Female hair loss is a complex issue that affects many women worldwide. In a recent live stream hosted by the International Society of Hair Restoration Surgery (ISHRS), top experts Dr. Jennifer Krejci, Dr. Antonella Tosti, Dr. Paul Cotterill, and Dr. Nicole Rogers shared their knowledge on the causes, treatments, and considerations for female pattern hair loss.
Here’s a comprehensive summary of their discussion, offering valuable insights into managing this condition.
Causes and Diagnosis of Female Hair Loss
Hormonal Influences
Dr. Tosti emphasized the importance of understanding the hormonal aspects of female hair loss. She highlighted the role of conditions like androgenetic alopecia (female pattern hair loss), which is often influenced by hormonal imbalances. Key questions for diagnosing include inquiring about menstrual cycles, pregnancies, and the use of hormonal supplements, as these factors can significantly impact hair health.
Medical History and Lifestyle
Dr. Cotterill and Dr. Rogers discussed the importance of a thorough medical history and lifestyle assessment. This includes looking at family history, nutrition, medications, and even exercise routines, which can all contribute to hair loss. Stress-related hair loss, such as telogen effluvium, has also become more common during the COVID-19 pandemic.
Tools for Diagnosis
The experts agreed that tools like trichoscopy (scalp examination with a dermatoscope) are essential for accurately diagnosing the type of hair loss. Dr. Tosti, who developed trichoscopy, uses it to differentiate between conditions like female pattern hair loss and telogen effluvium.
In addition to trichoscopy, pull tests can evaluate hair shedding and breakage. Hair check test is also used to monitor hair density, thickness, and overall hair health. These tests should be conducted both before starting and during treatment to track the patient’s progress and assess the effectiveness of the treatments.
Treatment Options for Female Hair Loss
When it comes to treating female pattern hair loss, there are several options available.
Topical Medication
One of the most important first-line therapies is topical minoxidil. Dr. Tosti always prescribes this treatment, usually opting for the 2% solution for women over the 5% solution. Minoxidil foam can also be used to make the application on the scalp easier for women. It’s crucial to explain to patients that this treatment requires commitment and consistency and that managing hair loss is a long-term endeavor.
Oral Medication
Oral medications such as oral minoxidil, finasteride, dutasteride, or spironolactone may also be used to address hormonal imbalances. Oral minoxidil, in particular, has gained popularity due to its convenience, cost-effectiveness, and cosmetic benefits. However, it’s important to manage patient expectations and inform them of potential side effects, such as increased facial or body hair growth. Dr. Tosti uses 0.6mg dosage of Oral Minoxidil for women and 1.25mg dosage for men.
For post-menopausal women, finasteride at 5 milligrams can be beneficial. Additionally, dutasteride is worth considering for women who have plateaued after several years of finasteride use.
Dr. Tosti also prescribes Spironolactone but it is only prescribed if there are signs of hyperandrogenism. A dosage of 50 to 200 milligrams daily of Spironolactone, is a valuable option, especially for pre-menopausal women, as it can help with acne and unwanted facial hair.
Dr. Tosti also prescribes Bicalutamide to some patients with hyperandrogenism, at a dosage of 50mg every other day as that is the lowest dose available. But she also advises checking liver function after about 3 weeks as it can alleviate liver enzyme levels. She doesn’t prescribe Flutamide due to the danger of liver damage.
PRP, LLLT, and Microneedling
Platelet-rich plasma (PRP) therapy, Low-level laser therapy, and microneedling were discussed as adjunct treatments. However, Dr. Tosti cautioned against using these as monotherapy, stressing that they are most effective when combined with other treatments.
Scalp Micropigmentation
Dr. Cotterill mentioned scalp micropigmentation as a non-surgical option to improve the appearance of thinning hair. This technique involves tattooing tiny dots on the scalp to mimic hair follicles, creating a fuller look.
Hair Restoration Surgery
Hair transplantation can be a viable option for women, but it requires careful patient selection. Both Dr. Tosti and Dr. Cotterill highlighted the importance of setting realistic expectations, especially since women often have diffuse thinning, making them less ideal candidates for surgery compared to men.
Further Read: A Guide to Hair Transplant for Women
Supplements and Nutrition
Ensuring adequate levels of iron, zinc, and vitamin D is crucial, as these nutrients play a significant role in hair health. Dr. Rogers noted that low ferritin levels, even within the normal range, can affect hair growth and should be addressed in treatment plans.
Mesotherapy
Dr. Antonella Tosti discussed her experience with mesotherapy and microneedling as treatments for hair loss. She explained that mesotherapy, which involves injecting vitamins and other substances into the scalp, is effective and she uses it in her practice in Europe, though it is not FDA-approved in the United States. Dr. Tosti also mentioned using microneedling in combination with dutasteride for enhanced results but cautioned that it must be done with the correct solutions to avoid complications like silicon granuloma. She advised against using these treatments in the U.S. due to regulatory concerns and the risks associated with unapproved therapies.
Hair Care and Maintenance
The experts also provided practical advice on hair care, emphasizing the importance of gentle handling to prevent further damage. Dr. Tosti warned against friction, tight hairstyles, and excessive heat from styling tools, all of which can weaken hair. She also recommended using conditioners and being mindful of the ingredients in hair products, which can affect hair quality. Dr. Tosti issued warnings about certain hair care methods that can damage hair. She cautioned against the use of keratin treatments, noting that they can lead to significant hair shedding (telogen effluvium) and are marketed with misleading labels but still contain harmful chemicals like formaldehyde.
Dr. Paul Cotterill discussed several camouflaging techniques for women experiencing hair thinning. He suggested that those with dark hair might consider coloring it lighter to reduce the contrast between the hair and scalp, making thinning areas less noticeable. Additionally, he recommended using perms to add body to the hair, which can create the appearance of more volume. These methods can help women manage the visual aspects of hair loss effectively.
Dr. Nicole Rogers highlighted the importance of educating patients about the differences between hair growth treatments and hair-thickening products. She emphasized that while treatments like minoxidil are designed to stimulate hair growth, other products marketed as hair-thickening solutions—such as shampoos, conditioners, and serums—work by coating the hair shaft with ingredients like keratin, hydrolyzed wheat protein, and silicone derivatives. These products can make the hair appear thicker and fuller, but their effects are temporary, lasting only until the next shampoo. Dr. Rogers stressed the need for patients to understand that while these products can enhance the appearance of hair, they do not contribute to actual hair growth, ensuring that patients have realistic expectations about the results.
Dr. Jennifer Krejci introduced the concept of a “hair diet” emphasizing the need to limit excessive styling practices that can damage hair. She explained that many women subject their hair to multiple processes—coloring, highlighting, blow-drying, flat ironing, and curling—all of which can weaken the hair shaft and lead to breakage and hair loss. The idea of a hair diet involves reducing the frequency of these damaging practices, giving the hair a break, and allowing it to recover its natural strength and vitality. By minimizing these stressors, patients can improve the overall health and appearance of their hair.
Conclusion
Female hair loss is a multifaceted issue that requires a personalized approach. Whether through medical treatments, surgical options, or lifestyle adjustments, the key to managing hair loss lies in understanding the underlying causes and setting realistic expectations for treatment outcomes. By combining different therapies and focusing on overall hair health, women can achieve better results and regain their confidence.
For those seeking more information, the ISHRS offers resources and future live streams to continue educating and supporting individuals dealing with hair loss.