This is an autoimmune disorder that is also known as “spot baldness” and can result in hair loss ranging from just one location (alopecia areata monolocularis) to the entire scalp (alopecia totalis), or to every hair on the entire body (Alopecia areata universalis). Although it is thought to be caused by hair follicles becoming dormant, what triggers alopecia areata is not exactly known. In most cases, the condition corrects itself.
Around 30 million U.S. women will experience hereditary hair loss, or female pattern baldness (androgenetic alopecia), while others will struggle with situational hair loss, brought on by medical conditions, medications, poor health and nutrition, environmental factors such as smoking and sun damage, or even from adverse reactions to hair care products or treatments.
Male pattern hair loss has been established as androgen-dependent because it is associated with changes in the androgen receptor and responds to antiandrogen therapy (Ellis et al., 2002). With FPHL, genes that encode aromatase, which converts testosterone to estradiol, are also implicated (Yazdabadi et al., 2008, Yip et al., 2009). The process of androgen biosynthesis is depicted in Figure 1.
Both of these hairy issues are related to excess androgens that are part of PCOS.  Our hair follicles respond overzealously to testosterone creating both hair loss and hair growth. This is because the follicles on the face tend to stretch and grow causing the hair to get stuck and not fall out when they should. Conversely, the scalp hair follicles actually shrink in response to androgens and the hair can fall out or just not be as robust.
The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is seen as hair thinning predominantly over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most commonly seen after menopause, although it may begin as early as puberty. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Genetically, hair loss can come from either parents side of the family.
Hansen's disease, also known as leprosy, is an infection of the skin and nerves caused by the bacterium Mycobacterium leprae. The disease often affects the skin of the eyebrow region, leading to loss of sensation and permanent loss of the eyebrow hairs. There are numerous other rare and uncommon causes of eyebrow hair loss, including vitamin A toxicity, nutritional disorders and other dermatological disorders. If you experience loss of eyebrow hair, see your doctor to evaluate the cause and to discuss a treatment plan.

The photo included here shows an example of one condition which could affect the eyebrows, eyelashes, facial hair and pubic hair. This is a type of thinning hair found in women that are regularly seen at Sussex Trichology in West Sussex. These symptoms obviously cause the sufferer much distress as the appearance has dramatically altered the hairline since the eyebrows define the face. Shuna Hammocks, our Consultant Trichologist, is able to diagnose your condition and discuss it at length and then design a treatment plan for you. It may be suggested that you attend the clinic for hair treatments which involve a combination of creams, steam and massage.
Although it’s generally only prescribed as a last resort for menopausal symptoms, hormone replacement therapy is a common and very effective hair loss treatment for some women — as long as they are menopausal or post-menopausal and are not at higher risk for adverse effects from HRT. It's most often prescribed for women who have androgenetic alopecia, also called pattern baldness. Hormone replacement therapy has a number of benefits for both general health and symptom management, but also a number of side effects — which range from unpleasant to dangerous.

