- Medical Treatments for Balding in Men
- Article Sections
- Minoxidil Solution Drug Facts
- Trade names
- How to take
- What if I miss a dose?
- Who should not take this medicine?
- What should I watch for while using this medicine?
- Side effects
- Contact with eyes, nose, mouth
- Hair color and texture
- Rogaine (minoxidil) Hair-Loss Ointment Results for Men & Women
- What are the uses for minoxidil?
- What are the side effects of minoxidil?
- What is the dosage for minoxidil?
- Which drugs or supplements interact with minoxidil?
- Is minoxidil safe to take if I'm pregnant or breastfeeding?
- What preparations of minoxidil are available?
- How should I keep minoxidil stored?
- Buy Minoxidil (Generic Rogaine) Online, Delivered
- Rogaine: Uses, Side Effects & Reviews – Drugs.com
- What is Rogaine?
- Important information
- Before taking this medicine
- How should I use Rogaine?
- Rogaine dosing information
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while using Rogaine?
- What other drugs will affect Rogaine?
- Further information
- Other Formulations
- Treating female pattern hair loss
- What is androgenetic alopecia?
- Hair loss treatment for women
- Hair transplantation
Medical Treatments for Balding in Men
DEAN THOMAS SCOW, M.D., ROBERT S. NOLTE, D.O., and ALLEN F. SHAUGHNESSY, PHARM.D., Harrisburg Family Practice Residency, Harrisburg, Pennsylvania
Am Fam Physician. 1999 Apr 15;59(8):2189-2194.
See related patient information handout on male pattern baldness, written by the authors of this article.
Two drugs are available for the treatment of balding in men. Minoxidil, a topical product, is available without a prescription in two strengths. Finasteride is a prescription drug taken orally once daily.
Both agents are modestly effective in maintaining (and sometimes regrowing) hair that is lost as a result of androgenic alopecia. The vertex of the scalp is the area that is most ly to respond to treatment, with little or no hair regrowth occurring on the anterior scalp or at the hairline.
Side effects of these medications are minimal, making them suitable treatments for this benign but psychologically disruptive condition.
Hair plays a large role in defining one's self-image. From the “snake oils” of the past to high-tech microsurgical hair plugs, men have been willing to try almost anything and to spend large amounts of money in search of a cure for male pattern baldness.
Minoxidil (Rogaine) and finasteride (Propecia) are labeled for the treatment of male pattern baldness.
Annual sales of minoxidil 2 percent solution have exceeded $162 million per year since the drug became available without prescription in 1996.
1 In total, an estimated $900 million is spent each year on efforts to regrow hair.1 Clearly, a large population of men eagerly awaits remedies for male pattern baldness.
Hair growth s divided into three phases: anagen, catagen and telogen. Un hair follicles of other animals, the hair follicles of humans are not in the same cycle at the same time; each follicle has its own schedule. As a result, humans do not shed seasonally but continually lose and regrow hair.
As male pattern baldness develops, the hairs in the affected areas of the scalp become shorter, finer and less pigmented with successive growth cycles.
This androgenic alopecia seems to be associated with the presence of dihydroxytestosterone (DHT), a metabolite of testosterone. Eunuchs, who have low levels of testosterone, do not lose scalp hair.
In addition, men with a genetic deficiency of 5α-reductase, the enzyme that converts testosterone to DHT, do not suffer male pattern baldness.
Finasteride is a competitive inhibitor of type II 5α-reductase and can lower DHT levels in tissue.
In men undergoing hair transplantation, treatment with 5 mg of finasteride per day lowers the amount of DHT in bald scalp to levels comparable to baseline levels in hair-containing scalp.
2 The mechanism of action of minoxidil appears to be a direct effect on the follicles, increasing proliferation and differentiation of epithelial cells in the hair shaft.3
Since up to two thirds of men experience androgenic alopecia, male pattern baldness is considered a normal variant rather than a disease. Although devoid of serious health aspects, patient concerns about balding should be taken seriously since one half of balding patients have psychologic sequelae.4
Although androgenic alopecia is the most common cause of male pattern baldness, pathologic causes of alopecia must also be considered in the evaluation of hair loss in men.
