Hair Metrics Brief: What Causes Hair Loss in Women?

About half of women will suffer from hair thinning or loss, often after the age of 50. Although women can suffer from the same type of DHT-related hair loss as men where an overproduction or increased sensitivity to androgen results in follicle loss (Read: Hair Metrics Brief: What Causes Hair Loss in Men?), physicians may not be so willing, or able, to immediately prescribe the medication that has shown a long history of success in men for male pattern baldness.

The effectiveness of these drugs may be lower in women, or have gender-specific side effects, leading many physicians to more thoroughly question the cause of hair loss in a specific female patient over a male patient. Additionally, as opposed to being specific to the crown of the head as in male pattern hair loss, female pattern hair loss often results in thinning hair over the entire scalp.

Studies on female hair loss are not as plentiful as those conducted on men, further complicating the issue. An extensive workup may require ruling out thyroid conditions, autoimmune disorders, polycystic ovary syndrome (PCOS), and other conditions before initiating treatment targeting androgen-related causes. Minoxidil, at least the 2% version, is available and relatively safe as a first line treatment and can easily be obtained over the counter by women.

The good news, if you can call it that, is that women have some options for treating hair loss that men do not. In particular, certain antiandrogens that would wreak havoc on a man’s system due to the balance of their testosterone levels may be effective in women with less risk.  Some of these include cimetidine (brand name: Tagamet), an anti-ulcer histamine blocker, spironolactone (brand name: Aldactone), a potassium-sparing diuretic, estrogen and progesterone pills (hormone replacement therapy), and some low androgen oral contraceptives as well as those with cyproterone and ethinyloestradiol (also known as Diane 35 or Diane 50).

Nonetheless, a full evaluation by a physician will be necessary before starting any prescription treatment, and unfortunately some treatments are not yet available in the United States. However, women will rarely experience complete baldness as a result of female pattern hair loss.

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