Tag Archive for: Retinol

5 Facts All Men Should Know About Hair Loss

A few weeks ago, my husband pointed out a Facebook meme that made us laugh.  It showed two photos of hair and body care products.  One photo included products that women use in the shower, and another photo showed the products that men use.   The women’s photo was loaded with products, including body wash, face wash, two different types of shampoos, and a couple of different types of conditioner.  The men’s photo only had one product, a lone all-in-one bottle of body wash, shampoo, conditioner, shaving cream, and toothpaste.  Not only was it funny, but it also depicted the scene in our shower pretty accurately. 

The truth is, though, although some men don’t give their hair a lot of thought, I don’t know of any who are thrilled about the idea of going bald.  It’s a super sensitive topic.  As nonchalant as my husband is about his hair, even a hint that his hairline is receding results in a very alarmed “What?” and a close scalp examination in the mirror that night.   

Hair loss in men is common, but that doesn’t mean you’re okay with it.  Nor does that mean that you have to accept your fate.  So, if you’re a guy with some recession, thinning, or balding, this one’s for you.  We’re here to fill you in on what you need to know about losing your hair and what you can do about it.  

1) Hair Loss in Men is More Common Than You Realize

According to the American Hair Loss Association, by age 50, 85 percent of all men will have significantly thinning hair. (01)  Yes, you read that correctly.  The majority of men will deal with some type of hair loss in their lifetime.  

Men lose their hair for a lot of different reasons.  Balding or thinning hair can be due to autoimmune conditions, Covid, or even stress.  The most common reason, though, is genetics. The vast majority of men with thinning or balding hair have androgenetic alopecia, male pattern baldness.  Yup, that’s right.  Your parents or grandparents may have passed along a baldness gene.  

Male pattern baldness, also known as androgenetic alopecia, occurs when your testosterone is converted to an androgen (a sex hormone) known as Dihydrotestoterone (DHT).  The DHT attacks your hair follicles and causes a reaction called miniaturization which shrinks the follicles.  When that happens, the hair that is already there falls out.  New hair has trouble emerging through the shrunken follicles, and eventually, the hair stops growing.  

Although Male pattern baldness is the leading cause of hair loss among men; it’s not the only reason men lose their hair.  Other forms of alopecia can cause hair loss among men as well.  For example, Covid or other illnesses can cause a temporary hair loss called telogen effluvium.  In this case, your hair will grow back within six to twelve months.  Alopecia areata is an autoimmune condition that causes sporadic bald patches.  Some men’s hair spontaneously regrows, but flares can occur at any time without notice.   Lichen planopilaris is another type of alopecia that causes inflammation, leading to scars over the hair follicles that prevent new hair growth.         

2) Timing is Everything When it Comes to Hair Loss Treatments

Many men avoid doctors like the plague. (02)  However taking a “let’s wait and see what happens” attitude isn’t recommended when it comes to hair loss.  If you don’t get treatment when you first notice that your hair is thinning, then your hair loss will most likely progress, leaving you with a higher number on the Hamilton-Norwood Scale.  In case you don’t know what that is, the Hamilton-Norwood Scale is a classification system developed to measure the extent of baldness.  You don’t want to get high scores on that test.  

If you visit a board-certified dermatologist as soon as you see signs of thinning or balding, your doctor will identify the cause of your hair loss.  Once you are diagnosed, your dermatologist can recommend treatments to stop your hair loss and to promote new growth.  

3) Hair Loss Consultations Are Not a Big Deal (Really!)

If the idea of any medical procedure secretly has you a bit nervous, don’t let that prevent you from seeing a dermatologist.  The exam is much easier than you would expect, and trust me, your dermatologist will not think you are vain for seeking treatment.  Dermatologists evaluate men for hair loss conditions all the time.  So, while you may be out of your comfort zone, your dermatologist certainly isn’t.   

Your dermatologist will ask questions about your health, medications, family history, and lifestyle during your exam.  The more detailed information you provide, the better.  Your dermatologist will examine your scalp to evaluate your hair loss pattern and possibly do a pull test.  A pull test measures the severity of your hair loss.  During the test, your dermatologist will gently tug on small sections of your hair to see if any strands fall out.  If six or more do, you have active hair loss.  Dermatologists usually diagnose androgenetic alopecia based on visual exam.  A blood test or a small biopsy may be ordered if he or she suspects another type of alopecia.  Don’t stress if you need a biopsy.  You’ll be numb, the biopsy area is small, and it heals within a week.

