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If you have been noticing that your hair is thinner or your part is widening, you may be one of the millions of women affected by female pattern hair loss (FPHL). Unlike men, women do not usually go bald; instead, they may see a widening part, a thinner ponytail, recession of hair at the temples, or some combination (AAD, n.d.). Female pattern hair loss can begin in women as early as their 20s and affects almost 30% of women over 30 years of age (Norwood, 2001). By the age of 79, over 50% of women have some degree of hair loss (Fabbroncini, 2018).
- Female pattern hair loss (FPHL) is a common type of hair loss and affects over 50% of women by the age of 79.
- Minoxidil (brand name Rogaine or Women’s Rogaine) is the most recommended hair regrowth treatment for FPHL. It is FDA-approved for use in women in two forms: a 2% topical solution and a 5% topical foam.
- There is also a 5% topical solution of minoxidil, but it is only FDA-approved for use in men.
- Side effects of minoxidil include scalp irritation, redness, dryness, and itching. Also, once you stop using minoxidil, your hair regrowth stops, and hair thinning returns.
Female pattern hair loss is likely due to a combination of factors. Androgens (male hormones) play a key role in male pattern baldness, which is also called androgenetic alopecia. Androgens affect the hair follicles and the hair growth cycle. However, in FPHL, the role of androgens is unclear. Since there are more cases of female pattern hair loss after menopause, hormonal changes are likely involved in some way—scientists are still piecing together this part of the puzzle. Also, there seems to be a genetic component to this condition, and many women with thinning hair have a family history of hair loss. The genes for female pattern hair loss can come from your mother, father, or both. However, there is no definitive inheritance pattern, and there may be multiple genes involved (McMichael, 2020).
While FPHL is the most common type of hair loss in women, other things can cause hair thinning (Van Zuuren, 2016). For example, many women notice thinner hair or hair that comes out in clumps after pregnancy. If you use harsh styling products or hair dyes, the chemicals can damage your hair and lead to hair loss. Likewise, certain hairstyles, hair treatments, or over-brushing can thin out your hair.
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Alopecia can also be due to certain medications (e.g., chemotherapy drugs) or nutritional deficiencies (e.g., iron and zinc). Unsurprisingly, stress is another factor that can affect hair health. When your body is under stress, like after a stressful event, major surgery, illness, or weight loss of 20 pounds or more, hair loss may result. Hair thinning from stress is usually due to excessive shedding. Fortunately, the hair will often return to normal once the stress stops (AAD, n.d.).
Hair loss in women is usually progressive—this means that if left untreated, you will likely continue to lose hair. Even though women do not usually go bald as men often do, many desire treatment. Fortunately, treatments are available, including minoxidil, oral medications, surgery, and laser therapy.
What is minoxidil?
Minoxidil (brand name Rogaine or Women’s Rogaine) is the most recommended treatment for female pattern hair loss (AAD, 2020). Initially used only in men, minoxidil is an FDA-approved over-the-counter medication for hair loss for both men and women. Minoxidil dilates blood vessels, thereby encouraging more blood and nutrient flow to the hair follicles, leading to fuller hair.
Scientists don’t know the exact mechanism by which minoxidil prevents hair thinning, but it seems to keep hair in the active growing phase (anaphase) for longer (Fabbrocini, 2018). Since minoxidil acts on the hair cycle, it is necessary to keep using the medication. Once you stop, your hair growth may reverse, and your hair loss may continue to progress. The sooner you start using minoxidil, the better your results tend to be.
Can women use minoxidil?
According to the American Academy of Dermatology (AAD), minoxidil is the most recommended hair regrowth treatment for women. Studies have shown that it significantly increases the total hair count leading to fuller hair after using it for 24 weeks (Fabbrocini, 2018).
Minoxidil is FDA-approved for use in women in two forms: a 2% topical solution and a 5% topical foam (Van Zuuren, 2016). A 5% topical solution also exists, but it is currently only FDA-approved for use in men. Using the 5% topical solution in women is considered off-label usage of the medication, and it is not fully clear what the benefits or side effects would be.
How to use minoxidil
Minoxidil is a topical treatment, meaning that you apply it directly to your scalp, not your hair. Typically, dosing instructions are as follows:
- Minoxidil 5% topical foam: Apply ½ capful once daily
- Minoxidil 2% topical solution: Apply 1 mL two times a day
Massage the minoxidil into the scalp with your fingers, and make sure to wash your hands immediately afterward. Ideally, apply the treatment at least two hours before bedtime to allow it dry completely—this may help prevent the minoxidil from inadvertently spreading to other parts of the body while you sleep (UpToDate, 2020). Minoxidil can also stain clothing or bed linen if your scalp is not fully dry after using the medicine. Continue using minoxidil daily because after stopping treatment, your hair loss will return within three months.
