Hair Loss Women
- Best Results6-12 months+
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistMedical dermatologist
- Duration of ResultsLong -term
- AnaestheticNA
- Back to WorkNA
- Cost$-$$
Hair Loss Women
Hair Loss Women is more complex than hair fall in men. Common conditions include androgenic alopecia or female pattern hair loss, however other conditions such as telogen effluvium, hormonal imbalances, iron deficiency & thyroid disorders should be considered. A medical dermatologist can diagnose & efficiently manage. As with most hair loss disorders, early management gives the best results.
FactsFacts on Treating Hair Loss Women
- Telogen effluvium & female pattern hair loss are the most common forms of hair loss in women
- The former is self-limiting whilst the latter is progressive
- The very first step is to obtain a firm diagnosis by a medical dermatologist
- Effective treatments are available to slow down, & in many cases regrow hair
- Minoxidil is an effective over the counter solution for most cases
- Other treatments include PRP or platelet rich plasma
- Less common causes include alopecia areata, frontal fibrosing alopecia, traction alopecia, trichotillomania, inflammatory & drug induced causes
Hair Loss Women
The most common causes of hair loss include androgenetic alopecia (female pattern hair loss or baldness) & telogen effluvium (limited hair loss). It is not uncommon for both conditions to co-exist.
Other causes of hair loss include alopecia areata, traction alopecia, drug induced hair loss (e.g. Accutane), iron & vitamin deficiencies, inflammatory conditions like lupus, lichen planopilaris, trichotillomania, & many others. The very first step in treating hair loss is to identify the cause. A medical dermatologist can investigate, diagnose, & treat.
Disclaimer: I am a procedural dermatologist, namely my work in the context of hair loss disorders is FUE for complex cases. For medical management, please see my colleagues at Clinic Cutis.
What is a sensible hair loss treatment routine for women?
The treatment outlined below refers to cases of androgenic alopecia, or female pattern hair loss/baldness.
AM: Minoxidil 5% 1 ml.
PM: Minoxidil 5% 1ml
PRP 3 sessions monthly, followed by maintenance 3-6 months.
Option for minoxidil tablets 1mg daily, option for cyproterone acetate pulsed monthly, option for OTC vitamins including saw palmetto, option for Low Level Laser Therapy (home use). The above applies to cases of androgenic alopecia, also known as female pattern hair loss.
What is minoxidil & why is this the first step in treating female pattern hair loss?
Minoxidil is a very old (but very effective) drug used for the management of male & female pattern hair loss. It can be purchased from most pharmacies & cost approximately 60 to 80 cents per day.
Twice daily use of topical minoxidil has shown to improve hair counts by week 24. As with male pattern hair loss, minoxidil should be initiated early in the course of treatment. Currently there are 3 forms of delivery-
- Minoxidil lotion (with propylene glycol)
- Minoxidil foam (without propylene glycol)
- Minoxidil tablets
What percentage of minoxidil is best for female pattern hair loss?
The stronger 5% topical formulation is most widely recommended by dermatologists. FDA approval for females is 2%, however research has shown that 5% works better. There is scientific evidence that twice a day application works better than once a day.
Some dermatologists prefer to compound a compounded formulation with finasteride 0.1 to 0.25%. Addition of finasteride is off-label & classed as category X. Contraception measures will be discussed by your treating dermatologist.
*For patients with super sensitive skin or documented allergies to propylene glycol, the foam solution of minoxidil is advisable.
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What is the evidence of oral minoxidil tablets?
Oral minoxidil has been shown to be highly effective in the treatment of female pattern hair loss. The current literature suggests an average dose of 1 mg Minoxidil daily (0.25 to 2mg).
What are the potential side effects of minoxidil?
Oral minoxidil (tablets) have more side effects compared to topical minoxidil.
The most important side effect to understand is paradoxical shedding of hair in the first few months of use. This is a transient & self-limiting event.
Topical Minoxidil side effects are mild. They transient hair loss (minoxidil effluvium),& mild hypertrichosis (unwanted hair) around the cheeks, temples & forehead. Some patients may develop an itchy scalp, mostly due to ethanol & propylene glycol. Many patients prefer a foaming solution as this does not have propylene glycol.
