Hair Loss InformationPolycystic Ovarian Syndrome – Hair Loss Information – Balding Blog

i have pcos, i have hair loss in the front of my skull, there are still some left but only a pathetic few. what should i do , i used to have this long black great hair. can i get it back.. thank you for your time.

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Dr. Robert Bernstein (Hair Restoration Surgeon in New York) was kind enough to supply a thorough answer to this question for you…

Polycystic Ovarian Syndrome (PCOS), originally called Stein-Leventhal disease, represents a number of conditions where ovulation is inhibited and, as a result, the ovaries become cystic and secrete more androgens than normal. The most significant of these androgens is testosterone, but other related androgens such as dihydroepiandosterone (DHEA) may be produced as well. Testosterone is converted to a hormone called dihydrotestosterone (DHT). If women have a genetic predisposition to balding, this hormone will cause the follicles on the scalp to shrink (miniaturize) and eventually disappear.

There are a number of treatments for hair loss related to PCOS. The first is the drug finasteride. Although not FDA approved for women, finasteride blocks the production of DHT (this is the same medication that has been approved for treating hair loss in men under the name Propecia) and thus will decrease or reverse the process of miniaturization. Weight loss (if this is appropriate) may also be helpful as this will decrease the body’s production of testosterone. Spironolactone, a diuretic, blocks testosterone and can also be useful. Finally, birth control pills, because they contain estrogen, will lower testosterone in the blood stream and thus decrease the amount of DHT produced. Please remember that these treatments should only be used under a doctor’s supervision.

Hair Loss InformationHair Loss in Teenage Female – Hair Loss Information – Balding Blog

I am an active 17 year old high school cheerleader and my hair which used to be thick, is now falling out and becoming thin, like my mother, my grandmother and two of my aunts. They tell me it is in the family, but not when they were my age. What should I do? If I go to a doctor, how do I find one?

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Genetic causes of hair loss in a 17 year old female, is unusual. You were correct to ask your female relatives at what age the condition first appeared with them. I would first have a good doctor see you and look for medical causes of hair loss (there are many). The following problems are amongst those that should be considered: anemia, thyroid disease, connective tissue disease, various gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone if you are taking any of these. Many other medications can also contribute to hair loss so if you are taking any drugs of any type, then that should be looked into as well. The following laboratory tests may be useful if underlying problems are suspected: CBC, Chem Screen, ANA, T4, TSH, STS, Androstenedione, DHEA-Sulfate, Total and Free Testosterone.

It is possible that a medical condition may be the cause of your hair loss, so before you jump to conclusions that you are following your female relatives’ fate, I would have you checked out for these conditions. Also, please read my previous blog entry, Female Hair Loss.

Hair Loss InformationFemale Hair Loss – Hair Loss Information – Balding Blog

I am 25 years old and I have thinning all over, I’ve been to two dermatologists and both of them just tugged on my head and told me to use Rogaine. I want to know how to find out what the cause is and if there might be an underlying health condition. I have never taken ANY medication including birth control but I may have some other symptoms, only slight but possible indications of something medical or hormonal. There is also no baldness in any women on either side of my family, but there are men on both sides. This is absolutely destroying me and I just want to figure out how to get some answers because Rogaine is not working, I’m running out of hope. Do you know where I can go or what I can do? Thank you for your time and consideration to my question, I would appreciate any suggestion you might have.

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There is not a great deal understood about women’s hair loss. First, many women have hair loss secondary to a medical condition. You need to be check out by a competent doctor to rule out the conditions that cause hair loss. Thyroid disease, for example, seems to have hair loss associated with it. In addition to thyroid disease, hair loss can be a sign of a medical problem from anemia, connective tissue disease, gynecological conditions, polycystic ovaries and other androgen stimulating hormones. While you do not currently take any medications, some medications can cause hair loss including: oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone so at any time in the future, this awareness may have significant value to you.

The treatment of women’s hair loss with hair transplantation must be approached differently than men’s hair loss, as most women rarely develop patterned hair loss and it is much more widely distributed. In fact much of the hair remains, but the thickness of the hair shaft is smaller than normal hair and the areas that get impacted by this process can be localized or generalized. This reduction of hair thickness (miniaturization) causes the hair to appear thinner. Because a relatively large area has been subject to this thinning, for hair transplants to have any value it is important to place the hair in areas where it is cosmetically most significant and where it can augment a specifically “defined” styling plan to increase the appearance of fullness. Also, the ‘donor’ area might also be impacted so careful measurements of the donor density and distribution of miniaturization in the donor area is important before a transplant decision is made. For this reason, we generally confine the entire transplant process in women to a localized part of the scalp such as behind the “frontal hairline” or “along the part” in a plan that fits the way the woman combs her hair.

