Hair loss in women at any age and for any reason is discouraging, frustrating, and sometimes even devastating. The most common type of hair loss in women is called female pattern hair loss, or FPHL. Many factors are to blame for hair loss including medical conditions, genetics, some medications, harsh scalp or hair treatments, and hormonal changes. Methods to treat this condition in women are effective in some cases, but in others medical and surgical interventions may be needed to restore hair growth.
See your doctor to rule out a medical condition. Several medical conditions can either temporarily or permanently interfere with normal hair growth and development. Some of these medical conditions include the following:
Treat the medical condition. Medical conditions can lead to either temporary or permanent problems with hair loss.
With the help of your doctor, and possibly healthcare professionals that practice in specialty areas, treating the underlying medical condition may resolve your hair loss problem.
Your doctor will need as much information as possible about your hair loss problem, so be prepared to discuss this issue in depth. Be prepared to describe when it began, any significant life events that occurred just prior to the problem, steps you have taken to resolve it, and how much distress the hair loss is causing you.
If an underlying medical condition is discovered, specialists that may be part of your treatment may include endocrinologists, dermatologists, nutritionists, and psychiatrists.
Understand how your hair grows. Many of the medical conditions listed interfere with one of the three phases of hair growth.
The anagen phase is the period when your hair is actively growing. About 85% of your hair is in the anagen, or growing phase, at any given time.
The catagen phase is a short period of time, about two weeks in durations, that allows the follicle to regenerate. Hair growth is halted during the catagen phase.
The telogen phase is considered the resting phase of hair growth, and lasts for two to four months. At the end of this phase the hair falls out. Most people normally lose about 100 hairs each day due to the hair that is in the telogen phase.
Many medical conditions encourage hair to enter the telogen phase. This may cause as many as 300 hairs to be lost each day. The medical term for excessive hair loss during this phase is telogen effluvium.
Realize that telogen effluvium is often temporary. Many medical conditions that cause hair to move into the telogen phase can be treated.
Since your hair remains in the telogen phase for several months, your hair loss may not occur immediately after the event that triggered it. This would include physical trauma and severe emotional stressors.
Review your medications with your doctor. Many medications can cause temporary hair loss.
Do not alter your medications for any reason. Talk with your doctor about your concerns. If you feel a medication is causing your hair loss, your doctor may be able to help by either adjusting the dose or prescribing a similar medication to take its place.
Some medications that are known to contribute to hair loss include lithium, warfarin, heparin, and levodopa.
Drugs that are classed as beta-blockers can also cause hair loss. Examples of medications in this class include propranolol, atenolol, and metoprolol.
Amphetamine derivatives can cause hair loss. Examples of amphetamine medications include amphetamine salts, most commonly recognized by the brand name Adderall®, dextroamphetamine, and lisdexamfetamine.
Chemotherapy medications, such as doxorubicin, commonly cause sudden and complete hair loss, as does radiation therapy associated with cancer treatment.
Consider the role of genetics. Having family members that developed hair loss are an indicator that you may also be susceptible.
The most common pattern of genetically-induced hair loss involves losing hair at any earlier than normal age, losing hair more quickly than normal, and an overall thinning of hair in women.
There is an incidence of about 21% of hair loss in women that is passed on genetically.
Recognize hair loss from hormonal changes. Some situations that cause fluctuations in hormones result in temporary hair loss, and others a gradual but permanent change in hair growth.
A good example of temporary hair loss is from pregnancy and childbirth.
The onset of menopause is often accompanied by a noticeable loss of hair. Menopause is part of the normal aging process, and the associated changes in hormone levels lead to a gradual thinning of hair.
Some women with hair loss at an earlier than normal age, or excessive loss, have been tested for alterations in levels of male hormones including androgens like testosterone. The results of these studies are inconclusive as to the role those hormones may play in causing hair loss in women.
Your doctor can help to determine the role of hormones in your situation by performing blood work. Severe hormonal imbalances may be treatable in some cases.
Evaluate your diet. Sudden changes in your diet, and sudden weight loss, can contribute to hair loss.
