Since elementary school, I’ve had a scar on the front of my scalp from an injury. I’ve always been able to hide it with my hair. But recently, the scar has started peeking out. My hair is thinning.
Parden the pun, but it seems that hair is an ever-growing concern among women. And in the age of social media, mentions about hair and hair products are everywhere. Browse through Instagram, Pinterest or TikTok and you’ll see photos and videos about DIY techniques for styling, coloring or enhancing your hair. Even my guilty pleasure of watching TV has been interrupted lately by commercials featuring celebrities promoting various hair care products.
My patients, family and friends all ask about hair — and hair loss (alopecia). Discovering that I had alopecia myself made me realize that many women may not know what causes it and what can be done to treat it.
Basics about androgenic alopecia
There are many different types of hair loss, but the most common for women is female pattern hair loss. Known as androgenic alopecia, the condition may run in families because genetics are believed to play a role. Androgenic alopecia can start anytime during or after puberty, but most cases seem to occur after menopause. As hormone levels change over time, hair becomes thinner, shorter and less dense. Usually, there’s no scalp itch, pain or rash with this type of hair loss, so if you have any of those symptoms, you should see a dermatologist for diagnosis and treatment.
Non-prescription treatment options
For women diagnosed with female pattern hair loss, more treatments are available than ever before. Believe it or not, one of the safest and most effective is over-the-counter minoxidil (Rogaine, Theroxidil, others).
Studies have shown that minoxidil helps stop hair loss by protecting the hair you still have. Only a few people who use it experience hair regrowth, but the key is preventing further loss.
Once you start using minoxidil, don’t be alarmed if the areas where you apply it are itchy or you develop a rash there. These effects are not uncommon and usually improve with time. Many people will also have a temporary increase in hair loss for the first several weeks, which is temporary and a sign that the medication is working.
Rogaine comes in 2% or 5% strengths as a solution or foam. I chose the 5% and I’ve found the foam easy to use and less likely than the solution to make my hair feel sticky or wet.
So, what happens if non-prescription minoxidil doesn’t work or doesn’t work well enough? It’s also available in a pill form, with a prescription. But like any medication, it has possible side effects that you’ll need to consider. One of the most common is increased hair growth on areas of the body besides the scalp. Oral minoxidil also can have negative effects on the heart and related systems. However, the doses used to treat hair loss are so low that using it is generally safe if you’re monitored carefully by a qualified and experienced health care provider. You shouldn’t use it if you’re pregnant or intending to become pregnant because of risks to the fetus.
Other options are available for hair loss, too. Spironolactone (Aldactone), which is taken in a pill, seems to work best in women who haven’t yet reached menopause. It is not approved by the U.S. Food and Drug Administration for hair loss, but it’s helpful for hair loss.
As with minoxidil, spironolactone shouldn’t be taken if you’re pregnant or intending to become pregnant. Sometimes, it can cause headaches, breast tenderness or irregular menstrual periods, but it’s otherwise usually well tolerated. Bonus: Spironolactone also helps with acne, and in women with polycystic ovary syndrome (PCOS), it can minimize facial hair growth.
Finasteride (Propecia) is a pill taken daily that’s been used for some time by men with hair loss. It can also be used by women. Finasteride is well known to have a negative impact on sexual function, primarily in men, and it has potential for other side effects. However, it’s generally safe for and well tolerated by women, though again, should not be used by those who are pregnant or intending to become pregnant.
Another form of treatment for androgenic alopecia on the horizon is platelet-rich plasma injection. The name of this treatment is usually shortened to PRP. With PRP, your blood will be drawn and spun down into a nutrient-rich solution, which is then injected back into your scalp. The solution is usually used in conjunction with one or more of the other medications that I’ve mentioned. Small studies have shown benefit while high-quality large studies are hopefully forthcoming.
Bottom line on thinning hair
If you’re worried about hair loss, I’d recommend that you see a dermatologist. A dermatologist can determine whether you have androgenic alopecia and if minoxidil or another treatment is appropriate. As for my own case of hair loss? Although I probably shouldn’t be doctoring myself, I’ve been using Rogaine nightly for the past few months, and it seems that my scar is becoming less and less apparent.
Ashley Wentworth, M.D.
Ashley Wentworth, M.D., is a pediatric and adult dermatologist in Jacksonville, Florida. Dr. Wentworth is currently conducting research on hair loss in patients following organ transplant. She frequently serves a contributor to news, magazine, radio and articles regarding dermatology.