Hair loss can be caused by a variety of factors with heredity being the number one reason why men and women lose their mane. Hereditary hair loss in men and women has the same main cause, which is dihydrotestosterone (DHT) attacking our hair follicles. DHT is a metabolite of the male hormone testosterone but it is also present in the female body. Men and women lose their hair not because of increased levels of DHT in their bodies but due to the susceptibility of their hair follicles to DHT attacks, although the exact mechanism and reasons why certain hairs, mostly those on the top of the head, are more susceptible to such attacks are not yet know.
The main difference between the male and female form of hereditary hair loss is in its shape. The male form has a characteristic horseshoe pattern whereas the female form is typically a diffuse thinning across the entire scalp and is thus less easily-recognised. The female form of hereditary baldness is, in its form, practically indistinguishable from hair loss caused by various other factors. The second most common reason for a woman to lose her hair is hormonal imbalances during and after pregnancy or menopause. Such changes are typically of a temporary nature and so also is the hair loss, although post-menopausal hair loss is in most instances permanent.
When it comes to treating hair loss in female patients there are a number of specifics. First, most women do not make very good candidates for hair surgery due to their diffuse thinning pattern, which makes it impossible to identify the hair that will be resistant to future miniaturisation. Secondly, finasteride (Propecia), which is one of the only two FDA-approved hair loss treatments available today, cannot be used on women and neither can dutasteride, which is its closest and assumedly yet more powerful relative. Rogaine (generic name minoxidil) is the second FDA-approved hair loss treatment and its approved concentration for women is only 2% versus 5% for men. However, many doctors recommend their female patients use male formulations of minoxidil, with a concentration of 5%, such as Rogaine foam. Aminexil is a molecule similar to minoxidil and it is often recommended to women who are pregnant or breastfeeding as a safer option than minoxidil.
Although some antiandrogens such as finasteride or dutasteride cannot be prescribed to women, there are other antiandrogen medications that can be effectively used to treat female hair loss. Spironolactone (trade name Aldactone) and cyproterone acetate (used in contraceptives such as Diane 35, Diane 50 and Ginette 35) are antiandrogens most commonly used to treat female pattern baldness.
Another treatment with seemingly high rates of success is topical estrogen solutions such as Crinohermal, which use a female hormone, estradiol, as their main active substance. Estradiol is capable of inhibiting the conversion of testosterone into follicle-harming DHT. Hormone replacement therapy is another hormonal treatment suitable for women at menopause, with estrogens and progesterone pills and creams being the most common forms of treatment. Estrogen levels in the body decline with time. As women enter the menopause, estrogen levels decline and more of the male hormone testosterone is then available to be converted into follicle-harming DHT.
The above list of treatments for female hair loss is not exhaustive, though. There are a number of other remedies that are often claimed to help promote hair growth in women, such as ketoconazole, flutamide, fluridil, alfatradiol, as well as various substances of natural origin. Despite the fact that there are female patients who will swear by some of these treatments, none of them has ever been sufficiently clinically tested, let alone approved by any major national health supervisory authority as a treatment for female baldness and the claims of their guaranteed effectiveness should be taken with a grain of salt.
By Dody Gasparik M.Sc.
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