FPHL or androgenetic alopecia is the most common cause of hair loss in women and one of the most common chronic problems seen by dermatologists worldwide (Varothai and Bergfeld, 2014). FPHL is a nonscarring form of alopecia in which the frontal hairline is maintained, but there is progressive hair thinning at the vertex of the scalp. Thinning of the hair is secondary to alteration of the hair cycle with shortening of the anagen phase and simultaneous lengthening of telogen. This increase in the resting phase and decrease in the growth phase of the hair cycle results in the miniaturization of hair because long terminal hairs are gradually replaced by short vellus hairs (Messenger and Sinclair, 2006, Sinclair et al., 2011).
*Photograph used with permission of the Journal of the American Academy of Dermatology. This photograph was published in the Journal of the American Academy of Dermatology, Vol. # 60, Gathers RC, Jankowski M, Eide M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia,” 660-8. Copyright Elsevier (2009). Journal of the American Academy of Dermatology.   
Microblading is a semipermanent way to fill in brows that looks more natural than permanent makeup or tattooing. “Microblading differs from tattooing and the traditional form of permanent makeup in that it is typically done by hand versus a machine and doesn’t go as deep into the skin,” explains Studabaker. “In the past, tattooing and traditional permanent makeup usually resulted in a solid line and the color could change significantly with time.”
Madarosis of non-scarring type is commonly seen in alopecia areata which is a hair-specific autoimmune disease associated with patchy loss of hair.[56] It presents as round or oval patches of non-scarring hair loss. Madarosis occurs as isolated involvement [Figure 2] or as a part of alopecia universalis.[57] When alopecia areata involves the eyelashes exclusively, there is rarely involvement of other parts of the body.[58] Alopecia areata can involve both the eyelids without scalp involvement also.[59] Short exclamation mark hairs are pathognomonic for alopecia areata.
Contact dermatitis causes skin inflammation and when severe it can affect the hair follicles as well. It can either be due to some irritant making contact with the skin of the eyebrows or due to a substance to which a person has an allergy. This gives rise to the two types of contact dermatitis – irritant contact dermatitis or allergic contact dermatitis. Substances that could cause contact dermatitis at the eyebrow includes eye makeup including eyebrow pencils, hair removal creams and waxes, other cosmetics, hair dyes and scalp hair styling products.
There is pilosebaceous inflammation[45] with both scarring and non-scarring alopecia depending on the degree of inflammation. Most commonly, there is involvement of the head and neck, though widespread involvement is also seen. Eyebrow loss is a prominent finding and may be the presenting symptom when the eyebrow region is involved in the acute benign form of follicular mucinosis.[46]
Another reason that you have thinning eyebrows might be low thyroid (which is called hypothyroidism. The thyroid gland controls the rate of use of energy sources, protein synthesis by producing thyroid hormones. I the thyroid gland does not produce enough hormones, you might feel tired, freeze in the cold, gain weight or lose your hair. The most common cause of hypothyroidism is iodine deficiency.
Madarosis is the hallmark of lepromatous leprosy. It was reported in 76% of patients with multibacillary leprosy.[76] Bilateral symmetric cicatricial madarosis occurs in lepromatous leprosy due to histiocytic infiltration of hair follicles[77,78] [Figure 4]. It occurs in multibacillary leprosy after at least 5 to 10 years of untreated disease.[79] Loss or atrophy of the eyelashes may follow. Madarosis adds to the cosmetic disfigurement caused by leprosy. Absence of madarosis is a good prognostic sign in long-standing cases.[80] Unilateral madarosis may occur in tuberculoid leprosy due to the facial patch in the eyebrow region. In tuberculoid leprosy, madarosis occurs due to granulomatous infiltration of hair follicles leading to their destruction.
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.

Alopecia areata is a chronic autoimmune disease in which the immune system erroneously attacks the hair follicles, causing inflammation and temporary hair loss. Any hair-bearing skin site can be affected by alopecia areata, including the eyebrows. Treatment commonly involves corticosteroid injections into the site of eyebrow loss. Eyebrow hairs usually grow back, but may be a different color or texture than the lost hairs.
Alopecia areata is a patchy hair loss associated with immune disturbances. In this condition the immune system attacks the hair follicles thereby impairing hair growth. It is more likely to occur in people with other immune-related disorders and has also been linked to psychological stress as well as with certain drugs like some types of ARVs used for HIV treatment. Alopecia areata does not only affect the scalp as commonly thought. The eyebrows and beard area, as well as hairy parts anywhere on the body may be affected.

Yes. If you wear pigtails or cornrows or use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia (say: al-oh-pee-sha). If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals used in permanents (also called “perms”) may cause inflammation (swelling) of the hair follicle, which can result in scarring and hair loss.

