Spironolactone for hair loss

Treating female pattern hair loss

Noticeable hair loss in women can be deeply distressing. Here are some medical treatments that may help.

Updated: November 14, 2018Published: June, 2009

About one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair thinning or bald spots. Hair loss in women often has a greater impact than hair loss does on men w, because it’s less socially acceptable for them. Alopecia can severely affect a woman’s emotional well-being and quality of life.

The main type of hair loss in women is the same as it is men. It’s called androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic “M” shape; hair at the top of the head also thins, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman’s hairline rarely recedes, and women rarely become bald.

There are many potential causes of hair loss in women , including medical conditions, medications, and physical or emotional stress. If you notice unusual hair loss of any kind, it’s important to see your primary care provider or a dermatologist, to determine the cause and appropriate treatment. You may also want to ask your clinician for a referral to a therapist or support group to address emotional difficulties. Hair loss in women can be frustrating, but recent years have seen an increase in resources for coping with the problem.

Patterns of female hair loss

Clinicians use the Ludwig Classification to describe female pattern hair loss. Type I is minimal thinning that can be camouflaged with hair styling techniques. Type II is characterized by decreased volume and noticeable widening of the mid-line part. Type III describes diffuse thinning, with a see-through appearance on the top of the scalp.

What is androgenetic alopecia?

Almost every woman eventually develops some degree of female pattern hair loss. It can start any time after the onset of puberty, but women tend to first notice it around menopause, when hair loss typically increases. The risk rises with age, and it’s higher for women with a history of hair loss on either side of the family.

As the name suggests, androgenetic alopecia involves the action of the hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sex drive and regulation of hair growth. The condition may be inherited and involve several different genes. It can also result from an underlying endocrine condition, such as overproduction of androgen or an androgen-secreting tumor on the ovary, pituitary, or adrenal gland. In either case, the alopecia is likely related to increased androgen activity. But unlike androgenetic alopecia in men, in women the precise role of androgens is harder to determine. On the chance that an androgen-secreting tumor is involved, it’s important to measure androgen levels in women with clear female pattern hair loss.

In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair’s growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See “Life cycle of a hair.”) That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called “follicular miniaturization.” As a result, thicker, pigmented, longer-lived “terminal” hairs are replaced by shorter, thinner, non-pigmented hairs called “vellus.”

Life cycle of a hair

Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. Anagen (A), the active growth phase, lasts two to seven years. Catagen (B), the transition phase, lasts about two weeks. During this phase, the hair shaft moves upward toward the skin’s surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle. Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.

A clinician diagnoses female pattern hair loss by taking a medical history and examining the scalp. She or he will observe the pattern of hair loss, check for signs of inflammation or infection, and possibly order blood tests to investigate other possible causes of hair loss, including hyperthyroidism, hypothyroidism, and iron deficiency. Unless there are signs of excess androgen activity (such as menstrual irregularities, acne, and unwanted hair growth), a hormonal evaluation is usually unnecessary.

Hair loss treatment for women

Medications are the most common treatment for hair loss in women. They include the following:

Minoxidil (Rogaine, generic versions). This drug was initially introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it. Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then a 5% solution has also become available when a stronger solution is need for a woman’s hair loss.

Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — women, it can’t restore the full density of the lost hair. It’s not a quick fix, either for hair loss in women . You won’t see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you’ll need to keep using it to maintain those results. If you stop, you’ll start to lose hair again.

How to use minoxidil: Be sure that your hair and scalp are dry. Using the dropper or spray pump that’s provided with the over-the-counter solution, apply it twice daily to every area where your hair is thinning. Gently massage it into the scalp with your fingers so it can reach the hair follicles. Then air-dry your hair, wash your hands thoroughly, and wash off any solution that has dripped onto your forehead or face. Don’t shampoo for at least four hours afterwards.

Some women find that the minoxidil solution leaves a deposit that dries and irritates their scalp. This irritation, called contact dermatitis, is probably caused not by the minoxidil itself, but rather by the alcohol that is included to facilitate drying.

Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)

Because the patent on Rogaine (the brand-name version of minoxidil) has expired, many generic products are available. They all contain the same amount of minoxidil, but some include additional ingredients, such as herbal extracts, which might trigger allergic reactions.

