Because the unique reasons that women lose their hair can be multifactorial and complicated, finding the right treatments for hair loss in women can be difficult.
This is compounded by the fact that the causes for female hair loss often fall within multiple different medical specialties (dermatologists, primary care doctors, OB/GYN’s) which each specialist evaluating only the causes of hair loss unique to their specialty.
So what should I do?
It is of utmost importance to contact a doctor who can complete the entire comprehensive hair loss work up in order to diagnose why hair loss has occurred as well as providing the most recent advancements in aesthetic solutions for hair loss such as PRP.
A customized and comprehensive approach to diagnosing and treating female hair loss is essential in helping women regain a healthy head of hair.
Whether the causes for hair loss are permanent, reversible or temporary, there are many hair loss solutions available.
Possible Hair Loss Treatments
Spironolactone blocks androgen production that decreases the amount of DHT, the hormone that causes hair follicles to produce thinner, weaker hair follicles. This medication is also commonly used in PCOS where an excess of male hormone may be present. Normal dosages are 50-100 mg and it may take up to 3 months to work. Once the medication has been deemed effective, hair can typically be maintained with a lower dose. Side effects include hyperkalemia, headache, fatigue, menstrual irregularity, and GI bleeding.
A 2015 study (1) found that almost 75 percent of participants with female pattern hair loss noticed an improvement in their hair loss after taking spironolactone.
Finasteride is a 5-alpha reductase inhibitor that blocks DHT. Discontinuation can lead to loss of hair that was gained during therapy. It may take as long as 6 months to notice benefits with this medication. Side effects of Finasteride include sexual dysfunction, decreased libido, chills, cold sweats, confusion, and dizziness. These side effects usually occur with the 5 mg dose, however, the 1 mg treatment does not typically have these.
Progesterone blocks androgen production and decreases the amount of DHT, the hormone that weakens hair follicles and leads to thinner, weaker hair follicles.
Cimetidine sold under the brand name Tagamet belongs to a class of histamine blockers used mainly to treat stomach ulcers. The drug can also block DHT. Cimetidine has been used to treat excess facial hair growth (hirsutism) and androgenetic alopecia (AGA) in women.
Stimulate Hair Follicles (Topical And Oral Medication)
Minoxidil (Rogaine) is approved by the FDA for female pattern hair loss. This topical medication is thought to increase Nitric Oxide (NO). NO causes vasodilation of blood vessels that bring nutrients to the hair follicle. Additionally, Minoxidil promotes the growth phase of hair (anagen) and shortens the telogen (resting) phase. It can slow or stop hair loss in most women and may help hair grow back in up to a quarter of those who use it. However, the benefits are lost when you stop using it.
A study conducted in 2017 (2) showed that a combination of minoxidil and spironolactone decreased shedding, increased hair growth, and made hair thicker.
- Menopausal hormones (Estrogen, Progesterone, and Testosterone)
- Pregnancy Hormones (including HCG used for weight loss)
Based on blood results, nutritional supplements may be in order. These include:
- Iron Foods rich in iron include lean red meat, dried fruit, broccoli, egg yolks, lentils, spinach, and chicken.
- Vitamin D. Found in salmon, mushrooms, and grains.
- Glutathione. This critical antioxidant glutathione is responsible for quenching oxidative stress and calming autoimmune inflammation.
- Zinc. This nutrient can be found in foods such as lamb, turkey, pumpkin seeds, and chocolate. Periodic testing for levels of zinc should be done. 30 – 40 mg/day of zinc may be used for at least a 1 year period.
- Multivitamins with vitamins A, E, C, B complex, and Omega-3 and 6 EFA’s. A twice-daily dose of a complete multivitamin with the above nutrients should be taken for healthy hair as well as a healthy body. Additionally, B vitamins can be found in foods such as grains, eggs, and avocados.
- Biotin. It enhances hair growth, thickens hair fibers, and diminishes shedding. It also plays a role in the overall health of skin and nails. Biotin is commonly found in foods such as egg yolks, liver, rice, and milk.
