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Hair Loss In Women

Most of us care a great deal about our hair.  We grow it, cut it, wash it, condition it, style it, brush it, comb it, primp it, curl it, straiten it, relax it, dye it, perm it, braid it, etc. etc.  We may even describe our day by it…. with a ‘good’, or ‘bad’ hair day.

With so much time, effort, and money spent on a healthy head of hair, it is no wonder that hair loss in women can be unexpected, frustrating, and devastating for both self image and emotional well being.  Though most of us picture a man when we think of  “balding,” women actually make up forty percent of hair loss sufferers, affecting some 30 million women in the United States.

There are many reasons why women may lose hair, and it is very important to determine the reason for the hair loss.  Here, we will discuss only the most common type, called female pattern hair loss.

Female Pattern Alopecia (Androgenic Alopecia)

Female pattern alopecia is the most common type of hair loss in women.  Thinning is noted predominantly over the top and front of the scalp, as shown in the illustration below.  The process is gradual, and patients often notice an increase in the number of hairs they are losing in their brush, shower drain, and pillow.  This type of hair loss has a strong genetic predisposition and can be inherited from either parent.

ludwig chart

The cause of this type of hair loss is related to hormones.  Testosterone is converted to dihydrotestosterone (DHT) with the help of the enzyme 5-alpha reductase found in the hair’s oil glands.  DHT then binds with receptors deep within the hair follicle, altering the growth phase of the hair and causing the follicles to shrink.  Why does this happen?  Genetics play a strong role, but other factors that may stimulate female pattern hair loss include ovarian cysts, some birth control pills, pregnancy, and menopause.

What treatments are available for female pattern hair loss?

Before deciding on a treatment plan, the most important thing to do is obtain an accurate diagnosis.  Sometimes, hair loss can be diagnosed simply by clinical examination.   Other times, additional studies may be required.  Your doctor may choose to order blood tests looking at your hormones (DHEAs, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone), as well as other labs like iron, ferritin, thyroid hormones, blood count, and a VDRL (to check for syphilis).  At times, a scalp biopsy – where a small piece of skin from the area of hair loss is removed, and examined under a microscope – may be suggested.

Once you have determined the cause of the hair loss, it is important to start treatment as soon as possible.  The sooner you start, the sooner you will be able to help protect the hair you still have, and achieve the best results possible. 

Minoxidil 2% Topical Treatment

Minoxidil is the only FDA approved medication available for female pattern hair loss.  It is available in two strengths – 2% and 5%.  Only the 2% version has been approved by the FDA for use in women, but many dermatologists will recommend the 5% when used under their supervision.  The medication is inexpensive when purchased generically, and can be obtained in either a liquid or a foam.

Beyond Minoxidil 

Beyond Minoxidil, there are several non-FDA approved medications that one can consider utilizing to help treat female pattern alopecia.  These include Androgen Receptor Inhibitors (ie: Spironolactone), hormone replacement therapy, oral contraceptives (especially those with a low androgen index), ketoconazole (an antifungal medication that has anti-antrogenic effects), propecia, and in Europe Cyproterone Acetate with Ethinyloestradiol (Diane 35 and Diane 50).  Topical retinoids, prostaglandin analogues, and cyclosporine can also be beneficial in the right patients.  Some of these products can be used topically, and many can be compounded on an individual basis as needed.  We will not discuss these further here, as they are not currently FDA approved for the treatment of female pattern hair loss and their use needs to be carefully tailored to patients’ needs after the risks and benefits have been reviewed on an individual basis.  We mention them only to let you know that there are lots of options, and your doctor will be able to help you choose the best options with you. 

To supplement medical therapy, there are many things that you can do to camoflauge thinning hair and hair loss.  Two of our favorite cosmetic products are called toppik hair building fibers & DermMatch.  Toppik is a product that sprays keratin fibers that stick to the hair making each individual hair appear thicker – and your scalp appear fuller.  DermMatch is more like a mascara for the scalp.  It is slightly more water resistant, and recommended for active women who want cosmetic protection to last during their workout.  Both product washes out in the shower, and does not stain or change the color of the skin of your scalp. 

Wigs, extensions, weaves, scarves, and hats are all available to those who want to disguise their hair loss.   Be mindful of extensions and weaves – that they not be too heavy for your living hair.  We often see patients who end up destroying the hair that they have left by putting too much weight and traction on them.

What procedures are available?

Hair transplantation is an outstanding procedure that many women with female pattern hair loss may benefit from.  It is unfortunate that this procedure is often considered by men and overlooked by women.  The procedure is time consuming and can be expensive, but the results can be long lasting and dramatic.  In this procedure, a strip of hair is harvested from the back of the scalp.  Individual hairs are then dissected and planted one by one into the areas of thinning and hair loss.

On the Internet, there is much discussion of “cold laser”  or “Low Level Laser Therapy” for hair restoration.  We raise a flag of caution when considering these devices, as to our knowledge there are no studies that have demonstrated their efficacy. 

Are there new cures coming down the pipes?

There are some exciting products in the works.  For example, Allegran, the maker of botox, is thought to be working on a version of prostaglandin analgoues to promote hair growth.  Currently this medication is available in the form of eye-drops to treat glaucoma, but there is no formulation specifically designed with the use of hair growth in mind. 

Another product in the pipeline is Glaxo’s drug Dutasteride, called Avodart. Similar to Propecia, dutasteride is a 5-alpha-reductase inhibitor taken as a pill, but while Propecia blocks only type-II 5-alpha-reductase enzyme, Dutasteride has been shown to effectively block both type-I and type-II 5-alpha-reductase.  This medication has a promising future in the treatment of androgenic alopecia.

There are lots of products on the Internet for hair loss in women.  Are they legit?

There are lots of products out there, and when you read about them on-line many sound really good.  Are they?  For the most part, look at them with a skeptical eye.  Remember that if a product is truly miraculous – doctors and scientists will realize it, study it, publish it, and the product will become quickly become widely known as being efficacious and safe. 

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