Is Receding Hairline Caused By Female Pattern Hair Loss or FFA?'

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Name: Kristine

Question:  Hi, I’m a 46 year old woman, premenopausal, and have experienced generalized hair thinning over the past couple of years, but it’s particularly noticeable at the front hairline and temples. I can see from photos that my hairline has receded about a cm or so and it looks very thin there. I’ve been on iron supplementation for over a year as my ferritin was down to 4 it has picked up but was still in the 20s when last checked and have been using minoxidil (regaine 5%) for nearly a year, as my GP thought it could be either androgenic alopecia / iron deficiency / a mix of both.

My hair has thickened quite a bit since then and looks better overall, except at the hairline which has continued to recede. I have miniaturized hair in this area too, with lots of little hairs that don’t seem to grow any longer or thicker. It does look like a balding man’s hair at the front. Do you think this is more likely to be androgenic alopecia than frontal fibrosing alopecia? I’ve read about FFA online but my GP never mentioned it. Do you get miniaturized hairs in this condition, or do the hairs at the front just drop out? I was convinced it was hormonal hair loss, just more in a male pattern, but have been confused since I read about FFA.

I’ve not noticed any redness around the hairline and the hair has not receded in a particularly band-like pattern. It started at the right side and then the left side seemed to thin and catch up. Traction alopecia isn’t a possibility as I’ve hardly ever worn my hair fastened back and have never used extensions or anything else that pulls on the hair.

Answer: Hi, Kristine. The type of hair loss you are describing here does sound consistent with a diagnosis of Female Pattern Baldness (androgenic alopecia).

The hair does often start to become naturally thinner as we age due to decreased collagen, among other factors. Thinning hair can be attributed to side effects of both peri-menopause and actual menopause, due to decreasing oestrogen levels. In these cases, however, the whole scalp tends to be affected fairly evenly. Whereas there are three key hair loss conditions which affect the hairline specifically. You have already ruled out any possibility of Traction Alopecia - a common cause of frontal hairloss of the type you describe - which leaves FFA or Female Pattern Hair Loss.

If it were Frontal Fibrosing Alopecia you would have a smooth band of skin visible around your frontal hairline which would be noticeably paler in colour than the rest of your skin.  This band tends to be a few inches wide and is often obvious from its visual symptoms alone. Follicular miniaturisation does not occur as this condition is a form of scarring caused by inflammation. As you mention the hair has not receded in a band-like pattern, and have not noted any change in the colour of your skin, this does certainly sound like genetic hair loss. A recession of a centimetre does not sound uncommon, especially if there are vellus hairs in the area.

What you may not know is that it is possible for women to have Male Pattern Baldness - or so to speak. Basically, although androgenetic and androgenic alopecia both only affect the top of the head, from crown to hairline, each displays in a different pattern.

Male Pattern Baldness tends to result in defined areas of shedding, such as a thinning crown or a receding hairline, and these points may join up to form a balding vertex. Meanwhile, Female Pattern Hair Loss usually causes diffusely thinning hair in the whole of the affected area (the vertex). However, in some cases it is possible for men to exhibit patterns of hair loss akin to those seen in Female Pattern Baldness, and vice versa. Therefore, it may simply be that you are experiencing pattern hair loss in a different way to how you may have expected it. It is nothing to worry about whatsoever.

The rate at which shedding occurs in women with androgenic alopecia can be influenced by a number of factors, including underlying nutritional issues - often including low iron, B12 or ferritin levels - or illnesses, as well as stress - physical or emotional, including (ironically) worrying about your hair loss. These may take three months to become noticeable. If there are any factors putting strain on your body, it is likely that your rate of hair fall will be higher than normal and your hair growth cycle may be affected, therefore affecting regrowth potential.

It is for this reason that we always recommend women visiting Belgravia for the first time have their GP carry out a number of specific blood tests prior to their trichocheck. These include a full blood count, ferritin, zinc and thyroid hormone checks.

Furthermore, when it comes to women's hair loss treatment, there are a number of different minoxidil formulations and strengths available - it is worth noting that this is a dose-dependent drug. There are also additional non-pharmaceutical hair growth supporting products to stimulate follicles and encourage healthy hair growth, available. So, in order to ensure you are using the optimum products for your specific level and pattern of shedding, we would recommend having a consultation with a specialist. They can provide you with free hair loss advice regarding your condition and appropriate courses of personalised hair loss solutions, even if you use this as a second opinion in order to help put your mind at rest about your current plan of action.

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