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Female Hair Loss and Transplantation

Hair Transplantation– Female Pattern Hair Loss

If there is sufficient donor hair on the back of the head, women can be transplanted one to three times in the area of thinning to recover decent density. Sometimes the thinning goes over the sides and back of the head so that there is insufficient donor hair to do all of it. Generally, in these cases, if one starts at the hairline and transplants back to the apex (or highest point of the head), a drastic improvement in appearance will be had by adding several thousand hairs to the top of the head. It is not necessary or possible to transplant the entire thinning area in many women.

We have been seeing ever more females with hair loss in the office. Usually this is a typical female-pattern hair loss, although occasionally there is a scarring alopecia or alopecia areata. The FUE method is normally best here.

Females with female-pattern hair loss, in about 50-70% of cases, have sufficient donor hair to transplant the top of their hairline, rebuild the hairline, and obtain a good result. For many years, we have done this by doing two procedures about 3-6 months apart. There is usually a temporary loss of the miniaturized fine hair in the thinning and balding areas on ladies, so rather than go through that twice, it is better to put the procedures closer together. Ladies have the advantage of being able to style their hair “up” in order to cover the temporary thin area, or wear a wig for a while until the hairs are all grown out. Doing it this way, the hair will be well grown out at about the one-year point from the beginning, or in order words, six months after the second procedure. Also it is wise to use a little bit less density in terms of grafts per square centimeter in ladies who still have a reasonable amount of hair in their balding area. This will reduce the hair shock after the first procedure.

Also of note, there are some women who have a diffuse thinning of their donor area, as well as all the rest of their head, plus a slight female pattern. These people are said to have diffuse pattern alopecia and, while the cause is unknown, they are not good candidates for hair transplantation because of the thinning in the donor area. Thus an experienced physician needs to examine the donor area to determine whether or not they are candidates. Recent evidence suggests low-dose testosterone and thyroid may help immensely.

Hair Transplantation for Women’s Hairlines
(that have a receded hairline, but do not have frontal fibrosing alopecia)

Before and after photos of female hair transplant patient


Case Study – Female Ludwig Christmas Tree Pattern- EJ

Female Ludwig Christmas Tree Pattern Before and After


Case Study – Female Ludwig Pattern II – JA

Case Study - Female Ludwig Pattern II - JA
Female Ludwig Pattern II – Before
Case Study – Female Ludwig Pattern II – after


Update on the Treatment of Female Hair Loss

In a study by Drs. Glaser and Messenger, published in the British Journal of Dermatology, it was found that women who were being treated for androgen deficiency, including symptoms of hot flashes, insomnia, depressive mood, irritability, anxiety, premenstrual syndrome, fatigue, memory loss, menstrual or migraine headaches, vaginal dryness, sexual difficulties, urinary symptoms, and pain and bone loss were found to have an improvement in their hair thickness following several months of treatment with testosterone.

These women were treated such that their serum testosterone level was about 300 (or about four times normal for that age group). There were no cases of increased hair loss related to the higher testosterone. In the group of over 150 women, those that responded positively to the testosterone therapy with hair thickening were generally of a medium or slim build. Those ladies who were moderate to severely obese did not respond. The reasons for that are not yet determined but may be related to insulin resistance and other endocrinologic abnormalities.

The above suggests that female pattern hair loss and female hair thinning is definitely not due to excess testosterone as was postulated for many years. It is not “androgenetic” alopecia because it is not caused by androgen (testosterone, etc.).

It would seem that hair follicles in women are supported by testosterone. This is the same sort of support that is seen in men for their body hair, beard hair, and donor hair around the sides and the back of the head which is used for hair transplanting.

Conversely, the hair follicles on the top of the head of many men are sensitive to DHT (the high-potency form of testosterone) in a variable distribution. Some men find that the hair follicles in the front of the head are sensitive. In some, sensitivity lies in the hair follicles in the crown and back of the head, and in some both.

In addition, there are a few women who develop a male type 3 receding hairline pattern, and studies need to be done to see what the level of testosterone and DHT is in these women.

If a woman has an extremely high level of testosterone, such as that secreted by an adrenal gland tumor, they will, in fact, develop full-on Class 6 male pattern baldness, and we have seen that in a few cases over the years.

These observations suggest that a new treatment protocol for the treatment of either diffuse or patterned hair thinning in women, following a lab panel to evaluate their hormone status, is:

•     Testosterone cream 8 mg/g in 100 g tubes applied at the rate of 1.5 g 
bid to their inner thighs or vulva,
or 4 mg/gm applied to the scalp at bedtime.
•    Armour thyroid as needed to bring their free T3 level to 4.0-4.2
•    Minoxidil in either a 2% or 5% solution bid, or the M82 Minoxidil solution bid, or as a 2.5 mg or 5mg pill
•    Theradome LH80 Laser Cap used 30 minutes every other day.
•    Vitamin supplement with additional vitamin D, iron and biotin supplement, vitamin K2, selenium, DIM