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Alopecia in Women: Understanding and Managing Hair Loss

Hair loss is a challenge that affects many women and can have a profound impact on self-confidence and self-esteem. In this series, we'll look in-depth at alopecia, specifically targeting women, and provide insights, guidance and support for those facing this challenge.

The complexity of alopecia in women

Alopecia is more than just hair loss. For women, it can be an emotional journey that takes different forms, ranging from subtle thinning to more pronounced hair loss patterns. We explore the various types of alopecia and investigate how this condition manifests itself specifically in women.

The complexity of alopecia for women
The complexity of alopecia for women

Androgenetic alopecia: hereditary predisposition to hair loss

What is popularly called normal or classical baldness is medically called alopecia androgenetica. androgenetic alopecia occurs in both men and women. Hair loss or thinning hair in women due to androgenetic alopecia is a process that - in addition to heredity - is influenced by race, gender, age and a combination of genetic and hormonal factors, in which dihydrotestosterone (DHT) plays a role.

The role of DHT in androgenetic alopecia
The role of DHT in androgenetic alopecia

DHT is formed from testosterone via the enzyme 5-alpha reductase and plays a crucial role in androgenetic alopecia, also known as male pattern baldness. DHT attaches to hair follicle receptors on the scalp, shortening the growth phase of the hair and weakening the hair follicles. This causes the hair to become thinner and weaker, and eventually it will not grow back. This often starts in specific areas of the scalp, such as the center parting in women, and can gradually spread to other areas of the scalp, resulting in the characteristic hair loss pattern in women with this form of alopecia.

Each hair follicle can produce a hair about 20 times over a lifetime before it dies. Although a person may not experience baldness until the age of 60 to 90, hereditary baldness causes hair thinning at a younger age due to the sensitivity of specific hair follicles to dihydrotestosterone (DHT).

This shortens the growth phase of the hair from three to five years to sometimes just a few months. The affected hairs become finer and shorter with each hair cycle. If this process occurs in many hair follicles, you will initially notice this because your hair loses volume. Eventually the hair follicle will become exhausted and you will actually lose hair. The sensitivity of hair follicles to DHT is genetically determined, which explains why some people go bald and others do not. So it is not relevant whether you have a lot of testosterone or produce a lot of DHT. That is why there is no need to have testosterone or DHT measured in your blood. This says nothing about the degree of sensitivity.

What treatments are available for androgenetic alopecia?

A plethora of products and treatments claim to stop hair loss due to androgenetic alopecia (hereditary baldness). Every few months a new shampoo, lotion or nutritional supplement comes onto the market with claims about efficacy. Unfortunately, these often turn out to be empty promises whose effectiveness has not been scientifically proven. Nevertheless, there are plenty of options whose effectiveness has been proven through scientific studies.

Here is an overview of treatment options used at Intermedica, with estimated percentages of effectiveness in normalizing hair loss:

  • Minoxidil lotion 5%: 25%

  • Diane pill, Yasmin pill or Yaz pill: 25%

  • Androcur: 20%

  • Trix Basic Alpha: 25%

  • Finasteride: 70%

  • Dutasteride: 95%

It is important to note that the effectiveness of different products should not be added together. Sometimes combining products can slightly improve the effectiveness of one of them.

In addition, treatments are offered for which the evidence that they inhibit the process of hair loss due to androgenetic alopecia is weak. Some examples are light and laser therapies, as well as injecting vitamins and minerals into the scalp (such as PRP and mesotherapy). None of these treatments or therapies are performed at the Intermedica clinic.

Find out everything about effective treatments for androgenetic alopecia in our comprehensive guide!

What about finasteride and dutasteride for women with hair loss due to androgenetic alopecia?

For a long time, dermatologists at the Intermedica Clinic have been prescribing finasteride and dutasteride to women with hair loss due to androgenetic alopecia, with positive clinical results. These medicines are prescribed off-label, which means that they are prescribed for a different purpose or in a different way than for which they were originally approved. This is done exclusively on the basis of the professional assessment of one of our specialist doctors, which makes it legally permitted within certain regulations. Finasteride and dutasteride were originally approved and prescribed for prostate problems, but in low doses they also appear to be effective in preventing hair loss due to androgenetic alopecia, a so-called positive side effect.

These medications affect the amount of dihydrotestosterone (DHT) in the blood. DHT is important for the development of male genitalia, a process that begins in the womb and continues until the end of puberty in men. To prevent even the slightest risk of genital abnormalities in a male fetus, strict rules apply to the prescription of finasteride and dutasteride.*

Before and after treatment with finasteride and dutasteride
Before and after treatment with finasteride and dutasteride

In 2013, dermatologists from the Intermedica Clinic, in collaboration with internationally renowned trichologists, conducted retrospective research into the effectiveness of finasteride and dutasteride when used by women with androgenetic alopecia. The results of this study are available to read via the link below or can be downloaded in PDF format.

PDF scientific publication: “The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia”.Ids H. Boersma, Arnold P. Oranje, Ramon Grimalt, Matilde Iorizzo, Bianca M. Piraccini, Emiel H. Verdonschot.

*The Lareb side effects center received ten reports of possible side effects of finasteride/dutasteride in women in the period between 2005 and 2014. Two of these reports concerned the use of finasteride during pregnancy. On this basis, pharmacies are advised not to supply finasteride and dutasteride to fertile women. You can find Lareb's full message here.

