FPHL (Female Pattern Hair Loss) and MPHL(Male Pattern Hair Loss) are both types of androgenetic alopecia, but they differ primarily in their patterns of hair loss, onset, and genetic influences.
1. Pattern of Hair Loss:
FPHL: In women, hair loss typically occurs more diffusely across the scalp, particularly along the crown and top, without receding hairlines. Women may notice thinning or widening of the parting. The hairline often remains intact, and the frontal hairline is usually not affected.
MPHL: In men, hair loss often starts at the temples or the crown, with a receding hairline forming an "M" shape. Over time, the hair loss can progress to baldness at the crown, leaving a ring of hair around the sides and back of the head (male pattern baldness).
2. Onset:
FPHL: Female pattern hair loss often begins later in life, typically after menopause, though it can start earlier. The progression is generally slower compared to men.
MPHL: Male pattern hair loss typically begins earlier, often in the late teens or early twenties. It can progress more quickly and is usually more pronounced.
3. Hormonal Influence:
Both conditions are influenced by androgens (male hormones like testosterone), but women with FPHL may have a more complex interaction of hormones, including estrogen fluctuations. In contrast, men with MPHL have a direct sensitivity to dihydrotestosterone (DHT), a derivative of testosterone, which causes hair follicles to shrink.
4. Genetics:
Both FPHL and MPHL are genetically inherited, but the genetic factors may differ slightly in terms of how the traits are passed down. MPHL is more strongly linked to the X chromosome, which men inherit from their mothers, while FPHL involves more complex genetic and hormonal interactions.
5. Emotional and Psychological Impact:
FPHL tends to have a more profound psychological impact on women due to cultural associations with female beauty and the social significance of hair. Although men also face psychological effects, the societal expectations of masculinity may influence how MPHL is perceived.
In summary, while both FPHL and MPHL involve genetic predisposition and androgen sensitivity, the key differences lie in the pattern of hair loss, the age of onset, and the hormonal and genetic factors involved.
The investigation of Female Pattern Hair Loss (FPHL) involves several steps, including a thorough clinical evaluation, laboratory tests, and sometimes imaging studies, to differentiate it from other causes of hair loss and to assess its severity. Here's an outline of the investigative process:
1. Clinical History:
Onset and Progression: The patient’s history is crucial, including the onset of hair thinning, rate of progression, and any triggering events (e.g., pregnancy, menopause, medication use, or stress).
Family History: A detailed family history is important, as FPHL is often hereditary. Investigating patterns of hair loss in female and male relatives can provide clues.
Menstrual History: Since hormonal fluctuations can contribute to FPHL, information about menstrual cycles, menopause, and hormone replacement therapy is helpful.
Associated Symptoms: It’s important to note if there are any other symptoms such as scalp itching, inflammation, or shedding of large amounts of hair, which might suggest other conditions.
2. Physical Examination:
Pattern of Hair Loss: Examination of the scalp helps determine the pattern of hair thinning. In FPHL, thinning usually occurs in the crown and mid-scalp, with minimal or no recession of the hairline.
Scalp Condition: The scalp should be examined for signs of other conditions like seborrheic dermatitis, alopecia areata, or scalp infections that might cause hair loss.
Hair Pull Test: This test helps assess the shedding rate of hair. If more than 5-10 hairs come out with gentle traction, it may indicate active hair shedding.
3. Differential Diagnosis:
The investigation aims to rule out other potential causes of hair loss. Conditions that should be considered include:
Telogen Effluvium: A temporary hair loss often triggered by stress, illness, or medication.
Alopecia Areata: An autoimmune condition causing patchy hair loss.
Hypothyroidism: Underactive thyroid can cause hair thinning.
Iron Deficiency: Anemia can lead to thinning hair.
Polycystic Ovary Syndrome (PCOS): Can lead to hormonal imbalances and hair thinning.
Chronic Telogen Effluvium: Prolonged hair shedding due to various factors.
SLE
Dermatomyositis
Anorexia/bulimia
Psychiatric- eg Trichotillomania
Medications
Infection eg syphilis
Diabetes
4. Laboratory Tests:
While FPHL is largely a clinical diagnosis, laboratory tests can help exclude other conditions: (we will decide if blood tests will be useful.)
Thyroid Function Tests: To rule out hypothyroidism, which can contribute to hair thinning.
Serum Ferritin Levels: Low ferritin (iron stores) can be a cause of hair thinning.
Complete Blood Count (CBC): To detect anemia or other systemic conditions.
Hormonal Testing: Measurement of androgens (such as testosterone, DHEAS) and other hormones (e.g., estrogen, prolactin, LH, FSH) to rule out conditions like PCOS or adrenal disorders.
Vitamin D Levels: Low vitamin D has been implicated in hair loss in some individuals.
ESR, ANA, RF : to exclude connective tissue disorders
blood sugar levels, lipid levels, B12 levels, zinc and calcium are also tested.
5. Scalp Biopsy (if necessary):
In cases where the diagnosis is unclear or if there is uncertainty about the cause of hair loss, a scalp biopsy may be performed. A small sample of scalp tissue is taken and examined under a microscope. This can help differentiate FPHL from other forms of alopecia, such as alopecia areata or scarring alopecia. In FPHL, the biopsy might show miniaturized hair follicles (a hallmark of androgenetic alopecia) and a decreased number of terminal hairs.
6. Dermatoscopy:
Scalp Dermatoscopy (trichoscopy) is a non-invasive technique that allows for the visualization of hair and scalp characteristics under magnification. In FPHL, dermatoscopy may show:
Thinning or miniaturized hairs
Increased proportion of vellus hairs (fine, thin hairs)
A widening of the central parting
Punctate (dot-like) hemorrhages or follicular miniaturization
7. Imaging Studies (rarely needed):
In some cases, a trichogram or phototrichogram (where hair counts are taken at specific scalp locations over time) can be used to assess hair density and shedding patterns.
8. Assessing Severity:
The severity of FPHL is often assessed using clinical scales, such as:
Ludwig Scale: This is a common tool used to grade the severity of hair loss in women. It has three stages, ranging from mild thinning to severe thinning with bald patches.
Savill Scale: Another tool used to assess the extent of hair loss in women.
9. Referral to a Specialist:
If the diagnosis is unclear or if there is a suspicion of underlying systemic conditions, referral to a dermatologist may be necessary for further management and diagnosis.
Treatment options
Could include topical or oral minoxidil, and various hormonal medications, and then there is hair restoration and adjunctive options such as Emcyte PRP, and peptide therapy.
Conclusion:
The investigation of FPHL is largely clinical, relying on history, physical examination, and the exclusion of other causes of hair loss. In many cases, no invasive testing is required unless the diagnosis is uncertain or there are concerns about other underlying conditions. Managing FPHL involves both diagnostic clarity and understanding patient expectations, as treatments are often focused on managing the progression of hair loss rather than fully reversing it.