4) Today’s Hair Loss Treatments are Effective and Natural Looking 

After you get a diagnosis, you’ll have many treatment options.  The good news is more data than ever is available on hair loss treatments.  Research indicates that many are not only safe, they’re highly effective.  Here are some examples of the most popular prescription hair loss treatments used:

Minoxidil 

  • FDA approved to treat hair loss
  • Available in oral or topical formulas
  • Brings oxygen to the hair follicles, enlarging them so existing hair does not fall out and new hair can emerge

Finasteride

  • FDA approved to treat hair loss
  • Available in oral and topical formulas
  • Prevents testosterone from converting to DHT and attacking your hair follicles
  • First-line treatment for androgenetic alopecia

Dutasteride

  • Used off label to treat hair loss
  • Only available as a pill
  • Prevents testosterone from converting to DHT and attacking your hair follicles
  • Prescribed if patient does not respond to Finasteride
  • Lower dosage prescribed for Dutasteride than Finasteride

Cortisone

  • Available in pill and topical formulas
  • Reduces irritation and inflammation

Retinol

  • Available in topical formula
  • Proven to improve absorption of topical Minoxidil and Finasteride

Compounded Topical Formulas

Research has shown that combinations of topical formulas are more effective than monotherapy.  For example, topical Finasteride combined with topical Minoxidil works better than one of the medications alone. (03)  Finasteride and Minodixil combined with Retinol is more effective because the retinol helps the scalp better absorb the other two medications. (04)

Alternative Hair Loss Treatments for Men

You may also be a candidate for treatments such as Protein Rich Plasma (PRP), laser light treatments, and hair transplant surgery.  Let’s talk about what these are and how they work.

Protein Rich Plasma

PRP acts similarly to Minoxidil by bringing oxygen to the hair follicles to enlarge them.  During a PRP procedure, your dermatologist draws your blood.  The blood is then separated.  The plasma is then injected into sites where your hair is thinning or balding. 

Laser Light Treatment

You may have seen ads for laser light caps.  Do they work?  Well, the jury is out.  The philosophy behind them is that the light increases blood flow to the areas on your scalp that are thinning.  More oxygen and nutrients are able to reach the hair follicles, allowing the hair to grow thicker and longer.  Although research indicates that laser lights show promise for treating hair loss, the most effective intensity and frequency is still to be determined. (05, 06)  

Hair Transplant Surgery

In the 70s and 80s, you could always tell when a man had hair restoration surgery.  You could actually see little circular holes where the plugs were implanted.  It looked like a doll’s head.  Over time, dermatologists have been perfecting the surgery and today’s techniques give a natural appearance.  Dermatologists now move individual hairs from a place where the hair is dense to an area where the hair is thinning. (07)  You can’t even tell that the hair has been transplanted.  

5) Perceptions of Bald or Balding Men Have Changed for the Better

Men with thin or thinning hair tend to have lower self-esteem and lack confidence, which could explain negative perceptions of their appearance. (08)  The key is to work with what you do have so you feel as confident as possible.  

Yes, there was a time when bald or balding men were deemed less attractive.  That’s no longer the case, though.  Today, men who embrace their look are seen as intelligent, successful, and confident. (09)  Jeff Bezos, Samuel L. Jackson, Ed Harris, and The Rock are prime examples.  So if your hair is thinning or balding, work with your barber or hair stylist to find and own a fresh new look.  That look can evolve as you undergo hair loss treatment.  

If you notice some recession, thinning, or balding, and are concerned, contact us for a discrete consultation from the comfort of your home, on your schedule.  Our board-certified dermatologists and hair specialists are available to evaluate how much hair you’ve lost and your scalp’s condition.  Most importantly, they can offer a customized prescription solution to give you the desired results.  

 

Resources:

(01) https://www.americanhairloss.org/men_hair_loss/introduction.html

(02) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560804/#:~:text=At%20the%20societal%20level%20masculine,not%20go%20see%20the%20doctor.

(03) https://pubmed.ncbi.nlm.nih.gov/32166351/

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693596/

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8906269/

(06) https://www.karger.com/article/fulltext/509001

(07) https://www.aad.org/public/diseases/hair-loss/treatment/transplant

(08) https://pubmed.ncbi.nlm.nih.gov/16307704/

(09) https://journals.sagepub.com/doi/abs/10.1177/1948550612449490

 

Everything You Need To Know About Finasteride Interactions

If you have aging parents or grandparents and have seen their overflowing pill boxes, you know that it’s important to track their medications. One prescription can easily interact with another, and boom, you’re at the doctor’s office figuring out which drug is the culprit.  