In most cases, hair loss related to nutrition or diet falls in the category of telogen effluvium, meaning it is often temporary.
Talk to your doctor or work with a nutritionist. Your doctor can perform physical exams and lab work that can provide evidence of vitamin or nutrient deficiencies.
Working with a nutritionist can help to incorporate foods into your regular diet that will correct any vitamin or nutrient deficiencies identified, and help to resolve the problem of hair loss.
Realize the changes that occur with age. The normal aging process causes follicles to gradually reduce their size.
Reduced follicle size means that the area of your scalp that supports hair roots becomes smaller, but the number of follicles are basically the same.
The overall reduction in the size of hair follicles still allows for hair to grow and develop as always, only the hairs are much finer, leading to thinning of the hair as opposed to areas of baldness.
Studies done in women that experience FPHL indicate that the normal aging process includes thinning of hair. This usually begins somewhere around age 40, with the greatest impact in women 70 years of age or older.
Try applications of products containing minoxidil. Various brand names are manufactured that contained minoxidil. The most familiar branded product is called Rogaine.®
Monixodil is available without a prescription in 2% and 5% strengths. The products are made in a topical solution or topical foam. The 2 % product is recommended for use in women
Product directions recommend applying the solution or foam no more often that twice daily.
Results show that using minoxidil helps hair to grow in about 20% to 25% of women, but stops further hair loss in most women that try the product.
Once you begin using the product, it is necessary to maintain long term use in order to continue to see the positive results. Once the product is no longer used, its effects wear off.
The most common side effects of minoxidil include scalp irritation and unwanted hair growth on areas of the face or hands. Sometimes systemic absorption can cause tachycardia, or a rapid heart rate.
Talk to your doctor about finasteride. Finasteride is the only other approved medication for the treatment of hair loss, however it is only approved for use in men.
The use of finasteride has been shown to improve hair growth and slow the process of hair loss in men, however research studies are ongoing for the use of finasteride in women.
Studies using finasteride in women are currently ongoing and are showing promising results. Your doctor may consider using finasteride, or a similar agent, depending on your individual presentation, other medications you are using, your age, and other medical conditions you may have.
The use of finasteride in women is not FDA approved, so your doctor would be prescribing this to you in a manner called off-label prescribing.
Women of child-bearing age should not even touch tablets that contain finasteride due to the documented risk of birth defects.
The most common side effects of finasteride use in men include decreased sex drive and sexual function. Other common side effects include dizziness or faintness when getting up from a seated or resting position, chills, and sweats.
Ask your doctor about other possible medications. Some drugs have secondary effects that lead to hair growth. In some cases, these medications may be appropriate for use in women to treat hair loss.
These drugs are not approved for use in treating hair loss by the FDA. Some drugs that may be helpful include spironolactone, cimetidine, other drugs that fall in the same class as finasteride, birth control pills, and ketoconazole.
While these, or similar agents, may prove helpful in treating your hair loss, they have other effects for which they are FDA approved to treat. Talk with your doctor about using these medications. Your doctor will consider your other medications and any existing medical conditions in treating your hair loss.
Consult a hair transplant surgeon. The process of transplanting hair involves removing healthy hair follicles from areas on your scalp where your hair is thick, and transplanting those into areas where the hair is thinning, or where hair loss is most evident.
This type of procedure involves removing hundreds of hair follicles and grafting them into areas where they are needed.
While hair transplant surgery is expensive, the results are very good and are permanent.
Ask your doctor about low-level light therapy. The process of low-level light therapy, or LLLT, was discovered in the 1960s and found to be helpful in promoting wound healing.
Several products are available, and approved by the FDA, that use LLLT technology. While the documented results of this form of treatment do not meet scientific measures of efficacy, many individual patients did see positive results.
The underlying mechanism of action for LLLT is not completely understood, but studies have indicated that a change occurs at the cellular level, improving hair growth in many people. More work is needed to develop products that work more efficiently.
Take vitamins and nutrients. Work with a nutritionist to establish a diet that is rich in any vitamins or nutrients you may not routinely consume, or that your doctor may have identified as deficient. Take vitamins or supplements that may provide additional doses beyond what you consume in diet.
