July 7th, 2017 This article was written by one of the medical writers at Hair Loss In Women, and has been reviewed by a medical doctor.
If your hair loss is due to androgenic alopecia you may be able to stop losing more hair. You may even be able to regrow your hair. Many experts believe that the earlier you start treating androgenic alopecia, the better your chances of success.
The more advanced a case of androgenic alopecia the lower the success rates of regrowing hair. If your hair loss is irreversible there is still hope. Hair transplants are still an option.
It’s possible that you’re dealing with more than one form of hair loss. You may be combating androgenic alopecia AND another form of female hair loss. You just need to know what your treatment options are. Once you know your option you can narrow your search by which ones work best for you.
We’ll start exploring androgenic treatment options by focusing on over-the-counter treatment options. Over-the-counter options include minoxidil (the active ingredient in Rogaine and others), tretinoin (brand name Retin-A, that can enhance the absorption of minoxidil), ketoconazole shampoo (brand name Nizoral), low-level laser therapy, cimetidine (brand name Tagamet), and saw palmetto (use of which is neither evidence based nor FDA approved, but we include it here because of many users claims of its effectiveness).
After exploring over-the-count options we’ll focus on prescription only options. Prescription only options include spironolactone (brand name Aldactone), latanoprost (band name Xalatan), bimatoprost (brand name Latisse), hormone replacement therapy, finasteride (brand name Propecia or Proscar), platelet-rich plasma (PRP), Flutamide (Brand Name Eulexin), and oral contraceptives (including Cyproterone Acetate).
Treating Androgenic Alopecia With Minoxidil
Minoxidil was originally used to treat high blood pressure. Patients found that they were having the side effect of hair growth.
Minoxidil is an over-the-counter medication users appy directly to the scalp. It is only effective for women suffering from genetic hair loss (androgenic alopecia). It’s available as a liquid and as a foam. It is now available as a foam because some women were having irritation and flaking due to the propylene glycol.
Minoxidil is the only drug which with FDA-approval to treat female pattern baldness. It is available in 2 forms: 2% for women, and 5% for men (although the 5% formula received approval for women by the FDA). However, some dermatologists will prescribe 5% for women under supervision.
Recommendations are that you apply liquid minoxidil twice a day, or the foam once per day. Use may need to be a long term regiment.
The cost is as low as under $10 / month, which makes it relatively inexpensive compared to some other options (Latisse is around $150 / month just for the lashes, and finasteride is around $75 / month.
Does Minoxidil Work?
Minoxidil is a vasodilator (widens your blood vessels), and it opens potassium channels, which allows more nutrient and oxygen rich blood to reach the hair follicle. This causes the current hair in the telogen phase to shed, which is the phase of the hair’s life cycle where it’s no longer growing, and it “rests”before it will be shed by a new hair that grows from the hair root.
So your initial results with minoxidil may be unimpressive. It will take time to move your hair follicles from the telogen phase to the anagen, or growth phase.
Minoxidil is the active ingredient in Rogaine (Regain the UK). Minoxidil is also the active ingredient in many other brands:
- Avacor Physician’s Formulation
- Loniten (oral)
How Effective Is It?
According to Harvard Health Publications, two double-blind studies of women ages 18 to 45 demonstrated its effectiveness. In one study, 13% of female minoxidil users had moderate hair growth, and 50%, minimal growth (compared with 6% and 33% in the placebo group). In the second study, 60% of women in the minoxidil group reported new hair growth, compared with 40% in the placebo group.
What Are The Side Effects of Minoxidil?
Some women experience hypertrichosis (excessive hair growth not on the scalp).
Also, sometimes the new hair is a different color and/or texture.
If you’re using a solution that has alcohol in it, occasionally it may cause a skin irritation (the alcohol causes the irritation, not the minoxidil). The foam generally is less likely to cause irritation.
Additional ingredients in the formula that you’re using could be causing side effects as well.
Rarely, too much minoxidil gets absorbed into the body and the following side effects have been reported:
- blurred vision or other changes in vision
- chest pain
- fast or irregular heartbeat
- numbness or tingling of hands, feet, or face
- swelling of face, hands, feet, or lower legs
- weight gain (rapid)
How To Use Minoxidil
Use the pump or dropper to apply the solution wherever your hair is thinning, and only on dry hair and scalp. Massage it into your scalp, wash your hands, and let your hair air dry. Don’t shampoo for at least four hours afterwards.
How Long Does Minoxidil Take To Work?
It usually takes four to six months for the product to show results. You result may be slight to moderate hair growth. But one of the main benefits is that it can stop your hair from thinning.
