When Thea Chassin lived in Los Angeles, she liked to treat herself to great haircuts in Beverly Hills. So when she moved to upstate New York in 1992, her hair style took a hit. “I said, ‘Oh my Lord, I’ve gone back in time like 20 years,'” she says. “The 80s color palette in LA had come and gone, and it was just arriving in Albany.”

It wasn’t until Chassin moved with her family to Westchester County outside New York City four years later that she looked in a three-way mirror and realized the real problem was her thinning hair. “I said, ‘ This is why I can’t style my hair anymore,'” she recalls. “I hadn’t seen what was really going on all the way around.”

Chassin, who’s over 50 years old (she requested to keep her age private), is one of about 6.6 million people in the United States with alopecia areata, an autoimmune skin condition that causes hair loss on the body and head, according to the National Alopecia Areata Foundation.

However, androgenetic alopecia, or female pattern hair loss — the woman’s equivalent to male pattern baldness — is much more common than alopecia areata, affecting about one-third of women who are genetically predisposed to it, according to the American Osteopathic College of Dermatology.

Such conditions can be especially devastating for women, who have fewer viable treatment options and face more social stigma.

“Male pattern hair loss is something that is much more at the forefront of the societal conscious, but for women, it’s a harder thing to deal with,” says Nicole Rogers, a dermatologist at Hair Restoration of the South in Metairie, Louisiana. “A lot of times, women don’t feel comfortable talking about it, they don’t feel comfortable asking their doctors about it, they don’t always get a correct diagnosis.”

That’s why Chassin launched Bald Girls Do Lunch, a nonprofit that provides women with alopecia areata and other types of hair loss with support and accurate information.

“We want to live our own life and not let [hair loss] keep us from doing things,” Chassin says. “Women stop swimming, women stop playing tennis, women stop going on a bike. Why? Because they haven’t figured out how to do it and be comfortable.”

The Long and Winding Road

Chassin first learned she had alopecia areata in 1978 when a hairdresser spotted a bald spot on the back of her head. The condition is characterized by small, round patches of hair loss that come and go unpredictably. At the time, Chassin treated it with cortisone injections — a common short-term treatment for isolated patches — and didn’t think about it again until that moment looking at the three-way mirror. She’s since lost all her head, face and body hair.

For many women with hair loss, however, the path to a diagnosis is more complicated. “I always call it the long and winding road … because there are so many different causes of hair loss in women,” Rogers says. “A lot of times, it’s finding a needle in a hay stack.”

In addition to autoimmune conditions like alopecia areata and run-of-the-mill hair loss related to genetics, female hair loss can be triggered by childbirth, extreme stress, fad diets and going on and off hormonal birth control. Sometimes, these and other lifestyle changes prompt more hair follicles than normal to go into a resting state, in which the loss is called telogen effluvium — a temporary and reversible condition.

Other times, hair loss is a sign of a nutritional deficiency or reaction to hair products. It can also be a symptom of rheumatic conditions like lupus, androgen disorders like polycystic ovaryian syndrome or endocrine conditions like thyroid disease, says Rhoda Cobin,a clinical professor in the endocrinology division at Mount Sinai Hospital.

But for most women, female pattern hair loss is the culprit, though they often cycle through slews of medical providers before realizing it. “The majority of time for women with female pattern thinning, their thyroid is OK, their hormones are OK, their stress is OK — it’s just that it’s in their genes,” Rogers says.

Even in that case, time is of the essence since treatment can help slow the condition’s progression. “The sooner they can get … an accurate diagnosis,” Rogers says, “the better they’re going to be.”

Treatment Options

When women wind up in Rogers’ office, they’re often in tears. “The emotional aspect is a very big deal,” she says. “I can’t tell you how many times I pull out the tissue box when I’m treating female pattern hair loss.”

Many women are so distraught because they believe there’s nothing to do be done. To some extent, that’s true, says Spencer Kobren, founder and president of the American Hair Loss Association and author of “The Truth About Women’s Hair Loss.” “There are a lot of limitations when it comes to treating female pattern hair loss,” he says.

Rogaine, for instance, is the only hair loss treatment for women approved by the Food and Drug Administration, and it acts more like a Band-Aid than a long-term solution, he says. On the upside, a new formula was recently approved that requires one, rather than two, applications a day. “I think it’s a major step forward just to increase compliance,” Rogers says.

Low-level light therapy, hair transplant surgery and off-label drugs are also options, but not particularly effective or well-studied ones for women, Kobren says.

In Kobren’s view, the most promising option involves infusing growth factors from patients’ own platelets to their scalps to help regenerate hair. While the process is currently considered experimental and not covered by health insurance, it has no known adverse side effects and its success rate is about 80 percent at the Greco Medical Group in Sarasota, Florida, says Joseph Greco, a hair transplant specialist and physician assistant who pioneered the treatment in 2007.

“We are seeing more and more females with hair loss, but now we have more solutions, and we have more safe treatments in our bag,” he says. “I really feel that the future is treating patients with their own cells because it’s safe and it’s effective and it’s the most versatile thing in medicine today.”

For women like Chassin who have autoimmune-related hair loss, the options are slimmer. Some choose to try experimental drugs; others opt for wigs. Chassin rotates between stylish hats and scarves, clip-on hair pieces and bold baldness.

“It comes down to when you yourself can just say, ‘You know? I’m still me.'”

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Hair Loss: Not Just a Man’s Issue originally appeared on usnews.com