Treating Hereditary Hair Loss in Women

Hereditary hair loss in women is more common than most of us seem to think. At first look, it may not be as visible as it is in men due to its different pattern but it is no less challenging to treat than male pattern baldness. The typical female balding pattern is a diffuse hair loss affecting almost the entire scalp, although the thinning is more pronounced on top of the head rather than on the back and the sides. As a rule of thumb, one can say that we need to lose about 50% of our hair in the thinning area to notice that we are balding. This rule applies to the female pattern baldness too. But since female hair loss is less focused than the male form and thus covers a larger area of the scalp, women may lose a bigger portion of their overall hair before noticing any change.

Female pattern baldness has the same main cause as its male form and that is the biologically active metabolite of the male hormone testosterone called dihydrotestosterone (DHT), which attacks and kills hair follicles. The exact mechanism of its action is not known, though. However, treating female pattern baldness faces two major obstacles. First, women cannot use some of the most effective drugs proven to treat hair loss in males. They may not be prescribed male anti-androgen drugs such as finasteride (Propecia) or dutasteride and they can only use 2% minoxidil solution as a higher concentration might induce undesirable hair growth on other parts of their face and body. Secondly, women usually make poor candidates for hair transplantation as advanced female pattern hair loss may affect most of their scalp, leaving them with insufficient hair density in the donor area.

Doctors are often reluctant to prescribe anti-androgen medications to women suffering from hair loss, especially oral applications. But there are some anti-androgens that can be effectively used to treat female pattern baldness. The most common among them is spironolactone, better known under its trade name, Aldactone. Spironolactone's anti-androgen activity consists in binding to the androgen receptor and preventing its interactions with DHT.

Another potent anti-androgen that is prescribed for female hair loss is cyproterone acetate, better known under its many trade names, such as Diane 35, Diane 50 and Ginette 35. This contraceptive is also used to treat acne. Similar to spironolactone, cyproterone acetate exerts its anti-androgen activity by blocking DHT from binding to androgen receptors and is considered to be a more powerful weapon in fighting female pattern baldness than spironolactone.

An alternative to the oral use of anti-androgen drugs is a topical application of estrogen solutions, which is said to be almost as effective as their systemic administration. The best known product in this category is Crinohermal, which uses estradiol as its main active substance. This female hormone inhibits the production of 5-alpha reductase, the enzyme that converts testosterone to follicle-harming DHT.

Estrogen levels decline in the skin with age. Once women enter menopause, their levels of estrogen decline and more testosterone is then bio-available to be converted to DHT. A hormone replacement therapy is commonly prescribed at menopause, with estrogens and progesterone pills and creams probably the most common forms of treatment for hereditary baldness for women in menopause.

This list of treatments includes the best proven medicinal remedies for female pattern baldness but it is not exhaustive. There are some other substances that might be helpful, such as aminexil, ketoconazole, fluridil, flutamide, alfatradiol, as well as herbal hair loss cures that are always readily available to help us spend some extra money. However, none of these products has ever been clinically proven to be nearly as effective as the aforementioned medical treatments.

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