Hair Loss In Women: Treatments That Work

Last Editorial Review: 5/4/2005

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.

Other Options

In addition, Reed says women should be aware that most specialists treating hair loss have special preparations that can reduce many of the side effects of the over-the-counter or prescription drugs by suspending them in milder preparations. In addition, most also have customized formulations that combine two or more significant ingredients, and often add natural "hair helpers" such as zinc and biotin, to increase effectiveness.

"This is why it's important that a woman visit a specialist in female pattern hair loss, because she is likely going to need some of these specialized preparations in order to obtain optimum results," says Reed.

Lastly, Ricardo Azizz, MD, reports many women have found help through the use of estrogen-dominant birth control pills -- oral contraceptives that work by overriding the high levels of testosterone and flooding hair follicles with enough female hormones to keep testosterone-related hair loss from taking place.

"Most birth control pills function similarly, but we do try to avoid the super low-dose pills because we want more estrogen," says Azizz, director of the Center for Androgen-Related Disorders at the Cedars Sinai Medical Center in Los Angeles. Among the brands favored by hair loss specialists include Yasmin, Demulen, Desogen, and Orthocyclen.


It is normal to lose 100-150 hairs per day. See Answer

While a rumor has long persisted that birth control pills can actually cause hair loss in some women, Azizz says it's just not so.

"Birth control pills can cause a temporary change in the hair growth and shedding pattern, so if you are suffering from a non-hormonal cause of hair loss, and you take oral contraceptives, they might aggravate the loss, but they won't cause the loss," says Azizz.

Hope For The Future

Among the latest buzz in the alopecia (hair loss) community is a unique new process for regenerating hair growth via the formation of new hair follicles. Known as "follicular neurogenesis," it is a kind of cloning that attempts to generate "hair seeds" that may ultimately help new follicles to grow.

"Essentially the method takes a sample of your hair, sends it to the lab where the follicles are microdissected, and the cells the body uses to make hair are extracted and isolated," says Reed.

Those cells, he says, are then purified and cloned to make many cells, which are then microinjected back into the balding area where they will hopefully cause the cells to make more hair follicles.

While the system is still under development, Reed says that realistically it's many years from having a clinical application. In one study, published in Nature in 1999, a similar cloning system was shown to work on rodents. But to date, Reed says those specific results have not been duplicated.

A lot closer to reality is treatment with the drug Avodart (dutasteride), a cousin to the already popular finasteride (Propecia and Proscar) and also originally developed to treat prostate disease. The big difference, however, is that while finasteride helps block one enzyme involved in the conversion of testosterone to DHT, Avodart appears to block two -- and that may be a real boon to women.

"Propecia reduces body levels of DHT 50%-55%; Proscar reduces it 65%-70%, but Avodar reduces it up to 94% -- so the gain here is significant," says Reed.

Although still considered highly experimental for female pattern hair loss, it is currently being used in small in-office trials, and only in selected women who cannot get pregnant. Reed, who is one of the doctors testing the drug on women, says it is being tried on those patients for whom Proscar didn't work after one or more years of treatment. He is optimistic about the results thus far.

"It may turn out to be the best enzyme blocker for women we have," says Reed.

Finally, while hair transplants for men have long been considered a staple treatment, they were rarely considered appropriate for women -- mostly for cosmetic reasons. However, reporting in the November 2003 issue of the Journal of the American Academy of Dermatology, doctors from the Mount Sinai Medical School in New York City say that advances in transplant technology -- including less scaring -- combined with more realistic expectations, are now making this a viable option for women as well.

Rather than removing plugs of hair one by one and transplanting them to a different area of the scalp, the current techniques remove an entire strip of hair, then dividing it into smaller sections that are surgically placed precisely where the hair is needed -- even in between hairs that are still growing naturally.

Still, the experts advise that women should consider hair transplants only after a trip to a dermatologist, a diagnosis, and at least one round of treatment with medication.

Reviewed by Charlotte E. Grayson, MD.

Published December 2003.

SOURCES: Ted Daly, MD, Garden City Dermatology and Nassau Community Medical Center, East Meadow, New York. Michael Reed, MD, professor of dermatology, NYU School of Medicine, New York. Ricardo Azizz, MD, director, Center for Androgen-Related Disorders, Cedars Sinai Medical Center, Los Angeles. Nature, April 1999. The Journal of The American Academy of Dermatology, November 2003.

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