Crown Clinic’s surgeon Dr Asim Shahmalak answers 5 popular questions about female hair loss

POSTED: 27 February 2020

Consultant hair transplant surgeon Dr Asim Shahmalak from Crown Clinic is one of the UK's leading experts on hair loss.
His celebrity clients include the Coronation Street star Jack P Shepherd, model Calum Best, TV doctor Christian Jessen, former footballer Didi Hamann, Homes Under The Hammer presenter Martin Roberts and Gogglebox star Chris Butland-Steed.

1. What are the symptoms of thinning hair and how can you determine whether you’re suffering from hair thinning or hair loss?


In women, hair loss more often involves a general thinning across the entire scalp. Known as diffuse thinning, most women affected loss a lot of their hair volume, making their scalp more visible. In general, the hair remain intact, but in some rarer cases women with hair loss may experience a receding hairline. But more commonly, female hair loss starts in the central area of the scalp and then spreads outwards if it is left untreated.  
As with men, the most common cause of female hair loss is genetics. If you have female pattern baldness on the mother or father's side of the family, there is a greater risk of it happening to the next generation of women in the family. This hereditary hair loss is permanent as opposed to the temporary thinning of the hair which can be caused by other factors such as pregnancy, stress, poor diet and menopause.
Permanent hair loss tends to happen differently in women to men.
Whereas men typically tend to first start losing their hair in the crown area or in the hairline at the front of the scalp and then go on to develop bald patches, in women hair loss manifests itself through general thinning rather than more noticeable bald patches.
Hair loss tends to be subtler in women than it is in men. Hair may also fall out in large clumps during brushing and showering.
"This kind of thinning hair, while not as immediately noticeable as male pattern baldness, can still undermine a women's self-confidence and age her appearance appreciably. It is why so many women seek permanent remedies for permanent hair thinning/hair loss. Around 10% of my clients are women.

2. What are the specific causes thinning hair? (do genetics, lifestyle, stress, medicine play a role?)

Below are the most common causes of hair thinning particularly in women.

* Androgenetic Alopecia - hereditary pattern hair loss with a typical pattern of diffuse thinning over the central scalp. It is the most common type of hair loss. It occurs in about 20% of women.
* Alopecia Areata - a recurrent disease of unknown cause that results in patchy loss of hair from the scalp and/or eyebrows.
* Telogen Effluvium - a condition that causes shedding of hair over the entire scalp; it may be chronic but may also be acute following a stressful event such as high fever, sever dietary deficiency, and chronic blood loss from heavy menstruation.
* Loose Anagen Syndrome - a condition that causes hair to shed before its normal growth cycle is completed. Hair can be pulled out by normal combing or brushing.
* Traction Alopecia - tight braiding and corn-rowing can, over time, cause permanent damage to hair and scalp and result in hair loss.
Chemicals - some chemicals used in hair styling can, over time, cause permanent damage to hair and scalp and result in hair loss.
* Trichotillomania - (compulsive hair plucking) - a person feels compelled to pluck hair in regular or bizarre patterns, resulting over time in traction alopecia and permanent hair loss.
* Scarring Alopecia - hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top of the scalp and occurs predominantly in women. The condition frequently occurs in Afro-Caribbean women and is believed to be associated with persistent tight braiding or "corn-rowing" of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring.
* Hypothyroidism - thyroid deficiency can be associated with thinning, patchy hair loss.
* Pregnancy - hormonal changes and stress of pregnancy may cause temporary hair loss
* Menopause - due to hormonal changes in a women's body from the age of 45 onwards
* Stress - this cause cause temporary hair loss
* Poor diet - another cause of temporary hair loss
* Medicine - cancer treatments such as chemotherapy cause cause the temporary loss of hair. 

3. How common is it in women?

Hair loss in women is surprisingly common. Around 40% of women will suffer from hair loss at some point in their lives - for instance during pregnancy or the menopause. But unlike with men, hair loss in women is often temporary and the hair will eventually grow back.
However, permanent hair loss is still a relatively common problem in women and is largely for hereditary reasons.

4. What’s the growth phase/cycle of hair (does it all grow and shed at the same time) and what happens to the growth phase of those experiencing loss of volume?

Approximately 90% of your hair is growing at any one time, while the other 10% enter a resting phase. Every two to three months the resting hair falls out and allows new hair to grow in its place.
Telogen effluvium is the excessive shedding of hair that occurs one to five months following pregnancy. This is not uncommon, as it affects somewhere between 40% to 50% of women; but like most changes during pregnancy, it is temporary.
Hair loss that is connected to pregnancy usually occurs after delivery. During pregnancy, an increased number of hairs go into the resting phase, which is part of the normal hair loss cycle.
This condition is not serious enough to cause bald spots or permanent hair loss. The rise in hormones during pregnancy keeps you from losing your hair. After delivery, the hormones return to normal levels, which allows the hair to fall out and return to the normal cycle. The normal hair loss that was delayed during pregnancy may fall out all at once.
Up to 60% of your hair that is in the growth state may enter into the telogen resting state. After around five months after birth hair follicles rejuvenate themselves and the hair grows back."

Menopause is a natural biological process that all women experience at some point in their lives. During this time, the body goes through numerous physical changes as it adjusts to fluctuating hormone levels. Many women have unpleasant symptoms during menopause, including hot flashes, mood swings, and insomnia. Hair loss is another common occurrence.

Research suggests that hair loss during menopause is the result of a hormonal imbalance. Specifically, it’s related to a lowered production of estrogen and progesterone. These hormones help hair grow faster and stay on the head for longer periods of time. When the levels of estrogen and progesterone drop, hair grows more slowly and becomes much thinner. A decrease in these hormones also triggers an increase in the production of androgens, or a group of male hormones. Androgens shrink hair follicles, resulting in hair loss on the head. In some cases, however, these hormones can cause more hair to grow on the face. This is why some menopausal women develop facial “peach fuzz” and small sprouts of hair on the chin.

For women going through menopause, the cause of hair loss is almost always related to hormonal changes. However, there are many other factors that can contribute to hair loss during menopause. These include extremely high levels of stress, illness, or a lack of certain nutrients. Diagnostic blood tests that can help rule out other causes of hair loss include thyroid tests, and/or a complete blood count.


5. Can you self-treat or should you always seek a doctor/ trichologist?

It is always best to see a doctor or trichologist to get to the root causes of the problem. However, there are some over-the-counter remedies that can treat hair thinning and hair loss in women.
"Minoxidil [Rogaine] hair loss products are available over the counter in a weaker concentration than the 5% that is prescribed by doctors. It is usually applied directly to the scalp and is most effective as part of a treatment programme devised by a hair regeneration specialist. It is more effective in women than men and although has been proven to arrest hair loss is not particularly effective in the regeneration of hair.
Toppik Hair Building Fibrescan can instantly fill in balding or thinning areas, providing a temporary solution to the problem. Made of pure organic protein, Toppik is  undetectable and resistant to wind, rain and perspiration; yet easily washes out with shampoo.
If you're a woman with thinning hair, Toppik hair products can have an immediate positive effect and help to restore confidence.
Toppik fibres are made of all natural organic keratin protein, the same protein that hair is made of. The fibres in Toppik are charged with static electricity so they intertwine with your own hair and bond securely."

How long does it take to see results using your treatments, how many sessions?

Minoxidil does take some time to work. Users won't start to see visible results after three months and it will probably be up to six months before you see a noticeable improvement. Toppik can provide immediate relief.

The only long-term solution to permanent hair loss is a hair transplant. Around 10% of my patients are female and hair transplants can be just as effective on women as men."

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