Hair Loss and Treatment Options

By Teresa Otto, M.D.

April 12, 2022

Hair Loss

Hair loss affects 85% of men. Rogaine brought this to America’s attention years ago. A balding guy in primetime commercials would say, “What have I got to lose, except more hair?”

Outside of the spotlight, about 50% of post-menopausal women experienced hair loss, too. But until recently, hardly anyone was talking about it.

If you have noticeable hair loss, you join an estimated 50 million men and 30 million women in the U.S. Clearly, you are not alone.

Read on to learn about hair loss and treatment options, including finding the lowest over-the-counter medications and prescription drug prices.

Male and Female Pattern Hair Loss

By far, the most common type of hair loss in both men and women is male-pattern and female-pattern hair loss. Pattern hair loss is the currently preferred term. But if you’ve done some reading elsewhere, you might see other names for the same type of hair loss. They include:

  • Androgenetic alopecia: androgenetic refers to the influence of male hormones and inherited traits; alopecia means hair loss
  • Androgenic alopecia
  • Male-pattern baldness
  • Female-pattern alopecia
  • Diffuse alopecia in women
  • Hereditary alopecia

For males, beginning as early as puberty, hair loss begins above the forehead and recedes, making an “M” shape. Hair loss on the crown is next. And as the hair recedes from the forehead and the crown, hair remains as a rim or horseshoe around the head. Male pattern hair loss may result in baldness.

For females, hair loss begins at the central part of the scalp, at the part line, and spreads from there. And while the hair is thinner overall and often finer, baldness is uncommon. Female pattern hair loss typically begins after age 40.

Along with the sex-specific hair loss pattern, predominant features of pattern hair loss include no scar formation on the scalp and gradual, progressive hair loss.

What Causes Male and Female Pattern Hair Loss?

The old theory was easy to understand. Men inherited male pattern hair loss from their mom on the X chromosome. As it turns out, that’s just part of the story.

Research shows that over 200 genetic variations, inherited from both your mom and dad, play a part in pattern hair loss. Add in the effects of androgens (male sex hormones) and aging, and you have the current understanding of pattern hair loss. A byproduct of testosterone, called DHT, shrinks follicles so small that they can no longer grow hair.

Of the 100,000 scalp hair follicles you’re born with, you may have 50,000 that are “miniaturized,” as researchers say, by DHT in male pattern hair loss.

Genes inherited from both parents affect female pattern hair loss, too. And like male pattern hair loss, shriveled hair follicles don’t support new hair growth. But unlike the effects of androgens in male pattern hair loss, hormones may not influence hair loss in women. There are exceptions, though. For example, polycystic ovarian syndrome and metabolic syndrome with obesity and insulin resistance are associated with both higher levels of androgen and female pattern hair loss.

Other Types of Hair Loss

The normal hair cycle has three parts: Hair growth in the follicle (anagen phase), the growth stops (catagen phase), and the follicle’s resting phase, in which the hair falls out in two to three months (telogen phase). Anything that disrupts any of these phases, damages the hair follicle or breaks the hair will lead to hair loss. Here are several causes of hair loss:

  • Telogen effluvium: losing hair over the entire scalp due to stress (surgery, illness, rapid weight loss, childbirth), vitamin or mineral deficiency, an underactive or overactive thyroid, for example.
  • Anagen effluvium: hair loss from chemotherapy or other medications (antidepressants, beta-blockers, and blood thinners)
  • Alopecia areata: losing clumps of hair because your body’s immune system attacks the hair follicles
  • Tinea capitis: scalp ringworm, can cause permanent hair loss
  • Cicatricial alopecia: caused by any skin condition that causes scarring and damage to hair follicles
  • Traction alopecia: hair loss from tight braids or ponytails

When to Seek Help

Typically, you lose 50 to 100 strands of hair a day. And on average, 50 to 100 new hair strands emerge from your hair follicles daily, so it’s a break-even situation.

If you notice a lot more hair when you comb or wash your hair, make an appointment with your health care provider. Likewise, if you see clumps of hair falling out or bald patches on your scalp, you may have an underlying medical condition. Seek care from your health care provider.

Diagnosing Hair Loss

Getting your health history is the first step and includes questions about:

  • Recent stressful events (including Covid-19 infection)
  • Changes in your diet or rapid weight loss
  • Medications you take
  • Family history of hair loss
  • Other medical conditions

You may have lab tests to look for abnormal thyroid hormone levels or anemia based on your medical history.

And further testing begins with the low-tech pull test (just a pinch of hair tugged near the scalp to see how much hair is pulled out easily). A dermatologist may examination of your scalp with a magnifying dermatoscope. Rarely, you might need a scalp biopsy to diagnose your hair loss.

