Introduction to Female Pattern Hair Loss

Brought to You By > Dr. Sylvia Garnis-Jones, Dermatologist, MD MSc FRCPC

Hair loss in women, also known as female pattern hair loss (FPHL), affects at least 20 percent of adult women. It is characterized by a loss of the long hairs over the front of the scalp and in the temples. FPHL usually occurs after menopause but also can be seen in younger women. On average, 38 percent of women over the age of 70 have some degree of FPHL.

A diagnosis of female pattern hair loss is made by taking a history, by clinical examination and laboratory tests. On examination, an increased number of miniaturized hairs ie. shorter hairs are seen on the front of the scalp and in the temples.

Today, a combination of hormonal changes, environmental stressors and genetics are thought to contribute to the development of FPHL.

The Effect of Hormones
The implication of androgens in the pathophysiology of hair loss is thought to be the most important. Androgens impair the hair follicle stem cells and cause an impairment in hair growth.

Also, a steep decline in estrogen in menopausal women allows for the androgen dominance with resultant smaller hairs (miniaturization).

Environmental and Genetic Factors
Several nongenetic external factors contribute to hair loss such as ultraviolet light, pollutants and tobacco. The intrinsic factors that contribute to hair loss include genetics, aging and poor nutrition.

Chronic Stress
Hair follicles are also a target of stress mediators such as DHEAS and cortisol. Chronic stress can trigger the hair follicle to secrete its own stress hormones that further upset the environment of the follicle.


Recent research data underscores the flaws of designing monotherapeutic androgen targeting therapies for hair loss ie. topical minoxidil, spironolactone and finasteride. A therapeutic approach should be multifactorial.

At our clinic, we evaluate a person’s androgen status but also evaluate external triggers. We offer therapies such as platelet rich plasma growth factor injections and nutraceuticals in addition to dietary management.

This therapeutic approach is a comprehensive solution to restoring the imbalance of the disordered follicle.

1 - we recognize that hair loss has a complex etiology stemming from inflammation due to hormones, genetics, stress and other factors
2 - treatment of hair loss in women should be based on a combination approach that considers all the underlying factors
3 - the use of new generation approaches such as platelet rich plasma growth factor injections and advanced nutraceuticals can provide optimal clinical results