Up to forty percent of American women suffer some sort of hair loss. Often devastating to self-image and emotional well being the request for information on hair loss products and therapies is a common discussion in my chair. Often more devastating than many serious diseases, it’s emotional toll affects physical health. But since it doesn’t seem to be life threatening, many doctors dismiss hair loss anxiety.
Your hair will remain on your head unless something such as hormone imbalance, disease, or other systemic condition is not present. Hair loss can be a short term symptom of stress, pregnancy, rapid weight loss, medication or it can become a life long battle.
Different causes require different treatments. First let’s look at the causes.
Androgenetic alopecia (AGA)
Androgenetic alopecia occurs when testosterone converts to DHT. This in turn shrinks hair follicles which in turn causes hair loss. Rising androgen levels can still be within what doctors consider “normal” on a blood test, even though they are high enough to cause a problem. Even with no rise, if your body chemistry is overly sensitive to androgen, hair loss can still be a problem
“Male” hormones in women do not need to be raised to trigger a problem. But “female” hormones, when lowered, give an edge DHT. This imbalance can cause hair loss. Consequently when women’s hormone levels decline as menopause approaches and drop during menopause, many women notice hair loss. Androgenic alopecia can be caused by ovarian cysts, high androgen index birth control pills, pregnancy and menopause. Heredity also plays a major role.
Telogen Effluvium (TE)
Following a trauma to the system such as child birth, malnutrition, a severe infection, major surgery or extreme stress, the three hair growth phases (grow, rest, shed) can shift all at once into the shedding phase. You may notice shedding from 6 weeks to three months following the trauma. It is possible to lose handfuls of hair at time when in full-blown TE. Most commonly hair will grow back when life returns to normal.
Anagen Effluvium (AE)
Usually associated with chemotherapy, hair follicles in the growing phase are greatly affected. Soon after chemotherapy begins approximately 90 percent or more of the hairs can shed while still in this phase.
Caused by localized trauma to the hair follicles from something that pulls the hair over time, Traction Alopecia can result from braiding, cornrows, tight ponytails, and extensions. If the condition is detected early enough, the hair will regrow.
Few women are aware that oral contraceptives commonly trigger hair loss. Women who are predisposed to hormonal related hair loss or who are hypersensitive to the hormonal changes taking place in their bodies can experience hair loss to varying degrees while on the pill or more commonly, several weeks or months after stopping the pill.
The American Hair Loss Association recommends that all women interested in using oral contraceptives for the prevention of conception should only use low-androgen index birth control pills.And if there is a strong predisposition for genetic hair loss in your family they recommend using another non-hormonal form of birth control.
Chemical stress from irritants, pollutants, and ultraviolet (UV) radiation can also contribute to hair loss. As hair thins more UV Rays cause thickening and yellowing of the skin which in turn shrinks (and chokes) remaining hair. Keeping a clean scalp and protecting hair and scalp from UV rays will help.
Birth control pills from lowest androgen index to highest:
Desogen, Ortho-Cept, Ortho-Cyclen, Ortho Tri-Cyclen, Micronor, Nor-Q D, Ovcon-35, Brevicon/Modicon, Ortho Norvum 7/7/7, Ortho Novum 10-11, Tri-Norinyl, Norinyl and Ortho 1/35, Demulen 1/35, Triphasil/Tri-Levien, Nordette, Lo/Ovral, Ovrette, Ovral, Loestrin1/20, Loestrin 1.5/30.
Hormonal contraceptives that can cause or exacerbate hair loss.
Implants, such as Norplant, are small rods implanted surgically beneath the skin, usually on the upper arm. The rods release a continuous dose of progestin to prevent ovulation.
Progestin injections, such as Depo-Provera, are given into the muscles of the upper arm or buttocks. This injection prevents ovulation.
The skin patch (Ortho Evra) is placed on your shoulder, buttocks, or other location. It continually releases progestin and estrogen.
The vaginal ring (NuvaRing) is a flexible ring about 2 inches in diameter that is inserted into the vagina. It releases progestin and estrogen.
So What Can You Do?
Tests that can help diagnose hair loss causes:
- Hormone levels (DHEAs, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone
- Serum iron
- Serum ferritin
- Total iron binding capacity (TIBC)
- Thyroid stimulating hormone (T3, T4, TSH)
- VDRL (a screening test for syphilis)
- Complete blood count (CBC)
Having a scalp biopsy where a small section of scalp usually 4mm in diameter is removed and examined under a microscope can help to help determine the cause of hair loss.
The hair pull test is a simple diagnostic test in which the physician lightly pulls a small amount of hair (approx 100 simultaneously) in order to determine if there is excessive loss. Normal range is one to three hairs per pull.
The densitometer is a handheld magnification device which is used check for miniaturization of the hair shaft.
The use of topical and oral anti-androgens can help prevent further hair loss and encourage some hair regrowth. Stopping treatment, unfortunately, results in resumed hair loss.
Though effectiveness varies from person to person, many women find using these treatments have helped their hair and their self-esteem.
Minoxidil 2% Topical Treatment
There are three stages of hair growth: Anagen, Telogen and Catagen or more simply, growing, resting and shedding.
Mioxodil shortens the resting phase of the hair cycle, causing premature entry of growing hair prolonging growing stage while increasing hair follicle size.
Clinical trials of topical 2% and 5% minoxidil in male and female hair loss have all shown remarkably rapid increase in hair growth. The increase is evident within 6–8 weeks of treatment and has generally peaked by 12–16 weeks. Minoxidil seems to be more effective for women compared to men. The makers of Minoxidil recommend women only use the 2% concentration of Minoxidil and not 5%. Many dermatologists prescribe Minoxidil 5% for women with AGA if used under their supervision. Some small clinical trials have been conducted on 5% Minoxidil showing that the 5% solution is significantly more effective in both retaining and regrowing hair than the 2% solution.
Androgen Receptor Inhibitors
Aldactone / Spironolactone
Spironolactone or the more popular brand name Aldactone is a diuretic used to reduce the fluid in your body without the loss of potassium. It is also used to treat hypertension and edema and to treat potassium deficiency. Spironolactone slows down the production of androgens in the adrenal glands and ovaries preventing DHT from messing with your follicles.
Tagamet / Cimetidine
Cimetidine sold under the brand name Tagamet is a histamine blocker used mainly to treat gastrointestinal ulcers. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block DHT from casting its evil spell on your hair.
Cyproterone acetate is not available in the US and is thought of as one of the last resorts for treating female pattern hair loss because of its possible toxicity and long term side effects.
Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for thinning hair for women in menopause or for those who lack estrogen and/or progesterone for other reasons.
Since birth control pills decrease the production of ovarian androgens, they can be used to treat women’s hair loss. Only low androgen index birth control pills should be used to treat hair loss. High androgen index birth control pills actually contribute to hair loss.
Ketoconazole is currently used as a prescription antifungal agent that can cause a reduction in the production of testosterone and other androgens. Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for hair loss.
Finesteride works quite well for most men in both preventing hair loss and triggering regrowth, and it may work for some women, although women must not take it if they are pregnant and must not get pregnant while on the drug because of the risk of birth defects in a male fetus.
Cyproterone Acetate with Ethinyloestradiol
Sold under the brand name Diane 35 and Diane 50, this contraceptive tablet is prescribed in Europe for women’s hair loss. The drug works by blocking some of the actions of male hormones commonly present in women. Currently this drug is not available in the US.
For more in depth information check this out.