Female Pattern Hair Loss (FAGA/FPHL)
What Is Female Pattern Hair Loss (FAGA/FPHL)?
The causes of hair loss in women are wide-ranging, and it is important first to identify the cause. Causes of hair loss generally include alopecia areata, hair loss due to collagen disease or thyroid disease, hair loss due to inflammation such as eczema, hair loss due to changes in hormonal balance or the hair cycle, and hair loss due to malnutrition. Hair loss due to hormonal balance includes postpartum hair loss and hair loss due to ovarian tumors. When these secondary forms of hair loss are ruled out, it is considered to be androgenetic alopecia, or female androgenic alopecia (FAGA).
Female AGA, unlike the male pattern of hair loss, thins the hair over a relatively wide area of the crown. The time of onset is also later than in men, with most cases developing after menopause. Furthermore, regarding the cause, there are cases where the condition cannot be explained by the involvement of male hormones alone, and nowadays the name “female pattern hair loss” is increasingly used rather than male pattern hair loss.
At our clinic, for women troubled by thinning hair,
we evaluate the cause through interview, visual examination, trichoscopy (observation of the scalp using a dermoscope), blood tests, and so on;
(if necessary) we replenish deficient nutrients; and
if there is no nutritional deficiency, we treat it as female pattern hair loss (FAGA/FPHL).
This is the flow in which we provide care.
Note that if symptoms other than hair loss are found and the involvement of some disease is suspected, we perform the necessary tests under insurance.
*When booking, please select “Examination” → “AGA/FPHL hair loss.”
Main Causes of Hair Loss in Women
- 1 Iron deficiency (hidden anemia)
Hair matrix cells are among the most actively proliferating cells in the body. When iron, which is needed for DNA synthesis, is deficient, hair growth declines and it can become a cause of hair loss. Even those who have been told “you have no anemia” because their hemoglobin is normal on a blood test may have hidden iron deficiency.
- 2 Zinc deficiency
Zinc is an essential trace element involved in protein synthesis and the division of hair follicle cells. When it is deficient, hair formation is impaired and it can cause hair loss or thinning. Zinc can become deficient due to crash dieting, breastfeeding, and the like.
- 3 Thyroid dysfunction
Thyroid hormones are involved in regulating the hair cycle (growth phase and resting phase). In hypothyroidism and hyperthyroidism, the hair cycle is disrupted, and so-called diffuse hair loss, in which hair loss occurs over the whole head, can arise.
- 4 Rapid dieting, wasting diseases
When rapid weight loss or nutritional deficiency occurs due to dieting, illness, or the like, telogen effluvium, in which the hair cycle shifts into the resting phase, can occur.
- 5 Female pattern hair loss (FAGA)
In FAGA, miniaturization of the hair follicles and shortening of the growth phase occur, and the hair gradually becomes thinner and the amount of hair decreases.
Symptoms Seen in Female Pattern Hair Loss (FAGA/FPHL)
The following symptoms are seen in female pattern hair loss.
The part widens
Hair volume decreases
The hair becomes thinner
Hair loss increases
There is little of the hairline recession seen in male AGA; rather, it is characterized by a diffuse decrease in hair volume centered on the crown.
Comprehensive Hair Check-Up for Women
(Hair Health Screening)
STEP 1 Interview, visual examination, trichoscopy (dermoscopy examination)
In the interview, we ask about other physical symptoms, your menstrual status, illnesses you have had, and so on. We observe the condition of the hair using a dermoscope. This is called trichoscopy.
*If at this point the doctor determines that there is clearly pathological hair loss, we perform examination and treatment under insurance.
STEP 2 Blood test as needed
In women’s hair loss, nutritional status and hormonal abnormalities can be involved. At our clinic, we perform the following blood tests as needed. Regarding nutrition, even values generally considered within the reference range may be considered insufficient for the hair, so the interpretation of results requires care.
*If at this point the doctor determines that some disease is suspected, we will refer you to a specialist medical institution as needed.
Hair Loss Treatment for Women
~ Midori Glossy-Hair Regeneration Program ~
STEP 3 Selection of the treatment method
If pathological anemia or hormonal abnormality is found on the blood test and we determine that detailed examination and treatment as a disease are needed, we will refer you, after consultation, to an appropriate medical institution. Also, if nutritional deficiency is found on the blood test, we provide nutritional replacement therapy such as iron, zinc, and vitamin replacement. If it is neither, we treat it as FAGA/FPHL.
STEP 4 Follow-up
In any case, we check the condition of the hair every one to several months and consider continuing or changing the treatment. For those who had a nutritional deficiency, we perform a blood test again at around three months.
*The Women’s Hair Loss Follow-Up Test is a test intended to confirm the treatment effect for those who are continuing supplement treatment at our clinic. Those using only over-the-counter supplements are not eligible.
Treatments for Hair Loss
When There Is Malnutrition
If the blood test shows abnormally low values, or if values within the reference range are considered insufficient for the hair, we replenish heme iron (and vitamin C to improve absorption), zinc, and vitamin D (4000 IU or 1000 IU) with supplements. If malnutrition and FAGA/FPHL are considered to coexist, we also use the treatments described below.
*If there is anemia and a condition such as heavy menstruation or gastrointestinal bleeding is suspected, we may refer you to gynecology or gastroenterology.
When There Is No Malnutrition (In the Case of Female Pattern Hair Loss)
If the test results show no other disease causing hair loss and no malnutrition, we treat it as FAGA/FPHL. The treatments include the following.
Topical minoxidil (for women)
At our clinic, we offer 2% topical minoxidil for women. Minoxidil has an action that promotes hair growth by improving blood flow around the follicles and prolonging the growth phase of the hair cycle.
