While everyone can name a bald (or balding) male celebrity she thinks is sexy, the same can't be said for bald or thin-haired women. From infomercials to print ads touting hair growth treatments, we rarely see women with thinning hair. "Women are often forgotten as people with hair loss," agrees Dr. Lorna Thomas, a dermatologist at Detroit Medical Center. But women do experience hair loss. Twenty-two million American women are losing their hair, compared with 34 million men.
Everyone loses hair -- at a rate of about 100 strands a day. While some strands are falling out, other strands are in a rest phase for about three months and only loosely anchored, then they're shed and in their place, new hairs sprout.
Male or female pattern baldness, or androgenetic alopecia, accounts for the vast majority of hair loss. It runs in families, caused by a genetic defect that affects the androgens (male hormones, such as testosterone). Androgens are produced by the testes as well as by the adrenal glands, which are found in both sexes.
People with androgenetic alopecia are more sensitive to androgens. As a result, hair follicles shrink and new hairs are finer and grow for a shorter time. The typical male pattern -- with a receding hairline and baldness on top -- is easily recognizable. Not so for women, who thin out all over their heads but rarely go entirely bald. "Because the thinning is so gradual, by the time a woman realizes it, she may have already lost about 50 percent of her hair," says Dr. Thomas.
While androgens and genetics are the biggest cause of hair loss, there are plenty of other culprits.
Alopecia areata -- in which hair falls out in clumps, leaving small round patches -- is the second most common. The condition -- which also runs in families -- strikes between 100,000 and 200,000 Americans of all ages.
Researchers believe it's an autoimmune disease in which the body's immune system attacks hair follicles, mistaking them as foreign intruders. Usually hair grows back in six months to two years, though new bald patches may form as others grow back.
There are other, treatable problems that can cause hair loss, says Dr. Leonard Dzubow, head of dermatological surgery at the University of Pennsylvania. Many of the following only damage hair temporarily:
For those who refuse to accept their new look, a hairpiece or weave can give the illusion of a fuller head of hair. The look of today's high-quality pieces is so natural, it's hard to tell what's real hair and what's not.
All hairpieces have to be attached either to your remaining hair or to your scalp with tape, adhesive, clips, or hair weaving. Some hair clinics may try to sell you a permanent hairpiece sutured to your scalp. But the suturing may result in infection or scarring, so be sure to first check with your doctor.
The best hairpieces are custom designed and fitted; they're made from synthetic or human hair, or a combination. Quality ones can cost from $900 to $2,500 depending on construction and the type of fibers. Some insurance companies will pay for them if hair loss results from a disease. Bring a friend when you try it on or see if there's a return policy. And always have a spare. The American Hair Loss Council (312-321-5128) can help you find a specialist.
Rogaine (minoxidil) is sold over the counter in pink packages for women and in blue packages for men, but the product is the same. In clinical trials, the 2 percent minoxidil solution produced at least moderate hair regrowth in 26 percent of men age 18 to 49, and in 19 percent of women age 18 to 45. No one is sure how it works.
"While the majority of people don't grow a lot of hair (with Rogaine), 90 percent hold onto what they have," says Dr. Arthur P. Bertolino, director of the hair consultation unit at New York University Medical Center. Usually it takes four months to see some results and a good eight months to get the full effect. Rogaine -- which costs $30 for a month's supply -- must be used twice daily on a continual basis, otherwise the hair will fall out again.
The best Rogaine candidates are those who still have peach fuzz (not a slick bald spot), are bald on top, or have noticed their hair thinning over the past few years. Rogaine is not for you if you've lost your hair suddenly or in patches, your scalp is red and irritated, or there's no family history of baldness.
Rogaine made Tracy Pattin, 40, feel a lot better. Her hair had been thinning since she was in her 20s. "It was miraculous when someone said, 'What are you doing with your hair? It looks good,'" she says. But Craig Wilson, 47, a reporter for USA Today, tried Rogaine for six months and said the fuzz that grew in wasn't worth the money or effort. "I'm used to brushing my teeth and running a comb through my hair. Rogaine was just one more thing to do," he says.