Oral Minoxidil, possible side effects includes- dizziness, swelling of ankles, headaches, & fluid retention. Hypertrichosis may be generalised.
*Side effects such as irritant, allergic reactions, and excessive hair growth are proportional to the concentration of minoxidil & reversible with cessation of the drug. Discuss the pros & cons with your dermatologist.
Dreaded hair loss. 😱😱😱Dr Esh & Dr Heba @cliniccutis are experts👍🏻
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🔬Skin Science: Androgenetic alopecia (male & female pattern hair loss) is primarily due to DHT, a derivative of the male hormone testosterone. Testosterone converts to DHT with the aid of the enzyme 5-alpha reductase. When DHT binds to receptors in scalp follicular miniaturization can occur. This shrinks hair follicles, making it impossible for healthy hair to survive
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👉Treatment options: Depends on whether you are male or female. Male pattern hair loss treated with #finasteride +/- #dutasteride . These can be used in females off label & in caution at the discretion of your #dermatologist. Other antiandrogens such as cyproterone acetate preferred in females
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🧴💊Minoxidil can be used orally or topically in both males & females
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🩸PRP & #microneedling as well as thulium lasers can be useful adjunctive therapies in both sexes
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💯Early treatment & stabilization of hair loss is the key. If you are thining, book a consult with my colleagues @cliniccutis
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😎Dr Davin Lim
Dermatologist
@101.skin
Brisbane 🇦🇺
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#hairloss #baldnesstreatments #hairlosscure #hairlosstreatment #hair #growhair #FUE
#alopecia #regaine #femalehairloss #malehairloss #curehairloss #healthyhair #hairlossclinic #drdavinlim #dermatologist #dermatology
Can IPL be used on darker skin types?
Vitamins can help in cases of hair loss associated with nutritional deficiencies such as zinc, biotin, vitamin B, folate & iron. The majority of patients in first world countries will not have any deficiencies, however supplementation is harmless.
Other supplements work by inhibiting the conversion of testosterone to dihydrotestosterone or DHT. These include:
- Saw palmetto
- Green tea extract
- Alfatradiol
- Procyanidin B-2
Can finasteride be used to treat hair loss in women?
Studies have shown that finasteride & dutasteride are highly effective in improving androgenetic alopecia in 68.9% & 65% of women respectively.
These studies are off label & will be discussed with your treating dermatologist. Papers have shown that a higher dose of finasteride combined with the oral contraceptive pill may be required in female pattern hair loss (2.5 mg compared to 1mg in males).
Another option is to use minoxidil 5% & finasteride 0.1%-0.25%. Though most studies show low to negligible serum levels of finasteride, the usual pregnancy precautions apply.
*Finasteride & dutasteride are classed as Category X. Implications for pregnant women include feminisation of the foetus.
Why is PRP (platelet rich plasma) useful in treating hair loss?
There are many studies confirming the value of PRP or platelet rich plasma in the management of hair loss in both men & women.
PRP contains growth factors, cytokines & chemokines. This mix of molecules gives PRP the power to repair damaged cells including miniaturized hair follicles, as found in male & female pattern hair loss. PRP helps to activate hair growth, increasing the number of follicles as well making the hair shaft thicker. PRP also increases the lifespan of hair follicles.
How soon into hair loss should PRP be commenced?
ASAP. PRP is best utilized for early hair loss in both males & females. Advanced cases of alopecia cannot be reversed with PRP. The majority of studies have shown that mild to moderate cases of androgenetic alopecia respond better compared to late-stage disease.
A series of three monthly treatments are required, with maintenance therapy every 3 to 6 months thereafter. Studies have shown that PRP is best combined with medical therapy.
How is PRP delivered into the hair follicle & scalp?
There are 3 methods to deliver PRP into the scalp are-
- Injections spaced 1 cm apart to the area of concern & 3-5 cm beyond the boundary.
- Microneedling & PRP
- Laser assisted drug delivery. The most common laser we use is the 1927 thulium laser as this has the most amount of research behind it.
What is low level laser therapy & can it help?
