Women lose hair on an inherited (genetic) basis, too, but female pattern hair loss tends to be more diffuse, with less likelihood of the crown and frontal hairline being lost. Although some women may notice hair thinning as early as their 20s, the pace of hair loss tends to be gradual, often taking years to become obvious to others. There seems to be a normal physiologic thinning that comes with age and occurs in many women in their early to mid-30s. More women have underlying causes of hair loss than men. These include treatable conditions like anemia and thyroid disease and polycystic ovary syndrome (PCOS). These conditions are diagnosed by blood tests along with a historical and physical evidence. Although a few studies have suggested that baldness may be inherited through the mother’s family genes, these theories require further testing. Current studies are inconclusive. Although not indicated for female pattern balding, spironolactone (Aldactone) has had some success in treating this condition.
While stories about hats choking off follicles or long hair pulling on the roots may be more folklore, repeat hair trauma like tightly woven hair pulled back and consistent friction can potentially worsen or cause localized hair loss in some individuals. Individuals who pull their hair tightly back in a rubber band can develop a localized hair loss at the front of the scalp.