In extreme cases, such as disordered eating and anemia, an iron deficiency may be to blame for thinning brows. “Even if you don’t have anemia, and you have low levels of stored iron, that could contribute to hair loss,” says Rajani Katta, M.D., a dermatologist and clinical assistant professor of medicine at Baylor College of Medicine, who studies the link between nutrition and hair loss. Iron is found in meat, fish, and other animal products, plus beans and legumes, so vegans and vegetarians might be more likely to be low in iron. Your derm can do a ferritin blood test to check your iron levels. But don’t start an iron supplement without medical recommendation. Too much iron can also have negative effects, says Dr. Katta.


Our professionally-trained people, products and services can help any person of any age or ethnicity, with any hair type or level of hair loss—whether it’s just beginning, it’s all gone or somewhere in between. We’re constantly innovating, using cutting-edge technologies and the latest proven hair restoration methods. We combine that innovation and technology with decades of first-hand experience in helping people deal with the issue of hair loss. 

Dozens of other causes of eyebrow loss are also possible including a variety of infectious, autoimmune and inflammatory conditions. Consultation with a dermatologist or hair transplant surgeon is recommended. I strongly advise consulting a dermatologist before proceeding to hair transplantation for women over 40 with new onset eyebrow hair loss after age 40.
Physicians such as dermatologists and plastic surgeons have long recommended essential vitamins and supplements for hair growth to women and men. Now read why top medical experts including Dr. Craig Ziering and Dr. Steven Dayan have been telling their patients for years about Viviscal hair growth supplements to help grow thicker, longer and healthier looking hair.

The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is seen as hair thinning predominantly over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most commonly seen after menopause, although it may begin as early as puberty. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Genetically, hair loss can come from either parents side of the family.
Madarosis is the hallmark of lepromatous leprosy. It was reported in 76% of patients with multibacillary leprosy.[76] Bilateral symmetric cicatricial madarosis occurs in lepromatous leprosy due to histiocytic infiltration of hair follicles[77,78] [Figure 4]. It occurs in multibacillary leprosy after at least 5 to 10 years of untreated disease.[79] Loss or atrophy of the eyelashes may follow. Madarosis adds to the cosmetic disfigurement caused by leprosy. Absence of madarosis is a good prognostic sign in long-standing cases.[80] Unilateral madarosis may occur in tuberculoid leprosy due to the facial patch in the eyebrow region. In tuberculoid leprosy, madarosis occurs due to granulomatous infiltration of hair follicles leading to their destruction.
Most women with pattern hair loss don't get a receding hairline or bald spot on top of the scalp as is common in men. Instead, there is visible thinning over the crown. In men and women, hairs are miniaturized because of a shortened growth cycle where the hair stays on the head for a shorter period of time. These wispy hairs, which resemble forearm hairs, do not achieve their usual length.

Spending over a decade rigorously researching natural alternatives to a drug that negatively impacted his libido for seven years, Tsetis and his team reverse engineered the formula of a leading pharmaceutical only using patented sourced supplements. What they produced was a tested and proven hair health product that is now helping millions across the country avoid or actively cure for hair loss.
Giorgos Tsetis: Hair loss completely shattered my confidence, and losing your confidence in modeling isn't a good thing. It was a very high price to pay. For eight years I was struggling, trying different solutions, searching for answers, not knowing what was going on. It was exhausting to say the least. So, when I made the decision to close down my company and started working on Nutrafol, people really thought I was crazy. They wondered why I was taking the chance of getting into this industry. To me, it wasn't really a choice, because there was nothing on the market that was healthy, accessible and helping the other 80 million people who are effected in the United States. We wanted to help ourselves, but really help others by making a valuable product that addressed an unsolved issue.
Inflammation can play into thyroid related hair loss as can increased oxidative stress when the cause of the low thyroid is Hashimoto’s or autoimmunity. Immune activation in Hashimoto’s increases both of these additional causes of hair loss. As well it’s not uncommon to have multiple nutrient deficiencies when you have a low thyroid ranging from iron to B12 to a host of minerals including zinc and selenium. 
Eyebrow loss, also known as superciliary madarosis, can occur with a variety of medical conditions. Madarosis can affect one or both eyebrows with partial or complete hair loss. Infections, chronic skin disorders, hormone disturbances, autoimmune diseases and medications are among the many medical reasons for eyebrow loss. In most cases, identification and treatment of the underlying condition leads to regrowth of the eyebrows. Permanent eyebrow loss can occur with disorders that permanently damage the hair follicles.