Alopecia typically is divided into scarring and nonscarring types (Table 1). Scarring alopecia is typically seen in patients with infectious or connective tissue diseases. Androgenic alopecia is a nonscarring variety.
Table 1 lists other causes of nonscarring alopecia.5
The patient's history plays an important role in establishing the differential diagnosis. Key elements of the history include family history, medications, concomitant medical illness, stresses, and the pattern and speed of progression of hair loss.
A family history and a gradual progression of hair loss in the characteristic “M” pattern described by Hamilton (Figure 1) suggest male pattern baldness. Patchy hair loss may be associated with conditions such as tinea capitis, lupus erythematosus and immune-mediated alopecia areata. A history of abrupt hair loss following a significant stress is indicative of telogen effluvium.
Definitive diagnosis, particularly in cases of scarring alopecia or unusual patterns of hair loss, requires biopsy before treatment is initiated.
Concoctions purported to regrow hair have been sold to an uncritical public for generations. Most of these tonics have had a temporary effect or no effect at all. In 1989, the U.S. Food and Drug Administration (FDA) issued guidelines for the use of products for hair growth or hair loss prevention, which cleared the shelves of ineffective nonprescription products.
In 1980, the first case report was published of hair growth related to the use of oral minoxidil, an agent marketed for the treatment of severe hypertension.
Finasteride initially was marketed for the treatment of benign prostatic hypertrophy. The action of the latter agent lowers DHT levels by inhibiting 5α-reductase.
Since DHT had a known role in androgenic hair loss, the use of finasteride in treating hair loss was pursued early in the development of this agent.
No studies have directly compared minoxidil with finasteride in balding patients, and only a single case report describing their use in combination is available.6 The studies that resulted in the labeling of these agents have been published only in abstract form.
Minoxidil has been available for over 10 years at a 2 percent concentration, and a new, 5 percent formulation (Rogaine Extra Strength) is now sold without prescription. Finasteride, originally marketed as a 5-mg tablet for the treatment of symptoms of benign prostatic hypertrophy, is now available as a 1-mg tablet for the treatment of hair loss in men.
Studies published in the late 1980s showed that minoxidil 2 percent topical solution could grow hair of moderate to dense thickness in about 50 percent of patients.
7 Although few mature, terminal hairs were regrown, the number of fine, nonpigmented or vellus hairs was less, while the number of other hairs increased.
Patients deemed this growth cosmetically pleasing, and these findings led researchers to conclude that minoxidil is effective in slowing or preventing hair loss.
These studies identified the ideal candidate for therapy as a man who has been bald for less than five years and whose bald area is less than 10 cm (4 in) in diameter and located on the vertex.
Minoxidil was not useful for treatment of frontal hair loss. Men who stopped using minoxidil showed a rapid loss of the hair that was gained during therapy.
By three months after discontinuation of therapy, hair counts were at or below baseline hair counts.
One study questioned participants who had used the product for 2.5 years. The study results indicated that 32 percent of these men had hair that grew long enough to be cut, and 36 percent felt that it was worth the time and money to continue treatment with the product.8
Two studies have compared the new, higher strength minoxidil with the 2 percent solution.9,10 In one study, men used one of the two solutions for almost two years.
The outcome measured in this study was hair mass (the weight of the hair taken from a standard, defined area of the scalp). This measurement accounts for both the number of hairs and their thickness.
The higher strength led to a greater hair mass, with the difference being most marked early in the study.
After five months of treatment, the group treated with the 5 percent solution had a 55 percent increase in total hair mass over baseline, compared with a 25 percent increase for the 2 percent group. After two years of treatment, hair mass was down to 25 percent over baseline in the 5 percent group and 15 percent above baseline in the 2 percent group.9
In the second study, 5 percent minoxidil produced significantly more nonvellus hair by hair count. Patients using the higher strength also were more ly to notice a change in hair coverage of the scalp and in their assessment of benefit of treatment.10
The effectiveness of finasteride has been evaluated in three studies involving a combined total of 1,879 men.11 The participants were between 18 and 41 years of age and had mild to moderate hair loss (Hamilton stages III and IV).
Two studies evaluated vertex baldness, while the third study assessed the anterior mid-scalp. None of these studies evaluated the effectiveness of finasteride in terms of bitemporal or frontal hair loss.