Anti-androgens. Androgens include testosterone and other “male” hormones, which can accelerate hair loss in women. Some women who don’t respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens. Doctors will usually prescribe spironolactone together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.) Possible side effects include weight gain, loss of libido, depression, and fatigue.

Iron supplements. Iron deficiency could be a cause of hair loss in some women . Your doctor may test your blood iron level, particularly if you’re a vegetarian, have a history of anemia, or have heavy menstrual bleeding. If you do have iron deficiency, you will need to take a supplement and it may stop your hair loss. However, if your iron level is normal, taking extra iron will only cause side effects, such as stomach upset and constipation.

Hair transplantation

Hair transplantation, a procedure used in the United States since the 1950s to treat androgenic alopecia, involves removing a strip of scalp from the back of the head and using it to fill in a bald patch. Today, 90% of hair-transplant surgeons use a technique called follicular unit transplantation, which was introduced in the mid-1990s.

During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of tiny grafts, each containing just a few hairs. Each graft is planted in a slit in the scalp created by a blade or needle in the area of missing hair. Hair grows naturally this way, in small clusters of one to four follicles, called follicular units. As a result, the graft looks better than the larger “plugs” associated with hair transplants of yesteryear.

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Hirsutism Treatment & Management

Systemic therapies directed at hirsutism can be divided into those that decrease ovarian or adrenal androgen production and those that inhibit androgen action in the skin. The systemic therapies include glucocorticoids, oral contraceptives (OCs), spironolactone, flutamide, finasteride, cyproterone acetate (not available in the United States), and insulin sensitizers (metformin and rosiglitazone).

  • Glucocorticoids: Glucocorticoids (dexamethasone or prednisone), which suppress adrenocorticotropin hormone (ACTH)–dependent adrenal androgen synthesis, have been used with variable success in women with adrenal hirsutism, as in congenital adrenal hyperplasia (CAH) or idiopathic adrenal hyperandrogenism. Usually, 0.5-1 mg of dexamethasone at bedtime is sufficient to suppress ACTH and adrenal androgen production. Unfortunately, some patients gain weight and develop cushingoid features, even with this small of a dose. Further investigations may establish that lower doses (perhaps 0.25 mg) can be effective without adverse effects.

  • OCs: The drugs most widely used to suppress ovarian androgen production are OCs. They are probably the first choice for young women with hirsutism who do not want to become pregnant.

    • OCs are inexpensive and promote regular uterine bleeding. In addition, OCs can be used in combination with one of the antiandrogens or other forms of therapy. On the other hand, do not use OCs in women with a history of migraines, known or possible thrombotic disease, or breast or uterine cancer.

    • Moreover, for several reasons, OCs have a significant failure rate in patients with hirsutism. Low-dose OCs and progestin-only minipills fail to suppress ovulation in as many as 50% of women. Ovarian function continues at a variable rate, and ovarian androgens continue to be produced. Second, the progestins in OCs are attenuated derivatives of testosterone and have variable degrees of androgenic activity in women. The degree depends on the type of progestin and, more importantly, on individual susceptibility.

  • Spironolactone: Spironolactone, in daily doses of 50-200 mg, blocks androgen receptors. Spironolactone also decreases testosterone production, making it additionally effective for hirsutism. Spironolactone is especially useful in a patient with hypertension or edema because the drug is a mild diuretic.

    • Sexually active women taking spironolactone should ensure that contraceptive measures are adequate. In some cases, spironolactone can be combined with an OC for added effect on the hirsutism.

    • With current systemic therapies for hirsutism, 6 months to a year of therapy is usually required before results are noticeable. Even then, only approximately one half to three quarters of patients show improvement. The problem may lie partially in the nature of the hair follicle, which persists for 6 months to a year even after androgen levels have been normalized. Ineffectiveness may also be due to the inability of treatment to completely normalize elevated tissue dihydrotestosterone levels. Newer therapies directed at inhibition of 5-alpha-reductase or blockade of the androgen receptor may improve the ability to treat patients.