Dermatologists and hair specialists often recommend prescription hair loss medications because they are safe and effective.  However, if you are taking other drugs or supplements at the same time, you should be aware of potential unintended interactions.  Since Finasteride, also sold under the brand names Propecia and Proscar, is FDA-approved to treat hair loss, it’s the one most often prescribed.  So, for that reason, we’ll tell you everything you need to know about what mixes well with Finasteride and what might not be the best combination.

Finasteride is a Leading Treatment for Male and Female Pattern Baldness

Research continually demonstrates that Finasteride, a medication originally developed to treat Benign Prostatic Hyperplasia (BPH), is one of the most effective ways to treat androgenetic alopecia.  The statistics tell the story.  After two years on Finasteride, 83 percent of men included in Merck’s research study did not experience further hair loss.  More than 70 percent showed increased hair growth. (01)  Finasteride works just as effectively for women. (02)  That’s why Finasteride is often dermatologists’ drug of choice when it comes to stopping further hair loss and stimulating new growth.  

Finasteride Increases the Testosterone Levels in Your Body

So, how does Finasteride help stop your hair from shedding?  It blocks an enzyme called 5-alpha-reductase (5-AR).  When 5-AR isn’t produced, testosterone can no longer be converted to an androgen called Dihydrotestosterone (DHT), which is what causes your hair follicles to miniaturize.  Finasteride also increases testosterone levels in your body.  More testosterone shrinks prostate size and helps your hair grow.  The only catch is that when you stop taking Finasteride, any new growth will be lost.   

Finasteride Interactions are Uncommon

Complications stemming from Finasteride use are rare.  That’s not to say that it doesn’t or can’t happen.  Certain medications can either increase or reduce the amount of Finasteride in your bloodstream.  Carbamezepine, Rifampin, and St. John’s Wart may reduce Finasteride’s efficacy by metabolizing the Finasteride faster in your liver.  Other medications such as Itraconazole and erythromycin may actually increase the levels of Finasteride in your blood.  Checking with your doctor is the best way to know if other medications you are already taking will contradict Finasteride.  

Avoid Interactions with Other Medications by Using Topical Finasteride Versus Oral 

If you have androgenetic alopecia and are worried about Finasteride interacting with the other medications you are taking, ask your doctor about using topical Finasteride.  Research indicates that topical Finasteride is equally as effective as oral. (03)   Think of topical Finasteride as a spot treatment.  It works directly on the areas where your hair is thinning to prevent further hair loss and stimulate growth.  Oral Finasteride, on the other hand, is systemic since it is metabolized in your stomach.  Topical Finasteride is the ideal solution for men and women who want the benefits of the medication without any potential drug interactions.  

Some Medications Make Finasteride Work More Effectively

Some medications have been found to increase the efficacy of Finasteride.  Because some medicines work synergistically, dermatologists and hair specialists often recommend that patients use multiple hair loss treatments simultaneously to maximize results.  

Minoxidil, also marketed under the brand Rogaine, is a topical hair loss solution that has proven to complement Finasteride. (04)  While Finasteride blocks the testosterone from converting to DHT, Minoxidil enlarges the hair follicles, preventing hair loss, and allowing new growth to break through.  Minoxidil is available in both oral and topical formulas.

Retinol is also a medication that is often prescribed with Finasteride.  Retinol, a derivative of Vitamin A, is often prescribed to reduce wrinkles and improve skin texture.  The medication increases collagen production and stimulates the production of new blood vessels bringing oxygen to the skin.  In addition, retinol has been proven to improve the absorption of topical Finasteride. (05)

When patients with hair loss experience inflammation, topical or injected cortisone is often prescribed in conjunction with Finasteride as well.

Taking Finasteride, Minoxidil, Retinol, and Cortisone all at the same time can seem like a lot of medications to remember.  Fortunately, topical formulas are now available that combine all into one convenient bottle.    

Alternatives to Finasteride

Other options exist if you are experiencing male or female pattern baldness and oral or topical Finasteride aren’t suitable for you.

Dutasteride

Finasteride is effective for most people.  However, an alternative medication is Dutasteride. Dutasteride works similarly to Finasteride by blocking the conversion of testosterone into DHT.  The difference between the two medications is that Finasteride inhibits the Type 2 5AR isoenzyme,while Dutasteride inhibits both Type 1 and Type 2.  In addition, Dutasteride’s prescribed dosages are typically lower than Finasteride’s because the medication is a bit stronger.  

