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How is female pattern hair loss (androgenetic alopecia) in women treated?

Updated: May 19, 2023



 

Disclaimer: The information in this article is not meant as specific individual medical advice. Please consult your dermatologist or other medical professional about your skin or medical condition.

 

Hair loss can affect a woman's self-esteem, cause her to retreat from social interactions and decrease her overall quality of life. In this guide, I will review the current treatment options available for one of the most common causes of hair loss, which is androgenetic alopecia (female-pattern hair loss).


What is Female Pattern Hair Loss (Androgenetic Alopecia)?


Female pattern hair loss or androgenetic alopecia is a form of hair loss where diffuse hair thinning happens usually over the front and crown (top) on the scalp.


The frontal hairline is usually preserved in women, as compared to men who tend to experience a receding hairline.


This is usually noticed as an increase in hair loss after a shower or thinning of hair with the scalp being more visible or a widening hair part width over time.


What’s happening in androgenetic alopecia, is that the hairs become finer and shorter. This process is called miniaturization.


This means that thicker and longer hairs are replaced by thinner and shorter ones. Sometimes hair color is lost as well.


Androgenetic alopecia may begin as early as teenage years and may happen anytime during adulthood.


What causes Female-Pattern Hair Loss?


It is thought that several different genes in causing this type of hair loss, and the genes can be inherited.


Androgens (testosterone) are also thought to play a role in transforming hair follicles into ones that produce fine (miniaturized) hairs.


Hairs forms in cycles with a growth phase and a resting phase.


Through both genetic factors and androgens, it appears that there is a shortening of the growth phase such that long thick hairs become replaced by short thin ones.


Vitamin D deficiency may also be associated with female pattern hair loss.



How is androgenetic alopecia diagnosed?


Androgenetic alopecia is usually diagnosed on physical exam by a dermatologist.


Occasionally a skin biopsy may be performed to rule out other causes of hair thinning if there are reasons to suspect so.


Otherwise, most of the time, a skin biopsy is not needed for diagnosis.


It is common for your dermatologist to order lab tests to look for other causes of hair loss such as iron deficiency, vitamin D deficiency or thyroid disease.



Treatment of Female Pattern Hair Loss


There are a few options for treating female pattern androgenetic alopecia.


These include:

  • Topical minoxidil solution (Rogaine®)

  • Spironolactone

  • Low dose oral minoxidil

  • Finasteride

  • Light therapy

  • Platelet-rich Plasma (PRP)

  • Hair transplantation



Topical minoxidil (Rogaine®)

Topical minoxidil has been shown to stimulate hair growth when applied directly to the scalp.


This is different from the oral version of the medication which is used to treat high blood pressure.


Topical minoxidil does not fully restore the lost hair. It however can stimulate some finer hairs to become thicker.


It is FDA approved to treat androgenetic alopecia in the United States and is sold over-the-counter as a 2% solution and a stronger 5% foam or solution.


The brand name for this product is Rogaine®, and there are several generic products available as well.


Results are not usually noticeable until after three to six months of use. A reasonable trial to see if topical minoxidil works will be six months to a year.


If minoxidil works for you, you’ll need to continue using it to maintain the results. When treatment is stopped, the hair growth gained is usually lost over about 6 months.


Minoxidil is usually applied twice a day to the areas where there is hair thinning. It is meant to be applied to dry scalp. It is ok to gently massage the treatment into the scalp.


Allow the product to dry and do not shampoo the hair for at least four hours after that.


However, you want to wash off any minoxidil solution that came into contact with your face because it may cause excessive hair growth on the cheeks or forehead (hypertrichosis).


If hypertrichosis develops, the excessive hair can be removed by waxing, plucking, or a topical treatment called eflornithine (Vaniqa®).


It can be expected to experience an increase in hair shedding in the first few months of using topical minoxidil because hairs are transitioning from a resting to a growing phase.


Some women find that minoxidil solution leaves a deposit that irritates their skin. This is thought to be caused by alcohol or propylene glycol found in the solutions. This is more common with the 5% solution.


Topical steroids may be used to alleviate skin irritation if it develops. You can read more about topical steroids and its use in eczema here.


The 5% foam preparation does not contain propylene glycol and may cause less skin irritation.


Topical minoxidil is not recommended for use during pregnancy.



Spironolactone


Oral spironolactone has also been used to treat androgenetic alopecia in women.


Spironolactone reduces androgen (testosterone) production and action, and is able to slow the progression of hair loss in androgenetic alopecia.


It is also used to treat women with hormonal acne or excessive facial hair growth (hirsutism). (Do you also have hormonal acne? Read more about treatment of hormonal acne here.)


Spironolactone is usually used at doses of 50mg to 200mg once a day to treat female pattern hair loss.


Side effects of spironolactone are minimal. Some women may experience irregular menstrual cycles and breast tenderness.


Spironolactone is a diuretic which increases urine production and some women may notice an increased frequency of using the toilet.


At higher doses, some women may experience a blood pressure lowering effect causing lightheadedness.


Spironolactone can also cause potassium to be retained in the body usually in people with kidney disease. As such spironolactone is not recommended for use if a person has kidney disease and potassium supplements should be avoided when using spironolactone.


Spironolactone can also cause birth defects and is not recommended for use during pregnancy or when breastfeeding.


Low Dose Oral Minoxidil


Low dose oral minoxidil has gained popularity as a treatment option of androgenetic alopecia in men and women.


