Hair loss in women: a different diagnosis

When a woman comes to see me about thinning hair, the first thing I tell her is that her consultation will be different from the one her partner or brother might have. Male hair loss is usually one diagnosis wearing different stages. Female hair loss is a list of possibilities, and the pattern on the scalp is only the beginning of working out which one applies.

The reason is simple: women's hair is more sensitive to the rest of the body. Iron deficiency — common, and commonly missed — thins hair before it causes almost any other symptom. Thyroid disorders, both over and underactive, announce themselves in the hair. Hormonal change drives several patterns at once: the shedding that follows childbirth, the thinning that can accompany coming off hormonal contraception, the shift around menopause. Autoimmune conditions, significant weight change, illness, stress and certain medications each leave their own signature. Each has a different correct treatment, and several need a GP or a specialist rather than a clinic.

This is why the workup comes first. A proper assessment for female hair loss includes a detailed history — the timeline, the pattern, the context of your health — an examination of the scalp, often dermatoscopy, and blood tests more often than not. I know blood tests can feel like an anticlimax when you were hoping for a treatment. They are, very often, where the answer actually is. Treating the iron deficiency or the thyroid treats the hair.

In women, thinning is a symptom first. The diagnosis decides everything.

There is, of course, a female equivalent of pattern loss — female pattern hair loss is real, common, and manageable, with a different pattern from the male version: a widening part and diffuse thinning across the crown rather than a receding hairline. It responds to medical treatment, and it benefits from the same diagnosis-first discipline. But even here, the pattern alone is not enough. Female pattern loss and diffuse medical shedding can look identical from the bathroom mirror and need opposite responses.

It is also worth saying plainly what this means for transplantation. Because female loss is so often diffuse and medical, far fewer women are candidates for a hair transplant than men — the donor area itself is sometimes affected, and transplanting hair while an untreated medical cause continues is a poor investment. Where transplantation is the right answer for a woman — a stable, localised area, a hairline concern — it is planned carefully, and only after the medical picture is settled. At Lumière, women are assessed by me first for exactly this reason: the diagnosis must be right before any treatment deserves discussion.

If you have noticed your part widening, your ponytail thinning, or more hair in the brush than there used to be, the most useful next step is not a product. It is a diagnosis. That consultation is quiet, unhurried and confidential — and very often it ends with better news than the internet led you to expect.