Optimal levels of estrogen help to grow full thick hair, while low estrogen levels lead to thin and stalled hair growth, which eventually leads to hair loss. Through the years, a women will go through various cycles of highs and lows in estrogen levels. Puberty is typically associated with high estrogen levels as a woman starts to cycle through menstruation. Pregnancy typically increases hormone production, but once the baby has been delivered the mother can experience a drop in estrogen levels, which can result in thinning and loss of hair. Typically, this corrects itself as the woman's body heals and hormonal regulation returns to normal.  The largest decline in estrogen levels is during menopause. Estrogen is secreted through the ovaries and adrenal glands. When a woman hits menopause, the ovaries’ estrogen production is significantly diminished, which puts an excess burden on the adrenals to produce it. However, as the adrenals are typically overburdened due to stress, symptoms of menopauses like hair loss and hot flashes occur prematurely and excessively for some. Nourishing the body and balancing stress levels will support gentle and graceful transitions.   

Hair loss in women is not easy to diagnose because it is very often multifactorial in etiology and thus requires well-designed specific steps so that the patient is evaluated properly. The best way to do this is to evaluate the patient in person (rather than sending photos via email or Skype) because the patient gets a chance to meet her doctor to permit the development of a trusting relationship- critical because very often the treatment of hair loss is an involved process that requires a strong doctor-patient relationship.
Trichotillomania is a hair pulling disorder associated with anxiety, stress, depression, boredom and frustration. It is where a person manually removes hairs with their finger, either a few strands throughout the day or sometimes many strands at one time during an emotional outburst. This behavior is usually a means of coping with stress or emotional turmoil. However, it can sometimes become a habit that is difficult to break. The eyebrows is a commonly targeted area as is the scalp.
In extreme cases, such as disordered eating and anemia, an iron deficiency may be to blame for thinning brows. “Even if you don’t have anemia, and you have low levels of stored iron, that could contribute to hair loss,” says Rajani Katta, M.D., a dermatologist and clinical assistant professor of medicine at Baylor College of Medicine, who studies the link between nutrition and hair loss. Iron is found in meat, fish, and other animal products, plus beans and legumes, so vegans and vegetarians might be more likely to be low in iron. Your derm can do a ferritin blood test to check your iron levels. But don’t start an iron supplement without medical recommendation. Too much iron can also have negative effects, says Dr. Katta.
Also called “chastetree,” Vitex is an herb which is typically prescribed to treat estrogen dominance. It seems to be recommended as a remedy for especially low levels of estrogen as well however, and does seem to have a general balancing effect on the overall ratio of estrogen to progesterone. Vitex’s balancing effect is thought to result from the stimulation of dopamine production.
Thyroid Dysfunction: Since the thyroid gland regulates many body functions by releasing hormones, any disruption in its functioning can cause loss of hair, including eyebrow hair. If your thyroid is underactive, it could cause you to lose the outer third of your eyebrow. The only way to treat thyroid dysfunction is through medication. However, there’s still no guarantee that your eyebrow hair will grow back. 