Patchy baldness in women: what you need to know about Alopecia Areata

Alopecia areata, also known as patchy baldness, is a hair loss condition that can affect women of all ages. It is characterized by the sudden appearance of round or oval bald patches on the scalp, and sometimes on other hairy areas such as eyebrows or eyelashes.

Round or oval bald spots on the scalp due to alopecia areata
Round or oval bald spots on the scalp due to alopecia areata

For women, alopecia areata can be an unexpected experience, causing sudden and irregular patches of hair loss. These bald spots can vary in size and number, making them sometimes difficult to predict.

The exact cause of alopecia areata remains unclear, but it is believed to be an autoimmune disease, in which the immune system attacks healthy hair follicles. Heredity also appears to play a role, as this condition is more common in people with family members who have autoimmune diseases.

More about the causes of alopecia areata

The unpredictable nature of alopecia areata can take an emotional toll. Women may experience stress, insecurity and a decrease in self-confidence. It is important to pay attention to emotional support in addition to medical treatments. Seeking support from family, friends, or support groups can help tremendously.

Alopecia areata is caused by a disruption in the immune system, in which the body attacks hair follicles, resulting in hair loss and the appearance of bald spots. Normally the immune system protects us against foreign substances and organisms such as viruses and bacteria, but with alopecia areata it unintentionally targets our own hair follicles, leading to hair loss.

The precise cause of alopecia areata remains largely unclear, although several factors may underlie it. Possible triggers are thought to include autoimmune thyroid disease, vitiligo, psychiatric disorders and stress. However, not all factors mentioned have scientific evidence as a cause for this condition. Although stress is often associated as a possible cause, conclusive evidence that stress actually causes alopecia areata is lacking.

Alopecia areata occurs in approximately one in 500 Dutch people, with women being affected more often and the first attack often manifesting itself at a young age. Although extensive research has been done, the exact cause of alopecia areata remains largely unexplained, and it remains a complex condition that requires more research.

Treatment options for alopecia areata are available. For personal advice and treatment options, you can make an appointment with our dermatologist.

What treatment options are there for alopecia areata?

Treatment begins with framing the situation, reducing anxiety and stress, and recording and monitoring the condition. If the condition is not in remission after one year, active treatment may be considered. This may be considered even earlier if it appears that many hair follicles become significantly smaller during the first year.

To monitor the progress of the condition in the first year, overview images and microscopic images of the bald spots are made. On these microscopic images, the diameter of the place where the hair grows out is measured. If this diameter decreases, the hair follicle also becomes smaller.

Although the precise causes of alopecia areata are not clear, studies suggest that supplementing normal diet may be helpful in recovering from the condition. Vitamins B5, B6, B8 and B12, divalent iron and zinc are examined to stop the process of alopecia areata and positively influence recovery. During recovery, the skin suddenly has to produce a lot of hair, which requires specific nutrients. To prevent deficiencies, the diet can be supplemented with isoflavones, betasitosterol and L-cysteine.

The activity of the condition is assessed to predict whether there is progression, stabilization or remission. If progression or stabilization is expected, treatment may be considered. The age of the patient plays a role in the choice of treatment(s).

Baldness in the front hairline, frontal fibrosing alopecia

Frontal fibrosing alopecia, also known as FFA, is a form of chronic hair loss that mainly occurs in women after menopause. It is characterized by a gradual receding of the hairline at the front and sides of the scalp, often accompanied by redness, itching and burning sensation. Although the exact cause of FFA is unknown, it is thought to be an autoimmune disease in which the immune system attacks the hair follicles and causes scarring.

Baldness in the anterior hairline frontal fibrosing alopecia
Baldness in the anterior hairline frontal fibrosing alopecia

The diagnosis of FFA is made on the basis of clinical examination and sometimes a skin biopsy. There are treatment options available to slow the progression of the condition.

The condition can be persistent and will sometimes eventually fade away, but it can also cause irreversible hair loss.

What causes frontal fibrosing alopecia?

Frontal fibrosing alopecia is an autoimmune disease that causes inflammation around hair follicles, which can be visible as red dots on the scalp. These inflammations lead to scar formation.

The condition mainly affects women after menopause and is characterized by a gradual withdrawal of the hairline on the front and sides of the scalp. This is often accompanied by redness, itching and a burning sensation.

The treatment is based on controlling the inflammation as quickly as possible, as well as maintaining and improving the quality of the remaining hair.

Embracing and supporting alopecia in women

We hopen dat deze informatie je een helder inzicht heeft gegeven in de diverse vormen van alopecia bij vrouwen, de behandelingen en mogelijke wegen naar ondersteuning. Het is van cruciaal belang dat we actie ondernemen en elkaar ondersteunen in deze uitdaging. Onthoud dat je niet alleen bent en dat er verschillende manieren zijn om met alopecia om te gaan.

Bij onze kliniek staan we klaar om je te begeleiden en te ondersteunen. We bieden persoonlijke checks en meetings aan, waar je meer te weten kunt komen over de beschikbare opties en behandelingen. Aarzel niet om contact met ons op te nemen en de eerste stap te zetten naar een oplossing die bij jou past. Samen kunnen we de impact van alopecia verminderen en elkaar steunen op deze reis naar zelfvertrouwen en herstel.


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