Spironolactone

Spironolactone, also known as Aldactone, is used off-label to treat female pattern hair loss.  It was originally marketed to treat fluid retention caused by liver and kidney disease. The medication is only prescribed for women because it can cause feminizing features when used over time.  Research has not yet been conducted on a large sample size, but four women included in a study, saw reduced hair loss and experienced some growth. (06)

PRP

PRP, an abbreviation for Platelet Rich Plasma, is a three-step process designed to trigger hair growth by increasing the amount of oxygen available to the hair follicles.  First, blood is drawn. Then, blood is then separated into three groups using a centrifuge.  Lastly, the platelet rich plasma is injected into the scalp. PRP is often used in conjunction with other treatments to maximize results.  

Hair Transplant Surgery

If you are concerned about drug interactions, hair transplant surgery may be an option and a long-term hair loss solution.  During the past few years, many advances have been made in how the procedure is performed.  Rather than taking strips of hair to transplant, surgeons are now able to move individual hairs giving a more natural look.  

Low-light Laser Therapy (LLLT)

You may have seen ads recently for laser caps marketed for hair growth.  Most use light in the red or infrared range to penetrate the scalp and target the hair follicles.  Early studies show promise for the technology, but more research needs to be conducted on the efficacy.  One study found that LLT works better when used with Minoxidil or Finasteride.  The study also indicated that more data is needed to determine the optical laser power and wavelength. (07) 

Be Honest About Your Medical History

If your dermatologist recommends Finasteride or any other prescription hair loss treatment, the best thing you can do is be honest about your medical history.  In addition to telling your doctor about any other hormone, heart, or other medications you’re taking, remember to list any supplements. Also, although sharing information about smoking, drinking, or recreational marijuana use may seem embarrassing, remember that your dermatologist has seen and heard it all.  He or she is more concerned with giving you the best hair regrowth options and keeping you safe than passing judgment on your behavior.  

Is Finasteride Right For You?

If you have questions about whether Finasteride is right for you or could potentially interact with other medications you’re taking, let us know.  Our board-certified dermatologists have full medical degrees from accredited universities.  They are available and happy to review your medical history and suggest solutions based on the type of hair loss you are experiencing.  

Resources:

(01) https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf

(02) Note: Recommended doses differ for men and women

(03) https://pubmed.ncbi.nlm.nih.gov/34634163/#:~:text=Conclusion%3A%20Topical%20finasteride%20significantly%20improves,impact%20on%20serum%20DHT%20concentrations.

(04) https://onlinelibrary.wiley.com/doi/10.1111/dth.12246#:~:text=Efficacy%20assessment,combination%20therapy%20showed%20improvement%2C%20respectively.

(05) https://jamanetwork.com/journals/jamadermatology/article-abstract/557305

(06) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769411/#:~:text=In%20a%20case%20study%20of,total%20number%20of%20anagen%20hairs.

(07) https://pubmed.ncbi.nlm.nih.gov/29270707/

 

Why Self-diagnosing Your Hair Loss is a Bad Idea

“When did you graduate from medical school?” my husband asks me on a regular basis.  I didn’t, but I am a self-proclaimed expert in the medical field anyway.  Why wouldn’t my Google education make me highly qualified to diagnose the whole family’s symptoms and illnesses?  Evidently, I’m not the only one self-diagnosing.  A survey conducted in March 2020  indicated that nearly one-third of all Americans do their own medical research. (01)

Being your own doctor can work against you though.  In fact, when I first started losing my hair, I didn’t even think to have it checked.  Based on what I read, postpartum hair loss is normal, and I had two babies in two years.  I would never in a million years have guessed that I had alopecia.  However, knowing what I know now, I do not recommend waiting to consult with a medical professional if you’re noticing an unusual amount of hair loss.  Treating hair loss early helps you prevent further shedding and even regrow your hair.  Here are seven more reasons why you should schedule an appointment with a board-certified dermatologist and hair specialist if you’re concerned about the amount of hair you’re losing. 

Reason #1:  Dermatologists are familiar with hair loss patterns associated with specific hair loss conditions.  

