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Treatment of Hair Loss in Women

If you go by my statistics, though I treat many women for hair loss per se, only 2.5% of those who undergo hair transplant with me are women.

It is estimated that 45% women have hair loss by the time they are 45 years in age.

1. Why do women have hair loss?
The causes can vary from-
1. Genetic which is the commonest
2. Hormonal – pregnancy, menopausal,
3. Medical conditions- Hypothyroidism, PCOS
4. Radiation
5. Stress
6. Natural aging process

2. How much hair loss is normal?
Losing up to 90 hair every day is normal because the similar number grows back. Hair is living tissue and the growth is cyclical passing through 3 phases – of anagen or growth phase, catagen or resting phase, and telogen phase which is the shedding phase when the follicle goes into dormancy. The aim of medical treatment is to lengthen the anagen phase and shorten the telogen so there is more hair on the head at any given time.

3. Is Women’s hair loss different from that of Men?
The starkest difference is that in women the hair loss is diffusely distributed. Thinning happens all over the scalp.

Unlike in men, the back and side of the head are not spared. Their hair loss has a pattern, which female hair loss lacks.

4. Why is hair in young age thicker and longer than when you are older?
When women are younger, the anagen phase of the hair cycle is at the optimal and hair density is lush. As women grow older, the length of the anagen cycle starts to decrease and so do various hormones start to exert their effect on female hair. There are ups and downs when the hair loss is intense like after pregnancy.

5. You said pregnancy causes hair loss but most women look their best during this period. Why?
During the period of pregnancy the good hormones make the anagen cycle even longer and women look their healthiest during pregnancy. All these gains of pregnancy suffer a set back when the child is born and loads of strands suddenly fall off. This period can be very distressing and it is when a lot of women come seeking help.

6. What is Telogen Effluvium?
This condition of misdiagnosed can be confused with genetic hair loss. In this condition, hair follicles are due to various reasons pushed into the telogen phase or the resting phase. You will know of it only after 3-4 months when the hair will shed. Fortunately the condition is often reversible.

7. Are hair treatments safe?
1. Refrain from treatments like the Brazilian blow-out, keratin. Contrary to what these are marketed as, they, however, break the bonds in the hair shaft. These treatments are loaded with formaldehyde which is not only detrimental to the hair but is cancerous as well.

2. If you have thin hair, abstain from rollers, curling, straightening, hot oil treatments or even bleaching

3. If you are coloring your hair, go for deep conditioning before because hair needs strength before being loaded with chemicals and before absorbing color that may weaken it.

8. Is there no one treatment for hair loss in women? Because it is so confusing!
No treatment is 100% foolproof. The doctor has to temper and tweaks it to suit individual needs.

I have been taking medicines for 2 months now without any benefit. Do I stop?

Medicines do not have an instant beneficial effect. Since the benefit starts from the root and by the time the hair grows long enough it is 3 months at the least.

9. When should I visit a doctor?
When your hair loss is sudden, is more than normal or when you can see scalp through your hair, it is time to take medical help.

Take 50-60 hair in your fingers and tug gently. If 5 hair come loose it is normal. More than 10 hairs will need you to visit a doctor.

10. I have hypothyroidism. Any advice for me?
Take thyroxine regularly half an hour after meals and keep it regular.

Every 3 months get your thyroid levels checked.

11. How do I reduce stress?
Sleeping 7-8 hours every day, maintaining a regular set routine so you are more organised, eating a nutritious balanced diet, and Yoga will help you in ways you have never imagined.

12. Is PRP beneficial?
We have an in house hair sciences research lab which my wife runs and here is where we prepare our PRP. Most helpful for women since they need medical treatment for their hair loss more commonly then men do.

13. What treatment do you advise?
1. 2% Minoxidil is the most common form of treatment available in the market and is FDA approved. Women can graduate to 5% and see if it causes increased facial hair. Some do tolerate it well, most do not and stick to 2% Minoxidil.

2. Other treatments that fuel hair growth in women are:
(a) Spironolactone (anti-androgen) 25 mg a day
(b) Finasteride 1 mg a day recommended for post-menopausal women
(c) Oral Minoxidil, but under strict supervision by your physician
(d) Ketoconazole shampoo (Nizoral) esp. When inflammation of hair follicle is the culprit
(e) Corticosteroid injections
(f) Hormonal replacement
(g) Oral contraceptives
(h) Nutrition- Iron and Zinc supplementation
(i) High protein diet
(j) LLLT for women is now an FDA approved treatment
(k) Changing hairstyles and avoiding tight braids, ponytails,
(l) Using a comb with wide teeth

14. Is Finasteride effective in women?
No, not as effective as in men due to the hormonal profile.

Downside is that Finasteride is teratogenic and if a premenopausal woman is on the drug, she should ensure contraception. When planning a child, stop it clear 3o days before.

I a recent study, 2.5 mg Finasteride in pre- and postmenopausal women treated for 3 months, 65% showed significant improvement while 35% showed some improvement. This dosage was well-tolerated without significant side effects.

Increasing this once a day dose to 5 mg is known to cause side effects like decreased libido and breast tenderness or pain. Moreover, increasing dose does not improve response since the dose-response curve flattens out after 2.5 mg.

15. What is Spiro?
This is the short form of Spironolactone which is being used increasingly in women who have thinning of hair which is not responding to Minoxidil. Being a strong medication being anti-androgen in nature, it should be taken only under a physician’s prescription, guidance & supervision. You have to weigh the benefits since potential side effects are more severe than Minoxidil or Finasteride while regrowth is less significant. However, it is increasingly gaining an impetus.

16. How will Nizoral help?
The salt is called Ketoconazole.

Nizoral is a common ingredient in hair loss shampoos. It is basically anti-fungal in nature.

A 1988 study comparing Minoxidil with Nizoral concluded that the benefits of the increase in hair shaft diameter and prolonging anagen phase of the hair cycle were comparable for both the medications.

A 2004 study concluded that ketoconazole can disrupt the DHT pathway and can be a weak DHT inhibitor.

However, as I keep harping pharmaceutical research papers in this field are to be taken with a pinch of salt. All that is important is your opinion of how the medication works on you and the advice and guidance of a competent doctor.

It is easy to use since all it takes is a quick wash once a week.

If you notice dandruff along with hair loss, this treatment qualifies to be added to your hair care stack because even if it does not have any anti-DHT properties, it definitely does improve the environment around your hair follicles.

Use it once a weak and on other days a gentler DHT blocking shampoo.

17. Is hair transplant for women?
In women who have patterned hair loss. That is f the back and sides of the scalp have normal stable hairs, will have dramatic effects after a hair transplant for which they are eminently eligible.

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