Female-pattern baldness affects 20 million women in the United States. It is a diffuse pattern of hair loss throughout the scalp. It can be passed down from mother to daughter.

Causes for baldness

Androgenetic alopecia is a hereditary condition that causes 95% of hair loss. Circulating through the bloodstream, androgen is converted to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase. Those with greater enzyme activity have more DHT binding to hair-follicle receptors. If flooded by DHT, the follicles sprout thinner and thinner hairs until nothing regrows, and the follicles eventually wither away.

Alopecia areata is an autoimmune disease of unknown cause in which inflammatory cells attack the bulbs of the follicles under the scalp, leaving hairless patches. In more serious cases, hair may fall out from the entire head, eyebrows and beard included, and the entire body. Many times, though, the hair returns spontaneously.

Childbirth, severe malnutrition, chemotherapy, thyroid problems, and a form of lupus can also cause hair loss.

Pigtails or cornrows, if worn too long, can cause hair loss, because of the stress they cause to the hair shaft.

Extreme emotional trauma causes hair loss.

Wearing hats won’t cause hair loss.


Surgical hair transplantation moves hair from densely covered sites on the sides or back of the head to bald areas of the scalp.

The key to success, is to have good sites on the sides or back of the head from which to move hairs. Because their hair loss is diffuse, women generally lack good donor sites, making transplantation impractical for women.

With "micro" or "mini" grafts, 1 or 2 hairs are shot into the head with a needle. It achieves a very, very fine, natural-looking hair line. The problem is that you need a lot of hair to do that. Surgeons also use larger round plugs of seven to 10 hairs. Line grafts, the shifting of strips of 9 to 12 hairs, are common, too. Prosthetic hair fibers for transplantation are banned by FDA, because of the high incidence of adverse reactions, including infection.

Surgical scalp reduction removes large sections of a bald scalp. Elastic devices, extenders and expanders, are placed under the skin to stretch the hair-bearing scalp regions on the side of the head to the removed areas.

The flap technique rotates hair-bearing scalp areas from the sides or moves those areas from the back forward. The flap technique has the highest complication rate of bleeding, scarring and infection.

This page has been updated on the 2017-12-18.