After one year of therapy, patients treated with finasteride had an increase of 107 hairs in the number of hairs in a 1-in diameter of scalp compared with placebo.
This difference resulted from an approximate 20-hair loss in the placebo group and a 90-hair increase in the treated group, compared with an average baseline count of 876 hairs. This 10 percent improvement is still below the normal density of 1,300 hairs per inch.11
The greatest benefit of finasteride may be in preventing further hair loss in men during the early stages of baldness. In this study11 only 17 percent of the treatment group showed hair loss, while 72 percent in the placebo group showed a progressive loss over the course of the 24-month trial.
In addition, in a study of 326 subjects, men with mild to moderate frontal thinning of the hair had a significant increase in hair counts in the frontal area, although most of the improvement was graded as “slight.” Unfortunately, no growth occurred in the temporal areas or on the hairline.12
In all of the above studies, evaluation also was performed by patient self-assessment, investigator assessment and independent expert examination of photographs. Subjective improvements in hair growth were noted in all three groups in all the studies.
Ten years after its introduction, minoxidil has been found to be well tolerated; the most frequently reported side effect is pruritis of the scalp. Initial concerns that the topical solution might affect blood pressure or cause other systemic effects have not been realized. As a result, both concentrations are available without a prescription.
Finasteride has been well tolerated in all studies, with a discontinuation rate similar to that of placebo. Sexual side effects were the most common, with 3.8 percent of the treated group experiencing decreased libido, erectile dysfunction or decreased volume of ejaculate, compared with 2.1 percent of the placebo group.
Breast enlargement and tenderness, reported with use of the 5-mg dose, has not been reported with the 1-mg dose used to treat balding. Prostate-specific antigen (PSA) levels may be lowered with chronic finasteride therapy, hampering the diagnostic value of the PSA test. Finasteride should not be used in women or children.
It is a known teratogen, and the manufacturer recommends that the tablets not be taken or handled by pregnant women.
Finasteride affects DHT only in target tissues that contain the type II 5α-reductase enzyme and does not lower circulating levels of testosterone.13 As a result, patients taking the drug have no associated changes in muscle strength or bone density.
Minoxidil is applied twice a day to dry scalp. Six sprays, or 1 mL of solution, should be applied. Overuse will not add benefit, and patients should be told not to expect an immediate response. The dosage of finasteride is 1 mg orally once daily. Cost information is given in Table 2.
These two modestly effective medical treatments for male pattern baldness appear to be safe.
In counseling patients, it is important to communicate that effectiveness has primarily been demonstrated in younger men (18 to 41 years of age) and primarily in those with balding of the vertex.
To date, treatment of frontal hair loss has been less successful. These drugs are most useful in preventing further hair loss, and regrowth of a full head of hair should not be expected.
With either medicine, six months of therapy may be necessary before the effects are apparent. Even with success, use of the product must continue indefinitely. At present, there is no way to predict which patients will respond to which treatment or whether one product is better suited to an individual patient.
Some patients may prefer taking a tablet daily, while others may feel more comfortable applying a topical preparation. Since minoxidil is available without prescription, some patients may find this preparation to be more convenient.
It is unly that insurance will pay for either medication, so cost may be a significant factor.
Further study is needed to determine long-term benefit with these two medications, as well as the benefit of their use in combination. With greater experience, it may become possible to predict those who will respond to treatment. These products may also prove useful in combination with other methods of treatment in male pattern baldness.
Minoxidil Solution Drug Facts
MINOXIDIL (mi • NOX • i • dill) is used to increase new hair growth in cases of hereditary hair loss. When applied to the scalp, this medicine can promote hair growth in men with male pattern baldness. Women should not use extra-strength minoxidil products.
The list of names may not include all products that are available on the market.
How to take
- This is an liquid solution that should be applied twice a day. Use 1ml (marked on the dropper) for each dose.
- This medicine is for external use on the scalp only. Do not take by mouth.
- The hair and scalp should be dry before you use this medicine.
- Avoid getting your hair wet for at least 4 hours after applying.
- You do not need to shampoo your hair before each application.
- Follow the additional directions that are included with the product.
- Do not use more often than directed.
What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.
Who should not take this medicine?
