What treatments work for women with thinning hair?

Jennifer N. Choi is division chief of medical dermatology and oncodermatology at Northwestern University Feinberg School of Medicine.

Q: Are there any treatments that actually work for women with thinning hair?

A: Topical minoxidil, often known by the over-the-counter brand name of Rogaine, is my first choice treatment for the most common cause of thinning hair in women: female androgenetic alopecia (GAA).

Not only is topical minoxidil the most studied treatment available, it is also the only topical product that has been approved by the FDA for the treatment of AGA.

If you have noticed hair loss, the first step to take is to get a diagnosis from a primary care doctor or dermatologist, who can perform a scalp biopsy and order blood tests to look for potential causes, such as anemia or thyroid disorders.

But if your hair loss was gradual and started to widen on your side, with your frontal hairline still intact, you probably have AGA. It can start anytime after puberty and becomes more common as women get older. By age 70, up to 50% of women have some degree of AGA. Whites are more likely to be affected, followed by Asians and Blacks. If your mother or father has AGA, you are more likely to develop it.

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When it comes to treatments, patience and managing expectations are important. You have several options, including topicals, prescriptions, supplements, and procedures. But I advise my patients to wait at least six months before deciding if any of them are working.

Unfortunately, many women will still have thinning hair even after trying several treatments: there is no single solution and the chances of success vary in each case.

Here’s what you need to know about your AGM treatment options.

How should I use topical minoxidil?

Topical minoxidil is available in 2% or 5% strengths over the counter and can be applied once or twice daily. I generally recommend the 5% version as it has been shown to be more effective, but it also has an increased likelihood of side effects, such as scalp irritation, flaking, itching, and facial hair growth . Higher concentrations are available by prescription.

You can choose between a solution or a foam. The solution, which is applied with a dropper, can sometimes run down your face or leave your hair greasy. The foam has a more controlled application with your hands and it does not contain propylene glycol, which can cause irritation or allergy in rare cases. Both should be gently rubbed into the scalp – just be sure to wash your hands afterwards.

You should continue to apply topical minoxidil even after you see results. If you stop, you may notice hair loss from new growth within four to six months.

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What about oral minoxidil?

Oral minoxidil has traditionally been used to treat high blood pressure, but has been gaining a lot of attention lately as an off-label treatment for low-dose hair loss. More rigorous research is needed to confirm its overall safety and effectiveness, but in my practice I am using it increasingly in both men and women, with most experiencing at least some degree of noticeable growth. hair.

The studies are promising so far. A 2020 medical literature review found that 17 studies involving 634 patients showed it could help, but reported effectiveness varied widely: from 10-90% in terms of stabilizing hair loss, increasing overall hair density, improved hair thickness and decreased hair loss. Topical minoxidil has been shown to have reported efficacy in treating AGA in women ranging from 13-63%.

If you don’t like the mess of applying minoxidil topically or have had a reaction, talk to your dermatologist about taking the medication by mouth. I generally start patients on 1.25 milligrams or 2.5 milligrams daily, with room for higher doses if needed. It is only available by prescription and there are possible side effects including hair growth in places other than the scalp (such as the face), low blood pressure and swelling in the legs.

Other oral prescription medications that have been used to treat hair loss over the past 10-20 years are spironolactone, finasteride, and dutasteride. They haven’t been compared directly to oral minoxidil, so it’s unclear which is more effective, and women who can get pregnant shouldn’t use these drugs unless they’re using birth control methods. strict because they can cause fetal abnormalities. Finasteride and dutasteride are generally reserved for postmenopausal women for this reason.

The evidence is not as strong for supplements as it is for topical minoxidil.

My patients often ask me about two popular oral supplements: Nutrafol, which contains saw palmetto, and Viviscal, which contains a compound of marine extracts and polysaccharides. Many of the studies on these components and supplements have industry funding or interests, but they have suggested some effectiveness with few adverse effects.

Oral biotin supplements have long been touted to help with hair growth. But these high-dose supplements haven’t actually been proven to work.

Large-scale randomized clinical trials by independent researchers are always needed on supplements, but I occasionally mention Nutrafol and Viviscal – instead of regular biotin – to patients who want to try a supplement without a prescription, even though I can’t. promise that they will see significant results. .

Be sure to consult your doctor before trying any supplements, even if they are labeled as natural. For example, for breast cancer survivors taking estrogen-inhibiting drugs long-term, such as tamoxifen, certain supplements may interfere with the metabolism of the estrogen-inhibiting drug, potentially making it less effective.

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What if none of these other options work?

You may want to consider trying one of these therapies or procedures, but they are usually not covered by insurance and can be quite expensive. There is no rigorous evidence yet that they will work.

Red light devices: These devices use low-level light therapy (LLLT) and come in different forms, such as a comb, hood, or helmet. The HairMax LaserComb is a portable, non-invasive device that has been FDA cleared for the safe treatment of male and female AGA with a starting cost of $199. I would recommend this treatment to highly motivated patients who can commit to using it at least three times a week – preferably in combination with another treatment, such as minoxidil – because it is easy to use, relatively affordable and generally considered Like on.

Platelet-rich plasma: Platelet-rich plasma (PRP) is a plasma preparation that comes from your own blood. Some small studies have suggested that PRP injections into the scalp might help some patients, but more rigorous evidence is needed, especially since the cost can be so high and the procedure can be painful. Three monthly sessions, followed by a maintenance period of three to six months, are generally recommended. The cost of each session is usually around $250 to $750. PRP also tends to be used as an adjunct therapy in combination with other treatments, and not everyone is a candidate.

Surgical Hair Transplant: If one of the therapies does not work, surgical hair transplantation is another option. Intact hair is surgically removed from a part of your scalp that still has thick hair, separated into units of individual hair follicles, and surgically transplanted into tiny holes on the part of the scalp affected by hair loss or thinning. hair. This procedure typically takes several hours at a time, requires local anesthesia, and can be very expensive – ranging from $6,000 to $60,000, depending on the amount of hair transferred, the technique used, and the experience of the surgeon – but many my patients have had very long term results.

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About Donnie R. Losey

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