Although hair loss affects 60 million men in the United States, it affects women as well. The problem is serious, as it has been reported in the Journal of the European Academy of Dermatology and Venereology that the quality of life experienced by those with hair loss is similar to that of patients with severe psoriasis. Further, with Americans spending more than $25 billion on haircare products each year, hair is clearly emphasized in American society. Therefore, concern about hair loss is less vain than it is crucial to normal self-esteem.
What causes female pattern hair loss?
Common causes of female hair loss are hormonal fluctuations (pregnancy and childbirth, menopause, birth control pills), certain nutritional deficiencies or excesses (iron deficiency, retinoids, vitamin A excess, selenium excess), or certain circumstances (genetics, general anesthesia or surgery, and certain illnesses, which include lupus, diabetes, anemia, thyroid disease, high fever and certain infections).
What are the four types of female pattern hair loss?
According to a comprehensive 2001 review in Trends in Molecular Medicine, female pattern hair loss may be classified as androgenetic alopecia (common baldness), telogen effluvium (temporary loss of hair), chemotherapy-induced alopecia, and alopecia areata. Of these four types, alopecia areata is the most common.
What is androgenetic alopecia?
According to the review by Cotsarelis and Millar, in androgenetic alopecia, hair follicles diminish in size over time until they are insignificant. In women, there is no consensus on whether pattern hair loss is truly androgen-dependent. However, androgenetic alopecia in both sexes results in a decrease in hair follicle size, a decrease in the duration of anagen (hair-growing phase) and an increase in the percentage of hair follicles in telogen (hair-resting phase). There is also an additional lag period of several months between the hair-loss and hair-growth phase that is not present in normal individuals.
What is telogen effluvium?
According to Cotsarelis and Millar, several different mechanisms can cause telogen effluvium, but all result from the synchronous entry of many follicles into exogen (the hair-releasing phase). If there is a temporary loss of hair that occurs with hormonal changes in women (such as during pregnancy, following childbirth, when a woman stops use of birth control pills, and after menopause), these fluctuations can cause hair in the anagen (growth) phase to enter the telogen (resting phase) and soon be followed by the exogen, or hair-releasing, phase.
A different type of telogen effluvium is observed soon after starting medications, in response to a rapid change in the duration of daily exposure to sunlight, or fevers or medications. In these cases hairs in the telogen (resting) phase are spurred into the exogen (hair-releasing) phase within weeks of the precipitating event.
Telogen effluvium typically reverses itself in 3-6 months. If hair growth does not return to normal after this period, the condition may actually be androgenetic alopecia.
What is alopecia areata?
Alopecia areata is actually the most commonly exhibited form of female hair loss. In alopecia areata, an autoimmune reaction by T-cells causes the anagen (growing) follicles to enter catagen (regressing phase) and the hair shaft breaks off. In most patients, the hair loss occurs in scattered patches, but in some, all scalp and body hair are lost.
Is Rogaine effective for women?
For women, the only FDA-approved medication for hair loss is topical minoxidil 2% (Women’s Rogaine, $35.95, Amazon.com). The solution is rubbed into the scalp twice daily, and has been shown to stimulate hair growth within six months. Originally used as a vasodilator to lower blood pressure, minoxidil was found by L’Oréal scientists to potentially stimulate hair growth by activating PGHS-1 (prostaglandin endoperoxide synthase-1), which helps promote hair growth. However, although 5% minoxidil (as found in Extra-Strength Men’s Rogaine) is considered off-label for women, in a randomized, double-blind, placebo-controlled experiment conducted over 48 weeks, it was found that a 5% topical minoxidil solution was superior to a 2% topical minoxidil solution in restoring hair growth in women. It is not generally recommended because some women have reported unwanted facial and body hair growth when using the 2% minoxidil Rogaine for Women.
Are nutritional supplements helpful?
Women should also examine their diets and dietary supplements and take care that they are receiving proper nutrition, not consuming too much vitamin A (recommended value: 500 IU and no more than 10000 IU/day) or too much selenium (recommended value: 60 micrograms/day, and no more than 400 micrograms/day), and that they are receiving adequate iron (recommended value: 8 mg/day, and no more than 20 mg/day). In addition, recent studies in rats demonstrate that hair loss is exacerbated by going over the recommended amount (aim for 15 mg zinc/day and 2 mg copper/day). Finally, speak to your doctor about concerns with any medications you are taking.