Women should not use extra-strength minoxidil products, including the 5% topical solution. This medicine is not approved for use in children.
What should I watch for while using this medicine?
This medicine must be used on a regular basis for your hair to regrow. You may notice an increase in shedding during your first month using minoxidil. This is normal and should slow after the first month.
It may take 3 to 4 months of regular and consistent use before you notice any improvement. It is important to continue to use this product to maintain regrowth of hair.
Once you stop using it, the regrown hair will usually fall out within 3 months.
If you do not see any new hair growth after 4 months, stop using this product and contact your doctor or health care professional.
Although this medicine is generally safe, all medicines, it is associated with rare but serious side effects.
Contact your doctor or a health care professional immediately if you experience any of the following:
- Chest pain or palpitations
- Dizziness or fainting
- Skin rash, blisters, or itching
- Sudden weight gain
- Swelling of the hands or feet
The following side effects usually do not require medical attention (although you can report them to your doctor or health care professional if they are persistent):
- Redness, irritation and itching at the site of application
- Unusual hair growth, on the face, arm, and back
This list may not describe all possible side effects. Contact your doctor if you have additional questions about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Contact with eyes, nose, mouth
Do not get this medicine in your eyes, nose, mouth, or on other sensitive areas. If you do, rinse off with plenty of cool tap water. Always wash your hands after use. Do not apply if your scalp is cut, scraped, or sunburned.
Hair color and texture
Some people may notice changes in hair color or texture after using this medicine.
- Keep the reach of children
- Store at room temperature (between 68-77 degrees fahrenheit)
- Some products may be flammable. Keep away from heat, fire or flame.
- Throw away any unused medicine after the expiration date.
Rogaine (minoxidil) Hair-Loss Ointment Results for Men & Women
Minoxidil is a drug that is used for treating male-pattern baldness and hair loss in women.
Oral minoxidil was originally used for treating high blood pressure, but patients and health care providers noticed that hair growth was a side effect of treatment.
This led to the development of topical (solution applied to the skin) minoxidil for the treatment of male-pattern baldness. The mechanism of action leading to growth of hair is unknown. The FDA approved minoxidil in August 1988.
What are the uses for minoxidil?
Minoxidil is used to treat male-pattern baldness. In women, it is used to treat diffuse loss of hair or thinning of hair in the frontal areas of the scalp.
What are the side effects of minoxidil?
Common side effects of minoxidil include:
Other side effects include:
An increase in the absorption of minoxidil from the scalp can occur in patients with damaged skin, leading to increased side effects. Minoxidil's contains alcohol that can irritate the eyes. In case of accidental contact with eyes or other sensitive areas, the exposed area should be washed with cool water. Tendonitis has also been reported.
It is normal to lose 100-150 hairs per day. See Answer
What is the dosage for minoxidil?
Minoxidil should be applied as 1 ml of solution or half a capful of foam to dry hair and scalp once in the morning and again in the evening. It should be spread evenly over the affected areas, and then the hands should be washed with warm water (if the hands are used for application).
Minoxidil must be applied on the scalp at least twice daily and for at least four months to see results. Minoxidil works less well in patients that are older, have larger areas of baldness, and have been bald for longer periods of time. Minoxidil should be applied to a dry scalp only, and left in place for at least four hours.
Minoxidil must be continued in order to maintain or increase the hair growth achieved.
Which drugs or supplements interact with minoxidil?
Minoxidil should not be used with other topical medications because they may increase its absorption and side effects.
Is minoxidil safe to take if I'm pregnant or breastfeeding?
Minoxidil should not be used in pregnancy because it has not been studied adequately in pregnant women.
Minoxidil should not be used by nursing women because it has not been evaluated adequately in nursing mothers.
What preparations of minoxidil are available?
Solution: 2 and 5%; Foam: 5% (for topical use only, do not confuse topical minoxidil with oral minoxidil).
How should I keep minoxidil stored?
Minoxidil should be stored at room temperature, 20 C – 25 C (68 F – 77 F).
