AgingSkinNet Spotlight Article
Best Rx Options for Hair Loss in Women
Dermatologists Say First Find
When a woman starts losing her hair, it
is often unexpected and frightening. Not wanting to tell a soul,
many women cope by hiding hair loss with a new hairstyle. Some
experiment with products that guarantee hair re-growth.
Dermatologists understand the appeal of these options but caution
that getting to the root of hair loss is essential.
Cause Determines Treatment
Hair loss occurs for many reasons. Two of the most common reasons
women see thinning locks are stress and hereditary hair loss. An
underlying medical condition such as lupus, thyroid disease, or
polycystic ovary syndrome also can cause hair loss. Even what you do
to your hair — including bleaching, permanent waving, and certain
hairstyles — can result in noticeable hair loss. Each cause requires
a different approach to re-grow hair.
Stress-induced Hair Loss
Women can lose a noticeable amount of hair after a particularly
stressful event, such as childbirth, illness, surgery, or passing of
a loved one. Prolonged stress can force too many hairs into what is
called the “resting phase.” (Hair goes through 3 phases: growing,
resting, and shedding.) When stress pushes too many hairs into the
resting phase, the hairs remain on the head for about 3 months. Then
all of these hairs enter the shedding phase together, causing
noticeable hair loss.
Treatment: The good news is that stress-induced hair loss
usually does not require treatment. The phases tend to return to
normal, and hair re-grows on its own.
Hereditary Hair Loss
Many women are surprised to learn that like men, they, too, can have
hereditary hair loss. In men, this condition typically causes a
receding hairline or a balding patch. Women, however, tend to have
gradual overall thinning. An early sign of hereditary hair loss in
women is noticeable hair loss in the center part. If parting hair
down the center reveals a Christmas-tree pattern on the bare scalp,
the cause is usually hereditary hair loss. Another sign of
hereditary hair loss is thinning right behind the front hairline.
By parting this woman's hair in the center, the dermatologist
can see that this woman does not have visible hair loss.
This woman’s part reveals a Christmas-tree pattern, which is an
early sign of hereditary hair loss in women.
All photographs previously published in the Journal
of the American Academy of Dermatology, 1999 Jan;40(1):106-9. Olsen EA. “The Midline part: An important physical clue to the
clinical diagnosis of androgenic alopecia in women.” Copyright
Hereditary hair loss can be especially
troubling for women because it tends to worsen — often in an
unpredictable way. A woman may notice significantly more hairs in
the tub or on her brush for 2 or 3 months, and then the excessive
shedding stops. For the next 3 to 12 months, hair loss seems normal.
Then suddenly and unexpectedly, the excessive hair loss returns.
This unpredictably can leave a woman feeling anxious and uncertain
about what to do.
Treatment: Early treatment offers the best chance for hair
re-growth and preventing further loss. When hereditary hair loss
develops, the growing phase shortens. This causes hair to thin until
growth stops completely. The sooner treatment begins, the better the
chance that hair will re-grow.
There are a number of treatment options for hereditary hair loss in
women. Over-the-counter minoxidil is a common treatment. The U.S.
Food and Drug Administration (FDA) approved the 2% minoxidil
solution for women who have hereditary hair loss. Studies show that
it stimulates re-growth in about 60% of women with hereditary hair
To see re-growth, minoxidil should be applied twice daily every day.
It takes about 4 months to notice any growth. To continue seeing
growth, minoxidil must be used indefinitely. Once stopped, hair
re-growth tends to stop and the hair that grew usually falls out.
Patients often dislike the inconvenience of applying minoxidil twice
daily. Some dermatologists compare using minoxidil to brushing your
teeth. Done twice daily, both help prevent loss. Brushing helps
prevent tooth loss. Applying minoxidil twice daily can help stop
hair loss. Minoxidil also helps many women to re-grow their hair.
In some cases, dermatologists will prescribe a different — or
additional — medication to treat hereditary hair loss.