And remember that your situation may seem to get worse before it gets better. Overall your hair may look thinner because you will be shedding the old hairs in the telegen, or resting phase, and it will take time for the new, thicker hairs in the anagen phase to grow.
How Long Should You Take Minoxidil?
Rogaine (or any of the other less popular brands) is something that you’ll need to keep taking for the benefits. If you stop, in 6 to 9 months you will go back to the thin hair that you had before.
For this reason it could be smart to use Rogaine in conjunction with other hair loss treatments, such as androgen blockers like Finasteride or Nizoral. And to help increase absorption into your scalp, you can use tretinoin (Retin-A) as well.
For a more in-depth discussion of minoxidil, including how you can make minoxidil even more effective with micro-needling, check out our Ultimate Guide to Minoxidil For Women.
Treating Androgenic Alopecia with Tretinoin (Brand Name Retin-A)
Tretinoin, or retinoic acid, is a derivative of vitamin A. It was approved in 1971 by the FDA. Back then it was for treating mild to moderate acne, fine wrinkles and hyperpigmentation (skin discolorization). It’s prescription only, although there are products that are over the counter that contain tretinoin.
Available in a gel, cream, or liquid, it softens the outer layer of skin, preventing the skin from forming a thick layer of cells (called keratinization). That allows the minoxidil to be more easily absorbed. It’s available over the counter.
It’s the active ingredient in many products:
- Retin-A Micro
- Renova Pump
Side Effects of Tretinoin / Retin-A
Side effects may include hives, difficulty breathing, swelling of your face, lips, tongue, or throat. Users also report burning, warmth, tingling, stinging, dryness, itching, redness, swelling, peeling, irritation, and skin discoloration. Women may also develop photosensitivity, which is an increase in sensitivity to the sun. The increase in sensitivity may increase the chances of getting a sunburn or a burn in a tanning booth. Additionally,there aren’t any studies of its use during pregnancy. It’s unknown if it’s secreted into breast milk. Therefore, the recommendation is to refrain from using tretinoin orally while a mother is lactating. Nursing mothers should avoid topical use as well.
It’s also advised not to use with medicated or abrasive soaps/cleansers, astringents, drying agents, topical products with a high-alcohol content, and salicylic acid. Fruits and vegetables contain salicylic acid, especially berries, as well as some herbs and spices.
If you’re using anything with benzoyl peroxide, sulfur, resorcinol, or salicylic acid, allow them to dry before using tretinoin.
Treating Androgenic Alopecia with Ketoconazole Hair Loss Shampoo (Brand Name Nizoral)
One shampoo that many women have had success with for treating androgenic alopecia Nizoral 2% shampoo. It’s main active ingredient is ketoconazole. Its use is to treat sink infections due to yeast and fungus (such as dandruff, and seborrhoeic dermatitis). For skin infections come in the form of a cream, pill and shampoo. People with hair loss tend to use it as a shampoo.
The main benefit of Nizoral for women with thinning hair is to counter the effects of dihydrotestosterone. Dihydrotestosterone is the hormone that shrinks hair follicles.
Nizoral is available in a 2% as well as a 1% formula (which is available over-the-counter). Women generally report more benefit from the 2% formula.
It is generally safe to use along with other hair loss remedies.
Side Effects of Nizoral
In higher doses, there is a danger of causing sever liver issues. However, the small amount of ketoconazole you absorb through Nizoral shampoo is generally too low to have any effect in the rest of your body. However, the recommendation is to cease use of Nizoral during pregnancy.
Occasionally users report mild skin irritations. It may cause irritation if it comes in contact with your eyes. If you have dry scalp or irritation, it might not be the ketoconazole. It could be a reaction to sodium lauryl sulfate.
Treating Androgenic Alopecia Low-Level Laser Therapy (LLLT)
Low-level laser therapy is in use to treat many different conditions. There are several studies that indicate that it can facilitate healing, pain relief, reduce inflammation, and help restore function to an area. Many patients with osteoarthritis, rheumatoid arthritis, and general joint pain use Low-level laser therapy. Patients with psoriasis and/or acne also use it to treat their skin conditions. Many professional sport teams use LLLT (also known as cold lasers, soft laser, biostimulation laser, therapeutic laser) to help speed recovery due to an injury or inflammation.
There’s promising research regarding treating androgenic alopecia with low-level laser therapy.
Treating Androgenic Alopecia with Saw Palmetto
Saw palmetto is a palm plant native to North America that is now used for treating an enlarged prostate, bladder infections, and normalizing sex drive. It is also now in use for treating androgenic alopecia.