Your Hair and Scalp Can Say a Lot About Your Health See Slideshow Symptoms & Signs FAQs & Doctor's Views
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Buy Minoxidil (Generic Rogaine) Online, Delivered
Minoxidil is one of two FDA-approved treatments for male pattern hair loss (androgenetic alopecia). It was originally designed as an oral pill to treat hypertension. It was quickly abandoned as a primary treatment for hypertension because patients didn’t tolerate the oral (pill) form very well.
It is still available in oral form, but it is rarely used. One of the side effects of oral minoxidil was unwanted hair growth. This prompted a study of minoxidil in topical form, which turned out to still have the positive effect of stopping hair loss and in some cases, even regrowing hair that was lost.
The topical form is better tolerated and does not have the same effects as when it was taken by mouth.
Rogaine® was the original brand name version of topical minoxidil that was FDA-approved for male pattern hair loss. After several years of Rogaine® being on the market, the FDA approved generic formulations of minoxidil.
Rogaine® and generic minoxidil are both available in 2% and 5% strengths as a solution and as a foam. Minoxidil 5% has been found to be more effective in men, while the 2% and 5% are equally effective in women.
Both strengths are FDA-approved for use in men and the 2% strength is also FDA-approved for use in women.
The exact mechanism of action of topical minoxidil is not completely understood.
It increases the length of the growth phase of hair follicles (a process called ‘anagen’) and increases the size of hair follicles which dictates the thickness/diameter of the hair that comes the follicle.
Minoxidil relaxes smooth muscle in blood vessel walls causing them to widen, increasing blood flow. This may be one of the ways that minoxidil works to stop or slow hair loss, and, in some cases, regrow hair.
Minoxidil tends to work best on younger men who have been experiencing progressive hair loss for fewer than 5 years. In fact, the earlier the better. However, even if started early, minoxidil is more ly to stop hair loss than to regrow hair.
Hair regrowth can occur, but it is more common to stop or slow hair loss than it is to see hair regrowth. Minoxidil was studied and found to be effective at stopping or slowing down hair loss at the crown of the scalp.
Interestingly, in the first few months of using minoxidil, loss of fine hairs may occur before they are replaced by thicker, more mature hairs. For some men, it can seem it is getting a little worse before it improves.
Topical minoxidil is one of only two FDA-approved treatments for hair loss. It was first approved for the treatment of male pattern hair loss in 1988, and there have been many studies showing its safety and effectiveness at preventing further hair loss. In some men, it is effective at regrowing hair as well.
For example, a one-year study with minoxidil 5% solution showed that 62% of men had no increased hair loss. In addition, around 16% had significant hair regrowth and approximately 48% had moderate hair regrowth. When used topically, only around 2% of minoxidil is absorbed, and systemic side effects are rare.
Minoxidil is better at stopping or slowing hair loss than regrowing hair; nevertheless, some men (and women) can experience some regrowth.
A one-year study with minoxidil 5% solution showed that 62% of men had the same amount of hair at the end of the study as they had at the beginning of the year which means that they did not have any additional hair loss. In addition, around 16% had significant hair regrowth and approximately 48% had moderate hair regrowth.
Another study showed that approximately 40% of men using 5% minoxidil, and approximately 22% of men using 2% minoxidil showed moderate or dense regrowth. It’s important to remember that daily use of minoxidil is essential to maintain results.
Rogaine: Uses, Side Effects & Reviews – Drugs.com
Generic Name: minoxidil topical (mi NOX i dil)
Medically reviewed by Sanjai Sinha, MD Last updated on Mar 4, 2019.
What is Rogaine?
Rogaine (minoxidil) is used to help you regrow hair on your scalp. The exact way that minoxidil works is not known. It is possible that it dilates blood vessels in the scalp, which may improve hair follicle function and stimulate hair growth.
Rogaine will not cause permanent regrowth of scalp hair. You must continue using the product to keep the regrowth of your hair.
Do not use Rogaine if the skin on your scalp is damaged, irritated, or sunburned. This may allow more of the medication to be absorbed by your body, which could be dangerous.
Do not use Rogaine on any part of your body other than your scalp. Application to other body parts can be dangerous.
Do not use other topical products on your scalp during treatment with Rogaine, unless otherwise directed by your doctor.
Before taking this medicine
Do not use Rogaine if the skin on your scalp is red, swollen, irritated, or infected. This may allow more of the medication to be absorbed by your body, which could be dangerous.