[Main side effects]
Scalp irritation (itching, redness, peeling), initial shedding, hypertrichosis, excess hair on the face and elsewhere
Oral minoxidil (low dose)
When the topical effect is insufficient, we may consider low-dose oral minoxidil. To suppress side effects as much as possible, we carefully start from a low dose. Watching for the appearance of side effects, we increase the dose if the effect is poor. It cannot be taken during pregnancy.
[Main side effects]
Initial shedding, hypertrichosis, edema, weight gain, headache, palpitations, low blood pressure, rapid heartbeat, skin flushing, numbness, heart failure
Topical Ell-Cranell
Ell-Cranell is a topical drug that can be used by both men and women, and is used especially for women’s hair loss (FAGA). Its active ingredient, alfatradiol, suppresses the conversion of testosterone into dihydrotestosterone (DHT) within the hair follicle, reducing the amount of DHT that causes hair loss. It is positioned not as a hair-growth promoter but as a “drug that prevents the progression of hair loss.” Alfatradiol is an isomer of the female hormone 17β-estradiol, but because it does not function in the body, it does not affect hormonal balance, making it an easy drug to use.
[How to use]
- Once a day, apply it to the areas of concern on the scalp using the patented applicator. It can be applied to the target area easily and quickly.
- By continuing to use it, some people feel a reduction in hair loss and an improvement in hair firmness in about three to six months.
- Once the hair loss improves, you can reduce the frequency to once every two days or once every three days.
- It is a formulation that is easy to use, being low in stickiness and free of fragrance and coloring.
[Main side effects]
The alcohol content may cause the scalp to become irritated, red, or itchy for a short time. The scalp may also become oilier. If you notice anything abnormal, stop using it and consult the doctor.
Features of Our Women’s Hair Loss Treatment
- Examination by a dermatology specialist
Because women’s hair loss has wide-ranging causes, examination by a dermatologist is important. Rather than blindly taking supplements or starting treatment on the assumption that women’s hair loss equals AGA, it is necessary first to check whether a disease that should be treated is hidden and whether there is a cause that can be improved, and then to choose the treatment. At our clinic, a dermatology specialist examines and makes the diagnosis.
- Care that emphasizes evaluation of the cause
In women’s hair loss, various factors are involved, such as nutritional status, hormones, and the hair cycle. At our clinic, we perform blood tests as needed and provide treatment after evaluating the cause.
- Handling everything from topical to oral treatment
At our clinic, so that the treatment that suits each patient can be chosen, we stock both topical and oral drugs and provide treatment with attention to safety.
Frequently Asked Questions (FAQ)
Q Can women get AGA too?
A In women, it is generally called FAGA (female pattern hair loss). The pattern of hair loss differs from male AGA and is characterized by a diffuse decrease in hair volume centered on the crown. Recently, because there are cases that cannot be explained by the involvement of male hormones alone, it is also called Female Pattern Hair Loss (FPHL). However, since the cause of hair loss can also be something else, women’s hair loss does not necessarily equal FPHL.
Q May I eat before the blood test?
A To accurately evaluate zinc levels, it is considered desirable to draw blood in the morning on an empty stomach. This is to align the test conditions, because zinc values drop with eating and there is also a diurnal variation. You may have the blood test after eating or in the afternoon, but interpretation becomes slightly more difficult when the value is mildly low. In that case, we judge whether there is zinc deficiency taking into account whether you have eaten and the time of day.
Q I have a cold. May I have the blood test?
A Because it becomes difficult to evaluate iron deficiency, we recommend having it done when you are as well as possible, but it is possible to have it done.
Q What is trichoscopy?
A It is a test that observes the condition of the scalp and hair using the dermoscope that dermatologists normally use in practice. In AGA/FPHL, it is characteristic for thick and thin hairs to be mixed together, or for hair to be replaced by fine vellus hair.
Q Can minoxidil be used by women too?
A Yes. Minoxidil is also used in the treatment of women’s hair loss; for women, topical drugs of 1–2% and the like are used, and at our clinic we offer 2%. In the case of oral use, side effects are more likely to appear than in men, so it needs to be used carefully starting from a low dose (such as 1.25 mg).
Q Can Ell-Cranell be used by women too?
A Ell-Cranell is a topical drug that can be used by both men and women, and it has an action that suppresses the progression of hair loss.
Q Are supplements effective for hair loss?
A If a nutritional deficiency is the cause, there is a possibility of improvement with a supplement of the deficient component, but a supplement of a component that is not deficient will have no effect, and for pure androgen-dependent FAGA we do not expect an effect.
Please Note
Treatment for hair loss is not covered by insurance (self-pay).
Treatment effects vary by individual, and not everyone will obtain a hair-growth effect.
Disclosure Regarding Unapproved Drugs
Some of the FAGA/FPHL medications used at our clinic include drugs that are not approved in Japan. These are drugs imported for medical institutions from overseas pharmaceutical suppliers under the doctor’s judgment. Among the drugs approved domestically for women’s AGA treatment is topical minoxidil.
For Those Seeking Women’s Hair Loss Treatment in Minato-ku / Tamachi
Tamachi Ekimae Dermatology, Clinica Riviera Shibaura is a dermatology, pediatric dermatology, aesthetic dermatology, and cosmetic internal medicine clinic in Shibaura, Minato-ku, close to Tamachi Station. If you are considering treatment for women’s hair loss (FAGA/FPHL) in the Minato-ku, Tamachi, or Mita area, please feel free to consult us.
*When booking, please select “Examination” → “AGA/FPHL hair loss.”