Rogaine manufacturers, Pharmacia and Upjohn, are currently awaiting FDA approval of a 5 percent prescription minoxidil solution, which they hope will give women more dramatic results.
There are drugs available for women to help treat hair loss, says Dr. Wilma F. Bergfeld, chief of dermatology at The Cleveland Clinic. Possibilities include estrogen or hormone replacement therapy for hormonal fluctuations; nutritional support for malnutrition or iron or B-vitamin deficiency; and drugs classified as antiandrogens.
Because androgens are a key player in hair loss, blocking their effect on scalp hair should also block hair loss. The latest antiandrogen -- which could be approved by the FDA this year -- is Propecia. It's a new formulation of Proscar, a drug that is currently prescribed to treat an enlarged prostate.
At a recent meeting of the American Academy of Dermatology, researchers reported that one tablet of Propecia a day boosted hair growth in 48 percent of men, compared to 7 percent in the control group. Propecia works by blocking the enzyme that plays a role in balding.
"If you suppress androgens, you get a very significant effect in hair growth. There's no reason to suspect it will be different in women," says Dr. Howard Baden, a professor of dermatology at Harvard Medical School.
Though it's not approved for this use, many doctors prescribe Proscar for hair loss -- as well as other drugs, such as aldactone, a drug to treat high blood pressure. As with Rogaine, you get the best results if you start when your hair first thins.
Hair transplants have come a long way. Gone are the days when you could easily point one out in a crowd. "Traditional hair grafts were the size of a pencil eraser and looked like Barbie doll hair," says Dr. Randall K. Roenigk, a dermatology professor at Mayo Medical School.
The procedure has been revolutionized by micrografts, consisting of only one to two hairs, and mini-grafts, with three to four hairs. "It's almost impossible to tell." Here's how it works: A strip of hair is taken from the back of the head and a surgeon grafts tiny plugs containing one to four hairs into the bald or thin area. Each graft is painstakingly moved into a small hole or tiny incision. "Usually it takes three or four sessions, depending on the density you want," says Dr. Roenigk.
Cost is a big reason some people choose a hair transplant only when they're already bald. The procedure -- usually done under local anesthesia -- can cost as much as $4,000 per session.
Hair transplantation is the most common cosmetic procedure in men, but until recently, women rarely chose to do it. Women can do well with hair transplants, says Dr. Dzubow, especially those who lose their hair like a man. "But if a woman's hair in thin all over, there's no rich area to harvest," he says.
Other surgical techniques for hair replacement are more involved. A hair lift, which can cost up to $8,000, can reduce or virtually eliminate a large bald area. The surgeon removes a U-shaped area of bald scalp and advances the entire hair-bearing scalp into the bald area.
For someone with a tight scalp, scalp expansion can be done prior to a hair lift. A balloonlike device is first inserted under the scalp to stretch the skin. The best female candidates for a hair lift are women with male pattern baldness rather than diffuse thinning. They have more hair to work with, says Dr. Dominic A. Brandy, a clinical dermatology instructor at the University of Pittsburgh Medical Center.
During a procedure called flap surgery, the surgeon removes a patch of bald scalp and pivots hair-bearing scalp into its place. The results, however, aren't always satisfactory because once the hair is turned, it grows in the opposite direction, and sometimes looks too thick at the hairline. The procedure costs about $4,000.
If you're considering a surgical solution, ask your doctor for a referral (be sure the surgeon is board certified). You may want to first check with your state or local medical society to see if any complaints have been lodged against the doctor. The American Hair Loss Council or the American Academy of Cosmetic Surgery (800-263-9968) also can refer you to a surgeon in your area.
Be sure to get a second opinion, meet with several former patients, and take a close look at the photographs in the waiting room. "In the before and after pictures, make sure the way the hair is combed, the lighting, and the angle are all the same," says Dr. Brandy.