Your dermatologist has spent countless hours studying and memorizing the different types of hair loss.  Many times, just looking at patients’ hair loss patterns gives your dermatologist clues as to where to start with a work-up to get a diagnosis.  Common hair loss conditions and associated patterns are:

  • Androgenic alopecia (men) – Receding hairline and gradual thinning on top
  • Androgenic alopecia (women) – Widening of the part 
  • Alopecia areata – Patchy or circular bald spots on the head, eyebrows, or beard
  • Telogen effluvium – Overall thinning due to sudden hair loss
  • Fungal infection – Scaly patches that spread over the scalp
  • Alopecia totalis – Full-body hair loss

If your dermatologist suspects that you have androgenic alopecia, known as male or female pattern baldness, he or she may use the Norwood scale, a scale of 1 to 7, to track the progression of your hair loss.  The scale helps your dermatologist recommend the best possible treatment options to prevent further hair loss and stimulate growth based on the amount of recession or thinning you have.  

Reason #2:  Your doctor can determine the severity of your hair loss

Losing a certain amount of hair is normal and is part of the hair growth cycle.  How do you know if the amount you’re seeing in the sink or shower is too much?  You don’t.  However, once your dermatologist has an idea of your hair loss pattern, he or she has a number of tools and tests he or she can use to determine the extent of your hair loss.  The most common are:

Pull Test

A pull test is pretty much as the name indicates.  During the test, your doctor will gently tug on small sections of hair from parts of your scalp.  Usually, the litmus test is six or more strands.  If you lose that much, your hair loss is active.  

Scalp Biopsy

A scalp biopsy, also known as a punch biopsy, is often used to determine what type of alopecia you have. It allows pathologists to see inflammation and can distinguish whether the alopecia is scarring or non-scarring.  To take the biopsy, your dermatologist numbs the area and uses a pencil-sized device to remove a small amount of tissue that is sent to a lab for analysis. The incision is closed with a couple of small stitches.   

Trichometric Analysis

If your dermatologist wants to analyze your scalp and hair, he or she may do a trichometric analysis using a small handheld device with a high-definition camera.  The device magnifies images by up to 100 times so your hair, hair follicles, and scalp can be seen in great detail.  The tool shows how much hair is covering your scalp, and the diameter of each hair strand.  Dermatologists often use this camera to monitor progress after you begin treatment.  

Fungal Culture

If your dermatologist suspects that your hair loss is due to a fungus in your hair or scalp, he or she may run this test.  Fungal cultures determine if a condition called tinea capitis, scalp ringworm, is causing your hair loss.  During the test, a small sample of skin or hair is sent to a lab for incubation.   

Reason #3:  Your vitamin levels may need to be checked

Often one of the first questions dermatologists often ask new patients is whether they have recently had a routine blood test.  The reason why is because simple vitamin deficiencies can cause hair loss.  Fortunately, if this is the case, supplements will usually solve the problem quickly and easily.  The two most common vitamin deficiencies that cause hair loss are vitamin D and iron.  

Studies have shown that vitamin D has anti-inflammatory properties and affects the hair cycle. (02)  When your body has a vitamin D deficiency, regulation of the hair follicles is challenging.  Growth and shedding cycles are disrupted causing your hair to suddenly fall out.

Iron deficiency stunts the production of hemoglobin which transports oxygen to the cells in your body, including the cells that make your hair grow.  The hair follicles lack the nutrients they need to thrive.  With an iron deficiency, hair sheds and thins, giving the appearance similar to androgenic alopecia.

 

Reason #4:  Your hormones may be out of whack

 

Your dermatologist may also run blood tests to check for hormonal imbalances.  Hormone imbalances can cause hair to get dry, brittle, thin, or fall out altogether.  The only way to know if this is the case is to have your levels checked.  

Contrary to popular belief, high or low testosterone is not an indicator of hair loss.  Research has continually demonstrated that there is not a link between serum androgen levels and androgenic alopecia. (03)  Instead, male pattern baldness could be linked to an androgen sensitivity or high androgen density. 

Factors that can affect your hormone levels include:   

Menopause

Estrogen levels fall before, during, and after menopause while testosterone levels inversely increase.  During the process, the testosterone converts to dihydrotestosterone (DHT) which attacks your hair follicles, and makes your hair fall out.  

Stress

Stress is a bigger contributor to hair loss than most people realize.  When you are stressed out, your body creates cortisol which disrupts the function and regulation of your hair follicles as well as your hair growth cycle.  

Pregnancy

During pregnancy, estrogen levels rise, causing your hair to get fuller and thicker. After the baby is born, however, those levels drop rapidly, making the excess hair shed.  It can take a while for your estrogen levels and hair loss to balance out.  

Thyroid

Both hypothyroidism and hyperthyroidism have been linked to alopecia.  In a 2013 study, patients aged 21-40 with thyroid disfunction were likely to have diffuse alopecia and alopecia areata.  Patients older than 40 were more likely to have alopecia areata and androgenic alopecia. (04)  The findings confirm the importance of checking thyroid levels when there is a hair loss issue.  

