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Dude, Where's My Hair

Dr. Rebecca Kazin, MD

As women age, hormonal changes such as menopause can cause a decrease in estrogen levels, which can lead to thinning hair. This condition is called androgenetic alopecia (Androgens + genetics). As our estrogen levels decrease our relative testosterone (androgen) levels increase. Additionally, testosterone is converted into the hormone dihydrotestosterone (DHT), which can cause hair follicles to shrink and produce thinner hair. End result – we lose hair on our head and gain it on our upper lip and chin.

Hair loss in women can be caused by various other factors as well; vitamin D and B12 deficiencies, thyroid disorders, and rarely autoimmune diseases. Bloodwork can be helpful in identifying any underlying medical conditions that may be contributing to hair loss. But most of the time it’s just age.

Hair thinning caused by hormonal changes may start with a widening part or a noticeable decrease in hair density and is typically a gradual process that occurs over time. As the hair follicle ages, it shrinks and therefore the hair it produces is thinner, finer and more easily broken and damaged.

There are various treatment options available for hair thinning, including topical medications, oral medications and hair restoration procedures. Additionally, taking better care of your hair by avoiding harsh chemicals and heat styling, can also help to prevent further hair thinning.

Androgenetic alopecia, also known as female pattern hair loss, is a common form of hair thinning in women that is caused by genetic and hormonal factors. The following are some of the treatment options that are available for androgenetic alopecia in women.

Topicals, nutraceuticals and nonmedicated therapies:

  • Topical minoxidil (Brand name Rogaine): This is an OTC topical medication that is applied directly to the scalp to promote hair growth.

  • OTC oral nutraceuticals (Brand name Nutrafol): These are supplements with medical-grade‘drug-free’ ingredients that help decrease shedding and improve the appearance of hair.

Platelet-rich plasma (PRP) therapy: This is a treatment that involves injecting a concentrated solution of the patient's own blood platelets into the scalp to promote hair growth. The growth factors and proteins in the PRP can stimulate hair follicles, increase blood flow to the scalp and improve the overall health of the hair. It is typically a series of three to four treatments spaced a month apart.

Low-level laser therapy: This is a non-invasive treatment that uses low-level laser light to stimulate hair growth. It involves exposing the scalp to low levels of red or near-infrared light, which can stimulate hair follicles and promote hair growth.

Prescription oral therapy: Oral minoxidil is a medication that works by dilating blood vessels, which increases blood flow to the hair follicles and stimulates hair growth. It is believed to increase the size of hair follicles and prolong the anagen (growth) phase of the hair cycle.

Oral spironolactone and finasteride are medications that work by blocking the effects of DHT on the hair follicles, which can help to slow down or even reverse hair loss.

Surgical: Hair transplant surgery: This surgical procedure involves transplanting hair follicles from one area of the scalp to another. It is usually recommended for women with advanced hair loss.

My biggest piece of advice: The best way to address hair thinning is to make a plan as soon as you notice it. I speak as the doctor and the patient on this one!

Dr. Rebecca Kazin is a Johns Hopkins-trained dermatologist who combines concierge-level patient care with clinical research and teaching at Icon Dermatology and Aesthetics in North Bethesda, MD. Additionally, she formulated and patented HairSanity medicated shampoo and conditioner to help her patients achieve healthier scalps and hair.


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