Since hair will be transplanted into a part of your scalp that is thin, but not completely bald, there is a risk that some or all of the original hair in this area may be lost. This process is called “telogen effluvium” and is usually (but not always) reversible in women. In addition, if the donor area continues to thin, then the transplanted hair will also thin over time, since it came from the same area. The progressive hair thinning may be improved by subsequent procedures, but with significant loss, there is a limit to the improvement that can be achieved. In hair transplantation, as in all surgical procedures, it is important to balance the potential gain against the possible risks when making a decision to go forward with the treatment.

Once you rule out a medical problem, then a doctor with knowledge about hair transplantation may be considered. The problem here is that too many women are so desperate for hair that any doctor wanting to offer a hair transplant to a balding women, set up a woman as an ‘easy mark’ for a sale. You must find a doctor who understands who can be helped and who can not be helped; a doctor who is honest and has a good reputation. There is an easy test to give to a doctor. Ask him/her, “What is the percentage of women patients who get hair transplants in your medical practice?”. If he reports significantly more than 5% of patients are women, you can generally assume that he is doing more transplants on women than he should be doing. Some doctors claim that half of their patients are women and that puts me on an alert that this doctor may doing more hair transplants on women than he should be doing. Women have different aesthetic challenges than men, so patient selection is critical and when a doctor elects to do a woman’s hair transplant, he/she has to fully understand the art. The thing that makes women’s hair loss different is that their donor area is frequently not healthy and the recipient area is very diffuse. Moving bad hair to another area just moves the problem around without helping, unless the goals and expectations reflect the reality of that woman’s particular problem.

Hair Loss InformationFemale Traction Alopecia – Hair Loss Information – Balding Blog

I have a full head of hair which is shoulder length. However due to many years of wearing a pony tail, I have developed a mild traction alopecia around the neck line and slightly behind the ears. Because of this, I am not able to wear my hair up, or side swept which limits my hairstyles. I was wondering if I may perhaps benefit from follicular hair transplant?

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Tight pony tails or ‘pig-tails’ can cause traction alopecia (hair loss from constant pulling). Of interest, the ‘falls’ that women use to add fullness to hair are a frequent cause of hair loss in women who use them to make their hair appear fuller. The more the use, the thinner the hair gets and the cycle of more use to treat thinner hair produces more thin hair.

With that said, the traction alopecia may not be permanent, that is, if you stop putting the traction on it. To find out, you would need to stop using a ‘pony tail’ for at least 6-8 months. What hair does not come back is probably permanent. There is a difference in the hair at the nape of the neck (which often has a different genetic ‘permanence’) then other scalp hair. Hair in the nape of the neck is generally more fragile and can be lost with stress (like traction).

We have extensive experience with treating temple hair and hair at the nape of the neck. The neck transplants were usually secondary to scarring from flap procedures which were surgically induced. The temple hair has been done in many, many patients wanting to move the temples forward or replace them from thinning. Send some pictures to me and I would be happy to give you an opinion. My email address is on the Contact page.

Hair Loss InformationHigh Hairline in Women – Hair Loss Information – Balding Blog

Hi I am a 24 year old blonde female. I am not experiencing hair loss, but I was born with a weak/receded hairline. Is it possible to correct something like this? I have very fine hair in two spots on either side of my hairline but you can’t see the hair unless you look closely. Let me know if there is any hope. Thanks

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High hairlines in women or thin hairlines are very common. Many women who have them would like to have them fixed, but not many come to people like us who have the expertise that might apply. Without discussing which one is better, they are:

  • Moving the entire hairline forward with a surgical procedure, similar to a brow lift but with a focus to bring the hairline down. This gives a very fast result and healing is fairly fast as well.
  • Transplanting the hairline. This has great value in many cases, particularly when the hairline is weak in an identified area as you seem to be describing. This may be one of the most popular hair restoration procedures we do in women.

Send pictures in digital format to me via email and I can give you an opinion.

Hair Loss InformationFemale Alopecia Areata – Hair Loss Information – Balding Blog

A female reader asks…

I have Hashimoto’s Syndrome and diagnosed alopecia areata. The hair on the crown of my head is not diminishing as fast as that around the face and all around the back of my head. What options do I have? I feel I will shortly have to wear a wig permanently. Is there anything that can be done?

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Hashimoto’s Syndrome and diagnosed alopecia areata are autoimmune diseases which are attacking the hair follicles in your situation. If the disease can not be controlled, then the hair will continue to fall out. Sometimes, these diseases are self limiting, but your doctor will be in a better position to judge this for you.

