“How beautiful you are, my love... your hair is like a flock of goats
frisking down the slopes of Gilead.” --Song of Songs 4:1

It is estimated that one in four women in the United States suffers from hair loss. About thirty five million females will experience significant hair thinning or virtual baldness during their lifetime. The averages are actually significantly higher in cultures (such as Persia and Arabia) where women routinely cover their hair, shutting off oxygen and clogging pores. Though men experience baldness more publicly, women experience it with an accompanying stigma of shame and a challenging complication of elusive diagnosis. They are victims of both physiological elusiveness and cultural conditioning.

Femininity is tied to hair. Long, lustrous, shining tresses have been symbols of feminine beauty throughout history. Its praises are sung in Koran and Tanakh; Confucius calls a woman’s hair “the veil of her mystery.” And in the Song of Solomon, that biblical poem of beauty and passion, it is celebrated:

Your head is held high like Carmel
and its plaits are as dark as purple;
a king is held captive in your tresses.
How beautiful you are, how charming,
my love, my delight! --Song of Songs 7:5

Ultimate symbol of grace and beauty, a woman’s hair is touted as her “crowning glory.” But what happens when the crown slips? And why is the stigma more severe for women?

For men, male pattern baldness is common, accepted, and though not always welcome, it lacks the extreme trauma experienced by women who suffer hair loss. Part of this is, of course, cultural. But part of it is a result of the nature of the actual thinning of the hair. In men, baldness occurs gradually, generally localizing on top of the head and working its way backward in a steadily increasing recession of hairline. In most women the hair becomes increasingly thinner over the entire top of the head, showing a each individual hair more starkly. The appearance is similar to the loss experienced by cancer patients as a result of treatments. According to a study by Forbes Magazine and Rogaine, many women will miss work, refuse social engagements, and generally hide from the public eye as a result of severe hair loss. Depression is a common result.

One of the problems in dealing with female hair loss is that women tend to be less forthcoming in telling a physician about the problem. They are embarrassed, feel that it is trivial, or are simply unaware that it is often treatable. A dermatologist, or in some cases endocrinologist, can generally examine the hair, loss patterns, and other factors and ascertain the reason for thinning. In some cases hair styling practices-- such as teasing, over-spraying, or coloring with harsh chemicals, can be the culprit. In almost all cases these practices-- which are generally the first line of defense women seek out-- are harmful.

Aging, heredity, and stress are also factors in hair loss among women. As male hormone levels increase in older women hair often thins. Pattern baldness is generally seen in women who had mothers with the problem. And stress is a known cause of hair loss in both genders, though it should be temporary. Permanent thinning or baldness is usually caused by one of three factors: female pattern baldness, shedding, and allergic immunologic hair loss.

Female pattern baldness, like male pattern baldness, is genetic. It usually surfaces when women are in their 30s or 40s and resembles male baldness, a general thinning on the top of the head. Though Rogaine and other topical treatments seem to show some “baby hair” regrowth, it is not seen as significant. Most women suffering from this condition opt for transplants or wigs.

Shedding occurs when telogen hairs-- those in the resting phase of the normal hair-growth cycle-- are subjected to various traumas including childbirth, serious illnesses, or even dieting they may remain dormant for longer periods and fall out. This occurs two to four months after the event. Shedding is not permanent and the hair will grow back.

Allergic immunologic hair loss is also not permanent and occurs, often, as a result of stress. It involves, usually, a localized “spot” of hair falling out and is most likely the result of autoimmune reactions in the body in response to medical changes, stress, or trauma. The hair will grow back.

Currently transplantation procedures are being recommended for women with permanent hair loss that is not responding to treatment. These procedures are expensive and not routinely covered by insurance. Recently the drug Tagamet, generally prescribed for stomach ailments, has shown some promise in treating pattern baldness. A drug called Diane25, which is commonly used to treat acne, has been prescribed for some other alopecia cases with moderate success.

The psychological suffering women undergo when they lose hair-- even temporarily-- is severe. When it happens it is important to remember that often the loss is only temporary, and in those cases, it is also treatable. Talk to a dermatologist or endocrinologist; get a recommendation from your general practitioner. In those cases where hair loss is going to be long-term, aggressively seeking treatments and styling options early makes the long journey less stressful, more manageable, and less traumatic.

Though our tresses-- which we fuss over and flaunt even in this modern age-- may be closely tied to our feminine selves, they are not the source of our womanhood. Thinning hair, whether temporary or permanent, is certainly unpleasant, even traumatic. But we live in a society of options: wigs, weaves, transplants, even masculine crew cuts. The important thing for women suffering any form of hair loss is to empower themselves with information, proactive treatment, and personal choices rather than giving in to the shame.