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Hair Loss in Women: Treatments

Oral Contraceptives

 

Since birth control pills decrease the production of ovarian androgens, they can be used to treat women's androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers age 35 and older who take the Pill are at higher risk for blood clots and other serious conditions.

Discuss your medical and lifestyle history thoroughly with your doctor. Contraceptive pills come in various hormonal formulations, and your doctor can determine which is right for your specific needs, switching pills if necessary until you are physically and emotionally comfortable with the formulation.

Only low-androgen index birth control pills should be used to treat hair loss. High androgen index birth control pills may contribute to hair loss by triggering it or enabling it once it has been caused by something else. See Causes for more information about oral contraceptives and hair loss.

Ketoconazole (Nizoral)

Available as a topical treatment by prescription, ketoconazole is currently used to treat fungal infections. It curbs the production of testosterone and other androgens by the adrenal gland and reproductive organs (in women, the ovaries).

These anti-androgenic effects can be used to help treat hair loss. Nizoral shampoo contains 2% ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1% version is now available over-the-counter, but it may not be as effective as the 2% prescription strength. There are no significant side effects.

Finasteride (Propecia, Proscar)

The drug finasteride inhibits the enzyme 5-alpha reductase in the hair follicle, thereby inhibiting the production of follicle-harming dihydrotestosterone (DHT). DHT shrinks hair follicles and makes it difficult for healthy hair to survive.

Finasteride was first marketed under the brand name Proscar to treat the prostate gland. It was available in 5 mg pills. In 1998, a 1 mg version with the brand name Propecia entered the market as the first pill approved by the FDA for men's hair loss.

It works quite well to prevent hair loss and trigger regrowth for most men, and it may work for some women, although women must not take it if they are pregnant. Also, women should not get pregnant while on the drug because of the risk of birth defects in a male infant. Less than 2% of men have transient sexual side effects, including erectile and libido difficulties, while taking finasteride. However, in women these side effects do not occur.

Cyproterone Acetate with Ethinyloestradiol (Diane 35, Diane 50)

Sold under the brand names Diane 35 and Diane 50, these contraceptive tablets are prescribed in Europe for women's androgenetic alopecia. Currently, both versions of this contraceptive are not available in the U.S.

The drug is a combination of cyproterone and estradiol, an estrogen. Both Diane 35 and Diane 50 contain 2 mg of cyproterone. Diane 35 contains 0.035 mg of estradiol, while Diane 50 contains 0.050 mg.

They work by blocking some of the actions of male hormones commonly present in women. Although it's possible for the drug to stop further hair loss and trigger regrowth of hair within about a year, it needs to be used on an ongoing basis to maintain regrowth and eliminate hair loss.

Possible side effects include breast tenderness, headaches, and decreased libido.


Published on March 1, 2010

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WebMD Medical Reference from the American Hair Loss Association

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