female, according to the American Hair Loss Association.
"Men sort of expect to lose their hair and they are glad when they don't," says Sarah Jensen, M.D., assistant professor of dermatology and pathology, Saint Louis University, St. Louis. "Women don't expect to lose their hair and when they do, it's a real concern for them."
Female pattern hair loss typically presents as more of a telltale thinning, compared to the receding hairline often seen in men, and the fact that it is less noticeable - and perhaps easier to cover up - may explain why many may not realize its prevalence.
"Patients often will have had some hair loss for years, but not have been aware of it, and they will suddenly experience telogen effluvium, or acute shedding, possibly related to pregnancy, illness or medication, and that makes them notice the hair loss even more," she says.
Diagnosis and treatment
The peak periods for female pattern hair loss tend to occur following major hormonal upheaval, including pregnancy or menopause, and patients often seek treatment well before reaching a point of extensive hair loss, Dr. Jensen says.
"I think most women develop some degree of female pattern hair loss, but most patients fall in the mild to moderate category."
The only treatment for female pattern hair loss approved by the Food and Drug Administration (FDA), minoxidil (Rogaine, McNeil-PPC), is approved for women only in a 2 percent strength. Dr. Jensen says she sees better results with the 5 percent strength with females as well as with males, however, and encourages application twice a day for at least six months before determining whether it's effective.
"If they're able to comply with that regimen course, I encourage them to give it a good six months," she says. "Twice a day can be a hassle for women and their hairstyling, however, so if they can only manage once a day, I recommend they give it a full year before they decide if it's working."
Clinical studies of minoxidil, mainly involving women age 18 to 45 with moderate degrees of hair loss, have shown about 19 percent of women reported moderate hair growth after using the medication for eight months, and 40 percent had minimal regrowth. Several clinical trials have shown statistical superiority in treatment of female pattern hair loss with 5 percent versus 2 percent minoxidil.
Side effects from Rogaine can include scalp irritation resulting from the propylene glycol in the solution, in which case Dr. Jensen recommends patients switch to the foam version of the product. The foam product, which can dry quickly, is also often preferred because it can have a reduced effect on the appearance of the hair.
Patients may also see some temporary shedding of hair between two to eight weeks of treatment, but the effect is normal and patients should continue to treat through the shedding, Dr. Jensen says.