Feature Archive

Hair Loss In Women: Treatments That Work

What works for men may work just as well for women.

By Colette Bouchez
WebMD Feature

Reviewed By Charlotte Grayson

You can style, spray, tease, mousse, and gel to your heart's content. But when your brush begins to hold nearly as much hair as you have on your head, all the styling products in the world won't do you much good.

The problem -- if haven't already figured it out -- is hair loss, and today, women are nearly at the same risk as men.

The good news: New treatment options can make a major difference. While the first step is always to have the cause of your hair loss diagnosed by an expert (a dermatologist is a great place to start), once that cause is determined, there are a variety of medications and treatments that can help -- some developed especially for women.

Among the most popular is the FDA-approved over-the-counter topical preparation minoxidil (Rogaine). Originally developed as a treatment for male pattern balding, it works for women as well, helping to enlarge and lengthen the hair follicle. Though it may do little to grow more hair, it can extend the growth phase and thus can help you to keep the hair you do have, longer.

Over-the-counter minoxidil comes in two strengths -- a 2% solution for women and 5% solution for men. But experts say women may see better results with the stronger preparation. "The 2% solution is way too weak for female pattern hair loss -- you really need to use the 5% solution to get results," says Michael Reed, MD, professor of dermatology at the NYU School of Medicine in New York City.

A study in the April 2004 issue of the Journal of the American Academy of Dermatology compared 48 weeks of treatment with 2% and 5% minoxidil in women with female pattern hair loss. Compared with placebo, 5% minoxidil was superior in regards to hair count and patient and researcher evaluations of hair growth. While the 2% solution improved hair count and researchers' assessments of hair growth, the patients did not appear to notice a significant improvement in hair growth.

Overall, both doses were well tolerated by the 381 women in the study without serious side effects. However, there were more side effects with the 5% solution -- more itching and irritation as well as hair growth in areas other than the scalp, such as on the forehead.

"If you do have female pattern balding, the recommended treatment is minoxidil, and generally we recommend 5%, the one approved for men, because it is much more effective than 2%," says Ted Daly, MD, of Garden City Dermatology and the Nassau Community Medical Center in East Meadow, N.Y. "The reason it is not approved for women is because a very small number may grow hair on the edges of their forehead, but if that happens, we cut it down to the lesser strength, and when we do that, it goes away."

Be aware, however, that in higher concentrations minoxidil is likely to cause scalp irritation, itching, and dryness -- problems that are often remedied by customized minoxidil preparations available in doctors' offices.

For Men Only?

Reed says what is far more likely to help women are "off-label" medications -- drugs approved for other problems, or strictly to treat hair loss in men.

Among the most popular is the decidedly "male" medicine finasteride -- a drug originally developed to treat prostate disease and later, hair loss, in men. Prescribed under the names Propecia (1 mg strength) or Proscar (5 mg strength), they are known as enzyme blockers and they work by interfering with the process that converts testosterone to DHT in the hair follicle. Both drugs are pills that are taken orally.

Although both drugs have been shown to be dangerous to a fetus -- hence, approved by the FDA for use only in men -- experts say that in selected women they can be a real hair saver.

"Both can be safely used in women who can't or won't become pregnant -- and it does help retard hair loss and will even help regrow hair in some women, if it's used long enough and in high enough doses," says Reed.

Side effects include heavier growth around the hairline, but that is reversed when the drug is either discontinued or the dosage lowered. It also has been known to have a slight effect on libido, causing some women to experience a reduced desire for sex.

Still another available treatment is the pill Aldactone (spironolactone), a diuretic and testosterone inhibitor, which works by impacting the enzyme receptors in the hair follicle, thus stopping the cycle of androgen-related hair loss. While it works well for some women, it can cause breast tenderness and other annoying side effects.