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Hair loss - Women and hair loss

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If losing hair is miserable enough for a man, it's a "downright catastrophe for a woman", says Elizabeth Steel, of support network Hairline International.

For women, says Steel, the stigma of hair loss is much more difficult to handle.

She says society considers hair as a defining part of a woman and a mark of her femininity, youth, health and grace.

"Hair is such an important part of how you look," says Steel. "I think it's perhaps more important to women than men.

"Hair loss isn't life-threatening but it can ruin your life in so many ways," she says.

An estimated eight million women in the UK suffer from serious hair loss, leading to loss of self-confidence and heightened self-consciousness.

Hair loss is a well-known side-effect of chemotherapy, and around 50% of women lose more hair than usual after they've given birth.

Trauma

However, there are less well known or understood conditions where the hair loss can be permanent. The most common alopecia conditions in women include:

  • Telogen effluvium: general shedding and thinning of the hair. This usually occurs a few months after a shock to the system, such as extreme stress, fever, childbirth, sudden weight loss, an operation, or as a reaction to medication. The hair loss is usually temporary.
  • Female-pattern baldness (androgenetic alopecia): women's hair gradually thins with age but they often only lose hair from the top of the head. This usually gets more noticeable after the menopause. Androgenetic alopecia also tends to run in families.
  • Alopecia areata: affects about one in 100 people, mostly teenagers and young adults. Symptoms include patchy hair loss. This condition is linked to a problem with the immune system. The hair follicles are not permanently damaged, and in many of these cases the hair grows back in a few months.

With alopecia areata there's a good chance that your hair will eventually grow back. But with alopecia totalis (complete loss of scalp hair) or universalis (complete loss of all body hair), regrowth is unlikely.

Steel was a writer and TV presenter when she started to lose her hair after developing alopecia areata at the age of 30. Within a few months she had lost 90% of her hair.

"When it happened I felt totally alone," she says. "I felt like a complete freak." 

Steel's own experience, and that of other women she has helped, illustrate how the trauma of hair loss among women isn't fully appreciated.

A survey by Hairline International found that 78% of female patients no longer felt like women, 40% said their marriage had suffered, and 63% had considered suicide.

Research by the University Hospital of Wales in 2001 found that women believed that going bald was worse than developing a skin disease like psoriasis.

"The psychological impact is dreadful. I no longer felt attractive. I thought my husband wouldn't want a bald wife," says Steel.

Effective treatments

The only proven treatment for female-pattern baldness is minoxidil. Most users see improvements, including a halt to the balding or slowing down of it, as well as thicker hair. Up to 25% of women experience hair regrowth.

Other solutions include wigs, hair transplants (taking hair from the sides and back of the head) and plastic surgery (such as scalp reduction, where the bald area is removed and the bit with hair on is stretched forward).

There is no effective treatment for alopecia areata. Some treatments can encourage hair to grow, such as steroid injections or creams, or minoxidil lotion. In 60-80% of cases, the hair grows back after about a year without any treatment.

Steel used minoxidil for eight years before her hair grew back. Whether it was due to the treatment, she can't say for sure.

In the meanwhile, she says that wigs helped her to cope. "Once I found one that I liked, I felt like I'd got my life back again," she says. "I recovered my self-esteem instantly."

Medical Review: December 10, 2008

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