Hair Loss Information
Mistakenly thought to be a strictly male disease, women make up a significant percentage of American hair loss sufferers. Forty percent of women have visible hair loss by the time they are age 40 according to the American Academy of Dermatology. Hair loss in women can be absolutely devastating for self image and emotional well-being.
Unfortunately, society has forced women to suffer in silence. It is considered far more acceptable for men to go through the same hair loss process. Even more unfortunate is the fact that the medical community pays little attention to the issue of women's hair loss. Since hair loss doesn't appear to be life threatening physicians often overlook women's complaints about hair loss and essentially tell their patients that "it's no big deal," and that "you'll just have to live with it."
Of course what these physicians don't seem to realize is that the psychological damage caused by hair loss and feeling unattractive can be just as devastating as any serious disease and in fact can take an emotional toll that directly affects physical health.
Women and Hair Loss: The Causes
From Lady Godiva to the Breck Girl, Farah Fawcett to Jennifer Aniston, there is no question that, at least for women, hair is often a defining point in personal style. That's one reason why so many women panic at even the thought of losing a few hairs down the drain with each shampoo.
Those fears are not unfounded as each year more women are forced to come to grips with the possibility of serious hair loss. According to the American Academy of Dermatology, it's a growing problem, affecting some 30 million women in the United States; with some forms of loss occurring at earlier ages and being seen in increasing numbers.
To understand that, it's important to know a little something about how hair grows.
The Difference between Male and Female Pattern Hair Loss
Experts say our tresses usually grow at the rate of about one-half inch per month -- with each hair having a growth phase of two to six years. At that point the hair "rests" for a period of time, then falls out and the follicle from which it sprang soon starts growing a new strand. And so the cycle continues, usually well into our senior years.
In some folks, those with a genetic predisposition to hair loss a group of hormones called androgens interferes with this natural process. Androgen hormones include testosterone, androsteinedione, and dihydrotestosterone (DHT), all of which are made in men's bodies in large amounts and in women's bodies in small amounts.
In those who are genetically susceptible, when testosterone comes in contact with enzymes residing in the hair cell, it is converted into the more potent androgen DHT, which then binds with receptors deep within the hair follicle.
Over time, an excess build-up of DHT in the follicle causes it to begin shrinking, which in turn alters the natural resting and growth phases of the hair. Some of the follicles eventually die, while others are rendered incapable of producing or maintaining healthy hair growth. The end result is hair loss and a condition that is medically known as androgenic alopecia.
For many decades, doctors believed that androgenic alopecia was the primary cause of balding in both men and women. Today they know this is not true, at least where women are concerned.
Although the science of female balding is still largely misunderstood, there is evidence that many other types of enzymes as well as hormone receptors and blockers may be at work in women.
One clue that there is a true difference between male and female balding is the pattern in which the hair loss occurs.
Female pattern balding goes around the whole top of the head, it's diffuse whereas men lose it on the temple, the crown, the bald spot in the back. Not coincidentally, the hormone and enzyme receptor sites are also different in varying areas of the scalp, another reason doctors now believe the loss patterns are caused by different precipitating factors.
Another important difference: While balding in men is almost always the result a genetic predisposition coupled with age, in women it can happen at any time. In addition, underlying medical conditions can also be the cause of hair loss, even when true androgenic alopecia is the diagnosis.
When it comes to drug treatments for androgenetic alopecia, women are in a difficult position. While many drugs may work to some degree for certain women, doctors hesitate to prescribe them. What's more, drug companies aren't falling over themselves to test drugs specifically for their ability to prevent and treat female pattern baldness.Physicians are reluctant to prescribe systemic treatments (pills or other form of treatment that affects your entire system) because they can tamper with your body's own androgen levels. The doctor will first want to confirm that the hair loss is due to an excess of androgen (another name for male hormones) in the system or a sensitized "over-response" to normal amounts of androgen. Therefore, physicians often choose topical treatments, which are applied directly to the scalp.
Beginning treatment as soon as possible after the hair loss begins gives the best results because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will help prevent further damage and encourage some hair regrowth from follicles that have been dormant but are still viable. Stopping treatment will result in the hair loss resuming if the androgens aren't kept in check in some other way. Maintaining your vitamin and mineral levels helps while you're on anti-androgen medications.
Below you will find a list of treatments used to treat hair loss in women. Currently there is only one FDA-approved treatment for female pattern hair loss. Others have not been approved by the FDA for this particular application, but have been approved for other applications and are used "off-label" to treat hair loss.
The effectiveness of these agents and methods varies from person to person, but many women have found that using these treatments have made a positive difference in their hair and their self-esteem. As always, treatments have the best chance of being effective if they are geared to the cause of the hair loss as well as to the triggering of hair growth.
Minoxidil (Rogaine)
Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil developed excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth.
When applied topically, the amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.
Widely available in generic versions and under the brand name Rogaine, minoxidil seems to be more effective for women suffering from diffuse androgenetic alopecia than it is for men. Product labeling recommends that women only use the 2% concentration of minoxidil, not 5%, because the FDA has not approved use of the higher concentration in women.
Many dermatologists do prescribe 5% for women with androgenetic alopecia if used under their supervision. Small clinical trials have shown that the 5% minoxidil solution is significantly more effective in both retaining and regrowing hair in women with androgenetic alopecia than the 2% solution.
Results from clinical studies of mostly white women ages 18 to 45 years with mild to moderate degrees of hair loss report that after using minoxidil for eight months, 19% of users had moderate regrowth and 40% had minimal regrowth. Of those using a liquid without active minoxidil (a placebo) during the same time period, 7% reported moderate hair regrowth while 33% had minimal regrowth.
Estrogen and Progesterone
Estrogen and progesterone pills and creams may be an effective treatment for women with androgenetic alopecia who are going through 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 age 35 and older 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.
Only low-androgen index birth control pills should be used to treat hair
loss. High androgen index birth control pills may contribute to hair loss by
triggering it or enabling it once it has been caused by something else.
Ketoconazole (Nizoral)
Available as a topical treatment by prescription, ketoconazole is currently used to treat fungal infections. It curbs the production of testosterone and other androgens by the adrenal gland and reproductive organs (in women, the ovaries).
These anti-androgenic effects can be used to help treat hair loss. Nizoral shampoo contains 2% ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1% version is now available over-the-counter, but it may not be as effective as the 2% prescription strength. There are no significant side effects.
Finasteride (Propecia, Proscar)
The drug finasteride inhibits the enzyme 5-alpha reductase in the hair follicle, thereby inhibiting the production of follicle-harming dihydrotestosterone (DHT). DHT shrinks hair follicles and makes it difficult for healthy hair to survive.
Finasteride was first marketed under the brand name Proscar to treat the prostate gland. It was available 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 to prevent hair loss and trigger regrowth for most men, and it may work for some women, although women must not take it if they are pregnant. Also, women should not get pregnant while on the drug because of the risk of birth defects in a male infant. Less than 2% of men have transient sexual side effects, including erectile and libido difficulties, while taking finasteride. However, in women these side effects do not occur.
