female pattern hair loss Archives -

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.

Female Pattern Hair Loss

Female Pattern Hair Loss is more common than people think. With men, the hair loss is quite obvious. For women, Female Pattern Hair Loss presents with general thinning across the top of the scalp and may take years before it is quite evident.

What causes Female Pattern Hair Loss?

The exact cause of Female Pattern Hair Loss has not been delineated. Unlike Male Pattern Hair Loss, where excess of Dihydrotestosterone (a male hormone) has been shown to be the main causative factor, there has been no direct association with hormonal imbalances in women. In fact, most women with this condition have normal levels of androgens (male hormones). Female Pattern Hair Loss does worsen after menopause, giving some the theory that there could be a role for a relative decrease in oestrogen, and consequently relative rise of androgens, cause hair loss.

There is, however, an inheritance pattern. Like men, women can inherit Female Pattern Hair Loss from either their mother or father. The number of genes inherited will determine how thin the hair becomes.

Presentation of Female Pattern Hair Loss

For most women, they will find that their centre part will be wider than usual. In general, they will find that the top and crown of their scalp is quite thinned out. For some they may have a more “Male Pattern” type of hair loss, with thinning and recession to the temples. The staging system used is the Ludwig Classification:

ludwig

Next month : Treatment

Pattern Hair Loss

First in our series on non-scarring hair loss is the ever pervasive Pattern Hair Loss or Androgenetic Alopecia. It is mostly an inherited condition affecting up to 40% of women by menopause, and up to twice that amount in men by age 50.

Pattern Hair Loss presents differently between men and women. Women tend to have generalised thinning to the top and sides, whilst men start off with thinning at the temples eventually ending with the “horse shoe” shape that is often dreaded.

The cause of Pattern Hair Loss, though largely known, is still being determined. In men it is due to excessive sensitivity to the male hormone dihydrotesterone. In women, male hormones are not seen as a major factor, however, the exact mechanism is yet to be determined. In fact, it has been postulated that there are other non-hormonal factors which may contribute to Pattern Hair Loss in both men and women.

As it is a genetic disorder, there is no permanent cure for Pattern Hair Loss. Gene therapy, ideally the perfect treatment, has not been developed for the condition. The best that is available today is hair transplantation. In the near future, stem cell therapy will likely lead the way. For most, topical Minoxidil is the best option in addition to oral therapy with Finasteride and other anti-androgen medications are useful.

Next month: Male Pattern Hair Loss- Cause and Staging

Question of the Month – January

questiontext

Dear Doc,

I just had a baby boy and I got the same hair loss that I had after my first pregnancy. I expected that, but this time I noticed that my hair did not grow back the same way. It looks thinner in the front. What’s up with that? What can I do to stop this?

Concerned Mama

answertext

Dear Concerned Mama,

Congrats on your second child!

Yes you have experienced the typical Postpartum hair shedding also known as Telogen Effluvium. During your pregnancy almost all of your hairs are in the anagen (growing) stage of hair growth. This is due to the high levels of the hormone oestrogen in the body which is known to keep the hair in the growing stage longer. As soon as your hormone levels go back to normal after delivering your baby boy, your hair follicles converted back to the regular 90% anagen :10% telogen. The telogen stage is the resting stage, the stage right before the hair falls out. What happens in some women is that this shedding can reveal latent or hidden Female Pattern Hair Loss (1) resulting in decreased density in their hair at the front of your scalp right behind their hairline. Some of their hairs have grown back in smaller, finer and thinner. Their parts look much bigger than usual and they see more scalp. Look at your family members. Do all the men have hair? Do the women have thin hair as well? If so, this is unfortunately showing up in you as well.

So what can you do about this? If you’re not breastfeeding, you can try topical 2% or 5% Minoxidil (Rogaine is a brand) twice a day. It is available over the counter in a lot of countries. If after four to six months you do not see an improvement you may need to visit a doctor to see whether or not you may need oral medication to help slow down your hair loss.

(1) Birch, M. P., Lalla, S. C. and Messenger, A. G. (2002), Female pattern hair loss. Clinical and Experimental Dermatology, 27: 383–388. doi: 10.1046/j.1365-2230.2002.01085.x