Reason #5:  You could have a scalp infection 

A number of scalp infections can cause hair loss.  These infections can easily be confused with various types of alopecia, but once treated, hair typically regrows.  Examples include:

Ringworm

Ringworm is a fungal infection that forms scaly, raised, red patches.  Itching is a common complaint among patients with scalp ringworm and is typically treated with anti-fungal medications.  

Scalp Psoriasis

Psoriasis is an autoimmune condition that causes thick red patches, and sometimes scaling.  There isn’t a cure, but proper management can help prevent hair loss.

Seborrheic Dermatitis

Seborrheic dermatitis causes dandruff in adults, characterized by dry, flaky skin, and typically does not cause hair loss.  Shampoos and topical medications are often recommended. 

Lichen Planus

Lichen planus causes inflammation and can leave tiny red bumps on your scalp.  The cause is not known for certain, although autoimmune dysfunction is one of the possible causes.  Topical creams are often used to treat symptoms, but in many cases, lichen planus will disappear without treatment.  

Your dermatologist has been trained to address and treat all of these infections.

Reason #6:  Sometimes you need an outside perspective

When your dermatologist takes your medical history, he or she may be able to identify bad habits that are affecting your hair and contributing to your hair loss.  Some of these habits may include:

  • Smoking
  • Poor diet filled with processed foods
  • Stress
  • Tight buns, ponytails, braids, or other hairstyles that can pull on your hair and cause traction alopecia
  • Compulsively pulling on your hair (trichotillomania)

Reason #7:  The most effective medications are only available by prescription

Hair loss products are similar to skincare products in that very few over-the-counter (OTC) products are truly effective.  If you have a graveyard of barely or partially used tubes and containers under your bathroom sink, you get the picture.  The reality is that besides Minoxidil which is sold OTC as Rogaine in a 5 percent formula, you’re wasting your money on OTC hair loss products.  You’ll need a doctor to write a prescription.  Some of the most effective and widely used prescription hair loss medications that your doctor may prescribe are:

Minoxidil

Designed to enlarge the hair follicles and prevent miniaturization.  Used to treat a broad spectrum of hair loss conditions.  

  • Sold OTC in foam and liquid formulas
  • Available by prescription in higher dose pills and topical formulas

Finasteride

Prevents testosterone from converting to DHT, which attacks the hair follicles and causes hair loss.  Often used to treat male and female pattern hair loss.  

  • Available only by prescription
  • Reported sexual side effects such as lower libido by some users
  • Used by both men and women, but not recommended for women of childbearing age
  • Topical formula is proven to be equally as effective as the pill without the undesirable side effects since it is not systemic.  

Retinol

A derivative of Vitamin A that improves the absorption of Minoxidil, Finasteride, and other medications that stimulate hair growth.

  • Typically not used as a stand-alone hair loss solution
  • Low OTC doses not as potent as prescription doses

Spironolactone

A DHT blocker used to treat female pattern hair loss.

  • Available only by prescription
  • Safe for women who have not been through menopause

When to see a doctor

In a 2015 study conducted by the National Library of Medicine, nearly one-third of people surveyed reported avoiding the doctor, even those with major health problems. (05)  The result was later detection, reduced survival rates, and more suffering than necessary.  You won’t die if your hair falls out, but why lose your hair if you don’t have to?  If you are experiencing hair loss, be sure to seek medical treatment from a licensed dermatologist.   Early medical intervention not only prevents further hair loss but in many cases, can help you regrow your hair.  

If you have hair loss concerns and if accessibility and/or affordability is an issue, visit us at happyhead.com.  You will have the opportunity to consult with one of our board-certified dermatologists and hair specialists.  No insurance or co-pay is required.  You only pay for the product if deemed necessary and appropriate.

Resources:

(01) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084283/#:~:text=Surveys%20suggest%20that%20a%20large,self%2Ddiagnose%20using%20online%20information.

(02) https://pubmed.ncbi.nlm.nih.gov/34553483/

(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746235/

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/#:~:text=People%20often%20avoid%20seeking%20medical,survey%20reported%20avoiding%20the%20doctor.&text=Even%20individuals%20with%20major%20health,12%20avoid%20seeking%20medical%20care.

When Women Get Male Pattern Hair Loss


Female pattern hair loss can progress from a widening part to overall thinning.