Check the medicine label carefully to make sure Rogaine will treat your specific type of hair loss.
Use only the Rogaine formula that is made for your gender. Women should not use minoxidil products that are made specifically for men.
Ask a doctor or pharmacist if it is safe for you to use this medicine if you have other medical conditions, especially:
FDA pregnancy category C. It is not known whether Rogaine will harm an unborn baby. Do not use this medicine without a doctor's advice if you are pregnant.
It is not known whether minoxidil topical passes into breast milk or if it could harm a nursing baby. Do not use Rogaine without a doctor's advice if you are breast-feeding a baby.
Do not use Rogaine on anyone under 18 years old without medical advice.
How should I use Rogaine?
Use Rogaine exactly as directed by your doctor or as directed in the package labeling. Do not use in larger or smaller amounts or for longer than recommended.
Using more of this medicine than recommended will not speed up hair growth, and may cause dangerous side effects.
This medicine comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.
Dry your hair and scalp before applying Rogaine.
Apply the recommended amount to the affected areas of the scalp. Rogaine is usually applied twice daily, in the morning and at night.
Wash your hands after applying Rogaine.
Use Rogaine only on your scalp. Do not use on any other part of your body.
It may take up to 4 months or longer before you notice new hair growth. New hair may be soft, colorless, and barely visible. With further treatment, the hair should begin to have the same color and thickness as your existing hair.
Talk to your doctor if you do not see any hair growth after 4 months of treatment.
Store at room temperature away from moisture and heat.
Keep the foam canister away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot. Do not puncture or burn an empty canister.
Rogaine dosing information
Usual Adult Dose for Alopecia:
Solution:Apply 1 mL topically to the affected area(s) of the scalp twice a day. The dose should not exceed 2 mL per day. Foam:
Apply half a capful topically to the affected area(s) of the scalp twice a day.
What happens if I miss a dose?
Apply the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
An overdose of Rogaine is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.
What should I avoid while using Rogaine?
Avoid getting this medicine in the eyes, nose, or mouth. If this occurs, rinse the area with water.
Avoid using other skin products on the areas you treat with Rogaine, unless your doctor tells you to.
Get emergency medical help if you have any of these signs of an allergic reaction to Rogaine: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Although the risk of serious side effects is low when Rogaine is applied to the skin, side effects can occur if the medicine is absorbed into your bloodstream.
Call your doctor at once if you have:
- severe scalp irritation;
- unwanted growth of facial hair;
- chest pain, fast heartbeats;
- swelling in your hands or feet, rapid weight gain;
- a light-headed feeling, you might pass out;
- headache, dizziness, confusion; or
- flushing (warmth, redness, or tingly feeling).
Common Rogaine side effects may include:
- changes in the color or texture of your hair.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Rogaine?
It is not ly that other drugs you take orally or inject will have an effect on topically applied minoxidil. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.
Remember, keep this and all other medicines the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2020 Cerner Multum, Inc. Version: 4.01.
- Women's Rogaine Topical
- Rogaine For Men Extra Strength Topical
Treating female pattern hair loss
About one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair thinning or bald spots. Hair loss in women often has a greater impact than hair loss does on men w, because it's less socially acceptable for them. Alopecia can severely affect a woman's emotional well-being and quality of life.
The main type of hair loss in women is the same as it is men. It's called androgenetic alopecia, or female (or male) pattern hair loss.
In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic “M” shape; hair at the top of the head also thins, often progressing to baldness.
In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman's hairline rarely recedes, and women rarely become bald.
There are many potential causes of hair loss in women , including medical conditions, medications, and physical or emotional stress.
If you notice unusual hair loss of any kind, it's important to see your primary care provider or a dermatologist, to determine the cause and appropriate treatment.
You may also want to ask your clinician for a referral to a therapist or support group to address emotional difficulties. Hair loss in women can be frustrating, but recent years have seen an increase in resources for coping with the problem.
Clinicians use the Ludwig Classification to describe female pattern hair loss. Type I is minimal thinning that can be camouflaged with hair styling techniques. Type II is characterized by decreased volume and noticeable widening of the mid-line part. Type III describes diffuse thinning, with a see-through appearance on the top of the scalp.