- Gingko (antioxidant)
- Saw palmetto (blocks male hormones)
Red light therapy in the spectrum of 630 – 670 NM stimulates growth, extracellular matrix deposition, and cell proliferation at the hair follicle improving hair growth as well as hair health. This therapy decreases inflammation and increases blood supply to the scalp area. Hair follicles need to be present for this treatment to be effective Late in the hair loss process or in scarring types of hair loss, the hair follicle may be completely gone and will not respond to light therapy.
Theradome has an 820-900 NM light range that has been shown to be beneficial for hair growth
Platelet Rich Plasma (PRP)
Platelet-rich plasma (PRP) therapy uses injections of the patient’s own platelets which are isolated from the blood during an in-office blood draw. Platelets produce more than 300 active substances which help in numerous bodily functions. PRP helps with hair growth by:
- Promoting telogen to anagen transition
- Prolonging the anagen or hair growth phase
- Neo angiogenesis- formation of new blood supply which brings nourishment to the hair
- Decreasing inflammation which can damage hair follicles and cause hair loss
PRP has been scientifically verified for aesthetic hair applications and has been cleared by the FDA as a 510K Class II medical device for hair loss. This therapy works 95% of the time and lasts from 18 months to 3 years.
In a 2017 study (3) on 19 people with AGA, treatment with PRP increased hair growth and thickness, while decreased hair death and thin hair growth. Moreover, research (4) on 45 men with alopecia areata, showed that PRP increased hair regrowth and decreased hair dystrophy, burning or itching sensation better than TrA (steroid) or placebo.
Finally, in a 2016 study (5), 40 men with hair loss were divided into two groups; a PRP group and a saline-injection hair transplant group. The PRP group had new hair growth at only 8 weeks, more than 75% regrowth at 6 months and higher than 75% graft density. On the contrary, the hair transplant group had <75% graft density and less hair growth.
Microneedling works by:
- Releasing hair growth factors which are increased by platelet activation during the microneedling process
- Stimulating & activating stem cells in the hair bulge area that leads to healthy hair growth
- Targeting multiple pathogenic factors that cause androgenic alopecia
- Overexpressing genes related to hair growth
In a 2015 study (6) on men with AGA, after 15 monthly sessions of microneedling, their hair regrew, the hair density improved by 75% and the hair thickness increased after the 4th week! There was also a sustainable improvement after 18 months of follow up.
Further, in another study (7), 100 men with AGA were split into 2 groups, one taking 5% minoxidil and the second one taking 5% minoxidil plus weekly microneedling sessions. After 12 weeks, the microneedling group had a significantly higher mean hair count (91.4) compared to the minoxidil only group (22.2).
Fortunately, the more we learn about female hair loss, the better we get at creating nutraceuticals that can support healthy hair. A great example of nutraceuticals is the Folliceutical MD blend which contains:
- Soluble Keratin (Cytanine)
- Polypodium Leucotomos Extracts
- Bacillus Coagulans (probiotic)
- Turmeric Root
- Daily vitamin & mineral complex (Vitamins A, B6, B12, C, D, calcium, magnesium, zinc)
And it is shown to:
- Strengthen hair
- Fight free radicals
- Improve gut health
- Reduce inflammation
- Improve wellness
Surgically Replace (Hair Transplant)
This procedure involves moving hair from thicker to thinner areas of the scalp from donor sites. With female pattern hair loss, hair tends to thin from all over, making donor sites limited. The exceptions are women with male pattern baldness or hair loss caused by scarring
Cosmetic Camouflage (Hair Tattooing)
Using spray or tattooing the scalp to cover the baldness
Take Away Message
A variety of causes are behind female hair loss. Hormonal shifts, genetics, stress, diet, and medication are just a few of the triggers of hair loss in women. That is why it is important for women suffering from thinning or falling hair to undergo a comprehensive evaluation including medical and lifestyle evaluation to identify the chief complaint, determine root causes and rule out risk factors leading to hair loss. The Hair Loss program at Ruthie Harper MD evaluates ALL of the factors that lead to female hair loss and creates a customized and integrated approach that provides you with the most effective solution designed just for you.