Psychological Effects of Hair Loss in Women

Courtesy of International Society of Hair Restoration Surgery

As psychologically stressful as hair loss is for a man, it is likely to be even more so for a woman. A number of scientific studies have shown that women are more likely than men to suffer psychologically painful effects due to hair loss, and that the psychological effects are likely to be more severe in women than in men.

Reasons for this difference have been documented in studies of women and men with hair loss who responded to validated questionnaires designed and administered by psychologists and physician investigators:

Women more than men have a significant psychological investment in their appearance, and are likely to react more negatively to events such as hair loss that they regard as changing their appearance for the worse.

Women are highly sensitive to a social expectation that “a woman’s hair is her crowning glory”. When she perceives that hair loss detracts from the appearance of her “crowning glory” a woman is likely to experience a loss of self-esteem.

Women who have hair loss often perceive that it is not taken seriously by family and friends. Women have less of a support system for hair loss than is available to men. Family and friends may commiserate with a man about hair loss and even help him find humor in it. Hair loss (balding) in typical male-pattern alopecia is an event that is accepted as “normal” in men. Female hair loss is not widely regarded as “normal” even though it occurs normally in both sexes. The typically diffuse pattern of hair loss in women is not as well recognized as typical male-pattern baldness. The psychological effect of hair loss in women is under-appreciated, perhaps due in large measure to lack of public awareness of hair loss in women.

The response of women to investigators questions show that women are often devastated by loss of hair in any degree from slight to severe:

“I think about my hair loss all the time.”
“I wish I had more hair.”
“I worry about losing even more hair.”
“I feel frustrated and helpless about my hair loss.”
“I feel self-conscious about my looks due to hair loss.”
“I worry about how my hair loss will affect my career/marriage/dating/sexual activity.”
“I worry that I am unattractive.”

Men can often cope with hair loss better than women. Women are more likely than men to:

• Try to hide hair loss
• Ddiscuss hair loss with a hair stylist
• Try to develop a hair style that disguises hair loss
• Spend more time on other aspects of physical appearance to divert attention from hair loss

Even slight hair loss may be psychologically unsettling for a woman. With whom should she discuss her concern?

Consultation with a board-certified dermatologist may be the most effective way to (1) discover the cause of hair loss, (2) learn the treatment options that are available based on the diagnosis of the cause of hair loss, (3) weigh treatment options based on discussion of procedures, costs and any other concerns, and (4) undertake a treatment program agreed upon after full discussion. After consultation with a dermatologist, a woman with hair loss might then choose to meet with a physician hair restoration specialist to determine if she is a candidate for surgical hair restoration. Often the combination of surgical hair restoration and medical treatments provides the most satisfying result.

Unless a woman mentions it as a concern, hair loss may not be discussed by a woman’s personal internist or gynecologist as part of a regularly scheduled physical examination. Thinning hair may be regarded as a “normal” phenomenon associated with conditions such as pregnancy or aging.

However, a woman’s hair loss should never be overlooked, disregarded or underestimated. Hair loss should be recognized for the impact it has on a woman’s self-esteem and psychological well-being. The cause of hair loss should be investigated with appropriate physical examination and laboratory tests until a diagnosis is confirmed. No treatment of hair loss should be undertaken until a diagnosis is made. Hair loss due to the most common causes, such as hereditary female-pattern alopecia, can be often effectively treated with hair transplantation or with minoxidil, the only hair restoration medication available to treat women with hair loss. Other causes may require the care of a qualified dermatologist who has special knowledge of hair loss diseases such as alopecia areata or lichen planopilaris. In some cases an underlying cause such as hypothyroidism must be treated as part of overall effective treatment. Fortunately, most cases of female pattern hair loss may be treated with a combination of minoxidil and surgery. (See Surgical Hair Restoration and Medical Hair Restoration for detailed discussion of treatment options).

Common Causes of Female Hair Loss

• Androgenetic alopecia– hereditary pattern hair loss with a typical pattern of diffuse hair thinning over the central scalp.
• Alopecia areata– a recurrent disease of unknown cause that results in patchy loss of hair from the scalp and/or eyebrows.
• Telogen effluvium– a condition that causes shedding of hair over the entire scalp; it may be chronic but also may be acute following a stressful event such as high fever, severe dietary deficiency, and chronic blood loss from heavy menstruation.
• Hypothyroidism– thyroid deficiency can be associated with thinning, patchy loss of hair.
• Loose anagen syndrome– a condition that causes hair to shed before its normal growth cycle is completed.
• Pregnancy– hormonal changes and stress of pregnancy may cause temporary hair loss.
• Traction alopecia– tight braiding and corn-rowing can, over time, cause permanent damage to hair and scalp and result in hair loss.
• Chemical processing– some chemicals used in hair styling can, over time, cause permanent damage to hair and scalp and result in hair loss.
• Trichotillomania (compulsive hair plucking)– a person feels compelled to pluck hair in regular or bizarre patterns, resulting over time in traction alopecia and permanent hair loss.

See About hair loss for more details of causes of hair loss.

References

Kingsley DH. The psychological and quality of life effects of hair loss in women. Presented at the 11th Annual Meeting of the International Society of Hair Restoration Surgery, New York, October 15-19, 2003.

Price VH. Androgenetic alopecia in women. J Investigative Dermatol Symposium Proceedings 2003; 8:24-27.

Cash TF, Price VH, Savin RC. Psychological effects of androgenetic alopecia on women: Comparisons with balding men and with female control subjects. J Amer Acad Dermatol 1993; 29:568-575.