Decoding Female Pattern Hair Loss (FPHL)

The cytochrome P450 enzyme 5-reductase converts testosterone into DHT, and aromatase then changes DHT into estrogen. On the basis of tissue distribution, substrate affinity, and pH maxima, two isoforms of 5'-reductase have been discovered and distinguished. DHT is assumed to be the major androgen responsible for hair loss. (Fabbrocini et al., 2018)

After the commencement of adrenarche, hair loss can start at any age and can happen before pubarche and menarche.

Before any discernible decrease in hair volume, FPHL may first manifest as episodic or chronic hair losing. As an alternative, some women exhibit subtle crown thinning without noticing any increased hair loss. (Birch et al., 2002)

Instead of baldness per se, a scalp examination reveals an enlargement of the center region and a generalized decline in hair density across the frontal scalp. There is often some indication of a general decrease in hair density across the scalp, even though certain locations exhibit the most pronounced decline in hair density.

The self-limiting condition known as acute telogen effluvia is frequently brought on by physical sickness, surgery, bleeding, or crash dieting. Chronic telogen effluvium (CTE) may appear as a result of iron deficiency anemia, systemic lupus, thyroid illness, drug use, and other conditions.

Inquiring about the patient's plans to conceive in the near future is particularly helpful because anti androgen medications have the potential to be teratogenic. Not every patient need blood tests for screening. It would make sense to check women for thyroid conditions, iron deficiency anemia, and hyperandrogenism suspicions before considering endocrinological screening. (Tosti et al., 2013)

Female androgenetic alopecia: The type of hair implants available will depend on the severity of the hair loss.

A thorough inspection of the hair will allow for an estimation of the required number of hairs and will suggest additional medical care based on either a static classification (Ludwig) or a more accurate multifactorial classification given by Dr. Pierre Bouhanna.

There will be three evaluation phases:

Minoxidil topical solution is the only androgen-independent drug that is currently popular. According to the medication's theorized mechanism of action, telogen is prematurely terminated, anagen is likely prolonged, and hair cycling is affected. Although there are 2% and 5% formulations of this, only the 2% solution has FDA approval for FPHL at this time.

Typically, a dropper is used to apply 1 ml topical minoxidil twice day to a dry scalp. In order to enhance the medication's absorption, this is kept on for an hour before showering. Patients should be informed that a brief, self-limiting telogen effluvium may develop in the first 2–8 weeks.

Before a thorough assessment of effectiveness can be done, the course of treatment needs to be continued over at least 12 months. (Dinh et al., 2007).

Finasteride

The mechanism by which finasteride functions is to obstruct the 5-reductase II enzyme, which catalyzes the transformation of testosterone to the far more potent chemical 5 DHT. Finasteride inhibits total circulatory androgen activity, hence suppressing overall androgen activity. (Dinh et al., 2007).

This drug blocks androgen receptors and suppresses gonadotropin-releasing hormone (GnRH). Cancer of the prostate, hirsutism, and chronic acne are among further indications. It is frequently used in Australia in the oral contraceptive medication Diane-35, which also contains estradiol.

Menstrual irregularities, weight gain, libido loss, depression, nipple tenderness, and digestive issues are among the list of adverse effects. (Dinh et al., 2007).

Flutamide is an effective androgen antagonist that works by blocking androgen receptors. As a result, it is frequently utilized to treat hirsutism and advanced prostate cancer. (Dinh et al., 2007).

When hair loss has stabilized and people with FPHL over the age of 25 have tried medicinal therapy without success, transplantation of hair is a viable alternative. Hairs located in the occipital region are moved or transferred to the bald area during hair transplantation.

Women who have significant hair loss or frontal scalp thinning and good hair density over the occipital area make excellent surgical applicants for hair transplantation. (van Zuuren et al., 2016)

Follicular unit transplanting hair is a surgical procedure used to cure baldness. To achieve a natural appearance, follicular units of hair, which naturally form bundles of hair, undergo dissection under a stereomicroscope.

One session of the treatment, which is carried out under local anesthetic, entails the transplanting of 800 – 1200 grafts. Follicular unit transplantation has greatly reduced the amount of invasiveness of the procedure while still producing natural-looking, undetectable, and repeatable outcomes. (Olsen et al., 2001). 

The current medical approach not only halts further progression but may also stimulate partial regrowth. Regardless of the specific medication employed, both the patient and the healthcare provider must exhibit patience and perseverance due to the gradual nature of the treatment response.

Bouhanna, P. (2001). Multifactorial Classification of Male and Female Androgenetic Alopecia. Dermatologic Surgery, https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1524-4725.2000.00009.x

Dinh, Q. Q., & Sinclair, R. (2007). Female pattern hair loss: current treatment concepts. Clinical interventions in aging, 2(2), 189-199. https://www.tandfonline.com/doi/abs/10.2147/ciia.S12159900