What is androgenetic alopecia?
Almost every woman eventually develops some degree of female pattern hair loss. It can start any time after the onset of puberty, but women tend to first notice it around menopause, when hair loss typically increases. The risk rises with age, and it's higher for women with a history of hair loss on either side of the family.
As the name suggests, androgenetic alopecia involves the action of the hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sex drive and regulation of hair growth.
The condition may be inherited and involve several different genes. It can also result from an underlying endocrine condition, such as overproduction of androgen or an androgen-secreting tumor on the ovary, pituitary, or adrenal gland.
In either case, the alopecia is ly related to increased androgen activity. But un androgenetic alopecia in men, in women the precise role of androgens is harder to determine.
On the chance that an androgen-secreting tumor is involved, it's important to measure androgen levels in women with clear female pattern hair loss.
In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See “Life cycle of a hair.
“) That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called “follicular miniaturization.
” As a result, thicker, pigmented, longer-lived “terminal” hairs are replaced by shorter, thinner, non-pigmented hairs called “vellus.”
Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. Anagen (A), the active growth phase, lasts two to seven years. Catagen (B), the transition phase, lasts about two weeks.
During this phase, the hair shaft moves upward toward the skin's surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle.
Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.
A clinician diagnoses female pattern hair loss by taking a medical history and examining the scalp.
She or he will observe the pattern of hair loss, check for signs of inflammation or infection, and possibly order blood tests to investigate other possible causes of hair loss, including hyperthyroidism, hypothyroidism, and iron deficiency.
Unless there are signs of excess androgen activity (such as menstrual irregularities, acne, and unwanted hair growth), a hormonal evaluation is usually unnecessary.
Hair loss treatment for women
Medications are the most common treatment for hair loss in women. They include the following:
Minoxidil (Rogaine, generic versions). This drug was initially introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it.
Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women.
Since then a 5% solution has also become available when a stronger solution is need for a woman's hair loss.
Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — women, it can't restore the full density of the lost hair. It's not a quick fix, either for hair loss in women .
You won't see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you'll need to keep using it to maintain those results.
If you stop, you'll start to lose hair again.
How to use minoxidil: Be sure that your hair and scalp are dry. Using the dropper or spray pump that's provided with the over-the-counter solution, apply it twice daily to every area where your hair is thinning.
Gently massage it into the scalp with your fingers so it can reach the hair follicles. Then air-dry your hair, wash your hands thoroughly, and wash off any solution that has dripped onto your forehead or face.
Don't shampoo for at least four hours afterwards.
Some women find that the minoxidil solution leaves a deposit that dries and irritates their scalp. This irritation, called contact dermatitis, is probably caused not by the minoxidil itself, but rather by the alcohol that is included to facilitate drying.
Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more ly with the stronger 5% solution.)
Because the patent on Rogaine (the brand-name version of minoxidil) has expired, many generic products are available. They all contain the same amount of minoxidil, but some include additional ingredients, such as herbal extracts, which might trigger allergic reactions.
Anti-androgens. Androgens include testosterone and other “male” hormones, which can accelerate hair loss in women. Some women who don't respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia.
This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens. Doctors will usually prescribe spironolactone together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.
) Possible side effects include weight gain, loss of libido, depression, and fatigue.
Iron supplements. Iron deficiency could be a cause of hair loss in some women .
Your doctor may test your blood iron level, particularly if you're a vegetarian, have a history of anemia, or have heavy menstrual bleeding.
If you do have iron deficiency, you will need to take a supplement and it may stop your hair loss. However, if your iron level is normal, taking extra iron will only cause side effects, such as stomach upset and constipation.
Hair transplantation, a procedure used in the United States since the 1950s to treat androgenic alopecia, involves removing a strip of scalp from the back of the head and using it to fill in a bald patch. Today, 90% of hair-transplant surgeons use a technique called follicular unit transplantation, which was introduced in the mid-1990s.
During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of tiny grafts, each containing just a few hairs.
Each graft is planted in a slit in the scalp created by a blade or needle in the area of missing hair. Hair grows naturally this way, in small clusters of one to four follicles, called follicular units.
As a result, the graft looks better than the larger “plugs” associated with hair transplants of yesteryear.
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