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Every Hair On Her Head

Hair loss for men gets a lot of attention - serious and not-so-serious - but men aren't the only ones who worry about hair piling up in the sink and the tub.

Millions of women also suffer from various forms of hair loss - for many different reasons. For some, the problem can be embarrassing and even emotionally devastating.

The Early Show examines the issue in a three-part series. In the first part, Dr. Diane Berson, a dermatologist at New York-Presbyterian-Weill Cornell Medical Center in New York, discusses the common forms and common causes for hair loss among women.

Female-pattern hair loss is characterized by a more diffuse thinning, as opposed to men who have a "patterned" type (hair loss that is specific to a particular area). Women will usually maintain their frontal hairline and loose hair behind it. The hair loss is most often very gradual, with the rate accelerating during or after pregnancy and at menopause.

It is more often cyclical, with changes that can reverse it. Hormonal changes, medical conditions, and external factors, such as diet and stress, more easily affect it.

Genetic Factor

The genes that cause hair loss can be inherited from either your mother or father. The expression of these genes is dependent on hormones called androgens and is therefore called "Androgenetic Alopecia" (the same term is used for common balding in men). Because the basic patterns are different however, the condition is called Female Pattern Androgenetic Alopecia.

There are a number of reasons to explain why hair loss in women presents differently than in men. Probably the most important reason is that men have a much higher level of the androgen testosterone. This is the hormone that is responsible for male sexual characteristics and when the body converts it to DHT, it becomes the main culprit in causing baldness. Fortunately, the much lower levels of testosterone in women spare them from the extensive hair loss that is often seen in men.

With age, some normal degree of hair loss occurs in everyone so that total hair volume will decrease over time in both sexes. The hair loss associated with genetic balding is also dependent upon time to express itself. Hair loss tends to occur at different rates at different periods in ones life with increased loss often occurring during periods of hormonal change, such as pregnancy, post-partum, and menopause.

Other Causes of Diffuse Hair Loss in Women

A number of "non-androgenetic" factors may be responsible for hair loss in women. Women's hair seems to be particularly sensitive to underlying medical conditions. Since "systemic" problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, especially of the diffuse or "unpatterned" type, be properly evaluated. It's also important to note that hair loss in women is not always permanent - it depends on the cause.

Among the many medical conditions that can cause hair loss, the most common ones are:

  • Anemia
  • Iron deficiency: perhaps from heavier than normal menstruation
  • Thyroid disease
  • Other endocrine problems (especially those that produce excess androgens)
  • Gynecological conditions: such as ovarian or adrenal tumors
  • Connective tissue disease (such as Lupus)
  • Surgical procedures, general anesthesia, or high fevers
  • Rapid weight loss, or crash diets that are not nutritionally balanced causing protein deficiency and/or low in iron, e.g. very strict vegetarian or vegan diets

It is also important to review the use of medications that can cause hair loss. The more common ones are:

  • Oral contraceptives - these pills vary in their degree of androgen effect
  • Thyroid medication - too much, too little
  • Blood pressure medication (such as beta-blockers or water pills)
  • "Mood" medication (such as lithium, Prozac, or tri-cyclic antidepressants)
  • Blood thinners such as heparin or coumadin
  • Cholesterol lowering medications
  • Medication for gout, such as Zyloprim
  • Anti-inflammatory drugs such as cortisone
  • Vitamin A or tryptophan in high doses
  • Street drugs (such as cocaine)
  • Many OTC drugs
For more information, visit the following Web sites:

American Academy of Dermatology

National Alopecia Areata Foundation

American Hair Loss Council

National Library of Medicine at the National Institutes of Health

National Institutes of Health (NIH)