Hair Loss InformationAlopecia in African-American Women – Hair Loss Information – Balding Blog

I am a 22 year old African American female. I very curly, short, and extremely dry frizzy hair. Due to experimenting with different hairstyles I have managed to pull out some of my hair from the root and now I have bald spots all over my head, which i have fortunately managed to hide with my other hair. I have tried many produts to see if I could regain the hair lost in these particular areas, but nothing has worked thus far. My hair is also particularly thin around my forhead and basicly non-existent around the temples/edges of my head. I want my hair to be longer, thicker, more healthy all while still looking natural and not too “fake” What would be the best hair procedure for me to opt in my particular case and what are the estimated costs for this/these procedure(s)?

Note: Just so that you know the extent of my hair damage. It is so bad that I have had to resort to wearing hair weaves, wigs, and other hair pieces.

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I would want to see you before rendering an opinion. Your history is one I hear with great frequency, but the cause of the hair loss needs to be determined before making any plan to fix it. Different diagnoses would include traction alopecia and a variety of autoimmune alopecias. You need to be careful with wigs, because they can induce traction alopecia, compounding your problem. If you are in the California or New York areas, you can meet with an NHI affliated doctor. If not, visit ISHRS.org to find a doctor specializing hair restoration in your area. Or you can find a local qualified Dermatologist to get the diagnosis you need.

Hair Loss InformationFemale Hormones and Hair Loss – Hair Loss Information – Balding Blog

I was prescribed topical estradiol shampoo .05% for hair loss (Bout with TE spring 2004, Hair wasn’t growing back in very well in some areas). Within 3mos. of using this hair is now falling out. Do you have any information on this. My Dr. says that it does not cause hair loss suppose to maintain growing phase longer. Came across a study that says that it can induce hair into telogen. Who’s right? Any help would be greatly appreciated!!!!

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Yes, hormones can cause hair loss. Female hair loss is a strange ‘beast’ because our understanding of it is very poor. The best indication of the hair loss impact of your estradiol is the observation that it caused hair loss in your situation. I would suggest stopping it and seeing if it returns. You might have to wait 6 months for reversal.

Hair Loss InformationHair Loss From Hair Color? – Hair Loss Information – Balding Blog

Carol asked…

I have hair loss. I also us an herbal hair color. Is using hair color promoting hair loss?

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Hair coloring agents only impact the part of the hair follicle which is essentially the visible hair located on the head. Hair represents highly compressed skin which is not alive. As such, coloring agents can not promote hair loss of new hair per se. If chemicals are used which go down below the skin level, then damage to the growing elements of the hair follicles can occur. This would be difficult to do and would require a real chemical burn. What most people who report hair loss from topical solutions are talking about is the hair that is already outside of the head, the hair that we comb and style. Hair can be made brittle by the use of chemicals and as such, hair can break off, creating the illusion that it is promoting hair loss. But this hair loss is strictly above the skin and does not usually impact the hair below the skin which is deep and well protected from the things you can do to it. The new hair, which grows at about 1/2 inch per month, will replace the fallen hair almost 100% of the time. If you are used to hair that is 6 inches long, the normal replacement might take 12 months on its own (a half inch per month), reinforcing the concept that topical agents can promote hair loss.

Hair Loss InformationAfrican-American Female Hair Loss – Hair Loss Information – Balding Blog

Here’s an email I just received today…

Dear Dr. Rassman,

I am an African- American female, aged 62, with pattern baldness around my hairline. I would like to know if the “new hair” will grow and how will any chemicals, ie. straightners, dyes, etc. might affect the transplanted hair. I would also like to know where and how I can schedule an appointment for consultation ASAP. I have been using Rogaine but I am still compelled to wear wigs to look my best…HELP! I am VERY interested in getting this procedure and I have the blessing of my husband of 40 years!

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I have done work on many African American females. As you may know, frontal balding is common amongst African American females largely because of the combined effect of pigtails that were used for styling in their youthful days as well as the abuses with chemicals, ie. straightners and dyes. First, a good examination needs to be done to separate the effects of chemicals and pigtail styling (if appropriate) to the female genetic hair loss. Then, a complete examination needs to be done to make sure that other medical conditions are not the cause of the hair loss such as thyroid disease, hormone imbalances, anemia, etc. There are a series of blood tests that can rule this out.

My recommendation is to make an appointment first (if you wish to see me, ask for me by calling 800-NEW-HAIR). The consultation is free.

Thanks for the good question.