Traditionally, oral minoxidil at its regular dose of 5mg to 40mg daily is used to treat high blood pressure (hypertension). It was noticed that oral minoxidil stimulated hair growth, and hence it was formulated into topical minoxidil for treatment of hair loss.


Low doses of oral minoxidil (between 0.5mg to 5mg daily) has been shown in clinical studies to increase hair thickness and volume in androgenetic alopecia.


Some side effects associated with oral minoxidil use include increased hair growth in other parts of the skin (hypertrichosis), decrease in blood pressure when sitting or standing up (postural hypotension) and leg swelling.


Low dose oral minoxidil is considered an alternative treatment to topical minoxidil when applying is not well tolerated.


Finasteride


Finasteride is an oral medication the prevents the conversion of testosterone to its active form (dihydrotestosterone or DHT).


Oral finasteride (Propecia®) has been effective and commonly used in men with androgenetic alopecia at a dose of 1mg once a day.


However, a clinical trial of using finasteride at 1mg once a day did not show improvement of hair loss when used in post-menopausal women.


Oral finasteride at a higher dose of 5mg once a day was used to treat pre- and post-menopausal women.[1]At the end of the study, there was about a 20% increase in hair density and about 80% of treated women had improvement on photographic assessment.


Other studies have shown mixed results of high dose oral finasteride when used to treat women with androgenetic alopecia.


Currently, oral finasteride has not received FDA approval for use to treat androgenetic alopecia in women, but it has been used off label at a higher dose of 5mg daily when other treatments do not appear to be effective.


Oral finasteride can cause birth defects during pregnancy and is not recommended for use during pregnancy or when breastfeeding.



Light Therapy


Low-level light therapy (LLLT) uses LED devices (650-900nm) to increase hair growth.


How light therapy increase hair growth is uncertain, but it is thought that it may activate dormant hair follicles and increase blood flow to the hair follicles.


The HairMax® laser comb was FDA approved in the United States in 2007 as a laser-light device for treatment for androgenetic alopecia in men, and later in 2011 for women. The device emits red light at 655nm and uses a hair comb design to target the light toward the scalp.


When first used in a clinical trial in men, the HairMax® device was used three times a week for 15 minutes, and patients experienced an increase in hair density after 6 months of use.


When tested in a group of 35 men and women, patients reported increase hair counts and improved hair strength.[2]


Since then there has been multiple light therapy devices created and sold in the market.


These come in the form of caps, helmets, head bands and combs.


These devices appear to be safe and painless to use and are designed for at home use.


Improvement in hair growth is usually reported after 3 to 6 months of use.


Most LLLT devices are used 3 times a week for about 15 minutes each time.


Some people experience scalp irritation or redness.


The HairMax, iRestore and iGrow hair treatment systems are reputable brands selling these devices in the market.


The iGrow Hair Growth System and iRestore Laser Hair Growth System both use LED red light in the form of caps to promote hair growth.


The iGrow system received FDA approval in 2014 and the iRestore system received FDA approval in 2016 for use in androgenetic alopecia.



Platelet-rich Plasma (PRP)


Platelets are a component of our blood, and plays a role in helping our blood clot and promote healing.


Platelet-rich plasma (PRP) is a extract of a person’s blood sample (usually 10-60ml) that is concentrated in platelets.


When PRP is injected into the scalp, it is believed that the growth factors that the platelets produce promotes hair follicle cell activity and stimulates hair growth. As a result there is increase hair thickness, hair density and hair count.


The procedure usually involves the injection of 1ml of PRP in a grid-like fashion over the area of hair loss over 3 to 5 treatment sessions.


There have only been small studies on the use of PRP for treating female pattern hair loss, where it is reported that PRP produces high levels of satisfaction and improved quality of life in women.


Potential side effects are minor, and include mild headache, scalp pain, redness, swelling and minor bleeding.


Larger clinical studies are needed to determine the true effectiveness of PRP in treating female pattern hair loss.



Hair transplantation


Hair transplantation is a surgical procedure where hair follicles are removed from one part of the scalp and re-planted in an area where there is hair loss or hair thinning.


This procedure is usually performed under local anesthesia.


Hair follicle units are first harvested in strips, usually from the back (occipital) or side (temporal) of the scalp.


The strips of hair follicles are then divided into smaller individual grafts of small groups of hair follicles called a follicular unit.


These grafts are then place into small slits made in the area of hair thinning.


This grafting process can take five or six hours during which an average of 2000 to 3000 follicular units are transplanted.


Swelling is expected immediately after hair transplantation and usually resolves after a week. This swelling can be reduced by wearing a head-band.


Scabs from the surgery tend to fall off about two to three weeks after surgery.


A lot of care is required after the procedure to avoid damaging the newly transplanted hair follicles.


Often, topical minoxidil is used after the procedure for three to six months to promote hair growth.


New hairs usually start growing about three months after the procedure.


Complications from hair transplantation surgery include infection and cyst formation.



I hope the information here has been useful in helping you understand female pattern hair loss (androgenetic alopecia) and their treatment options in women. I also hope it empowers you when you make your medical decisions with your dermatologist.




[1] Yeon JH et al. 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss. J Eur Acad Dermatol Venereol. 2011 Feb; 25(2):211-4. [2] Satino J. Markou M. Hair regrowth and increased hair tensile strength using the HairMax laser comb for low-level laser therapy. International Journal of Cosmetic Surgery and Aesthetic Dermatology. 2003;5(2):113–117.

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