Spironolactone and flutamide can be effective for some women. As
these medications carry the risk of birth defects, women should not
take these medications if they are pregnant or plan to become
pregnant. Women who can get pregnant must use an oral contraceptive
when taking these medications.
Cortisone medication in topical (applied to the skin) or injectable
form can help some women re-grow their hair.
A procedure called “hair transplantation” may be an option. This
procedure involves taking hair from a healthy area and moving it to
an area(s) that has thinning. Rest assured, this procedure has
improved dramatically since the days of the hair plug. Today, hair
transplantation produces natural-looking results. It can be
effective for women with early or mid-stage hereditary hair loss.
Without early treatment, hereditary hair loss in women tends to
progress, eventually causing visible thinning across the scalp. In
the later stages, treatment may not lead to hair re-growth.
Underlying Medical Condition
An undiagnosed medical condition can cause noticeable hair loss.
Treatment: Treating the underlying medical condition may stop
excessive hair loss and allow the hair to re-grow.
How Dermatologists Diagnose Hair Loss
To diagnose the cause of hair loss, a dermatologist generally does
Takes a thorough medical
history. Be sure to tell your dermatologist about all
medications, vitamins, and food supplements that you are taking
and have recently taken. It also is important for the
dermatologist to know if you have been dieting. You also will be
asked about your menstruation history, pregnancies, and
If you have been using any hair re-growth products, be sure to
tell your dermatologist. This includes shampoos, laser combs,
vitamins, and food supplements.
Examines the hair and scalp.
This typically involves a visual exam of the hair and scalp. To
learn about the health of the roots, a dermatologist will gently
tug on your hair. The doctor also may need to look at the hair
over the rest of your body. This tells the doctor if there is
too little or too much hair, which can be helpful in diagnosing
the cause of hair loss.
If an underlying medical condition is suspected, you may need
blood work or other testing. Sometimes the dermatologist
performs a scalp biopsy to determine the exact cause of the hair
loss. This simple procedure can be quickly and safely performed
in the dermatologist’s office.
Benefits of Seeing a Dermatologist
With so many causes, it can take a bit of detective work to uncover
the reason for hair loss. Sometimes, more than one cause is
responsible. And as we age, one cause may follow another.
Dermatologists receive specialized medical training that gives them
expertise in diagnosing and treating conditions that affect the
skin, nails, and hair. These doctors are best able to diagnose the
underlying cause — or causes — of hair loss. An accurate diagnosis
and early treatment offer the best chance for successful re-growth.
American Academy of Dermatology. “Hair Loss.” Available at:
Last accessed July 23, 2009.
American Academy of Dermatology. “Don’t Let Hair Loss Tangle You Up
– Dermatologists Can Identify Common Hair Disorders,” News release
issued February 3, 2008. Available at
Last accessed July 23, 2009.
American Academy of Dermatology. “Hair Loss in Women: More than
Meets the Eye.” News release issued March 2, 2006. Available at
Last accessed July 23, 2009.
Dinh QQ, Sinclair R. “Female pattern hair loss: current treatment
concepts.” Clin Interv Aging 2007; 2: 189-99.
Iorizzo M, Vincenzi C, Voudouris S et al. “Finasteride
treatment of female pattern hair loss.” Arch Dermatol 2006;
McMichael, AJ. “How to Approach Hair Loss in Women.” Presented
during symposium S001 “What’s Hot: Women’s Dermatology” at the
Summer Academy Meeting of the American Academy of Dermatology, July
Olsen EA. “The midline part: an important physical clue to the
clinical diagnosis of androgenetic alopecia in women.” J Am Acad
Dermatol 1999; 40: 106-9.
Rogers NE, Avram MR. “Medical treatments for male and female pattern
hair loss.” J Am Acad Dermatol 2008; 59: 547-66; quiz 67-8.
All content solely
developed by the American Academy of Dermatology
It is important to tell
your dermatologist about all treatments you have used to
treat hair loss.