Female pattern hair loss (FPHL) has also been called androgenetic alopecia, male pattern baldness in women, and diffuse alopecia. FPHL is a common condition, affecting up to 50% of women. It presents as hair thinning, mainly on the crown, but sometimes also affecting the parietal, posterior vertex and bitemporal areas. There is relative preservation of hair density on the occipital scalp. The frontal hairline is usually preserved. There is often accentuation of the thinning in the midline, just posterior to the frontal hairline (Christmas tree pattern). Rarely, there is deep bitemporal notching and frontal recession similar to male balding.
This pattern of thinning in a woman suggests possible hyperandrogenism. FPHL can occur anytime after puberty, however there are two peaks of onset, in a woman’s 20′s and her mid to late 40′s. FPHL can also occur in association with hormonal changes such as post-partum and perimenopausally. In my experience, the most common time of onset is mid to late 40′s, often in association with other signs of impending menopause. A patient with FPHL often complains of being able to see her scalp, experiencing sunburn on the scalp for the first time or a decreased hair density, particularly affecting the crown. Most patients perceive that their hair loss is occurring in a pattern with sparing of the occipital region although some patients feel that the hair loss is diffuse.
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