Your body needs to be hydrated in order to function properly. Load up on H2O all day long and pass on juices, sodas, and other flavored drinks that contain more sugar than your body needs. The amount of water needed varies from person to person and depends on various factors, including overall health and exercise intensity. As a general rule, however, you should aim to have eight 8-ounce glasses of water per day.
A. I think it's a personal preference, but why is a cosmetic solution such a big deal? To use sprays, powders and hair extensions? It doesn't address the problem, but it can do wonders for your self-esteem. I see patients who are extremely depressed, and this is ruining their life. We always have hope for that miracle solution, but it's very hard to do research studies. … As much as this affects people's mentality, there's not a lot of (National Institutes of Health) funding because hair loss isn't killing anyone.
Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha reductase, which is held in a hair follicle's oil glands. Scientists now believe that it's not the amount of circulating testosterone that's the problem but the level of DHT binding to receptors in scalp follicles. DHT shrinks hair follicles, making it impossible for healthy hair to survive.
Eyebrow loss, also known as superciliary madarosis, can occur with a variety of medical conditions. Madarosis can affect one or both eyebrows with partial or complete hair loss. Infections, chronic skin disorders, hormone disturbances, autoimmune diseases and medications are among the many medical reasons for eyebrow loss. In most cases, identification and treatment of the underlying condition leads to regrowth of the eyebrows. Permanent eyebrow loss can occur with disorders that permanently damage the hair follicles.
Hair loss may also occur due to dieting. Franchised diet programs which are designed or administered under the direction of a physician with prescribed meals, dietary supplements and vitamin ingestion have become popular. Sometimes the client is told that vitamins are a necessary part of the program to prevent hair loss associated with dieting. From a dermatologists’s standpoint, however, the vitamins cannot prevent hair loss associated with rapid, significant weight loss. Furthermore, many of these supplements are high in vitamin A which can magnify the hair loss.
The startup recently closed its Series A round of funding, with Unilever Ventures, the investment and private-equity vertical of the consumer goods company, stepping in as the lead investor. Unilever was introduced to Nutrafol through investment platform, CircleUp. The investment from Unilever Ventures, along with other strategic partners, will be used to advance research efforts, product development and expand within the medical, salon and e-commerce channels. With continued investment in research and clinical studies, Nutrafol is poised to take the lead in the fragmented multibillion-dollar global hair loss industry.
Some cancer chemotherapy drugs cause temporary hair loss, which affects all body hair. Along with the loss of scalp hair, people undergoing chemotherapy also commonly lose their eyebrows and eyelashes. Chemotherapy drugs that frequently cause hair loss include paclitaxel, 5-fluorouracil, carboplatin, cisplatin, actinomycin-D, bleomycin, vincristine, cyclophosphamide, altretamine, etoposide, docetaxel and doxorubicin. Hair loss typically begins 2 to 3 weeks after the start of chemotherapy. Lost eyebrow hair regrows in the weeks to months following completion of treatment.
Exercise is a key component of a healthy lifestyle. You’ll feel stronger and happier once you incorporate exercise into your daily routine. It also helps prevent some of the other symptoms of menopause, including mood swings, weight gain, and insomnia. All of these factors are important for maintaining hormonal balance, which promotes healthy hair growth.

Thinning hair, noticeable bald spots, receding hair line, large clumps of hair showing up in your hair brush or shower drain, these are typically things you hear about from men, not women. More and more though, we are contacted by women who are experiencing hair loss who want to know if this is a sign of something wrong with their hormones and how they can fix the problem. Fortunately, hair loss is not a sign of infertility, but is a side effect of hormonal imbalance which can impact your fertility.

Telogen effluvium is a condition where a large number of hair follicles enter the resting phase known as telogen. As these hairs may fall off, it is not replaced with new hair at the same area and this leads to a bald patch on the eyebrows. A number of hormonal factors (like with hypothyroidism and pregnancy) may be responsible and it is also related to certain diseases, nutritional deficiencies, chronic medication use and even metal toxicity. It is now also known that stress can push many more hair follicles than normal into this phase.

These are only a few of the common myths heard by physicians and other hair loss specialists on a daily basis. The American Hair Loss Council suggests that you first have your hair loss diagnosed by a competent dermatologist who sees hair loss patients on a regular basis. Once you know the diagnosis you will have a better understanding of exactly which treatment option may be best for you.


