Propecia, the second FDA-approved treatment, is taken in pill form. However, it is not approved for use in women because it may cause birth defects. In fact, the FDA requires warnings against its use in women who are or may become pregnant. Still, doctors often find that Propecia works for women too, says Greene. "Many doctors do prescribe Propecia off-label to women with hair loss, especially those past menopause," he says.
Sawaya, however, warns against the practice for women of childbearing age. "In almost every clinical trial I have worked on, women will say they are on birth control and aren't planning to get pregnant, but every time we find that one or two do get pregnant anyway," she says. Because of the risk of birth defects, she feels women of childbearing age should not take Propecia or even handle it.
What's more, there appears to be no advantage to taking this drug -- it hasn't been proven any more effective than topical minoxidil. And Propecia also takes up to a year to make a significant difference and must be taken for life.
Another option that women like Tracy might consider is hair-transplant surgery. In this treatment, a strip of donor hair follicles is taken from an area of the head not affected by thinning. The strip is then cut into very small grafts, containing just a few follicles each, which are then implanted into small cuts made in the areas of thinning. If all goes well, the transplanted follicles establish a new blood supply and the hair grows. The treatment may take several sessions to relocate enough hair to adequately cover the desired areas, and final results won't be seen for at least a year.
Not every woman is a good candidate for surgery, however. "The problem is that women need to have an area to get the donor hair from," says Greene, who performs hair transplants on women. But because female pattern baldness tends to be diffuse, in many cases the back of the head is often no better than the top or the sides, he says.