Take products that contain omega 3 and omega 6. The use of omega 3 and omega 6 products are not approved for use in the treatment of hair loss. However, one study done in women with FPHL showed good results when they took products contain omega 3 and omega 6 for six months.
Another study done in women resulted in positive results when products containing the B vitamins and L-cysteine were taken for a four month duration.
Ask your doctor about taking melatonin. One research study done in a small group of women showed positive results in treating hair loss when melatonin was used.
The women that participated in this study showed an increase in the anagen phase of hair growth, and resulted in improvement in hair thinning.
The women in the study used a 0.1% topical solution of melatonin applied to the scalp area for six months.
This was the first clinical trial using melatonin in this manner. More research is needed to determine any risks that may be involved in using melatonin in this manner.
Consider using topical lavender. One small study showed positive results using lavender.
There is very little evidence to support the use of herbal remedies in treating hair loss, however one preliminary study showed good results when using lavender combined with other herbal oils, in treating some forms of hair loss.
Lavender should not be taken orally. Scalp or skin irritation may occur when lavender is applied topically.
Most people considering surgical hair restoration are unaware of the scope and possible pitfalls of this medical specialty. While some perspective patients may understand the basic science behind these procedures, few have any grasp of the aesthetics and artistry required to perform them well. Unfortunately, many of the physicians who perform these procedures are as ill informed as their patients.
Flashy marketing and high-pressure sales pitches dominate the field, making truly objective and rational decision making by the patient nearly impossible. In general, hair transplantation is not handled as the medical specialty that it is, one that serves patients, but rather as a business that serves consumers.
With that said, The American Hair loss Association fully endorses surgical hair restoration for those candidates who can benefit from the procedure. It is important to note, however, that there are only a handful of qualified surgeons and surgical staffs performing hair restoration surgery in the US and worldwide. In this section you will learn what questions to ask during your consults, as well as what to look for and what to avoid when choosing a hair restoration surgeon.
The donated hair follicles, surrounding tissue and skin are called grafts . Each graft contains one or more hair follicles with accompanying hair, tissue, and skin.
The art of hair transplantation is as important as the mechanics of this medical technique. It is important to remember that no two heads are alike, and each procedure should be looked at on an individual basis. Hair density is the number of hair follicles per squared centimeter of scalp. Scalp laxity constitutes the flexibility or looseness of the scalp, the more flexible your scalp, the easier it is to harvest donor follicles . Conversely, the tighter the scalp the more difficult it is not only to harvest donor hair, but also to close the donor area after excision. More hair can be transplanted if the scalp is loose and the density is high.
Hair grows in several different directions from the scalp ; forward at the top and front, down or away from the middle and the sides of the head, and back or down in the rear.
Coarse Hair has naturally greater bulk, therefore covering more surface area and can be transplanted using fewer grafts. Fine hair obviously has less bulk, consequently providing less coverage on the scalp than coarser hair . More grafts will be required to create a fuller appearance.
Curly and wavy hair usually gives superior results more easily in hair transplantation because a single curly hair has a tendency to curl on itself and covers more scalp than straight hair be it fine or course. Straight hair tends to lie against the scalp, thus providing a less dense appearance than curly or wavy hair. The closer the hair color is to the skin color, the better the appearance of coverage . For example, African hair is dark and very curly and provides the least contrast against various shades of dark skin. This will produce the best hair transplant results visually. Fair-haired men (blondes) with a light complexion also have a low contrast between hair and skin shades. This too can produce excellent results. Asian men however, with dark straight hair and light or beige complexions have a higher contrast between hair and skin, and usually pose the most challenges in hair transplantation. However, excellent results can be achieved by a highly skilled surgeon and team
It is imperative that the doctor considers the patient's future hair loss pattern and rate of change while designing the hair transplant procedure. It is important to remember that a natural hairline will vary from person to person. When a doctor chooses the recipient sites for hairline placement, several things should be taken into account - the shape of the face, the age of the patient, and the prognoses of future hair loss.