Treatment Options

Treatment depends on the underlying cause of your hair loss—replacing vitamins and minerals, correcting an underactive or overactive thyroid, treating ringworm with an antifungal medication, for example.

Some hair loss gets better with tincture of time. If you’ve had a baby or major surgery or rapid weight loss, hair growth will most likely return in several months without any treatment.

For male- and female-pattern hair loss, on the other hand, your health care provider will recommend treatment, either with over-the-counter or prescription medications.

Treatment for Male Pattern Hair Loss

The Federal Drug Administration (FDA) has approved two medications for male pattern hair loss:

  • Minoxidil for men (Rogaine): used originally in pill form for high blood pressure, patients noticed hair growth as a side effect while taking oral minoxidil. Formulated as a topical solution or foam, minoxidil 5% helps two out of three men regrow hair by shortening the hair follicle’s resting phase (telogen phase). It’s available over the counter at a pharmacy near you.
  • Finasteride (Proscar): used originally to shrink enlarged prostates, patients noted hair growth while taking it, too. Finasteride blocks testosterone’s conversion to DHT, the hormone that shrinks hair follicles. More than 80% of men see improvement in hair growth using this drug. Side effects include decreased sex drive, erectile dysfunction, and impotence. It is prescription only.

Health care providers also prescribe medications for off-label use (not yet FDA approved for hair loss treatment). They include:

  • Dutasteride (Avodart): research shows dutasteride is more effective at blocking the conversion of testosterone to DHT than finasteride. Theoretically, men will have more hair growth with this drug. The incidence of sexual dysfunction is similar to finasteride.
  • Latanoprost (Xalatan) and bimatoprost (Latisse): patients using these medications for glaucoma grew thicker and longer eyelashes. Studies show that both are effective for scalp hair growth, too.

Treatment of Female Pattern Hair Loss

Topical 2% minoxidil (Rogaine) is the only FDA-approved medication for female pattern hair loss treatment. Although women can use either the 2% solution or the 5% foam labeled for men, there seems to be no difference in effectiveness between the two concentrations. The 5% foam carries more risk of scalp itching and irritation.

Other medications used or prescribed off-label for female pattern hair loss include:

  • Spironolactone (Aldactone): originally prescribed to lower blood pressure, spironolactone decreases the androgens made by the ovaries. It’s particularly helpful for women with polycystic ovarian syndrome because of the excess androgens they produce.
  • Ketoconazole shampoo: an antifungal shampoo that reduces scalp inflammation and circulating androgens.
  • Finasteride: only used in women who cannot get pregnant. Male babies exposed to finasteride before birth are more likely to have congenital abnormalities.

Choosing the Best Medication

The earlier the treatment, the less irreversible hair loss you’re likely to be left with. After reviewing your health history, your health care provider can offer you the best and safest options for treating male or female pattern hair loss. Some medications are contraindicated with certain health conditions, such as:

  • Chest pain, recent heart attack, or heart failure: avoid minoxidil
  • Pregnancy, breastfeeding, male breast or prostate cancer, liver disease, or suicidal thoughts: avoid finasteride
  • Eye inflammation: avoid latanoprost and bimatoprost
  • Kidney disease, low adrenal hormone production (Addison’s disease): avoid spironolactone

The list is generalized. Your health care provider will dig deeper into your medical conditions to find the best treatment option for you.

No matter the hair loss treatment, it will take months rather than days to see results after starting medication. And finding the most effective medication for your type of hair loss may take more than one try. Patience and using the medication consistently as directed are key.

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Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.

References:

  1. https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat
  2. https://www.aad.org/public/diseases/hair-loss/causes/hairstyles
  3. https://www.aad.org/public/diseases/hair-loss/types/female-pattern
  4. https://dermnetnz.org/topics/male-pattern-hair-loss#:~:text=Male%20pattern%20hair%20loss%20is,is%20also%20called%20androgenetic%20alopecia
  5. https://journals.lww.com/menopausejournal/Citation/2022/04000/Prevalence_of_female_pattern_hair_loss_in.7.aspx
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986111/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573453/
  8. https://www.clinmedjournals.org/articles/ijdrt/journal-of-dermatology-research-and-therapy-ijdrt-7-103.php?jid=ijdrt
  9. https://www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss
  10. https://www.webmd.com/connect-to-care/hair-loss/male-pattern-baldness-genetics#:~:text=Male%20pattern%20baldness%20is%20influenced,role%20in%20male%20pattern%20baldness
  11. https://www.mayoclinic.org/diseases-conditions/ringworm-scalp/symptoms-causes/syc-20354918
  12. https://medlineplus.gov/genetics/condition/androgenetic-alopecia/#frequency
  13. https://nyulangone.org/conditions/hair-loss/types
  14. https://consultqd.clevelandclinic.org/male-and-female-pattern-hair-loss-a-guide-to-treatment/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388756/

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