  • Finasteride: Finasteride is a 5-alpha-reductase inhibitor approved for the treatment of benign prostatic hyperplasia. No adverse effects have been reported in women, and the efficacy is similar to that of spironolactone. In at least one study, finasteride was added to spironolactone, demonstrating an additive reduction in hirsutism scores. The main concern with finasteride, however, is the risk of ambiguous genitalia in male fetuses exposed to the enzyme inhibitor during the first trimester. Therefore, use this drug only in women who are postmenopausal with no chance of becoming pregnant.

  • Flutamide: Flutamide, an example of the newer therapies, is a potent nonsteroidal selective antiandrogen without progestational, estrogenic, corticoid, or antigonadotropin activity. Preliminary data indicate that it is effective as therapy for hirsutism (and also acne); however, flutamide is expensive and has caused fatal hepatitis.

    • Unluhizarci et al investigated the effectiveness of combining finasteride with flutamide for the treatment of hirsutism. Of the 44 women in the study, 14 patients received finasteride (5 mg/d), 16 women received flutamide (125 mg/d), and 14 women received a combination of finasteride and flutamide (5 mg/d and 125 mg/d, respectively).

    • The authors found that after 12 months of treatment, the hirsutism score for patients receiving combination therapy had been reduced by 49%, compared with 45% for the group receiving flutamide alone, and 32% for patients receiving only finasteride. They therefore concluded that a combination of finasteride and flutamide is approximately as effective as flutamide alone in the treatment of hirsutism and that both of these alternatives are more effective than the administration of finasteride by itself.

  • Cyproterone acetate has been effective in the treatment of hirsutism. When added to ethinyl estradiol, it is as effective as flutamide in the treatment of hirsutism. Cyproterone is not available in the United States.

  • Insulin sensitizers: Both metformin and rosiglitazone improve insulin resistance and have been shown to be effective in lowering androgen levels and in treating hirsutism.

  • Sibutramine (withdrawn from US market October 8, 2010 ): Weight loss with this anorectic agent improves hirsutism scores, androgen levels, and cardiovascular risk factors in women with polycystic ovary syndrome (PCOS).

There is no “cure” for hair loss, but a prescription from your dermatologist may be on the horizon. An observational study in the International Journal of Dermatology suggests that taking low doses of both spironolactone (a drug typically used to treat high blood pressure and acne) and oral minoxidil (the active ingredient in Rogaine) can help combat female-pattern hair loss. One hundred testers popped a combo pill once daily for 12 months.

It’s science, not magic. When ingested together in this one pill, the two drugs act synergistically and tackle different problems associated with thinning hair. Spironolactone stops hair shedding by inhibiting the effects of androgens (like testosterone) that combine with an enzyme to create a hormone that causes hair loss, explains study author Rodney Sinclair, a dermatologist in Australia. Minoxidil, on the other hand, works to widen the hair fibers and stimulate growth.

When taking this pill over a period of one year, testers across a wide age range (they were between the ages of 18 and 80) saw a fuller head of hair and decreased fallout. They started seeing results within three to six months and were shedding approximately three times less by the end of the trial. As expected, some subjects experienced a few side effects, including hair growth in unexpected places (i.e. their faces) — which is nothing a wax or some tweezers can’t fix. Some saw urticaria (itchy, raised skin or hives) and low blood pressure. Those who had these side effects were asked to stop using the pill.

So what does this mean for the future? For those suffering from female-pattern baldness, with a few tweaks and clinical trials, there could be a treatment that can drastically alter the state of their scalps. There is the potential for a little pill to be the answer to female-pattern hair loss. So sure, it is science, but it could be a little magic too.

For more on hair loss:

  • How to Deal With Excessive Hair Shedding in the Fall
  • This Study Claims McDonald’s Fries Might Help Your Hair Grow
  • Here’s What You Need to Know About Platelet-Rich Plasma Treatment for Hair Loss

Now, learn more about why your hair is breaking (and how to fix it)

Aldactone for Hair Loss

Some women lose their hair because they have an overproduction of male hormones. When that happens, there is a drug that can help: Aldactone.

There are many reasons why women may experience female pattern hair loss, which is when the hair thins gradually over time and eventually leads to thin or bare patches on the top or front of the scalp. This type of hair loss, also referred to as androgenetic hair loss, tends to worsen after menopause, and is usually hereditary.

