Hair Loss affects more than 80 million women in the United States. There are statistics that estimate 60% of women, at some point in their life, experience hair loss.
And yet, as common as it is, there is little understanding of why hair loss happens as well as the efficacy of available treatments.
This is particularly true for women. Male pattern hair loss (MPHL) is better understood (albeit more researched) while the role of androgens (the group of hormones shown to play a key role in MPHL) in females is less understood.
However, for both genders, hair goes through a cycle of growth and rest (see more information on the hair cycle here). On a non-thinning scalp, 90% of hair remain in the anagen (or active) phase. The remaining 10% of hair that is in the telogen (resting) phase stay dormant for about 3-4 months.
Hair loss occurs when the rate of hair loss exceeds that of hair growth, which can occur due to many different reasons for women.
This article is meant to be a guide, not a diagnosis. Additionally, treatments are not “one size fits all” solutions. What works for one person may not work for another.
I highly recommend you consult a physician to further understand your hair loss and available treatment options.
In addition, I think it’s is a personal decision on whether one pursues treatment. At the end of the day, you may find yourself trying several different treatments and have little to no results. It’s a frustrating process!
If you’re someone that decides to forego treatment or wear hair pieces instead, I support that! If you’re someone that decides to pursue treatment, I support that! And if you’re someone that decides to do both, I support you too!
Is there a cure?
Let’s cut to the chase because, at the end of the day, that’s what we’re all here for. And the short answer is no.
There isn’t a miracle cure that’s going to completely stop hair loss forever. There really isn’t a cure that will bring back your hair to your high-school glory days either. Chance are, treatments will have some effect, but you won’t experience drastic Rapunzel-like transformation.
I liken it to aging. We will all eventually (unless you’re Jennifer Lopez or Halle Berry) will get wrinkles; there’s no “cure” to banish wrinkles once and for all. However, there are treatments that help you maintain your youthful skin.
This is a similar case with hair (with the exception of some hair loss disorders, see below). While there’s no miracle cure, there are treatments available that slow hair loss progression, strengthen the hair follicles that you still have, and extend the growth phase of the hair cycle. See below for more information.
With all of these treatments, maintenance and upkeep are absolutely required. Even with hair transplant surgery, dermatologists and plastic surgeons recommend patients schedule additional appointments for upkeep.
So then, why consider treatment?
For most people who have hair loss (again there are exceptions below), your hair undergoes a miniaturization process as it thins. This happens when hair follicles spend more time in the telogen phase; the hair follicle itself shrinks and becomes shallower, making the hair follicle both finer in density but also weaker and more prone to breakage. After some time, the hair follicle can close completely and disappear.
It’s important to note because once your hair follicle is gone, it’s gone. There are no treatment options, as of now, for follicles that have completely disappeared.
Treatments, as a result, will be optimal when applied in early stages of thinning – this is when you’ll most likely see best results. When your hair follicles are strong, it’s important to maintain their health as best as possible.
Androgenetic/Androgenic Alopecia (AGA):
This is the most common form of female hair loss. While it is still not well understood, most doctors agree that it is likely related to increased androgen activity (the exact role of androgens is unclear for women).
- 5-alpha reductase enzyme activity, which converts testosterone to dihydrotestosterone (DHT), increases in balding scalp
- DHT increases in balding scalp
- Number of DHT receptors on the hair follicles increases in balding scalp
- Blocking conversion of testosterone to DHT delays progression of AGA
Based on these findings, DHT is a key factor in the miniaturization of hair follicles in AGA.
For women, hair slowly thins all over the scalp via the hair miniaturization process, but the hairline does not usually recede. Many women experience this as a natural part of aging, but it can happen any time after puberty.
Telogen Effluvium: [Cited from linked NYU Lagone article]
“This occurs when large numbers of hair follicles enter the resting phase of the growth cycle. This causes hair to fall out all over the scalp. The hair may appear thin, especially at the crown and temples.
A medical event or condition, such as a thyroid imbalance, childbirth, surgery, or a fever, typically triggers this type of hair loss. Telogen effluvium may also occur as a result of a vitamin or mineral deficiency—iron deficiency is a common cause of hair loss in women—or the use of certain medications, such as isotretinoin, prescribed for acne, or warfarin, a blood thinner. Starting or stopping oral contraceptives (birth control pills) may also cause this type of hair loss.
