AGA-Female Pattern Baldness

Definition:

Female Pattern Baldness(FPB) is a form of Androgenetic Alopecia  triggered by hormonal changes in women like menarche, pre-menopausal state & menopause.

                Fig-Female Pattern Baldness 

Description:

Female Pattern Baldness is affecting more than 50% of women at 40-50 years of age and that we call it age related thinning. Emotionally it devastates the affected women & it is trivial to the observer.

Sometime FPB occurs alone or may be associated with some other systemic diseases. 

Like in men there is front-temporal receding hair line due to AGA but not in case of FPB because androgen receptor protein present in front is 5 time less in females as compare to males.

In the year 1977 Ludwig was the first person who had observed that female may also have progressive hair loss and he classified it into 3 stages with preservation of frontal hair line.

There is racial differences in FPB as more of European descent women are affected.

Histological Features:

Histological features are same as we have seen in Male Pattern  Baldness.

Etiological Factors:

There are mainly 2 factors triggering the FPB. 

A) Hormonal Factors

    1)Androgens

    2) Estrogens 

B) Genetic Factors

A) Hormonal Factors

1) Androgens: 

  Androgen is a male hormone that we know with common name Testosterone and regarding this we have seen also how this hormone affects male & causes Male Pattern Baldness. But here we will discuss how androgen that is circulating androgen triggered the Female Pattern Baldness.Circulating  androgen in female available through 3 sources like adrenal gland, ovary gland & peripheral conversion.These primary androgen in hair follicle causing cellular-androgen effects.

It depends on central steroid bio-synthesis pathway that will synthesis dehydroandroepiendrosteronesulphate(DHE-S) in presence of 17 beta hydroxysteroid dehydrogenase, 5 alpha reductase, and 3 beta hydroxysteroid dehydrogenase .All these enzymes are available in hair follicles. 

Circulating androgens are mainly age dependent both from adrenal & gonadal sources, increasing with puberty and starts decreasing from fourth decade of life. In postmenopausal women androgens available completely from conversion of adrenal debydroapiendrosterone in periphery.

The enzyme aromatase also affects Testosterone & DHT and converts Testosterone to estrogen and decreasing    both  circulating Testosterone & DHT in tissue. Aromatase P450 generally present in cytochrome is important part of normal androgen conversion and have protective effect on follicles.Aromatase affects  conversion of Testosterone to estradiol & estrone resulting in less conversion of Testosterone to DHT. Aromatase is very in hair follicles of women. Aromatase is 6 times higher in frontal area & 4 times higher in occipital are in women as compare to males. And I think this is perfect reason to understand why receding hair line is not present in women as very often found in men. 

So, hyperandrogenism is the reason for FPB but not the only reason. 67% of 89 women are having PCOS when pelvic ultrasound is done.

2) Estrogens: 

    Estrogen receptors present in hair follicles making them estrogen sensitive organs. Estrogens are produced by both gonads & other tissues in hair follicles like androgens. The enzymes responsible for estrogen production are aromatase & 17-hydrosteroid dehydrogenase estrogen receptors(ER) present in follicular tissues. ER is of 2 types , first is ER alpha & second is ER beta. First one is activator of transcription and poorly expressed in hair follicles while second one suppresses the cellular functions & expressed in many parts of  hair follicles.

B) Genetic Factors:

A family history of hair loss is common but its not necessary to have it in your family for FPB. FPB in female is like  less than 30% in comparison to male with first degree baldness.

 Centeroparietal Thinning:

Majorly there are 2 types of onset of FPB in relation to ages.First in the 3rd decade and second one in 5th to 6th decade of life. 

                Fig-Centero-parietal Thinning

Women who are affected with FPB very very early, it is found that it nay be associated with hyperandrogenism in compare to others who affected lately due to Pre-menopause or menopause.

Clinical Features:

1-There is decrease in hair density but always greater in central scalp.

2-The miniaturization process does not progress to baldness as we have seen in men.

3-Frontal Fibrosing Alopecia(Link) & Centrifugal Cicatratial Alopecia are commonly confused with FPB but high diversity in hair diameter is the differentiating feature of Female Pattern Baldness.

Management of  FPB:

Management of FPB is the same as we have discussed in MPB. And medical treatment for FPB is better in progress as compare to MPB.

Spironolactone:

 It is a antiandrogen. It blocks the production of testosterone by decreasing the activity of cytochrome P450    and also acts as a inhibitor of DHT receptor. It bas some side effects like breast tenderness, irregular menses & mood swings. 