But some women lose their hair in this type of pattern due to higher-than-normal levels of androgens — hormones normally made in very small quantities by women and in larger quantities by men — or increased sensitivity to androgens such as testosterone, says Chad Prather, MD, clinical assistant professor in the department of dermatology at Louisiana State University Health Sciences Center in Baton Rouge, La. Women with polycystic ovary syndrome (PCOS), for example, tend to produce more androgens, which can cause hair growth on the face and hair loss on the head, as well as infertility and metabolic problems.

Try the Hair Loss Prevention Diet

Aldactone (spironolactone) helps to restore the hormone balance and treat female pattern hair loss.

Aldactone as a Hair Loss Treatment

Aldactone isn’t approved specifically for hair loss treatment, so when doctors use it, it’s considered an “off-label” use. Aldactone is a potassium-sparing diuretic, which means it rids the body of excess fluid as do other diuretics (water pills), but it doesn’t make you lose potassium in the process as many diuretics do. It’s normally used to treat swelling, high blood pressure, and potassium deficiency.

But because Aldactone acts as an anti-androgen, it can help when women are experiencing hair loss due to higher levels of androgens. The drug causes the adrenal glands and ovaries to slow down their production of androgens, and also blocks the action of androgens that are produced. One way it does that is by stopping dihydrotesterone — the form of testosterone that causes the hair loss — from binding to its androgenetic receptor and affecting the hair follicle.

Aldactone won’t help you grow new hair, says Francesca J. Fusco, MD, assistant clinical professor of dermatology at Mount Sinai School of Medicine in New York. But it can help the thinning hairs become thicker and fuller.

Pros and Cons of Aldactone for Hair Loss

Like any drug, Aldactone has its pros and cons. Read on to find out why it may be a good idea to talk to your doctor before deciding to take Aldactone for hair loss:

Pros of Using Aldactone

  • It’s easy to determine if it’s an appropriate treatment for you. If your dermatologist suspects that androgens are behind your hair loss, a simple blood test can confirm it and let your doctor know if you’re an ideal candidate for the treatment.
  • It targets the problem. Because it helps stop the production of androgens and the action of androgens by preventing them from binding to their androgenetic receptors, Aldactone gets to the source of the problem. “It helps fight some of those hormones that are causing the hair loss in the first place,” Dr. Prather says. At the same time, it can help get rid of hair growth in unwanted areas, such as on the face, and helps clear up acne, he says.
  • It’s affordable. Aldactone is a medication that’s usually covered by insurance, Prather says. Even without insurance coverage, it only costs about $20 to $30 a month.
  • It can be taken with other medications. Some women take Aldactone while using over-the-counter minoxidil (Rogaine), a solution that’s applied to the scalp, for even better results.

Cons of Using Aldactone

  • It can make you urinate more often. One side effect of taking a diuretic is that it may make you run to the restroom more often. It’s usually not a problem for women taking lower doses of Aldactone (up to 100 milligrams), Prather says. But if you’re taking a higher dose of up to 200 milligrams, you may have to urinate more frequently. Dr. Fusco tells her patients to make sure they’re home or can get to a bathroom for about 90 minutes after taking the medication.
  • It may cause irregular menstrual cycles. Anything that interferes with your hormones may cause a change in your menstrual cycle, Prather says. Women often take oral contraceptives when they’re taking Aldactone to regulate their cycles and also to be sure they don’t get pregnant while taking the drug.
  • It can raise potassium levels. It’s important to get your potassium levels checked by your doctor every few months while you’re taking Aldactone, Prather says. “This is one of those times when you want to see somebody who has expertise in this area, such as a dermatologic surgeon” who can monitor you while you’re taking the drug, Prather says. High levels of potassium can cause dangerous side effects, including heart rhythm abnormalities.
  • It can lower blood pressure. Be aware that dizziness and lightheadedness might be signs that Aldactone is causing your blood pressure to go too low, especially if you tend to have low blood pressure to begin with, Fusco says.
  • It can interact with other drugs. Aldactone may interact with other medications, such as blood pressure medications, so it’s important to let all of your doctors know when you’re taking it.

7 Things Not to Do for Hair Loss

Don’t hesitate to call your doctor if you’re experiencing any side effects of Aldactone, Fusco says.