The crown of the head should never be transplanted unless the patient is older with stabilized hair loss (which is difficult to gauge). The front and the top of the head should be the areas considered in a hair transplant. This is the area that frames the face and makes the most dramatic change in one's appearance.
While losing a little off the top isn’t the social exile that it once was, the experience of hair loss is still stressful and frustrating for most people.
About 70 percent of men and 40 percent of women go through some degree of hair thinning as they age, almost usually as a result of androgenic alopecia (AGA), otherwise known as male or female pattern baldness. Though a number of products and treatments currently exist to fight back against hair loss, a so-called permanent "cure" would probably be one of the most exciting scientific discoveries to come along in a long time, right behind fat-free bacon and unlosable house keys. But is such a cure actually even possible? And if so, just how far from it are we?
1.HAIR TODAY, GONE TOMORROW
By conventional standards, the current line of hair loss treatments are pretty damneffective, though ultimately limited in their capabilities. Finasteride (Propecia) and Minoxidil (Rogaine) are very safe medications that significantly boost and even regenerate our noggin’s capacity for hair growth.
For the short primer: Hair continuously grows out of a single follicle for a period of about four years, all the while being nourished by surrounding cells. The follicle then undergoes a short hibernation phase of about three months, recuperates, and sheds the current hair strand attached to it before starting production back up. At any one time, about 10 percent of our follicles are in that resting state while the rest are happily pumping out luscious tubes of keratin.
However, the cycle can be interrupted or made shorter by a number of things, including when blood levels of the androgen Dihydrotestosterone (DHT) are too high, such as with AGA, or when the immune system is mistakenly compelled to attack the follicle, such as with alopecia areata (AA). It can also be permanently shut down when follicles are damaged beyond repair (we’re born with all the hair follicles we’ll ever have, so once one is taken out of commission, that’s that).
Minoxidil circumvents hair loss largely by increasing blood flow (and nutrition) to the follicles, though it’s also believed to return some dormant follicles to a healthy state of growth. Finasteride, on the other hand, is a DHT inhibitor and restores a degree of normal function to the follicles. But both treatments need to be applied daily to work; have a limit to the amount of hair they can restore (they won’t work on permanently damaged follicles), and lose their effectiveness over time for a subset of users (Dutasteride, another more potent but off label DHT inhibitor, faces the same limitation).
Hair transplantation, where productive follicles from the rest of the head or body are seeded into the balding areas, is a more permanent option. Far from the old perception of fake-looking hair grafts, these techniques have become very good at replicating "natural" hair. In recent years, we’ve seen the advent of robotic technologies that aid the surgeon in precisely extracting and transplanting follicle grafts with minimal scarring. But these surgeries are plenty expensive, costing upwards of $10,000, can only shift around the amount of total hair you have, and don’t stop additional hair loss.
Other treatments, like low-light laser therapy, or nutritional supplements, have the barest of evidence or plausibility supporting their use.
Though low-light laser therapies like the above have become popular, there's little proof showing that it can combat hair loss.Journal Sentinel/Gary Porter
Despair not though, embarrassed cap-wearing readers. As it turns out, there might actually be a bona-fide cure for hair loss already out there. Kind of.
About this time last year, the news was abuzz with the story of 25-year old Kyle Rhodes, a man whose head had become entirely bald, eyelashes included, because of his alopecia areata, first diagnosed when he was two. Like Lazarus rising out of a beauty salon, though, once Rhodes was treated with Xeljanz (tofacitinib), a drug ordinarily used for rheumatoid arthritis, his hair grew back after a scant eight months.
Kyle Rhodes' hair loss was completely reversed by the drug tofacitinib, but is it really a cure for baldness?Yale University
Funnily enough, his dermatologist, Dr. Brett King of Yale University, only prescribed the medication to help with Rhodes’ severe psoriasis, also an off-label use for the Pfizer-owned drug. "I was ecstatic," King told CNN. "I was truly overjoyed for him." He later published a study documenting Rhode’s hair recovery in the Journal of Investigative Dermatology.
"The results are exactly what we hoped for," King said in a statement released by the university. "This is a huge step forward in the treatment of patients with this condition. While it’s one case, we anticipated the successful treatment of this man based on our current understanding of the disease and the drug. We believe the same results will be duplicated in other patients, and we plan to try."