Although there are many pills and supplements on the market that claim to improve hair growth, some are questionable in nature. As with skin care products, always investigate the ingredients. One particularly new over-the-counter hair regrowth treatment is Kérastase Densitive Daily Anti-Hair Thinning, Anti-Hair Loss Dietary Supplement ($60.00, ShopFredSegalBeauty.com), which contains taurine (an amino acid), grape seed and green tea (as antioxidants), and zinc (to stimulate keratin production). However, there are few independent clinical trials to back up these ingredients, as Jeffrey J. Miller, an associate clinical professor of dermatology at Penn State Milton S. Hershey Center, tells Allure, “I am not aware of any definitive clinical studies showing that these ingredients reduce hair loss.” Indeed, studies are limited; only one study seems by Yeh et. al. demonstrates that taurine lowers vitamin A toxicity in rats. Because excess vitamin A contributes to hair loss, if taurine does indeed reduce vitamin A levels in humans, it may prevent hair loss by this mechanism, but it seems much easier to just keep vitamin A ingestion below the toxic level (10000 IU) in the first place. Grape seed and green tea are antioxidants, but independent studies at this time do not firmly establish a link between antioxidant use and hair regrowth. Zinc supplements are available for much less than $60.00. And if you consume a diet rich in red meat, poultry, seafood, beans, nuts, whole grains, fortified breakfast cereals and dairy products, it is likely that you do not have a zinc deficiency. If you do not consume these foods regularly and wish to use a zinc supplement, use one with less than 20 mg of zinc, as consumption of over 20 mg of zinc per day has been associated with reduced immune function, amongst other symptoms.
Does finasteride (Propecia) work for women?
No, not usually. According to a 2002 study in the Journal of the American Academy of Dermatology, only women suffering from hyperandrogenism (high amounts of testosterone) increased hair growth after finasteride treatment. This makes sense, as finasteride blocks formation of the enzyme 5-α reductase, which in turn results in a decrease in production of DHT (dihydroxytesterone). However, if hair loss results from other causes, then finasteride is not effective.
Will chemotherapy patients always have to lose their hair?
Hopefully not. There is promising new research that suggests that, in the future (hopefully in as few as 10-15 years?), chemotherapy patients will not have to lose their hair. Botchkarev et al. have shown that the gene p53 is necessary for the development of chemotherapy-induced alopecia. When Botchkarev et al. knocked-out the p53 from mice treated with chemotherapeutic agents, the mice remarkably did not lose their hair. As pointed out by Cotsarelis and Millar, chemical inhibitors of p53 already exist, and so testing their efficacy for local inhibition of p53 in hair follicles is realistic indeed.
In a second recent development, Davis et al. showed that inhibition of the cell cycle regulator cyclin-dependent kinase 2 (CDK2) using a novel, topically applied CDK2 inhibitor, prevents chemotherapy-induced alopecia in
rats. Human skin maintained as grafts on immunodeficient mice was also sensitive to the CDK2 inhibitor, suggesting efficacy in preventing chemotherapy-induced hair loss in human patients (Cotsarelis and Millar).
Hair loss is traumatic and prevalent in the United States. Women experiencing hair loss are urged to speak to their doctors about nutritional intake and medications. Although hair loss is temporary after pregnancy, childbirth, birth control pill cessation and menopause onset, hair that does not resume normal activity after three to six months may have another cause.
Women may wish to keep a food journal of food ingested and supplements to keep their vitamin A intake below 10000 IU and selenium intake below 400 mg. Women are also urged to make sure that they are receiving enough iron (8 mg/day), zinc (18 mg/day) and copper (15 mg/day) without exceeding maximum levels to prevent toxicity in the system.
Finally, while topical minoxidil 2% (Women’s Rogaine, $35.95, Amazon.com) has been proven effective, beware of treatments and supplements without independent scientific studies backing their ingredients.