Losing Your Hair?
Reviewed By Gary Vogin
Tracy Pittin was just 17 when she discovered that her thick, brown hair was gradually falling out. One day a friend cutting her hair remarked that it was noticeably thinner. Tracy couldn't believe it -- she thought her hair was her best feature, and to begin to lose it at such an early age was devastating. Unable to accept what was happening, Tracy avoided professional stylists -- anyone who might draw attention to the loss. As her hair thinned, her self-esteem declined, too.
"There simply was no information about hair loss or treatments available to women at that time," Tracy says. "It just wasn't talked about." With nowhere to go for help or answers, she went into denial. She told herself the loss was temporary, perhaps related to a crash diet she had tried. But it wasn't, and her hair only got thinner.
Although women in Tracy's position often feel alone, they aren't. According to the American Academy of Dermatology, nearly half of all adults in the U.S. will experience thinning hair by age 40. And while baldness is largely considered a male problem, for every five men who experience hair loss, there are three women who suffer as well. Hair-loss treatments are typically advertised for men, but effective options exist for women, too. But to get them, women must move beyond denying their hair loss and seek help.
Getting to the Root of Things
Determining the cause of the problem is the first step, says Richard S. Greene, MD, co-chairman of Advanced Dermatology Management and managing partner in Skin and Cancer Associates in Plantation, Fla. Greene recommends that women see a primary care physician or dermatologist for a complete workup to rule out any underlying causes, such as malnutrition, hormonal imbalances, or the autoimmune diseases lupus and scleroderma. Sometimes pregnancy, a reaction to a medication, or stress may cause hair to fall out in large clumps; fortunately, this problem usually reverses on its own.
Oddly enough, the most common type of hair loss in women like Tracy -- female pattern baldness -- is caused by testosterone, a hormone we typically associate with men. But women's bodies produce it, too. When testosterone breaks down, a chemical called dihydrotestosterone, or DHT, is created, says Spenser David Kobren, founder and director of The Bald Truth Foundation and author of the book The Truth About Women's Hair Loss. In his book, Kobren explains that in both female and male pattern baldness, DHT attacks the hair follicle, causing it to shrink in diameter and produce smaller and thinner hairs until they become baby-fine or stop growing at all, allowing the scalp to become more visible. This type of hair loss frequently responds to treatment with medications or, in some cases, surgery.
For Tracy, it was a co-worker's casual comment that finally spurred her to take action. Ten years after her hair began to fall out, a male co-worker with thinning hair asked what she did about her hair loss. "Suddenly it felt like someone had ripped my clothes off, and I was standing there in public, naked," she says. "But he did me the biggest favor."
That conversation signaled a turning point for Tracy. The energy she directed toward denying her problem fueled a quest for answers. Tracy's search led to a clinical trial in San Francisco for the then-unreleased drug Rogaine.
When Tracy started using the drug, not only did her hair stop falling out, it started growing back. "While it wasn't a lot, maybe 20%, it meant the world to me," she says. "More important, the drug stopped any further loss."
Treating Female Pattern Baldness
While many products promise to restore lost hair, only two are FDA-approved drugs that have been shown to do so: Rogaine and Propecia. Both interfere with the follicle destruction triggered by DHT. However, these androgen-blocking drugs cannot be used during pregnancy, and for this reason, says Kobren, drug companies are reluctant to market them to women.
A 2% minoxidil solution is approved for use in women by the FDA and is available in drugstores without a prescription. It's a liquid that must be applied to the scalp twice daily. A 5% solution is also available for men but is neither approved for use in women, nor proven to be more effective for them. Therefore, women should likely resist the temptation to buy the stronger formula thinking that more is better.
Keep in mind, too, that if you take the minoxidil route, you'll have to stick with it. "The biggest reason women fail with this treatment is because they stop using it too soon," says Marty Sawaya, MD, PhD, dermatologist and principal investigator of clinical research at Alopecia Research and Associated Technologies in Ocala, Fla. "Women need to adjust their expectations -- they aren't going to look like Lady Godiva in two weeks." Sawaya says women may see some improvement in three months but will need to use the drug for an entire year for full results to show. And to maintain whatever improvement occurs, women need to continue to use minoxidil once a day for life, or the new growth will fall out.
Propecia, the second FDA-approved treatment, is taken in pill form. However, it is not approved for use in women because it may cause birth defects. In fact, the FDA requires warnings against its use in women who are or may become pregnant. Still, doctors often find that Propecia works for women too, says Greene. "Many doctors do prescribe Propecia off-label to women with hair loss, especially those past menopause," he says.
Sawaya, however, warns against the practice for women of childbearing age. "In almost every clinical trial I have worked on, women will say they are on birth control and aren't planning to get pregnant, but every time we find that one or two do get pregnant anyway," she says. Because of the risk of birth defects, she feels women of childbearing age should not take Propecia or even handle it.
What's more, there appears to be no advantage to taking this drug -- it hasn't been proven any more effective than topical minoxidil. And Propecia also takes up to a year to make a significant difference and must be taken for life.
Another option that women like Tracy might consider is hair-transplant surgery. In this treatment, a strip of donor hair follicles is taken from an area of the head not affected by thinning. The strip is then cut into very small grafts, containing just a few follicles each, which are then implanted into small cuts made in the areas of thinning. If all goes well, the transplanted follicles establish a new blood supply and the hair grows. The treatment may take several sessions to relocate enough hair to adequately cover the desired areas, and final results won't be seen for at least a year.
Not every woman is a good candidate for surgery, however. "The problem is that women need to have an area to get the donor hair from," says Greene, who performs hair transplants on women. But because female pattern baldness tends to be diffuse, in many cases the back of the head is often no better than the top or the sides, he says.
"Transplants really are a last resort," says Sawaya. "I recommend that women try more conservative treatments first." Doctors who push a patient toward transplants may have a financial motivation. "Hair transplants are a money maker," Sawaya says.
Both Greene and Sawaya agree that skill and training level from doctor to doctor can vary greatly. For that reason Sawaya recommends that women ask about training, the number of surgeries the doctor has performed on female patients, and rates of success. Even better, talk to a few former patients and see the results in person before agreeing to surgery.
Women should be wary of products that claim to stimulate the scalp, unblock pores, or produce overnight results, says Greene. These products may even provide elaborate pseudo-scientific research to prove they work. But if the FDA hasn't proven them effective, they probably can't stand up to real medical scrutiny, says Sawaya. Save your money.
If you're not game for prescription medications, or surgery, or if you just want to add to the hair you've got, you also can experiment with cosmetic accessories and styles. Tracy, now 43, has used minoxidil for 16 years. She tried a hair weave, where artificial hair is added to existing hair, as part of a makeover. And while she was happy with her hair before the weave, she notices a real difference in the way people respond to her with a full head of thick, auburn hair.
While Tracy doesn't plan to keep the weave -- which requires maintenance every four weeks and can damage the natural hair -- it inspired her to look into other hair augmentation products like wefts (small hairpieces that cover the crown of the head) and falls (hair attached to combs or clips). "Hollywood stars have secretly been using these products for years," she says. "I don't see why we shouldn't be!"
Tracy's final message to women is this: Get treatment if the hair loss bothers you. "Whether you lose 5% of your hair or 55%, it can be devastating. But you don't have to just let it happen -- especially not now."
Originally published Sept. 25, 2000
Updated Nov. 21, 2001
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