Treatment of Female Pattern Hair Loss

It’s been a little while since I’ve done a blog post. The last blog post was on Female Pattern Hair Loss, a very common and distressing entity.  Though the the true cause of FPHL has not been completely determined, it certainly has more medical (non-surgical) treatment options than Male Pattern Hair Loss.

Medical Management of Female Pattern Hair Loss

The medical management of FPHL can be categorised into two types: Topical and Oral.

Topical Treatment of Female Pattern Hair Loss

Topical Minoxidil (Rogaine)

Like Male Pattern Hair Loss, FPHL is treated with the agent Minoxidil. The dose recommended for women is the 2% solution used twice daily or the 5% foam (available only in the brand Rogaine)  once daily. To be honest, most hair loss experts like to use the 5% solution or foam twice a day as it just seems to work better. The real problem lies in one of the side effects which is excessive hair growth (hypertrichosis). It is more likely to occur in women and with the 5% concentration used twice daily. To combat this, it is best to decrease the dosing to once a day or once alternate day. Again, like with Male Pattern Hair Loss, it takes 4-6 months with continuous use, to see the benefits.

Oral Treatment of Female Pattern Hair Loss

This medical management of Female Pattern Hair Loss is has many more options for women. Men only have Finasteride (Propecia) available for use, while women typically have four major agents available. Most of these agents are anti-androgen or anti-male hormone, HOWEVER, most women with Female Pattern Hair Loss have been found to not have excessive male hormones. The interest thing however, is that they still respond to the use of these agents. Why this is so, is still being determined scientifically.

Finasteride (Proscar/Propecia)

Finasteride is also used for Female Pattern Hair Loss. This agent is a 5 alpha reductase antagonist. This therefore blocks the formation of dihydrotesterone from testosterone, stopping the more potent androgen from acting on the hair follicle. The optimal effect is at a much higher dose than what is used in men. Again, like with men, it takes about 4 months to see the benefit.

It is not recommended in women who plan to get pregnant. Persons who are in that stage of their life are advised strongly to not get pregnant whilst on the drug as because it is an anti-  male hormone drug, it potentially could affect male foetuses. It however, does not stop someone from getting pregnant. In fact we advise persons to try starting conception at least 1 month after stopping the medication.

Dutasteride (Avodart)

This is another 5 alpha reductase inhibitor. However, it is more potent as an anti-androgen as it acts on two forms of the enzyme that converts testosterone to dihydrotestosterone. It is a newer agent that is use off-label mainly for post-menopausal women as it stays in the body for a much longer time than Finasteride. Again, the time to see a difference is up to 4 months of using the medication continuously.

Spironolactone (Aldactone)

Spironolactone is an anti-hypertensive diuretic aka a “water pill” that promotes loss of Sodium in the urine to help aid in dropping the Blood Pressure. It, at a low dose has been used for this indication in both men and women for more than 50 years. At much higher doses, it  has anti-male hormone effects. Again, it takes 4 months to see any difference.

It is used more in women with an underlying cause of Female Pattern Hair Loss such as Polycystic Ovarian Syndrome (PCOS). It can reduce body hair on the chin and chest BUT it increases the growth of hair on the head. It is used more in pre-menopausal women.

This medication is used a lot in the United States where Diane 35 is not available.

Cyproterone acetate (Androcur)

This is another anti-male hormone medication that has been used in pre-menopausal women. It is present in low doses in certain contraceptive pills such as Diane 35 which is found in many countries other than the United States.  For effective control of hair loss, Androcur is used because it is at a higher dose. Again, women are advised not to get pregnant whilst taking the medication.

Flutamide

This is another anti-androgen medication that is available in the arsenal of medication for Female Pattern Hair Loss. The problem with this medicaiton is that it can cause severe liver toxicity. Most use this as a last resort.

To get optimal effects, a combination of topical and oral modalities is preferred especially since in women the true nature of the cause of Female Pattern Hair Loss is not known.

 

Surgical Management

Like with Male Pattern Hair Loss, sufferers of FPHL can also benefit from hair transplantation. However, women can be poorer candidates than men because their hair loss tends to cover a much larger area from very early. It is quite a successful operation as more than 95% of the transplanted hairs will grow and stay. The main problem is that the original hairs surrounding the transplanted hairs are still being affected by Female Pattern Hair Loss. These hairs will have to be addressed using some sort of medical management or the person will have to end up doing more than one hair transplant in their lifetime. Hopefully hair cloning will be successful and will be available in the future.

Treatment of Female Pattern Hair Loss can be quite tricky, however, the results can be so life changing for women who suffer from this condition.

 

 

 

 

 

 

 

 

 

 

 

Treatment of Male Pattern Hair Loss

Treatment options for Male Pattern Hair Loss are quite limited. With more men seeking treatment, and plenty start suffering from hair loss at quite young ages, more research is being placed on reversing or slowing this frustrating condition.

Treatment of Male Pattern Hair Loss are mainly divided in to three: Topical, Oral, and Surgical

Topical Treatment of Male pattern Hair Loss

Topical Minoxidil

This is the mainstay of treatment for Male Pattern Hair Loss. Studies have shown that 5% Minoxidil prolongs the anagen phase and thickens the hair fibre. The exact mechanism by which it does this is still unknown. It takes 4-6 months before results can be seen. It is up to 60-70 % effective in the crown and 30-40% effective in the front of the scalp. The brand is Rogaine and it comes in 2 forms- solution and foam. There are many generic brands available and quite a few countries that provide it OTC.

In  Europe, OTC caffeine based products are available in shampoo and lotion form. Caffeine has been shown to increase the anagen phase. The studies have been found to be encouraging.

Oral Treatment of Male Pattern Hair Loss

The two main medications used are Finasteride and Dutasteride. Both are used off-label from their intended use, which is for the treatment of Benign Prostatic Hypertension.

Finasteride (Propecia or Proscar) help to stop the conversion of Testosterone to Dihydrotestosterone by the enzyme 5 alpha reductase. Fiansteride takes up 4 months before results can also be seen. It has a slightly greater efficacy compared to Rogaine. Together with Minoxidil, there is increased benefit to the patient. Most persons can start off with Minoxidil and Finasteride added to see if there is any more improvement.

Dutasteride (Avodart)  is a more potent form of Finasteride because it acts on the many forms of the enzyme. It is 95% effective compared to the 50-70% seen with Finasteride. However, it has 5 times more the effects of side effects compared to Finasteride. The main concerns for both Finasteride and Dutasteride include: decreased libido, decreased power of orgasm/ejaculation,  erectile dysfunction, and depression. For Finasteride, this is quite low, but much higher in Avodart. The side effects usually go away after cessation of the medication, however, it should note that many men who start this medication are already at risk of having these issues.

Surgical Treatment of Male Pattern Hair Loss

The ultimate treatment of this condition is Hair Transplantation. It involves permanent removal of hair from the back of the scalp, which is less likely to be affected by the condition. These are then transplanted to the front of the scalp and will take and grow keeping their inherent properties from where they are coming from.  There are two main types: Follicular Transplant (strip harvesting that leaves a visible scar) and Follicular Unit Extraction (individual harvesting of hair follicles). Hair growth is not immediate. It takes about 4-6 for the transplanted hairs to start growing, and up to a year for it to be noticeable.

Surgical treatment is limited to how much hair is present in the donor site. There are many factors that can cause decreased hair growth. However, up to 99% of the hairs transplanted usually grow.

 

Treatment of Male Pattern Hair Loss is limited but promising as there are many new treatment therapies such as Stem Cell Therapy are actively being investigated.