I met my friend Barbara (01) twelve years ago when our boys were toddlers.  Barbara is a tiny woman with lots of spunk.  I always thought of her as strong, smart, and confident.  She called one day and confided in me that it bothered her that her hair was thinning.  She had been losing hair on the crown of her head since she was in her late 20s, and she never did anything about it.   She knew that I had lichen planopilaris and wanted to get the name of the dermatologist I used to treat my hair loss.  

Anyone knew just from looking at Barbara that her hair was sparse, and it took me by surprise that she hadn’t already had it checked out by a dermatologist or a hair specialist.   But then again, Barbara isn’t exactly a fashionista.  She’s an elder care nurse who spends most of her weekdays in scrubs and her weekends in sweats.  But still, I was surprised.  Barbara visited my dermatologist, and it turns out that she has androgenic alopecia, also known as male pattern baldness.  Who knew that women can get male pattern baldness?  And who knew that it could start so young?

How do Women Get Male Pattern Baldness?

Women get male pattern baldness for the same reasons men do.  Also known as androgenic alopecia, female pattern hair loss is usually inherited.  The condition occurs when a woman has a shorter than normal period of hair growth and a longer than normal period between when her hair sheds and grows.  In some cases, women have the misfortune of inheriting smaller hair follicles and thinner strands of hair.  

Almost every woman experiences female pattern hair loss at some point in her life.  Most first notice androgenic alopecia around menopause, but it can start any time after puberty begins.  If anyone on either side of your family has lost his or her hair, it’s more likely that you will too. 

What Does Female Pattern Baldness Look Like?

There’s some good news if you have female pattern baldness.  Women’s hairlines usually don’t recede and you won’t end up with a donut.  The other good news is that women typically don’t go completely bald.  Usually women with androgenic alopecia have one of three different patterns of hair loss.  A bald spot can form at the crown of your head, you could lose hair along your center part, or your hair could thin all over.  In some cases, hair gets so thin that the scalp can be seen.

If you’re a Woman, How do you Know if you Have Male Pattern Baldness?

Although it’s tempting, don’t try to self-diagnose or treat yourself if you think you have androgenic alopecia. Get an appointment with a board-certified dermatologist and hair specialist.  Your dermatologist may do one or several of the following:

  • Evaluate your hair loss pattern
  • Review your medical history
  • Rule out other possible causes for your hair loss, such as iron or vitamin D deficiency, thyroid disease, or another type of scarring alopecia
  • Determine whether you are producing too much androgen (male hormone)
  • Use a dermoscope or a microscope to look at the structure of your hair shaft
  • Take a small biopsy of your scalp and send it to a pathologist

Androgenic Alopecia Often Goes Undiagnosed in African American Women

Women of every race are affected by androgenic alopecia and other types of hair loss.  African American women are no exception.  In a 2016 survey conducted at Boston University’s Sloane Epidemiology Center, 47.6 percent of African-American women surveyed reported hair loss. (02)   

However, like my friend Barbara who noticed that her hair was thinning and didn’t do anything about it, many African-American women are not seeking treatment for androgenic alopecia.  Out of the group surveyed, 81.4 percent reported that they had never consulted with a physician about their thinning hair or bald spots.

The moral of this story?  If you think that your hair is thinning and have a history of hair loss on either your Mother’s or Father’s side of the family, don’t ignore it.  Make an appointment with your dermatologist to get evaluated and treated. 

Do Asian Women get Alopecia?

Asian women do get alopecia, but traditionally rates have been lower than those of Caucasian or African-American women. (03)  That number seems to be on the rise, though.  Diet is believed to be a contributing factor.   

Early research indicates that diets rich in vegetables, herbs, and soy may contribute to hair growth and health thanks to their anti-inflammatory nutrients. (04)  The traditional Asian diet, loaded with fish and vegetables, meets that criteria.  

Today’s modern Asian diet looks more like a typical American diet though, filled with processed foods.  The fat, salt, and empty calories lead to higher BMI and blood sugar levels that have been linked to female pattern hair loss. (05)

What Treatments are Available to Women with Female Pattern Baldness?

Treatments for androgenic alopecia are designed with two goals in mind:

  1. Prevent further hair loss
  2. Stimulate hair growth

Sounds logical, right?  Well, it is.  Here are medications that dermatologists typically prescribe:

Retinol (Tretinoin)

Retinol is derived from Vitamin A and has been found to be effective for treating female pattern hair loss when used either alone or in combination with Minoxidil. (06)  Retinol has been proven to stimulate growth and improve the absorption of other ingredients that promote hair growth.