For hair loss, saw palmetto is thought to be an androgen blocker. There isn’t a lot of research about the effectiveness of saw palmetto, but it seems to be mildly effective- even minoxidil includes saw palmetto in their formula.
Side effects of saw palmetto are mild, if they ever occur. It’s not recommended for women to take while pregnant. In additions, saw palmetto treatments should cease two weeks before surgery as it may slow blood clotting.
Saw palmetto isn’t necessarily fast. Users generally report benefits after two to twelve months of regular use.
One of the best things about this supplement is that it can be used with other forms of treatment as part of a comprehensive women’s hair loss treatment program. It’s also relatively inexpensive (you’ll probably end up spending less than $20 per month for a high quality brand.)
Cimetidine (Brand Name Tagamet)
Cimetidine (brand name Tagamet) is a histamine blocker is usually prescribed for gastroesophageal reflux disease (GERD), or ulcers.
It has a mild anti-androgen effect, and the few studies that have been done on it involved high doses, with mixed results. And as it’s an androgen blocker, it’s not recommended for men.
It’s available over-the-counter as well as by prescription, but because of it’s side effects, you should only use it for treating androgenic alopecia under a doctor’s supervision.
Side Effects of Cimetidine
Some users get headaches, have dizziness, experience diarrhea, sleepiness, and in more extreme cases, depression, nervousness, and hallucinations.
It’s not recommended for women that are pregnant, or if you’re taking antidepressants, antacids, or ketoconazole.
Although it’s not expensive over-the-counter, it’s not recommended as a first option for female hair loss. There are more effective androgen blockers that your doctor may recommend before Cimetidine, such as Finasteride, Nizoral (with ketaconazole). Some women have even had success with the supplement saw palmetto.
Spironolactone (Brand Name Aldactone)
Spironolactone decreases the synthesis of testosterone, which converts to dihydrotestosterone (DHT) with the help of Type II 5-alpha reductase. DHT which is the main source of hair loss for women with androgenic alopecia. DHT basically attacks hair follicles causing hair to thin, and even kills hair follicles.
Women normally have a small amount of testosterone in their bodies. The testosterone, and it’s conversion to DHT isn’t necessarily the problem. It’s the level of DHT binding to receptors in scalp follicles.
Aldactone (with the active ingredient of spironolactone) is a medication that is used mainly for high blood pressure (hypertension), not as a hair loss treatment. But it’s an anti-androgen, which will slow the rate of hair loss for women with higher levels of DHT binding to androgen receptors in the hair follicle. The drug causes the adrenal glands to slow their production of androgens, and also blocks the androgens that are in your system.
It doesn’t regrow hair, but it can help your follicles produce thicker hair.
Your dermatologist can administer a blood test, and if they suspect that androgens are the main reason for your hair loss, they can prescribe Aldactone for treating androgenic alopecia.
And some case studies suggest that women who didn’t regrow hair with minoxidil may benefit from the addition of spironolactone, although more research is needed to confirm this.
Side Effects of Spironolactone
Besides stopping hair loss on your scalp, and getting your hair follicles to produce thicker hair, it can also get rid of hair growth in other areas, such as your face, and it can help clear up acne. It can be combined with other hair regrowth treatments.
Another benefit is that it is relatively inexpensive (around $25 / month).
Aldactone is ONLY for women. It can create serious sexual side effects in men as it blocks male hormones. As it changes your hormone levels, it may change your menstruation cycle.
Another drawback is frequent urination (remember it’s a diuretic). The higher the dose, the higher the chances of frequent urination. So you may want to time your taking of aldactone so that you have access to a bathroom after taking it. Most of the time it’s prescribed to be taken twice per day.
Even though it’s a diuretic, you’ll still retain potassium, so your doctor will need to make sure that your potassium levels don’t go to a dangerous level (causing hyperkalemia).
If you have low blood pressure, it can cause your blood pressure to drop, which can also be dangerous.
If you’re taking other medications, talk to your doctor to make sure that Aldactone isn’t dangerous in combination with any other drug you are taking.
Make sure that if you are taking Aldactone that you aren’t getting any negative side effects. If you do, talk to your doctor.
Latanoprost (Brand Name Xalatan)
Latanaprost has been used to treat glaucoma, and has been noted to cause an increase in the length, thickness, and number of eyelashes.
A study published in the May 2012 issue of the Journal of the American Academy of Dermatology has found that it can be effective for treating hair loss. It mimics prostaglandins, which increased hair density on the scalp after 24 weeks of treatment.
It may cause hyperpigmentation of the skin near the eyelashes when applied to eyelashes, and may cause a gradual change in eye color.
