Hair loss in women – evaluating causes of female pattern baldness

Hi Dr Irwin, Firstly, thanks for running such a great informative blog, the time you set aside to do this is much appreciated and serves the community a great deal of good. I know its not easy fitting everything in. I would like to seek advice for female pattern baldness, I'm in my early 30s and have a receding hairline. I maintain a healthy lifestyle, have not had children and none of my parents (or older generations) have experienced this. I take a lot of supplements (not too much Vit A though) but I have a very stressful job and have a hard time getting out of fight or flight mode. Could you provide some guidance on what this could be caused by and how to stop this? Thanks so much.

You are SO welcome. I really love being able to talk to all of you from places all over the world. Thank you for sharing your hair loss concerns with me. Many people don’t realize but there are numerous internal causes of hair loss as well as diseases that affect only the hair follicles.   Stress is generally NOT a cause of hair loss or it’s a diagnoses of last resort.

Please see a dermatologist (dermatologists are specialists in skin, hair and nails) and ask for a hair loss evaluation.   Often, but not always, you may be tested for various hormonal imbalances including male and female hormones, thyroid hormones, and things like iron balance. In the case of hair, it correlates best with a ferritin level which is a measure of total body iron stores.   There are also diseases like lupus which can cause hair loss (just one of a several) and also medication side effects.  Many blood pressure medications have hair loss as a side effect, for example.   I’m just scratching the surface here, but I’m sure you see my point.

Also, tests besides blood tests may be indicated. Another common test is a scalp biopsy. This is not a scary as it sounds. A small area about the size of a pencil eraser is numbed with lidocaine, and a small “punch” is used to remove a small piece of scalp with the roots of the hair intact. The pathologist needs to see the roots. The punch looks like a tiny, round cookie cutter. Then, 2-4 stitches are usually placed and then removed about a week later. It’s not painful at all, except for the small sting of the numbing medication. Pathologists can really help with finding the cause of the hair loss with this small piece of tissue.

I’d really encourage you to go in and be evaluated. You’ll feel much better in the long run!!

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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