Minoxidil (Rogaine)

Minoxidil, sold over-the-counter under the name Rogaine, is a hair regrowth treatment.  It works by enlarging the hair follicles and elongating your hair’s growth phase.  Minoxidil is available in both a topical foam and a pill.  Although the foam is available in a two percent formula for women and a five percent formula for men, dermatologists often recommend the five percent for women to use for androgenic alopecia.  Any hair growth realized while using Minodixil can be lost if you stop using the product, so it is highly recommended to use it under the care of a licensed dermatologist.

Finasteride (Propecia)

Finasteride is a prescription medication that was initially designed to treat enlarged prostates.  Because it prevents testosterone from converting into dihydrotestosterone (DHT), the medicine is helpful for women with female pattern hair loss. (07)  Finasteride is available as an oral medication and as a topical solution.  Many women prefer topical to avoid potential side effects.

Dutasteride (Avodart)

Dutasteride is similar to Finasteride.  Both medications prevent your body from converting testosterone into DHT, which causes female pattern baldness.  Dutasteride is newer to the market and is used off-label for androgenic alopecia in women. Finasteride is highly effective for most women, but when stronger medications are required, Dutasteride is a good option. (08)  Like Finasteride, Dutasteride is best for women who are not pregnant or thinking about becoming pregnant.   

Spironolactone (Aldactone)

Spironolactone is an effective treatment for hormone-induced hair loss that is only prescribed to women.  The medication blocks DHT production by simultaneously decreasing testosterone and increasing estrogen.

Data indicates that Spironolactone is highly effective for treating female pattern baldness.  In a research study conducted, 74.3 percent of patients who were treated with Spironolactone reported stabilization or improvement in their hair loss. (09)  

Oral Spironolactone can cause low blood pressure, drowsiness, and other side effects.  Topical Spironolactone, which does not go through the digestive system and is less likely to induce side effects, is often prescribed and preferred.  Topical Spironolactone is often compounded with Minoxidil to help your hair grow even faster and thicker.   

Compounded Topical Treatments

If you’re not thrilled about using multiple products, all-in-one topical treatments that combine multiple medications into one are now available and can be more effective than using just one medication alone. (10)   Popular combinations are:

  • Retinol, Minoxidil, and Finasteride 
  • Minoxidil and Spironolactone

Many women appreciate the convenience and ease of applying just one formula twice a day.  

With so Many Medications Available to Women with Androgenic Alopecia, How do you Choose?

Are you confused about all of the different options?  If so, that’s understandable since some of the DHT blocking medications work similarly.  Thankfully, dermatologists have experience selecting the right medications for patients with female pattern hair loss.  Your dermatologist will help you choose the right medication, dosage, and combination of medication based on the severity of your hair loss and your medical history.  

Remember that treatment for female pattern hair loss isn’t one-size-fits-all.  Different medications work for different women.  It’s common to go through a trial process to see what works best for you.  

Also, keep in mind that patience is key when treating androgenic alopecia.  Medications work over time, so it may be a few months before you see a noticeable improvement, no matter which treatment you and your dermatologist choose.

Women with Androgenic Alopecia Often Need a Support System

Every woman deals with androgenic alopecia differently.  My friend Barbara took her diagnosis in stride, but many women are devastated.  Hair is a huge part of a woman’s identity, and losing it can take a toll on a woman’s confidence.  

If you’re having trouble coping with your hair loss, resources are available to you.  Best of all, some of the resources are free.  Facebook has a closed group dedicated to females with androgenic alopecia.  Members share information about their diagnosis and treatment plans. Sometimes, they’re just there to tell each other that it’s okay to be sad about their hair loss.  Whether it’s on Facebook, another social media outlet, or in person, support groups are a good way to connect with others who are feeling the same way as you about your hair loss situation.  

If you’re not in a good place mentally, make sure you contact a qualified psychologist or a psychiatrist.  Depression and anxiety are common among women with female pattern hair loss.  It’s important to seek help so you can regain your sense of self.

Resources:

(01) Name has been changed to protect confidentiality

(02) https://www.sciencedaily.com/releases/2016/03/160304093239.htm

(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560543/

(04) https://www.karger.com/Article/Fulltext/504786

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560543/

(06) https://pubmed.ncbi.nlm.nih.gov/3771854/

(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060023/

(08) https://pubmed.ncbi.nlm.nih.gov/25382509/

(09) https://www.jaad.org/article/S0190-9622(15)01878-2/fulltext

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314881/