What treatments work for women with thinning hair?

Jennifer N. Choi is the Division Chief of Medical Dermatology and Oncodermatology at Northwestern University Feinberg School of Medicine.

Q: Are there any treatments that actually work for women with thinning hair?

A: Topical minoxidil, often known by the over-the-counter brand name Rogaine, is my go-to treatment for the most common cause of thinning hair in women: female androgenetic alopecia (AGA).

Not only is topical minoxidil the most studied treatment available, it is also the only topical product approved by the FDA for the treatment of AGA.

If you’ve noticed hair loss, the first step is to get a diagnosis from a GP or dermatologist, who may do a scalp biopsy and order a blood test to look for possible causes, such as anemia or thyroid disease.

But if your hair loss has been insidious and started to widen on your side with your frontal hairline still intact, you probably have AGA. It can start anytime after puberty and becomes more common as women get older. By age 70, up to 50 percent of women have some degree of AGA. White people are affected more often, followed by Asians and blacks. If either your mother or father has AGA, you are more likely to develop it.

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When it comes to treatments, patience and managing expectations are important. You have several options including topical, prescription, dietary supplements and procedures. But I advise my patients to wait at least six months before deciding if any of them are working.

Unfortunately, many women continue to experience thinning hair after multiple treatments: there is no one-size-fits-all solution and the chances of success vary from case to case.

Here’s what you need to know about your options for treating AGA.

How should I use topical minoxidil?

Topical minoxidil is available over the counter in 2 percent or 5 percent concentrations and can be used once or twice a day. I usually recommend the 5 percent version as it has been shown to be more effective but also has an increased chance of side effects such as scalp irritation, flaking, itching and facial hair growth. Higher concentrations are available by prescription.

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You can choose between a solution or a foam. The solution, applied with an eyedropper, can sometimes drip onto your face or make your hair look greasy. The foam offers more controlled hand application and is free of propylene glycol, which in rare cases can cause irritation or allergies. Both should be rubbed gently into the scalp – just make sure to wash your hands afterwards.

You must continue to use topical minoxidil even after seeing results. If you stop, you may notice a shedding of new growth hair within four to six months.

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What about oral minoxidil?

Oral minoxidil has traditionally been used to treat high blood pressure, but it has recently garnered a lot of attention as an off-label hair loss treatment in low doses. More rigorous research is needed to confirm its overall safety and effectiveness, but in my practice I’m increasingly using it on both men and women, with most of them experiencing at least some level of noticeable hair growth.

Studies so far have been promising. A 2020 review of the medical literature found that 17 studies involving 634 patients showed it may help, but reported effectiveness varied widely: from 10 to 90 percent in terms of stabilizing hair loss, increasing overall hair density, reducing hair loss Improving hair thickness and decreasing hair loss. Topical minoxidil has been shown to be 13 to 63 percent effective in treating AGA in women.

If you don’t like the messiness of using topical minoxidil, or have experienced a reaction to it, talk to your dermatologist about taking the medication orally. I usually start patients on 1.25 milligrams or 2.5 milligrams daily, with room for higher doses if needed. It’s only available by prescription, and there are possible side effects, including hair growth outside of the scalp (such as the face), low blood pressure, and swelling of the lower legs.

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Other oral prescription medications that have been used to treat hair loss for the past 10 to 20 years include spironolactone, finasteride, and dutasteride. They have not been directly compared to oral minoxidil, so it is unclear which is more effective, and women who can become pregnant should not use these drugs unless using strict birth control methods, as they can cause fetal abnormalities. Finasteride and dutasteride are generally reserved for postmenopausal women for this reason.

The evidence is not as strong for dietary supplements as it is for topical minoxidil.

My patients often ask me about two popular oral supplements: Nutrafol, which contains saw palmetto, and Viviscal, which contains a combination of marine extracts and polysaccharides. Some of the studies on these ingredients and supplements have funding or industry-related interests, but they have suggested some effectiveness with few side effects.

Oral biotin supplements have long been touted to aid in hair growth. But these supplements in high doses have not actually been shown to be effective.

Dietary supplements still need large-scale randomized clinical trials by independent researchers, but I occasionally mention Nutrafol and Viviscal — rather than plain biotin — to patients who want to try an over-the-counter supplement, although I can’t promise they’ll see significant results.

Make sure you consult your doctor before trying any supplements, even if they are labeled as natural. For example, in breast cancer survivors who are taking long-term anti-estrogen drugs such as tamoxifen, certain dietary supplements may impair the metabolism of the anti-estrogen drug, potentially making it less effective.

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What if none of these other options work?

You may want to try one of these therapies or procedures, but they are not usually covered by insurance and can get quite expensive. There is also no rigorous evidence that they will work just yet.

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Red light devices: These devices use low-level light therapy (LLLT) and come in a variety of forms, such as: B. as a comb, hood or helmet. The HairMax LaserComb is a wearable, non-invasive device that has been cleared by the FDA for the safe treatment of male and female AGA with a starting price of $199. I would recommend this treatment to highly motivated patients who can commit to using it at least three times a week – preferably in combination with another treatment like Minoxidil – as it is easy to use, relatively affordable and generally considered safe.

Platelet Rich Plasma: Platelet rich plasma (PRP) is a plasma preparation derived from your own blood. A few small studies suggest scalp injections of PRP might help certain patients, but more rigorous evidence is needed, especially since the cost can be so high and the procedure can be painful. Three monthly sessions are usually recommended, followed by a three to six month maintenance period. The cost of each session typically ranges from $250 to $750. PRP is also typically used as an adjunct therapy in combination with other treatments, and not everyone is a candidate.

Surgical Hair Transplant: If one of the therapies doesn’t work, surgical hair transplantation is another option. Intact hairs are surgically removed from a portion of your scalp that still has thick hair, separated into individual hair follicular units, and surgically transplanted into tiny holes on the part of the scalp affected by hair loss or thinning hair. This procedure typically takes several hours, requires local anesthesia, and can be very expensive — anywhere from $6,000 to $60,000, depending on the amount of hair transferred, the technique used, and the surgeon’s experience — but many of my patients have very much long-term results achieved.

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