Low level laser therapy, also known as LLLT or light emitting diode therapy can be a useful adjunct for treating both male & female pattern hair loss. It works by stimulating the hair follicle.
LLLT is best used to prevent hair loss, however there are limited studies to suggest that hair counts can increase by up to 39%. This should be combined with medical therapy as well as PRP. Treatment is lifelong. Refer to the page on LLLT for more information on home devices versus in clinic lasers.
Why is a firm diagnosis essential in the treatment of hair loss?
Hair loss in women is more complex compared to men. There are many more differential diagnoses to consider in females including-
- Telogen effluvium: Most commonly seen post pregnancy or cessation of the oral contraceptive pill.
- Chronic telogen effluvium: can be very difficult to diagnose.
- Iron deficiency, thyroid disease: are common causes of hair loss. Simple blood tests can be helpful.
- Drug induced hair loss- including Accutane hair loss.
- Autoimmune disorders- such as frontal fibrosing alopecia, lupus; more common in women.
Disclaimer: I am a procedural dermatologist, I do not diagnose hair loss disorders. Please book an appointment with our medical dermatologists @cliniccutis
Can FUE or follicular unit hair transplantation be effective for hair loss in women?
FUE hair transplantation is a good option for the management of male pattern hair loss, however in women, this form of hair ‘regrowth’ treatment is more complex.
The reason is that male pattern baldness affects the vertex/crown & frontal-temporal areas of the scalp (horseshoe pattern). This means that for most men, we have a good source of hair follicles at the back of the head (occipital scalp). The hairs in this area are usually resistant to miniaturization, & hence can be excellent donor hairs.
Hair loss in women is more diffuse, namely follicular atrophy or miniaturization of follicles is more global. Hence hair transplantation is limited in value. Exceptions include FUE for disorders such as frontal fibrosing alopecia, as this condition affects the front of the scalp. Refer to section on FFA & FUE for FFA for more information.
Who do you see for management?
In most cases female pattern hair loss is a straightforward diagnosis. This can be confirmed on examination with specialized lighting & magnification. In some cases, your dermatologist may need to take a scalp biopsy & perform a hair pull test (for examination of telogen/anagen hairs under a microscope).
Blood tests are occasionally required to ensure that you are not iron deficient or have other conditions that may contribute to hair loss (such as thyroid disease).
Disclaimer: I am a procedural dermatologist, I do not provide medical management for hair loss conditions, nor do I perform investigations. Please see my colleagues at Cutis Medical for hair loss disorders.
Davin’s Viewpoint on Hair Loss in Women
Hair fall is something that most women will experience. The majority of cases are self limiting, namely telogen effluvium (delayed hair loss) postpartum (after childbirth). This is due to the fact that the hair cycle is partially disrupted, & shedding of dormant follicles occur after the telogen or sleeping phase. This usually occurs at 3-6 months after a traumatic event (pregnancy, surgery, emotional stress, trauma, physical stress, crazy diets).
Where it gets challenging is if one has two synchronous hair loss conditions, the most common being telogen effluvium & female pattern hair loss. Both can give telogen hair, however the latter is more insidious & associated with follicular miniaturization. A medical dermatologist can investigate & manage accordingly. Hair loss is a very complex field of dermatology as there are many other hair fall conditions ranging from inflammatory dermatoses such as frontal fibrosing alopecia, lupus, drug induced causes, through to alopecia areata, chronic telogen effluvium & over 100 more conditions. A firm diagnosis is the very first step.
Surgical options for women, unlike male pattern hair loss, are limited due to lack of donor dominance in females. The diffuse pattern of female hair loss negates the use of follicles in posterior or occipital regions of the scalp. In this context the most frequent application of FUE hair transplantation is treatment of lichen planopilaris, namely FFA patterns involving the eyebrows & frontal/temporal scalp. FFA should be in remission for at least two years before attempts at FUE hair transplantation. Recurrence rates should be discussed prior to hair transplantation.
Disclaimer: I am a procedural dermatologist. I do not provide medical management for hair loss conditions. Please see my colleagues at Cutis Medical for hair loss disorders.