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All material on Amalie is provided for educational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, exercise, or other health program.
This is a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue and cause permanent hair loss. The hair loss may be accompanied by severe itching, pain and burning, and may progress rapidly. In other cases, the hair loss is gradual, has no symptoms and is unnoticed for long periods. It is also sometimes known as scarring alopecia and can occur in otherwise healthy men and women of all ages.
Traumas such as major surgery, poisoning and severe stress may cause a hair loss condition known as telogen effluvium, in which a large number of hairs enter the resting phase at the same time, causing shedding and subsequent thinning hair in men and women alike. The condition also presents as a side effect of chemotherapy. While targeting dividing cancer cells, this treatment also affects hair’s growth phase, with the result that almost 90% of hairs fall out soon after chemotherapy starts.
There is also a different in the form of 5AR enzyme (5 alpha reductase) found on the facial hair follicles vs. the scalp hair follicles. This enzyme converts testosterone into that more problematic DHT. Type I DHT is found in sebaceous glands on the face and genital area whereas Type II is found in hair follicles of the scalp. Type II DHT is typically more of a problem in men, but Type II is increased in disorders with high testosterone like PCOS.
Insulin, that helper hormone in charge of regulating blood sugar levels, also affects a number of different body processes, including fat storage, heart health and, you guessed it, hair growth. One study published in the European Journal of Cardiovascular Risk found that women with some markers of insulin resistance have a greater risk for androgenic alopecia (AGA), or female pattern baldness.
See a dermatologist for itchy skin or rashes around your brows. These patches may indicate a skin infection or interaction with a new beauty product or environmental trigger. You could also have inflammation from dermatitis or psoriasis.[32] These conditions don’t actually cause hair loss, but they can lead to it if you rub and scratch the affected areas.
Male pattern baldness, or androgenic alopecia, affects an estimated 50 million men and 30 million women in the United States, according to the National Institutes of Health (NIH). Hair loss is due to the shrinkage of hair follicles and the resulting impact on the growth cycle. New hairs become finer and finer until there’s no hair left at all and the follicles become dormant. This hair loss is caused by hormones and certain genes.
How to Stop the Itch of Folliculitis LATISSE as a Treatment for Thinning Hair Unexplained Weight Loss & Hair Loss Skin Problems That Cause Eyebrow Loss Hypothyroid Symptoms & Itching Diseases that Cause Eczema Causes of Pubic Hair Loss Diseases Causing a Change in Hair Texture Causes of Dark Skin on the Chin Eyebrow Dandruff Causes Scalp Conditions That Cause Hair Loss Vitamins for a Dry Scalp Causes of Itching on the Face and Neck Whey Protein and Hair Regrowth Alopecia & White Hair Causes of a Pimple-Like Rash on the Face What Are the Causes of a Sensitive & Painful Scalp? What Causes Body Hair Loss? Reasons for Thinning Hair in Young Men What Are the Causes of White Spots on Tan Skin?
FPHL or androgenetic alopecia is the most common cause of hair loss in women and one of the most common chronic problems seen by dermatologists worldwide (Varothai and Bergfeld, 2014). FPHL is a nonscarring form of alopecia in which the frontal hairline is maintained, but there is progressive hair thinning at the vertex of the scalp. Thinning of the hair is secondary to alteration of the hair cycle with shortening of the anagen phase and simultaneous lengthening of telogen. This increase in the resting phase and decrease in the growth phase of the hair cycle results in the miniaturization of hair because long terminal hairs are gradually replaced by short vellus hairs (Messenger and Sinclair, 2006, Sinclair et al., 2011).

Yes. If you wear pigtails or cornrows or use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia (say: al-oh-pee-sha). If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals used in permanents (also called “perms”) may cause inflammation (swelling) of the hair follicle, which can result in scarring and hair loss.

When you see more hair in the shower drain, in your hair brush or your ponytail holder goes around an extra time all of a sudden this is typically low thyroid, high stress or low estrogen. It can also be the increased inflammation or oxidative stress or as a result of nutrient deficiencies especially anemias (low iron, B12, etc.). Let’s dig into each of these.


Hair loss in women can be related to genetics, hormones and age. Androgenetic alopecia, also known as female pattern hair loss, is one of the most common causes of hair loss in women. Hair loss in women may be caused by a serious medical condition that needs proper attention and treatment as early as possible. The hair loss patterns in women usually differ from those in men. Find out more about hair loss in women. 

