The Journal of Clinical Endocrinology & Metabolism has published a new report entitled ‘Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee’.
Expert task force recommendations
Experts in dermatology, endocrinology and reproductive endocrinology from Italy, Spain and across America were appointed to a task force by the Androgen Excess and PCOS society.
They were assigned the job of determining the level of general knowledge in the area of Female Pattern Hair Loss among medical professionals, and to make suitable, evidence-based recommendations to ensure this is improved, where necessary.
After reviewing a number of peer-reviewed Female Pattern Hair Loss evaluation studies up to December 2017, a number of recommendations were made. These were published by the Endocrine Society on 20th February 2019.
Firstly, it was advised that genetic hair loss in women should always be referred to as ‘Female Pattern Hair Loss’ – the term Belgravia specialists always use when discussing this particular hair loss condition.
The other terms which can be used for this – for example, androgenetic alopecia – should be avoided. The reasons for this are not provided, however, it is likely to involve the word ‘alopecia’ – which is simply the medical term for any kind of hair loss – being extremely distressing to people.
Secondly, it notes the shapes Female Pattern Hair Loss typically presents in – presumably as a suggestion that everyone be made aware of the key forms it can take. These differ from how genetic hair loss appears in men, as women rarely go bald, though their hair thinning may become extensive.
The report details the most common patterns as being ‘centrifugal expansion of the mid scalp or a frontal accentuation or Christmas tree pattern’.
It does not mention, possibly because this area of knowledge was found to be sufficiently solid, that Female Pattern Hair Loss only affects the top of the scalp, from the crown to the hairline and temples, in those affected.
The third recommendation states: ‘Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal’. Whilst the fourth advises that the assessment needed to diagnose Female Pattern Hair Loss is ‘primarily clinical’ – meaning no biopsy is needed to spot this condition.
Check for iron, zinc, thyroid and vitamin D issues
The last two of the six recommendations made, relate to further investigation in women presenting with hair loss or thinning hair.
In cases where women are diagnosed with Female Pattern Hair Loss, it recommends that an ‘assessment of a possible androgen excess’ should be mandatory.
Furthermore, women should have the option of getting their vitamin D, iron, zinc, thyroid hormones and prolactin levels checked.
Although the report does not expand on why this should be suggested to patients, high prolactin levels in women are linked to excessive hair growth, whilst issues with vitamin D deficiency, thyroid problems, and iron or zinc levels that are either too high or too low, are known to cause thinning hair. In fact, in a 2018 study, women with genetic hairloss were found to have lower levels of zinc and iron.
This is generally from a separate, temporary condition called Telogen Effluvium, but may also exacerbate existing cases of Female Pattern Hair Loss, or prematurely trigger this in those with the relevant genetic predisposition. As both conditions can present simultaneously, it is important to know exactly what is causing the shedding a patient presents with so that a suitable course of hair loss treatment can be tailored.
Lastly, the report advises that Female Pattern Hair Loss Treatment should initially start with the only clinically-proven medication for this issue, high strength minoxidil, at a 5% dosage, “adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism”.
Many of the above recommendations are extremely straightforward and encapsulate the basic requirements for diagnosing and discussing genetic hair loss with women.
Though it is somewhat surprising that some of these points need to be made, frequently Belgravia clients tell us that they have spoken to their GP about their shedding but found them unsympathetic or lacking in knowledge as to potential courses of action they could take, which is why they then chose to visit a specialist hair loss clinic.
The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.