Telogen effluvium usually begins three months after a medical event. If the triggering event is temporary—for example, if you recover from an illness or stop taking the medication that is causing the hair loss—your hair may grow back after six months. Telogen effluvium is considered chronic if hair loss lasts longer than six months.
For reasons that are unclear to doctors, this type of hair loss may last for years in some people. If hair doesn’t regrow on its own, our dermatologists can offer medication that can help.”
Hair Shaft Abnormalities:
Examples of these conditions are Trichotillomania, Traction Alopecia, and Loose Anagen Syndrome. Hair loss from this specific group is slightly different – hair loss occurs due to damage in the hair shaft, which is the visible part of the hair, versus in the follicle (applies to AGA).
Repeated damage to the hair in conditions such as trichotillomania and traction alopecia causes strands to thin and become brittle, which makes them vulnerable to breaking. Over time, this may cause scarring and can permanently affect hair growth as well.
Information for other types of Hair Loss can be found here for conditions such as Anagen Effluvium, Alopecia Areata, Hair Loss from Inflammatory Disorders, Autoimmune diseases, and Rare Genetic Conditions
Treatments largely will depend on what type of hair loss with which you are diagnosed. Depending on your condition, you may choose to treat the scalp, hair follicle, hair shaft, or take medication/supplements to treat other conditions for which hair loss expresses as a side effect.
There are a few FDA approved treatments for hair loss (Minoxidil, Finasteride, and Low Level Light Therapy) as well as other emerging treatments available. Minoxidil and Finasteride are older treatments and therefore have had more testing for efficacy and safety.
One reason why there are few FDA approved treatments is that it’s hard to execute large-scale and controlled tests for hair growth due to long testing periods (hair takes a long time to grow!).
It is also challenging to standardize each test candidate and isolate out factors that could attribute to hair loss during the testing period. Finally, hair follicles are difficult to grow in lab isolation! They are best tested when “grown” from a person’s scalp, which adds to the testing difficulty.
As a result, there are few studies for now on hair growth products. I hope this will change over time as demand for treatment efficacy increases.
My two cents on treatment:
I think it’s really helpful to understand how each treatment works to understand which one you’d like to use.
For me personally, I have relatively strong hair follicles (no breakage). My problem area is even thinning all over, but most noticeably along my hair scalp, which seems like my hair follicles are miniaturizing versus breaking. In addition, I’m biased towards using more naturally-derived treatments and products with little/no known side effects.
As a result, I’ve decided to try a combination of Low Level Light Therapy, plant stem cells, and DHT blocking shampoo (with Saw Palmetto). This allows me to tackle my hair loss from multiple directions. For example, while plant stem cells aim to lengthen the anagen (growth) phase of my hair cycle, DHT blocking shampoo aims to block DHT from forming which causes hair to miniaturize in the first place.
When you are informed on how each treatment works and consult your doctor on these treatments, you’re able to set more realistic expectations for yourself and feel like you’re in better control of your hair loss journey.
Minoxidil (e.g. Rogaine):
This drug, initially a treatment for high blood pressure, dilates blood vessels and improves the blood flow to areas on which is it topically applied. When blood flow increases, more oxygen, and nutrients are able to reach hair follicles, which promote hair growth and strength.
There are many research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth with many different types of hair loss including AGA, alopecia areata, autoimmune diseases, telogen effluvium, anagen effluvium, hypotrichosis, etc.
As a result of the studies, the FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then a 5% solution has also become available when a stronger solution is needed for a woman’s hair loss.
However, minoxidil is NOT a miracle drug. It has not been shown to regrow hair for all women and for those women for which it did work, it will not restore your original hair state. In addition, one needs to wait to see improvement after at least two months, although it is ideal to assess after 4-12 months.
Finally, if minoxidil works for you, you absolutely need to keep using it to maintain those results. Because it works by supplying more blood and nutrients to hair follicles, your hair is constantly being nourished by that supply. If that supply goes away, so does your hair!
This has been shown to be less effective for women versus men and less effective for older female patients. Here’s a helpful article.