Dutasteride is a 5-alpha-reductase inhibitor that binds both types I and II enzymes. Compared with finasteride, its inhibition of type II enzymes is three times more potent; its inhibition of type I enzymes is 100 times more potent (Clark et al., 2004). Dutasteride is not approved for the treatment of FPHL by the FDA, and ongoing studies on the efficacy of the inhibitor are promising but largely focus on male patients (Gupta and Charrette, 2014, Olsen et al., 2006). A study of women after 3 years of therapy showed that dutasteride may be more effective than finasteride in women under 50 years of age as measured by hair thickness (not hair density) at the center and vertex scalp (Boersma et al., 2014). One case report of a 46-year-old female with FPHL showed some response after 6 months of treatment with a dose of 0.5-mg dutasteride daily despite a minimal response to treatment with finasteride and minoxidil (Olszewska and Rudnicka, 2005). Data with regard to the treatment side effects in women is extremely limited. Dutasteride is classified as pregnancy category X because of teratogenicity and should have the same theoretical risk of breast cancer as mentioned in relation to finasteride (Kelly et al., 2016).
SOURCES: George Cotsarelis, MD, director, Hair and Scalp Clinic, University of Pennsylvania School of Medicine, Philadelphia. Andrew Kaufman, MD, assistant professor, department of dermatology, University of California, Los Angeles; medical director, Center for Dermatology Care, Thousand Oaks, Calif. Tom Barrows, PhD, director of product development, Aderans Research Institute Inc., Atlanta. Cotsarelis, G. and Millar, S.E. Trends in Molecular Medicine, July 2001; vol 7: pp 293-301. American Society for Dermatologic Surgery web site. American Academy of Facial and Reconstructive Plastic Surgery web site. American Hair Loss Council web site. Springer, K. American Family Physician, July 1, 2003; vol 68: pp 93-102. Hair Loss Help web site, "Interview with Dr. Ken Washenik from Bosley." Fuchs, E. Developmental Cell, July 2001: vol 1: pp 13-25.
Tames and Goldenring described a case of bilateral loss of eyebrows and eyelashes in a patient with AIDS-related complex who had smoked crack cocaine. This has been attributed to hot vapors during the process of smoking, and which therefore caused singeing of the brows and lashes. There was a complete reversal once the patient abstained from cocaine.[93]
Postpartum hair loss is related to the drop in estrogen experienced after giving birth. During pregnancy, the body has higher levels of estrogen (and progesterone) and estrogen increases hair’s “resting phase,” or the time hair stays on your head before naturally falling out (which is what accounts for the 100 or so hairs that healthy heads shed every day). When estrogen drops after pregnancy, all the hair that had been “resting” starts to shed. Post-pregnancy hair loss is usually temporary, lasting for several months.
This is most commonly found in women wearing ponytails, tight braids or any hairstyles that typically pull on hair with excessive force. In addition, rigorous brushing, heat styling and rough scalp massage can damage the cuticle, the hard outer casing of the hair. This causes individual strands to become weak and break off, reducing overall hair volume.
SOURCES: George Cotsarelis, MD, director, Hair and Scalp Clinic, University of Pennsylvania School of Medicine, Philadelphia. Andrew Kaufman, MD, assistant professor, department of dermatology, University of California, Los Angeles; medical director, Center for Dermatology Care, Thousand Oaks, Calif. Tom Barrows, PhD, director of product development, Aderans Research Institute Inc., Atlanta. Cotsarelis, G. and Millar, S.E. Trends in Molecular Medicine, July 2001; vol 7: pp 293-301. American Society for Dermatologic Surgery web site. American Academy of Facial and Reconstructive Plastic Surgery web site. American Hair Loss Council web site. Springer, K. American Family Physician, July 1, 2003; vol 68: pp 93-102. Hair Loss Help web site, "Interview with Dr. Ken Washenik from Bosley." Fuchs, E. Developmental Cell, July 2001: vol 1: pp 13-25.

