Health Answers

Can anything be done for female pattern hair loss?

By Judy Foreman
August 10, 2009

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Q. Can anything be done for female pattern hair loss?

A. Yes - treatments similar to those for men.

As in men, there are many causes of hair loss in women - including scalp infections and inflammation, and auto-immune attacks on the follicles in the skin that make hair.

But the most common problem for women, especially after menopause, is “female pattern hair loss,’’ or androgenetic alopecia. High levels of the male hormone testosterone can trigger this, but “most women with androgenetic alopecia have normal levels of testosterone,’’ says Dr. Lynne Goldberg, a dermatologist and director of the hair clinic at Boston Medical Center.

These women may have hair follicles that are genetically programmed to be extra sensitive to testosterone, which causes them to produce thinner - and eventually, no - hair, says Dr. Deborah Scott, a dermatologist at Brigham and Women’s Hospital.

The first treatment, Scott says, is Rogaine (minoxidil), which must be used continuously to sustain any benefit. If it does not make new hair grow, it can help slow hair loss.

Propecia (finasteride) is used to treat hair loss in women in Europe, but is not government-approved here for that purpose. Studies suggest it does not work well in women, Scott says, though some doctors prescribe it, which they are allowed to do. Another option, though it, too, isn’t approved for this use, is Aldactone (spironolactone), a diuretic whose side effect is to block testosterone receptors.

Hair transplants are a good, but expensive, option, and not covered by insurance. The latest technique uses “micrografts,’’ meaning that hair follicles are surgically removed from one spot on the head - usually the back of the scalp - and inserted one or two hairs at a time in the bald area. While hair follicles in the crown of the head are often destroyed by testosterone, those at the back are not.

However, if your underlying problem is inflammation or infection, transplantation won’t help.

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Clarification: The Health Answers column in Monday’s “g’’ section about female hair loss may have implied that Propecia (finasteride) is government-approved in Europe for treating hair loss in women. It is not, though doctors there are permitted to prescribe it for this purpose, and some do.

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