The good news: If you’re experiencing hair loss at a young age and you start this medication, you may be able to restore the hormone balance, see improvement in the thickness of your hair, and eventually stop needing the medication.

Androgen Receptor Inhibitors.

Aldactone / Spironolactone

Spironolactone or the more popular brand name Aldactone is in a class of drugs called potassium-sparing diuretics (water pill). It is used to reduce the amount of fluid in your body without causing the loss of potassium. It is also used to treat hypertension (high blood pressure) and edema (swelling) and used to treat potassium deficiency and hyperaldosteronism (a hormonal disorder).

Spironolactone is an antiandrogen that works in two ways. Primarily it slows down the production of androgens in the adrenal glands and ovaries. Secondly it blocks the action of androgens in part by preventing dihydrotestosterone from binding to its androgenetic receptor.

Tagamet / Cimetidine

Cimetidine sold under the brand name Tagamet, belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block dehydrotestosterone form binding the follicle receptor sites.

Cimetidine has been used to treat hirsuitism in women (excess facial hair growth) and has been studied in women with androgenic alopecia showing promising results. Because of the high doses needed to achieve it’s hair raising results, men should not take cimettidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.

Cyproterone Acetate
Cyproterone Acetate is used to reduce sex drive in men which have excessive sex drive and for the treatment of pronounced sexual aggression. It is also prescribed to treat severe hirsuitism in woman of childbearing age and also androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of DHT dihydrotestosterone to its receptors.

Cyproterone acetate is not available in the US and is thought of as one of the last resorts for treating female pattern hair loss because of its possible toxicity and long term side effects.

As with any drug side effects other than those listed may occur, contact your doctor if you are experiencing a side effect that is unusual or particularly bothersome
Estrogen/Progesterone
Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for androgenetic alopecia for women in menopause or whose estrogen and/or progesterone are lacking for other reasons.

Oral Contraceptives

Since birth control pills decrease the production of ovarian androgens, they can be used to treat women’s androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers over thirty-five who take “the pill” are at higher risk for blood clots and other serious conditions. Discuss your medical and lifestyle history thoroughly with your doctor. Contraceptive pills come in various hormonal formulations, and your doctor can determine which is right for your specific needs, switching pills if necessary until you are physically and emotionally comfortable with the formulation. Note: Only low androgen index birth control pills should be used to treat hair loss. High androgen index birth control pills actually contribute to hair loss by triggering it or enabling it once it’s been triggered by something else.
Nizoral/Ketoconazole
Available as a topical treatment by prescription, Ketoconazole is currently used as an antifungal agent in the treatment of fungal infections. It also has anti-androgenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs (in women, the ovaries). Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1 percent version is now available over-the-counter, but it may not be as effective as the 2 percent prescription strength. There are no significant side effects.
Propecia/Proscar
The drug finasteride inhibits the enzyme 5-alpha reductase, thereby inhibiting the production of prostate-harming, follicle killing DHT. It was first marketed to treat the prostate under the brand name Proscar in 5 mg pills. In 1998, a 1 mg version with the brand name Propecia entered the market as the first pill approved by the FDA for men’s hair loss. It works quite well for most men in both preventing hair loss and triggering regrowth, and it may work for some women, although women must not take it if they are pregnant and must not get pregnant while on the drug because of the risk of birth defects in a male fetus. Less than 2 percent of men experience transient sexual side effects including erectile and libido difficulties. In women these side effects do not occur.

Cyproterone Acetate with Ethinyloestradiol

Sold under the brand name Diane 35 and Diane 50, this contraceptive tablet is prescribed in Europe for women’s androgenetic alopecia. The drug works by blocking some of the actions of male hormones commonly present in women. Although it’s possible for the drug to stop further hair loss and trigger regrowth of hair within about a year, it needs to be used on an ongoing basis in order to maintain regrowth and eliminate hair loss. Possible side effects include breast tenderness, headaches, and decreased libido. It does have one good side effect- it helps prevent osteoporosis. The drug is a combination of cyproterone and estradiol, an estrogen. Both Diane 35 and Diane 50 contain 2 mg of cyproterone. Diane 35 contains 0.035 mg of estradiol. Diane 50 contains 0.050 mg of estradiol. The drug is as effective as, if not more than, spironolactone. Currently this drug is not available in the US.

