Unlike the receding hair line creeping over a man's scalp, hair loss sneaks up on a woman.
Maybe she sees a few more hairs in her favorite brush. Her ponytail feels skinnier. Her part widens. Eventually she notices she can see her scalp peeking through in a photograph.
Whatever the telling sign, female pattern hair loss can be traumatic. But women today are less likely to suffer in silence than a decade ago; doctors report that women increasingly are coming forward to seek remedies.
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In some cases, pinpointing the cause is the first step to a cure, though the source of hair loss in women is not always as clear as it is in men.
The hormone fluctuations of puberty, pregnancy and menopause can cause hair to shed. So can the stress of general anesthesia, illness, anemia, crash diets and thyroid abnormalities. Some women -- and a few men, too -- suffer a compulsion to tug at the hair, damaging the follicles.
Stress on the hair itself, whether from chemical treatments, extensions or tight hairstyles that tug at the scalp, can also break the hair or scar the follicle. Black women are particularly vulnerable due to the hair relaxing treatments and braiding often begun at a young age.
"Half of our hair loss visits are African-American women," said Dr. Marianne O'Donoghue, a dermatologist in Oak Brook and associate professor at Rush University Medical Center. "They have a terrible time keeping their hair in."
The most common cause of female hair loss is androgenetic allopecia, or female pattern baldness. Thought to be influenced by levels of sex hormones, this type of hair loss usually begins after menopause, but it can start as early as puberty. Instead of a woman losing 100 to 125 hairs a day, which is normal, she'll lose so many that her scalp will show through.
Help is available. The topical medicines, laser treatments and hair transplants designed for men can help women, too.
Stopping the loss
One of the oldest treatments for hair loss in men and women is Rogaine, the brand name of the drug minoxidil. Spread over the scalp twice a day, Rogaine works by increasing the growth phase of the hair follicles. It also helps hair grow thicker, stronger and with more pigmentation.
Women's Rogaine is less potent than men's -- a 2 percent strength rather than 5 percent -- though some doctors recommend the 5 percent strength for women, too.
"If you're going to fill your tank up with gas, you may as well fill it up," said Dr. Alan Bauman, a hair loss specialist in Florida.
A new foam version of Rogaine is less irritating to the scalp, Bauman said.
The mistake many women make with Rogaine is quitting too early, Bauman said. Many women quit after six weeks. But it will take six to 12 months to see the results in the mirror, Bauman said. As soon as you quit you'll start losing hair again.
"About 70 percent of women are going to get a response from it, but it's a long-term commitment," he said.
Since it has not been studied in pregnant women, women who are nursing or pregnant are usually advised against using Rogaine.
Propecia is an oral medication that stops hair loss in 90 percent of men, but it's not FDA-approved for use in women and poses risks to a developing male fetus. But some doctors prescribe Propecia to women who are not of childbearing age. While the evidence is not conclusive, a few studies show it works in women whose hormones are controlled with birth control pills or hormone therapy, Bauman said.
Other medications are available for specific types of hair loss. Women with alopecia areata, an autoimmune disorder signaled by circular bald patches, may get cortisone shots in the scalp or a topical cream. Low iron levels or thyroid disorders can be treated and the patient usually will regrow her hair, O'Donoghue said.
A newer -- and less proven -- treatment involves beaming low-level lasers over the scalp, usually in a series of treatments lasting several months. The FDA recently approved a laser comb as a cosmetic device that can be used at home, though doctors said the laser hoods available in offices are more effective.
The lasers increase blood flow to the scalp and boost cell metabolism, said Dr. Stephen Dayan, a Chicago plastic surgeon who is testing a laser hair restoration device in his office.
"By increasing cell metabolism, you're creating more energy for the hair follicles, and the hair follicles are creating thicker hairs," he said.
The laser treatments work best on men and women with thinning -- not absent -- hair. They have to have functioning follicles.
"If they've been bald for a long time, it's probably not going to do a lot for them," Dayan said.
Jessica Hinkle of Streamwood is completing a series of laser treatments for thinning hair she first noticed five years ago. She didn't have a receding hair line, just more scalp where her bangs should be.
"My husband shaves his head on purpose," Hinkle said. "But a woman being bald is not OK."
Because she's planning to have more children, the 31-year-old didn't want to use Rogaine or other medications that pose any risk to a developing baby. So she entered a contest sponsored by a radio station and won a series of free laser treatments at Deerfield-based Natural Hair Growth Institute.
Once a week, Hinkle sits under a device shaped like a salon hair dryer while lasers glow on her scalp. Since she began treatments in May, Hinkle said her hair is thicker and her scalp less visible.
"I was skeptical, but it's noticeably different," she said. "A lot of people have noticed my hair has changed."
Not everyone can win a contest, and such treatments don't come cheap. Steve Bennis, a former engineer who launched Natural Hair Growth Institute after lasers helped with his own hair loss, says clients spend between $6,800 and $12,800 for a six-month series of treatments.
Bennis is not a doctor, so he requires clients visit one first to rule out medical conditions that could cause hair loss. He says clients start to see new hair growth within four weeks.
"When I started my business, I thought it was only for men," Bennis said. "Now I have 70 percent women. They like it because it's non-invasive, and it solves the problem."
You can also buy a variety of laser combs or brushes that range from $399 to $2,499. Newer versions cover wider areas in less time, Bauman said.
"The lasers are not a miracle cure, but I have noticed in my patients that laser therapy can certainly enhance hair quality and produce thicker, fuller, healthier, shinier hair," Bauman said. "It's not going to give you a teenager's head of hair, but you can see improvements over time."
The growing awareness among the public about what cosmetic surgery offers has spread to include hair transplants, even for women, said Dr. Arthur Kaplan of Medical Hair Restoration in Oak Brook.
"Women are the fastest growing percentage of patients," he said.
Part of that is due to more refined technique. A surgeon can implant follicles taken from the back of the head one, two or three at a time, rather than plugs.
"For women, plugs were unacceptable from day one, whereas with men there was a time that was acceptable," Kaplan said. "The aesthetics women required were much higher. As the field has evolved, that has opened up the opportunity."
Micrografts are essential for women, who often have diffuse thinning in a part of the scalp. A surgeon must take care to preserve existing follicles, Bauman said.
"You can't put large grafts into diffuse areas or you're going to cause trauma," he said. "You can't go into a tomato garden with a backhoe. You have to use a small instrument to plant those seeds."
The cost depends on the number of follicles transplanted. Women are usually less expensive than men because a smaller area is involved. Most women spend between $4,500 and $6,000 for transplants at Medical Hair Restoration in Oak Brook.
The procedure takes two to four hours. Women start to notice new hair growth in three to five months, with full results taking a year to appear.