Flutamide: 

Flutamide is also a non-steroidal antiandrogen. It acts a inhibitor and prevents the binding of testosterone with receptors. Gastrointestinal tract are mainly affected with its side effects and it may be fatal also in some cases if not given in proper way & doses.

Cyproterone Acetate:

It blocks the DHT receptor and it has progesterone & gonadotropin properties with steroid structure. It is used in combination with estrogens to treat the hirsutism.

It has also some effects like nausea, vomiting, menstrual irregularity, weight gain, breast tenderness and loss of libido.

Androgen Blockage

5 alpha reductase inhibitor-

It has a potential to cause feminization of male fetus so it should be given very carefully in child bearing women. 

Estrogens: 

It is given to decrease the SHBG leading to decrease the free testosterone. Estadiol is the manor estrogen secreted by ovary. It is synthesized in Graafian follicle,  corpus luteum and placenta from cholesterol.

In liver estradiol is oxidized to estron which again hydroxylated to form estriol and all of these are found in liver and estradiol is the most potent one.  Natural estrogens have a short duration of action due to rapid metabolisation in liver. 

Minoxidil: 

Minoxidil is also used as a androgen blockage and that we have discussed in MPT( link) also.

Natural Management

Naturally so many things are available to combat the hair loss of women in the world. Traditionally many remedies and food supplements are also available. 

Followings are mostly used to treat FPB.

Dong quai:

Its a perennial herb and most important chinese medicine which is generally in those places where climate is cold . Its called female genseng in western world. It also has good potential for hormone replacement theory in female. This herb is also named as "return to order" due to its restorative potentials. Root of this herb is used as a anti-inflammatory, analgesics, anti-spasmodic & sedatives. Its also used for menstrual problem for recorrecting the cycle. Its a DHT blocker also and acts as a phytoestrogen which blocks androgen receptors. 

Black cohosh:

 Black cohosh & hair growth has been in relation for many years but at that time it was not recognised officially. It restores the estrogen level and used in menopausal women. And now it used widely in hair treatment. In North America & Canada it generally grows. It blocks the DHT production from testosterone by inhibiting the 5 alpha reductase.

Soy isoflavones:

Usually there are so many benefits of soy consumption like protection from breast cancer, prostate cancer, menopausal ailments, heart disease and osteoporosis. Its isoflavones give the most of the benefits. Isoflavones may reduce or activate the activity of estrogens. 

Flax Seed: 

It is also good source of phytoestrogens and found in grains, seeds & vegetables. Lignans are the richest source of flax seeds. And main lignan of flax seed is secoisolaricirecinol digoucide(SDG) which inhibits 5 alpha reductase.

Medical Treatment:

As I always say, there are many modes of treatment available in our great country India for any kind of diseases.

But people mostly prefer to take from Old School of Medicine(Allopathy) as their first choice and when some percentage of them do not get any satisfied results , they would take a move to other options available in medical field.

Yes, here we are talking about the world's 2nd largest practising system of medicine called Homoeopathy.But it does not mean that you should not take Old School of Medicine in your first choice because here I am just expressing the people's thought that I have been seeing in my day to day practice.

Homoeopathy has a great scope for treating the every kind of disease for last 200 years. And had been giving the wonderful satisfied results so AGA can be also treated & managed very well in Homoeopathy.But yes, it does not mean that you would get hairs back in your bald area of scalp.

If other health conditions is not a cause,medical treatment is not necessary. 

Medically there are many treatments available in market as of now with different names as per the different company establishments but motive of  all those treatments available in the medical field is only to give a better coverage of scalp.

Following ones you may opt for your hair loss after getting suggestion from a Trichologist. So, before opting any kind of treatment you should have a proper consultation with Dr.

I am going to give a brief idea of some treatments that are as of now in lime light.

1-Surgery:

Here surgery means obviously we are talking about the hair transplantation but its rarely indicated in case of FPB. Because females are not got affected with receding hair line as we can see in males.

2-Non-Surgical: 

Non-surgical is widely used in females when they got affected with FPB and also for fashion. Even it available at different styles also for every occasion . 

So, this is all about Female Pattern Baldness as per my best of best knowledge. For any concern kindly inbox me and will be happy to clear your valuable concern.

  

                                         *HaveGoodHair & LiveGoodLife*