Female pattern hair loss is a common condition in women indicated by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline.

This condition which is often referred to as the female counterpart of pattern baldness in men increases with in older age. A huge number of women with female pattern hair loss have clinical signs of gradual thinning of scalp hair which may take place over a period of several years. However, this kind of hair loss can start at any time between early teens and late middle age. Studies by Venning and Dawber reported that 13% of pre-menopausal women have reduced fronto-temporal activity—this increases to 37% in postmenopausal women.

While hair loss in men may easily be noticed, it is not as easily recognized in women. The androgen dependence and the hereditary nature of this process are also not as obvious on affected women as it is on affected men. Most often, excessive hair shedding might have taken place before but unlike telogen effluvium, hair thinning is usually noticed from the very beginning. Clinical findings about this case reveal a widening of the crown and scalp with a diffuse reduction in hair density. The pattern of hair loss varies in women and some may show hair loss that affects only a small area of the frontal scalp while others may get their entire scalp affected, including the parietal and occipital regions.

The final degree of hair loss and its rapid progression also show variations. The vertex balding seen in men is rare in women. In women’s case, the frontal hairline is typically retained although the minor degree of their post-pubertal recession at the temples is not uncommon. Observations done on women who have more pronounced temporal recession show that this state usually manifests more as hair thinning rather than a complete loss of temporal hair as it is seen on men.

Knowledge about the underlying cause of change or growth of hair follicle cycling in normal as well as balding scalp is the key to understanding the clinical presentation of pattern baldness. In normal scalp, the anagen or growth phase of hair lasts for several years while the telogen (resting) phase can lasts for 3 months. However, in pattern hair loss, the growth cycle is altered. This results to a progressive reduction in the duration of the anagen phase. Because of this, short, thin, hypo-pigmented and insignificant wisps of hair are produced and the condition is presented by baldness.

Pattern Hair Loss Classification on Women

Women usually develop an age-dependent form of scantiness of scalp hair. Hence, Ludwig has been credited as correct with the classification he brought about the clinical presentation of female pattern hair loss. In 1977, he described the distinctive features of female pattern hair loss and classified it into three grades of severity, often referred to as Ludwig I (mild), II (moderate) and III (extensive).

In all these three Ludwig stages, there is hair loss on the front and top of the scalp with where in the frontal hairline is usually retained. The back and sides of the scalp may or may not be affected. Type I is described as early thinning that can be easily hidden with proper grooming. Type II is characterized by the significant widening of the hairline’s midline part and decreased volume which can easily be noticed. Type III manifests a thin, see-through look on the top of the scalp, often associated with generalized thinning. In this stage the hair becomes very thin over the top of the scalp but a rim of hair is usually retained along the frontal margin.

The thinning of hair in Androgenetic alopecia in both men and women is attributed to decrease in hair density. Grave hair density on the frontal scalp of women is found to be progressively lower with increasing age after the age of about 40 years. There are several factors considered in clinical assessment such as curl, hair fiber and hair diameter which is considered as the most common factor.

Pattern Hair Loss in Men and Women

Women generally exhibit diffused less hair all over while men frequently have more "patterned" type of hair loss that spares the back and sides. Women often retain their frontal hairline while men, on the other hand, characteristically lose a significant amount of hair on the front part of their scalp. Hair loss in women takes effect in a gradual manner and tends to accelerate during pregnancy and menopausal stage. It is more often cyclical in women than in men, and is more easily affected by hormonal changes, medical conditions, and external factors.

More Information on Female Androgenetic Alopecia

There are several factors that influence hair quality, and these factors contribute to the subjective assessment of hair status. The theory that hair density is the major factor in assessing hair loss is implied by the observation that although average hair density is lower in Korean women compared to European women, the frequency of clinical hair loss in this race is much lower compared to other races. This discrepancy might be because of racial differences in other characteristics of the hair, which may have a big impact on how they look in general.