Low Level Light Therapy:
See my previous article here. I currently use this!
Are there other treatment options for FPHL?
As you’ve made it down this far into the article, you know that there is an increasing demand and curiousity to find alternative solutions for hair loss! Researchers are continuing to look for new ways to stimulate hair growth and stop hair breakage, some of which are below:
Spironolactone & CyproTerone Acetate: They are different therapies, but both works to block DHT’s interaction with androgen receptors and decrease androgen production. 88% of women receiving saw a decrease or halt in hair loss when taking either of these treatments. However, both have some serious potential side effects, so I really recommend researching them further if you decide to go this route!
Supplements: Many supplements, including biotin and folic acid, are said to help grow and thicken hair. In studying these different supplements, the findings have been mixed. In most studies, supplements had no effect on hair growth and thickness (for those who do not have nutritional deficiencies).
Hair loss shampoos:
There’s a wide range of shampoos that claim to prevent hair loss and/or thicken hair but have a wide range of solutions they provide to achieve desired results.
There are some volumizing shampoos that are cosmetic, meaning they make the hair appear fuller and thicker. Others seek to strengthen the hair shaft, which reduces breakage and in turn, reduces thinning. This may be beneficial with those who have damaged hair shafts due to hair shaft abnormalities (see above).
DHT Blocking Shampoos:
Finally, there may be some shampoos that work to block DHT via topical treatment. One newer natural ingredient is Serenoa repens, or Saw Palmetto. While there is still limited research, saw palmetto berry extract was shown to block 5-alpha-reductase, the enzyme that converts testosterone to DHT. There, unfortunately, were no studies with women at this time, only with men.
Platelet-rich plasma (PRP) therapy:
PRP is better known for its use in “vampire facials.” However, PRP is increasingly gaining popularity for other uses such as pain relief, recovery, as well as hair growth.
This therapy uses your own blood to concentrate platelets, which play a key role in your body’s natural healing process (it’s what causes blood clots and other healing functions). By injecting this concentration to the desired area of your body (in this case your scalp), it speeds up the regenerative and healing process in that particular area.
There is an increasing amount of research showing the effectiveness of PRP for hair growth, albeit small patient sample sizes. You can find some here and here. Dermatologist offices now offer PRP for hair growth given the new research and the treatment continues to grow.
A major downside to PRP is its extremely high price tag (especially because you have to keep the treatments up to see continuous growth). It’s also painful and time-consuming with repeated office visits.
Researchers are just beginning to study this therapy as a treatment for hair loss. This treatment aims to increase the anagen cycle for hair, which can, in turn, promote hair growth. Early findings show promise, but like PRP, more large-scale studies are needed for full testing.
I have recently tried (and continue to use) Reverie’s CAKE Restorative Scalp Tonic Spray. The main ingredient (and why it’s so expensive!) is Swiss apple stem cells, which has shown to increase hair growth. In a 2008 article in the International Journal for Applied Science, Isolated human hair follicles with the stem cell extract elongated faster and longer compared to the control follicle in which no treatments were applied.
Surgery (Hair Transplants):
Hair transplants are a procedure that has been used in the US since the 1950s but has come a long way since its inception. Previously, the surgery removed strips of scalp from the back of the head (or an area with healthy growth) to fill in bald patches. However, most hair transplants during that time looked very unnatural and thus, earned their reputation as “hair plugs.”
Today, most surgeons practice follicular unit transplantation, which transplants individual hair follicles one by one into new donor areas. This is done with robotics, which provides increased accuracy and consistency as well as achieves a natural look.
However, even hair transplants need upkeep with regular appointments and fill-in surgeries. Particularly with women, both transplanted and non-transplanted hair have an equal risk of falling out (unlike males who never lose hair in the back of their head), so regular maintenance is required.
You’ve finally made it to the end, whew!
Hair loss is a confusing, uncertain, and sometimes lonely journey. I hope that this at least helped you understand the basics of hair loss and informed you of all of the ways you can tackle your condition.
With that said, my advice is to be patient and set realistic expectations for yourself! Hair loss won’t be cured overnight and it may not be cured for you at all.
It may seem like a very discouraging and somber note, but please know that hair loss is a problem most people face at some level so you are not alone!