Potential side effects/safety considerations
Fortunately, minoxidil has relatively few side effects, including scalp irritation, scalp dryness, redness, scaling, and/or itching. However, during the first few months of using minoxidil, you may notice increased shedding of your hair—this will improve after the first few months, so don’t give up on the treatment (Fabbrocini, 2018). If you have not noticed an increase in the amount of hair regrowth after a few months of use, talk to your healthcare provider.
Another possible side effect is increased hair growth on the forehead or face. This may be due to accidentally applying the minoxidil to your face or forehead instead of limiting it to your scalp (Fabbrocini, 2018). Some women notice a change in their hair color and/or texture after using minoxidil. You should stop use and talk to your healthcare provider if you notice any of the above side effects or if you develop chest pain, rapid heartbeat, faintness, dizziness, weight gain (sudden, unexplained), or swelling of the hands or feet (UpToDate, 2020).
Lastly, if you are pregnant or plan to become pregnant, you should avoid minoxidil. Some animal studies have shown that minoxidil can be harmful to a developing baby (AAD, n.d.). Traces of minoxidil can pass into breast milk, so women who are breastfeeding should also avoid minoxidil (AAD, n.d.). Talk to your healthcare provider if you have any questions or concerns about the side effects or safety considerations of minoxidil.
Other treatments for female pattern hair loss
While minoxidil is usually the first treatment used in female pattern hair loss, other options are available. These include prescription pills, light therapy, microneedling, platelet-rich plasma, and hair transplants.
Oral prescription medications that affect hormone levels may work for women who have a hormonal component to their hair loss. Most of these medications are “off label”—this means that they are not FDA-approved to treat hair loss in women, but are approved for other conditions. Examples of these treatments include finasteride (FDA-approved for treating hair loss in men, but not women), spironolactone, flutamide, or dutasteride (AAD, n.d.).
Laser therapy, also known as low-level light therapy (LLLT), is a treatment for female pattern hair loss that you can do at home. There are no standard dosing regimens, but a few studies have shown that LLLT may be effective in treating hair loss and stimulating hair regrowth (Fabbrocini, 2018). The FDA has approved low-level light therapy devices (combs, helmets, and other devices) for the treatment of both male and female hair loss, but more research is needed in this area (AAD, n.d.).
Microneedling is a minimally invasive procedure that is under investigation as another potential option for women with female pattern hair loss. Fine needles are rolled over the skin of the scalp to puncture the upper layers of scalp skin. The small punctures trigger a wound healing response that releases growth factors and may help stimulate hair growth (Fabbrocini, 2018). Also, the wounds can improve the penetration of topical medications, like minoxidil. A few studies have shown that microneedling—especially when paired with hair-growth promoting remedies—can help hair regrowth (Fabbrocini, 2018).
Researchers are studying platelet-rich plasma (PRP) as a treatment for hair loss. Your blood is collected and separated into different parts. Platelets, one of the components of blood, are separated and treated. The platelet-rich plasma is then injected into your scalp. PRP has growth factors that may stimulate hair growth, and some surgeons use this therapy in conjunction with hair transplantation. Early clinical results are promising, but more research is needed to determine the effectiveness of this treatment in female pattern hair loss (Fabbrocini, 2018).
Hair transplantation is the most invasive treatment for hair loss. It involves surgery to physically move hair follicles from one part of your scalp to the area of hair thinning. Hair transplants are not for everyone—they are usually reserved for people who have already tried medical treatment without success. Most medical insurance plans do not cover hair transplant surgery, so cost may be an issue for some people. Some surgeons are combining hair transplants with platelet-rich plasma therapy (Fabbrocini, 2018).
Nutritional supplements, like folic acid, omega-3 fatty acids, biotin, and zinc, are not proven to work in treating hair loss. Studies looking at these therapies have shown mixed results. Be sure to talk to your healthcare provider before starting any nutritional supplements.
Female pattern hair loss is not talked about as much as male baldness, but it can be just as detrimental psychologically. Many women feel that their hair is an integral part of their body image, feelings of attractiveness, and femininity (Van Zuuren, 2016). Fortunately, treatment options are available, the most common being topical minoxidil therapy. If you are concerned that you may be experiencing hair loss, talk to your dermatologist or healthcare provider about your symptoms and treatment options.