Before we review a number of treatment choices available to female hair loss patients, it is important to recognize that in women, as well as men, disparate factors can cause scalp hair loss. These factors include underlying genetic susceptibility, hormonal changes, epigenetic factors, local inflammation, defects in hair cycling, defects in hair morphology, immunologic triggers, and so on. Thus, for example, the treatment for alopecia areata (AA) will differ markedly from appropriate treatment choices used to address androgenetic alopecia (AGA).
Overwhelmingly, most women who experience hair loss are affected by the female variant of AGA. AGA is a complex trait disorder, meaning that genetic and endocrinologic factors conspire to trigger the disease. With a few key exceptions, the treatment options available to AGA-affected females are quite similar to those used to treat males. These include drug based options such as minoxidil. Finasteride and dutasteride, two oral medications used to treat hair loss in men, are not indicated for use by women. This is due to the strong risk of feminizing birth defects linked to these drugs. On the other hand, the anti-androgen drugs spironolactone and flutamide are available to women, but usually not men. Often, spironolactone and/or flutamide may be dispensed to females suffering PCOS (Polycystic ovary syndrome) because hair loss may occur as a comorbidity of that disease.
Alopecia areata, a disorder wherein the body perceives hair follicles as foreign invaders, is the endpoint in a pathologic cascade characterized by a profound degree of inflammatory infiltrate and local destruction of the hair follicle by inflammatory cytokines and chemokines. Here, certain steroid hormones (e.g. dexamethasone) may be used to "turn down the burner" on the auto-destruct process.
Traction alopecia is another special case wherein mechanical pulling of the hair results in damage to the follicle, and, if continued, the eventual loss of all relevant structures. Hair extensions, hair pieces, braids, and even hair accessories can damage hair by literally pulling it out. There is a surprisingly common psychological disease called trichotillomania which mirrors traction alopecia. However, instead of passive traction by an affixed braid or accessory, hair is damaged by being pulled out in an obsessive, compulsive manner. Patients afflicted with this disease are guided toward counseling, and sometimes psychotropic medication.
Finally, chemical treatment of hair can also result in damage. Bleach, perm solution, straightening agents, etc. can eventually cause hair breakage and even hair follicle damage.
Recently, a new class of treatment options has become available, based on naturally-derived substances. The advantage of such materials is that they offer pleiotropic (i.e. multiple beneficial modes of action) activity. They are also largely free from negative side effect, such as found through the use of drug-based pharmacotherapy. A disadvantage is that most natural hair treatment products are marketed in the absence of objective third party evidence demonstrating safety and efficacy. There are treatment brands, ours among these, that invest energy in substantiating performance claims with actual proven data. As a consumer, it is in your hands to investigate the claims being published so that you end up getting value for your money. A good place to start is a visit to www.pubmed.com. This is the worldwide clearinghouse for all valid scientific and medical research. Also, the involvement of your primary care provider is an excellent idea. He or she is presumed to have your best interests at heart.
Before spending your dollars, become an educated consumer. Do not be pressured into buying or trying anything. This is your hair and your health we're talking about. Take your time. Do your homework. And when you're comfortable, and only when you're comfortable, make an informed purchase decision.
Finally, regardless what hair treatment you decide to use, take baseline before photos. Take follow up monthly photos. In this way you will establish an objective set of data points to help you assess the benefit your treatment is, or is not providing.
