Hair loss in women: psychological consequences and quality of life concerns for women with hair loss
Hair loss can have dismaying or even devastating influence on a women's quality of life, not least because hair loss is often wrongly considered a less significant psychological and emotional problem for women than it is for men. Too often, hair loss in women is not taken seriously by family and friends or even by a woman's personal physician.
While hair loss itself can present psychological and emotional problems for a woman, failure of others to recognize the seriousness of these problems may contribute additionally to psychological and emotional effects that can range from decreased self-esteem to anxiety and depression.
While hair loss occurs in women as well as in men, in women it is likely to be diffuse - a thinning of hair rather than the typical male-pattern "monk's tonsure" or "cue ball" hair loss. The less apparent diffuseness of typical hair loss in women may account in some degree for the underestimation of its importance in a woman's life. Many people do not commonly think of hair loss as a female problem. Scalp examination may not be part of a regular physical examination by a woman's personal physician, and thus the subject of hair loss may not arise unless the woman mentions it as a concern. Many women may be embarrassed to bring up the subject to their personal physicians. A personal physician who recognizes hair loss as a psychological or emotional concern for the woman can refer the woman to a physician hair restoration specialist for consultation and diagnosis.
Hundreds of women with hair loss were recently interviewed using a validated questionnaire, as described by David H. Kingsley, PhD, at a recent international meeting of the ISHRS. Women responding to the questionnaire reported:
Loss of self-esteem- "I feel other people are always looking at my hair." "I constantly compare my hair loss to others." "I feel unattractive or undesirable as a result of my hair loss."
Anxiety and depression- "Losing my hair has been the most disturbing event of my life." "I constantly worry about my hair loss."
Social dysfunction- "I go out less because of my hair loss." "I feel my hair loss is affecting my career." "My hair loss has limited my sexual activity."
Loss of control- "I am constantly seeking advice about my hair loss."
Lack of support- "Friends and family don't take my hair loss seriously or underestimate its importance to me."
Hair loss in a woman may also be overlooked as a "normal" phenomenon. Gradual hair loss is often associated with aging. Temporary hair loss is often associated with pregnancy. Very often, women have pattern hair loss that "runs in the family".
Hair loss in a woman should never be considered "normal", however. The cause should be pursued until a diagnosis is established. Of the many causes of hair loss in women, only a few such as aging, hormonal changes associated with pregnancy, and hereditary pattern hair loss may be considered "normal". Treatment is available for hair loss due to these "normal" conditions, and treatment should be considered when hair loss influences the woman’s quality of life.
Other potential causes of hair loss in women require medical treatment. These include cystic ovaries, hypothyroidism, autoimmune disease, chemotherapy, psychological or physical stress, and dietary deficiencies. Prescription drugs that commonly cause hair loss include beta-blockers, coumadin, anti-depressants and others. Medications may need to be changed or dosages adjusted due to hair loss. Damage to hair and scalp caused by tight braiding, corn-rowing, or chemicals used in hair styling are causes of hair loss that require change in life-style. Compulsive hair-pulling - a condition called trichotillomania that can cause unusual patterns of hair loss - may require psychological counseling.
If hair loss causes psychological or emotional problems for a woman, it should always be taken seriously by family, friends, and the woman's personal physician.
Dr. Kingsley, an authority on emotional and psychological problems associated with hair loss, recommended that primary care physicians who treat women (1) take the time to do a scalp examination and bring up the topic of hair loss even if the woman has not mentioned it, (2) take the time to discuss how the patient feels about her hair loss, and fully answer all questions from the patient, (3) conduct the diagnostic examinations and tests necessary to establish a diagnosis when necessary, or refer the patient to a physician hair restoration specialist for diagnostic tests, and (4) refer the patient to a physician hair restoration specialist for effective treatment options. Hair transplantation is one of the options that may be considered.