That same year, researchers in Nature Medicineannounced their own hair miracle, as they reported that an oral preparation of the bone marrow cancer drug ruxolitinib had restored more than half of the hair lost by three balding AA patients after five months of treatment, validating their earlier animal studies.
Miracles rarely come without some caveats though. The drugs likely worked to reverse hair loss because of their immunosuppressive effects on the body, with both drugs belonging to a new class of drugs known as JAK inhibitors. At the time, neither Rhodes nor the patients in the Nature study reported any adverse effects, but it’s known that sustained use of these sorts of drugs can have severe drawbacks like an increased risk of infection — as anyone who has undergone chemotherapy can attest to.
It also isn’t known whether taking someone off these drugs will, like Rogaine, result in the hair falling back out yet. In a follow-up interview with WebMD, the authors of the Nature study explained that out of the dozen people they treated with ruxolitinib, only six out of nine experienced the miraculous hair growth they first reported (the last three hadn’t been on the treatment long enough to conclude anything at that time). Being a recent invention, these drugs would be also fairly expensive to regularly prescribe.
Some of these concerns can be mitigated should a JAK inhibitor ever be made available in topical form. At the time of his study, King hoped to pursue a clinical trial using a cream version of tofacitinib. And as of last October, the Natureresearchers were eagerly looking to evaluate other JAK inhibitors in a placebo-controlled study. "Patients with alopecia areata are suffering profoundly, and these findings mark a significant step forward for them. The team is fully committed to advancing new therapies for patients with a vast unmet need," said study author Dr. Angela M. Christiano, professor in the Departments of Dermatology and of Genetics and Development at Columbia University Medical Center, in a statement.
Unfortunately, probably the biggest sticking point to these treatments is that they would likely do nothing for the majority of hair loss sufferers. AA, like rheumatoid arthritis and psoriasis, is an autoimmune disorder, and the mechanism by which baldness happens in these people is different than what causes AGA — though it would certainly be a great boon to the approximately four million people in America suffering from AA.
No, to permanently cure baldness will undoubtedly take a much more radical approach.
The major stumbling block to any hair loss cure is in restoring full functionality to our follicles, even those which have permanently become a Nair’d tundra. None of the current or proposed treatments we have available can pull that latter trick off.
Many researchers believe that the only way around this is to create new cells from scratch that stimulate hair growth for us, via stem cell therapy. Though stem cells, undifferentiated cells that can become a variety of specific cells, has been lauded as a potential means of regenerating organs or turning back the wheels of time, there’s logically no reason why they couldn’t also be turned into hair restorers.
Earlier this year, the authors of a PLOS-One study published this January may have made a giant leap in understanding how to accomplish that goal. From human pluripotent (embryonic) stem cells, they created cells that resembled dermal papilla cells, which reside underneath and regulate our follicles, and grafted them into the skin of albino mice. They discovered that these cells were able to stimulate hair growth.
Though it looks like razor stubble, the hair seen here, stimulated by bioengineered stem cells, might someday prove to be the cure to hair loss.Sanford-Burnham Medical Research Institute
What made their results particularly compelling was the fact that earlier attempts to use ordinary dermal papilla cells in grafting have come up short, due to their hair-simulating ability quickly fading away once removed from the body. It’s a shortcoming that the researchers believed they avoided by forcing the stem cells to pass through an additional transformation into a precursor stage of neural crest cells before finally becoming dermal papilla cells.
"Our stem cell method provides an unlimited source of cells from the patient for transplantation and isn't limited by the availability of existing hair follicles," said study author Dr. Alexey Terskikh, associate professor in the Development, Aging, and Regeneration Program at Sanford-Burnham University, in a statement at the time.
Though the research is only in the beginning stages, it "represents the first step towards development of a cell-based treatment for people with hair loss diseases," according to the authors.
"Our next step is to transplant human dermal papilla cells derived from human pluripotent stem cells back into human subjects," said Terskikh. "We are currently seeking partnerships to implement this final step."