Reviewed by Paul J. McAndrews, MD

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Thinning hair and hair loss: Could it be female pattern hair loss?

Without treatment, female pattern hair loss can progress from a widening part to overall thinning. Not every women who has this type of hair loss will develop overall thinning. Is your part widening? Have you noticed that your ponytail is thinner these days? You may have female pattern hair loss (FPHL), a condition that affects millions of women. FPHL is actually the most-common cause of hair loss in women.

For most women, FPHL begins in midlife, when a woman is in her 40s, 50s, or 60s. It can begin earlier for some women.

FPHL is a progressive condition. This means women tend to continue losing hair. But women do not lose all of their hair, as do some men. Instead, your part often gets wider. Hair near your temples may recede. Without treatment, some women eventually develop widespread thinning.

Treatment can prevent hair loss from worsening and help women regrow their hair. Treatment delivers the best results when started at the first sign of hair loss.

How can I tell if I have female pattern hair loss?

It’s best to make an appointment to see a dermatologist. Dermatologists are the experts in diagnosing and treating hair loss. A dermatologist can tell you whether it’s FPHR or something else that is causing your hair loss. Other causes of hair loss can look like FPHL, so it’s important to rule out these causes.

What causes female pattern hair loss?

It’s hereditary. You inherit the genes from your mother, father, or both. Because FPHL is more common after menopause, hormones may also play a role.

How do dermatologists treat female pattern hair loss?

To give women optimal results, dermatologists may use more than one hair-loss treatment. For FPHL, treatment options include the following.

Minoxidil (meh-nox-eh-dil): Long used to treat male pattern hair loss, the US Food and Drug Administration (FDA) has approved this non-prescription treatment for women. Today, it is the most-recommended treatment for FPHL. Products containing either 2% or 5% minoxidil have been approved to treat FPHL.

What should I know about using minoxidil? For the first two to eight weeks, you may notice a temporary increase in hair loss. This stops when your hair begins to regrow.

A common side effect of minoxidil is an irritated scalp, which may cause dryness, scaling, itching, and/or redness on your scalp. If this happens, it’s best to stop using minoxidil and see your dermatologist.

Another possible side effect is to see hair growing in places other than your scalp, such as on your cheeks and forehead. If this happens, you can limit it by:

  1. Trying to apply minoxidil only to your scalp and avoiding other areas

  2. Washing your face after you apply minoxidil to your scalp

When will I see results? Hair grows slowly, so it takes time to see results. You’ll need to use minoxidil continuously for about one year before you know how well it will work for you. If this medication works for you, you’ll need to use it every day to continue getting results. When you stop, the hairs that grew because of minoxidil will fall out within three to four months, and your hair loss can continue.

Minoxidil, pregnancy, and breastfeeding: Women who are pregnant or plan to become pregnant should avoid minoxidil. Studies of pregnant animals have shown minoxidil can be harmful to a developing fetus.

Women who are breastfeeding should also avoid minoxidil. Traces of minoxidil may pass into breast milk, which can be harmful to a nursing infant.

How is minoxidil used? You apply it to your dry scalp. Some products you should apply once a day. Others you apply twice a day.

Minoxidil, pregnancy, and breastfeeding

Women who are pregnant, plan to become pregnant, or who are breastfeeding should avoid minoxidil.

Prescription medications: Some prescription medications have proven effective in helping women with FPHL grow hair and prevent FPHL from worsening.

To date, these medications have received FDA approval to treat other conditions, but not FPHL. Doctors often prescribe FDA-approved medications to treat medical conditions other than those for which the drug was approved.

A dermatologist may prescribe one of the following medications to treat FPHL. Each of these medications is a pill.

Spironolactone (speh-ren-no-LAK-tone): This medication is a diuretic, which has been prescribed for decades to treat hair loss. It is a common treatment for FPHL because it can help restore hair growth and prevent hair loss from worsening.

Before taking spironolactone, be sure to tell your dermatologist about your medical conditions, including kidney and adrenal gland problems. Also, be sure that your dermatologist knows all the medications and supplements you take.

With any medication, side effects are possible. Ask your dermatologist about possible side effects that you might experience while taking one of these medications.

