When it comes to drug treatments for androgenetic alopecia, women are in a difficult position. While many drugs may work to some degree for certain women, doctors hesitate to prescribe them. What's more, drug companies aren't falling over themselves to test drugs specifically for their ability to prevent and treat female pattern baldness.
Physicians are reluctant to prescribe systemic treatments (pills or other form of treatment that affects your entire system) because they can tamper with your body's own androgen levels (see Causes for an explanation of androgens). The doctor will first want to confirm that the hair loss is due to an excess of androgen (another name for male hormones) in the system or a sensitized "over-response" to normal amounts of androgen. Therefore, physicians often choose topical treatments, which are applied directly to the scalp.
Beginning treatment as soon as possible after the hair loss begins gives the best results, because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will help prevent further damage and encourage some hair regrowth from follicles that have been dormant but are still viable. Stopping treatment will result in the hair loss resuming if the androgens aren't kept in check in some other way. Maintaining your vitamin and mineral levels helps while you're on anti-androgen medications.
Below you will find a list of treatments used to treat hair loss in women. Currently there is only one FDA-approved treatment for female pattern hair loss. Others have not been approved by the FDA for this particular application, but have been approved for other applications and are used "off-label" to treat hair loss.
The effectiveness of these agents and methods varies from person to person, but many women have found that using these treatments have made a positive difference in their hair and their self-esteem. As always, treatments have the best chance of being effective if they are geared to the cause of the hair loss as well as to triggering hair growth.
Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil developed excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth.
When applied topically, the amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.
Widely available in generic versions and under the brand name Rogaine, minoxidil seems to be more effective for women suffering from diffuse androgenetic alopecia than it is for men. Product labeling recommends that women only use the 2% concentration of minoxidil, not 5%, because the FDA has not approved use of the higher concentration in women.
Many dermatologists do prescribe 5% for women with androgenetic alopecia if used under their supervision. Small clinical trials have shown that the 5% minoxidil solution is significantly more effective in both retaining and regrowing hair in women with androgenetic alopecia than the 2% solution.
Results from clinical studies of mostly white women ages 18 to 45 years with mild to moderate degrees of hair loss report that after using minoxidil for eight months, 19% of users had moderate regrowth and 40% had minimal regrowth. Of those using a liquid without active minoxidil (a placebo) during the same time period, 7% reported moderate hair regrowth while 33% had minimal regrowth.
Androgen Receptor Inhibitors
Spironolactone, brand name Aldactone, is in a class of drugs called potassium-sparing diuretics (often called water pills). Spironolactone is typically used to reduce fluid in your body without causing the loss of potassium. It is also used to treat potassium deficiency, high blood pressure (hypertension), swelling (edema), and a hormonal disorder called hyperaldosteronism.
Spironolactone acts as an anti-androgen in two ways. First, it slows down the production of androgens in the adrenal glands and ovaries. Second, it blocks the action of androgens in part by preventing dihydrotestosterone (DHT) from binding to its androgenetic receptor.
Cimetidine, brand name Tagamet, belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine-blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has been shown to block dihydrotestosterone from binding the follicle receptor sites.
Cimetidine has been used to treat excess facial hair growth (hirsutism) in women and has shown promising results in studies of women with androgenic alopecia. High doses are needed to achieve results, so men should not take cimetidine to treat their hair loss due to possible feminizing effects, including adverse sexual side effects.
Cyproterone acetate is used to reduce excessive sex drive in men and to treat pronounced sexual aggression. It is also prescribed for severe hirsutism in woman of childbearing age and for androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of dihydrotestosterone (DHT) to its receptors.
Cyproterone acetate is not available in the U.S. Doctors consider it one of the last resorts for treating female pattern hair loss because of its possible toxicity and long-term side effects. As with any drug, side effects other than those listed on the package may occur. Contact your doctor if you notice a side effect that is unusual or particularly bothersome.
Estrogen and Progesterone
Estrogen and progesterone pills and creams may be an effective treatment for women with androgenetic alopecia who are going through menopause or whose estrogen and/or progesterone are lacking for other reasons.
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.
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.
Published on March 1, 2010