Postmenopausal frontal fibrosing alopecia, a variant of lichen planopilaris, is a distinct form of scarring alopecia which is described in postmenopausal women. It consists of a receding hairline with scarring associated with a partial or complete loss of eyebrows in most affected individuals. The loss of eyebrows may be the presenting sign; however, the hairline reveals evidence of perifollicular erythema on closer observation. Histologic features are identical to that of lichen planopilaris.[42]


Sinclair Scale: The 5-point Sinclair Scale is a modified visual grading scale. Grade 1 is normal. This pattern is found in all girls prior to puberty, but in only half of women age 80 or over. Grade 2 shows a widening of the central part. Grade 3 shows a widening of the central part and thinning of the hair on either side of the central part. Grade 4 reveals the emergence of diffuse hair loss over the top of the scalp. Grade 5 indicates advanced hair loss. This grade is uncommon, occurring in less than 1% of women.
Hair loss or baldness is a genetic trait, but unlike what you may have been told, it’s not necessarily passed down from your maternal grandfather. Medical science has come to learn that hair loss genes are actually passed down from both sides of the family, and they affect hair loss in both men and women. Hair loss genes may also skip generations and are utterly random in terms of which siblings (male or female) they will affect. The cause of hair loss for one family member may differ from that of another.
It’s natural for estrogen levels to fluctuate throughout a woman’s life, but drastic drops can disrupt the hair growth cycle and cause telogen effluvium. For example, during pregnancy, a woman’s estrogen levels are at their peak. Fewer hair follicles enter the telogen stage of the hair cycle, so hair looks thicker than usual. A few months after pregnancy, however, estrogen levels drop and the excess hair falls out. While totally normal, this type of telogen effluvium can be very upsetting for new mothers.
This plant is native to North America and has been used for centuries by indigenous people to treat menstrual and menopausal disorders. While modern research results are mixed, some studies do indicate that black cohosh can be effective as a treatment in menopause. While the research focuses on hot flashes and other symptoms of menopause that get more attention than hair loss, it follows that black cohosh could also help to improve hair growth when estrogen levels decline.
Skin infections can cause hair loss at the affected area. One of the more common causes is a fungal infection of the skin, also sometimes referred to as a ringworm. Eyebrow fungus is more likely to be related to a scalp fungus (tinea capitis) and both areas are often affected at the same time. A bacterial infection is another possible cause. Folliculitis for example is a condition where the hair follicle becomes infected usually with bacteria like Staphylococcus aureus. Eventually this can lead to loss of the hair in the infected follicle.

Despite the name androgenetic alopecia, the exact role of hormones is uncertain. It is well known that androgens affect the growth of the scalp and body hair and even Hippocrates observed 2,400 years ago that eunuchs did not experience baldness (Yip et al., 2011). However, hyperandrogenism cannot be the only pathophysiologic mechanism for FPHL because the majority of women with FPHL neither have abnormal androgen levels nor do they demonstrate signs or symptoms of androgen excess (Atanaskova Mesinkovska and Bergfeld, 2013, Schmidt and Shinkai, 2015, Yip et al., 2011). Furthermore, cases have been reported in which FPHL developed in patients with complete androgen insensitivity syndrome or hypopituitarism with no detectable androgen levels (Cousen and Messenger, 2010, Orme et al., 1999).
There is also a different in the form of 5AR enzyme (5 alpha reductase) found on the facial hair follicles vs. the scalp hair follicles. This enzyme converts testosterone into that more problematic DHT. Type I DHT is found in sebaceous glands on the face and genital area whereas Type II is found in hair follicles of the scalp. Type II DHT is typically more of a problem in men, but Type II is increased in disorders with high testosterone like PCOS.
There are numerous diseases that can affect the hair and scalp. Hair loss can be caused by a variety of conditions. Diseases such as alopecia areata, anemia, male/female pattern baldness, and infections of the scalp can all cause significant difficulty and loss of daily well-being. Stanford Dermatology has established a special clinic focusing on the diagnosis and treatment of these disorders of the hair.
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