When will I see results? If your dermatologist prescribes one of these medications, you’ll need to take it for 6 to 12 months before you’ll know if it works for you. No hair growth within 12 months means the medication won’t work for you.

Like minoxidil, once you stop taking a prescription medication, you lose the hair that grew. This happens in about three to four months. Women who are pregnant or may become pregnant should not take prescription hair-loss medicines. Pregnancy and hair-loss medications: All of these prescription medications may cause birth defects, so none of these is an option for women who are pregnant or plan to become pregnant.

Dermatologists recommend that all pre-menopausal women use birth control while taking one of these prescription medications.

Hair transplant: Long used to treat hair loss in men, a hair transplant may be an option for some women with FPHL.

The hair transplant has come a long way since the days of hair plugs. Today, most hair transplants look completely natural.

Not everyone is a good candidate for a hair transplant though. If the hair on your scalp is sparse all over, you may not have enough healthy hair to transplant. A hair transplant surgeon, many of whom are dermatologists, can tell you if a hair transplant may help restore your hair.

Are there other treatment options for FPHL?

Women want innovative treatments for FPHL. To meet this need, researchers continue to look for new ways to stimulate hair growth and stop hair breakage. Other treatments that you may find for FPHL include the following.

Lasers for at-home use: The FDA has approved laser combs, helmets, and other devices, which are available without a prescription, to treat hair loss at home. These devices emit a low level of laser light that may help stimulate new hair growth. A few studies show that this can be effective for treating FPHL.

As with minoxidil and prescription medicines, you must continue using an at-home laser device to see results. We still do not know whether these devices are safe for long-term use or if they can continue to produce new hair growth.

Preliminary research shows that blood-platelet therapy may help with female hair loss. Platelet-rich plasma therapy: This therapy uses your own blood. After a blood draw, the blood is placed into a machine that separates the blood into its different components. The platelets, which are a type of blood cell, are treated and injected into your scalp.

It is believed the platelets help stimulate your cells to grow hair.

Researchers are just beginning to study this therapy as a treatment for hair loss. The early findings show promise, but more studies are needed to know whether this is a safe and effective treatment for FPHL.

Stem cells: Using stem cells to treat FPHL is still in the experimental stages. Like platelet-rich plasma therapy, more studies are needed to know whether stem cells are a safe and effective treatment for FPHL.

Supplements: Many supplements, including biotin and folic acid, are said to help grow and thicken hair. In studying these different supplements, the findings have been mixed. In most studies, the supplements had no effect on hair growth and thickness.

In one study, however, 120 healthy women had thicker hair and less hair loss after taking specific omega-3 fatty acids, omega-6 fatty acids, and antioxidants. They took this combination for six months. If these results can be repeated in other studies, we’ll have some evidence to recommend taking these supplements.

In the meantime, you’re sure to find supplements that promise to regrow hair. Before taking any of these, it’s best to check with your dermatologist. Some supplements can interact with medications. Your dermatologist can also tell you whether we have any evidence to show that the supplement helps regrow hair.

Hair loss shampoos: These shampoos tend to do one of the following.

  • Help your hair hold moisture, which makes hair look fuller and thicker

  • Lessen breakage, which can reduce thinning

While hair loss shampoos may do the above, they cannot regrow hair or prevent hair loss from worsening.

A dermatologist’s diagnosis is best before treating hair loss

If you think you have FPHL, it’s important to see a dermatologist for a diagnosis. Women develop hair loss for many reasons. Other common causes of hair loss in women can look a lot like FPHL. Each of these causes requires different treatment. Without the right treatment, hair loss often continues.

You can find a dermatologist in your area by going to Find a Dermatologist.

Key points

  • See a dermatologist to make sure that you have FPHL, and to rule out another condition, which may be causing your hair loss

  • Treatment works best when started at the first sign of hair loss

  • Minoxidil is the most-recommended treatment for FPHL

Whether the newer treatments for hair loss, such as the lasers for at-home use, are safe for long-term use and can continue to stimulate new hair growth remain to be seen.

Images
Image 1: Used with permission of Journal of the American Academy of Dermatology. J Am Acad Dermatol 2004;51(2):191.

All other images from Getty Images.

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