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Female alopecia, what is it? How to recognize it?

The term “alopecia” indicates widespread or localized hair loss. Contrary to what one might think, the phenomenon does not only affect the male population but also the female population. Recent studies have provided some estimates:

It seems that the condition affects 18 million Italians and 4 million Italians.

Hair loss in women is usually less severe than in men, but the psychological repercussions are even more important and dramatic.

Generally, androgenetic alopecia in women occurs for the first time between thirty and forty years, so later than in men.

In 80% of women, a recession of the temples manifests itself physiologically with sexual maturation, but is much less marked than in men.

While in men, hormones do not affect the hair in the occipital and parietal areas of the scalp, hair loss in women often occurs with a reduction in overall density, with greater concentration in the upper scalp area. The fall does not affect the frontal area, so much so that a more or less dense hairline is always maintained.


The Causes of Female Alopecia

As just mentioned, at the base of androgenetic alopecia there is the presence of androgenic hormone. If, for specific genetic components not yet fully identified by scholars, hair follicles are particularly sensitive to the action of these hormones, the process of miniaturization occurs.

Women with hyperandrogenism (a condition in which an excess of androgens occurs) are generally more susceptible to alopecia although the two conditions are not always related.

In case of acne, seborrhea, hirsutism and hypertrichosis, suggestive but not pathognomic characteristics of hyperandrogenism, consequently, there is a higher probability that the woman may suffer from alopecia.

Most cases of hyperandrogenemia are related to PCOS (polycystic ovary syndrome). Symptoms include hirsutism, anovulatory cycle, alterations in the menstrual cycle and, in some cases, obesity.

More rarely hyperandrogenism is linked to the presence of androgen-secreting neoplasms.

Other hormones that affect hair health are estrogens. During the fertile age these positively influence hair growth and the functioning of its life cycle.

In the hair bulbs some enzymes can act on estrogens and androgens, transforming them into hormones capable of modifying the life of the hair. Among these we remember in particular the enzyme 5-alpha-reductase, able to transform testosterone into dihydrotestosterone, which is responsible for the miniaturization process of hair follicles.

The action of 5-alpha-reductase is countered by aromatosis, alpha-steroid dehydrogenase and 17-beta-hydroxysteroid, enzymes that convert androgens into estrogen, counteracting baldness and prolonging the life phase of the hair.

With the onset of menopause there is a decrease in estrogen and a change in the ratio between ovarian and adrenal steroids, and it is at this stage that androgenetic alopecia becomes more evident.

A similar situation can occur following a part, due to hormonal changes, or with the start or interruption of a birth control therapy.

Further causes of female alopecia may be:.

  • Anemia(iron deficiency);
  • thyroid dysfunctions;
  • ;

  • Lupus(connective tissue dysfunction);
  • Strict and unbalanced diets, bulimia, essential fatty acid and zinc deficiency, hypervitaminosis A, malabsorption;
  • .

  • Stress caused by surgery, general anesthesia;
  • Grave depressive forms.


La Scala Ludwig

Female alopecia differs from male alopecia in that it generally appears in older age, generally between 30 and 40 years, and for its different manifestation.

In men, baldness generally affects the fronto-occipital area, while generally, in women, the frontal line is preserved and thinning is widespread throughout the scalp and with the advance of the condition becomes increasingly marked. In the most severe cases, the fall continues until the vertex is completely uncovered.

The hair is thinner, less thick and more difficult to tame. In some cases they are more greasy, fragile, and some women have stated that they feel burning, itching, tingling and hypersensitivity of the scalp.

In 1977, Ludwig classified female androgenetic alopecia according to three main grades, based on hair density.

  • 1st grade: To this group belongs the majority of women. Hair loss is limited and still not very visible.
  • 2° degree: Thinning is more marked and more visible.
  • 3rd grade: Few women belong to this group. Thinning takes on the traits of the male, and therefore an assessment is required to understand if there is a hyperandrogenic state.


How do you make the diagnosis?

Making an early diagnosis is essential to hope to slow down or reverse the miniaturization process of hair follicles.

First, we proceed with an anamnesis, an evaluation of the overall clinical picture and a trichogram. It is important to understand if there are family cases of alopecia, if the patient is taking drugs or contraceptives, if there is regularity in the menstrual cycle and if signs of hyperandrogenism can be found. Among these we remember in particular:

  • excessive hair in typically male areas,
  • acne,
  • deep voice,
  • obesity,

It is essential to perform endocrinological and laboratory screening. The goal is to understand what is the concentration of:

  • androgenic hormons,
  • hyroid hormones,
  • cortisol,
  • estrogens,
  • progesterone,

For the therapy to be successful, especially in women, it is necessary to intervene on a hormonal level.


Terapies against female alopecia

We provide below a classification of universally recognized therapies for the treatment of female hair loss.

Topical therapeutic options include, in particular, Minoxidil and sulfateestrone sulfate. Some experts also recommend the use of solutions based on natural progesterone in association, in some cases, with spironolactone.

The Azelaic acid, applied directly to the scalp, can also reduce the activity of the 5-alpha-reductase enzyme.

Usually, the therapy most commonly recommended by experts involves the combined administration of progestins and estrogens. Examples are etinylestradiol and cyproterone acetate. These drugs have an important antiandrogenic function.

If the fall is at an advanced stage, a surgeon may be required.