Bimatoprost (Brand Name Latisse)
Similar to latanoprost, bimatoprost is similar to a prostaglandin analogue, which is used for eyelash alopecia. It’s FDA approved for eyelash alopecia. It has also been used to treat glaucoma.
One study found that 50% of its subjects had significant improvement in hair density. It also caused more hairs to go into the anagen or growth phase.
More research on bimatoprost and latanoprost is needed to determine recommended dosages and length of treatment.
The cost for regrowing eyelashes can be around $150 / month, so using it for the entire scalp could be expensive.
Side effects include mild hyperpigmentation of the skin, though that only usually occurs when used on the eyelash area.
Hormone Replacement Therapy For Thinning Hair
Hormone replacement therapy (HRT) involves taking female hormones, usually estrogen and progesterone to balance out hormone levels. They are usually taken in the form of pills, creams, or patches.
It’s rarely prescribed as a remedy for hair thinning alone.
It’s sometimes prescribed at menopause, which can be a difficult time for a woman: hot flashes, night sweats, difficulty sleeping, and mood swings (which can be difficult for others as well!).
HRT can also be used to prevent osteoporosis, which causes bones to be thinner and therefore weaker.
But there are many times in a women’s life that their hormone levels will be imbalanced, such as during and after pregnancy. While pregnant, women often find that their hair is fuller and thicker, because of the abundance of female hormones in their system. The result is that more of their hair is in the anagen or growing phase.
After childbirth, hormone levels drop, and hair goes into the telogen, or resting phase, where it isn’t growing anymore, and will later be replaced by a new hair that will push the old hair out.
So if your hair loss is due to hormone imbalance, your doctor may recommend this as an option for you, but it’s not without side effects.
Side Effects of HRT
Some of the potential side effects are serious. There’s a higher chance of breast cancer, and uterine cancer if estrogen is not taken along with progesterone. There’s also a higher risk of stroke, heart disease, as well as blood clots.
Non fatal side effects include headaches, sore breasts, irritability, nausea, bloating, as well as vaginal bleeding.
Because of the serious side effects of HRT, you’ll need to talk to your doctor about whether this is a good treatment for your hair loss. If breast cancer, uterine cancer, or heart disease run in your family, the risk may outweigh the reward of thicker and fuller hair. And if your doctor does prescribe HRT for you, you’ll want to take the lowest possible dose for the shortest amount of time.
Finasteride (Propecia or Proscar) For Women
You may have heard about Propecia (with the active ingredient finasteride) for treating androgenic alopecia. Finasteride is a DHT blocker, or anti-androgen.
Finasteride was first used in 1992 for benign prostatic hypertrophy (BPH, or enlargement of the prostate). In 1998, it was first licensed for male pattern hair loss, with great results: it stabilized hair loss in around 90% of men, and regrew hair in 50% to 75% of users. For women, however, the use of finasteride for hair loss is not so clear-cut.
Does Finasteride work?
The effectiveness of finasteride for women will require more research. Some women regrow hair, and some don’t. It is unclear who is and isn’t a good candidate, and dosage is also unclear. However, it’s suspected that women who have higher androgen (male hormone) levels are more likely to respond to finasteride.
Users must take finasteride for 6 months or more to expect results. Additionally, users have to continue to take finasteride to get the benefits.
Side effects of Finasteride
Finasteride isn’t FDA approved for women’s hair loss. In the few studies that have been done up to this point, there have been no side effects reported by women. However, if a woman is pregnant, finasteride may cause the feminization of male fetuses. So if a woman is pregnant, she shouldn’t take finasteride. And if a woman is of child-bearing age, she must use effective birth control. Long term side effects are unknown.
Women with liver issues shouldn’t take finasteride, because the drug is metabolized by the liver.
If you’re looking for treatment options for female hair loss, finasteride could be a possibility, but you’ll want to talk to your doctor.
Further studies are needed to know more about who are good candidates, recommended dosage, and long-term side effects. The cost is around $75 / month.
Treating Androgenic Alopecia with Platelet-Rich Plasma (PRP)
To get PRP, blood is drawn from a patient and placed in a centrifuge, concentrating the platelets, which increases the amount of growth factors by a factor of 5 to 10. That concentrated plasma is then injected into the scalp with a micro-needle.
Although the FDA hasn’t approved PRP for hair regrowth, there’s promise in its ability to help women regrow hair.
Flutamide (Brand Name Eulexin)
Flutamide is an anti-androgen that is commonly used to treat advanced prostate cancer and hirsutism (excess hairiness in women).
As of now, there haven’t been a lot of studies, but one study found that participants reduced their hair loss by 21% (rated on the Ludwig scale, which measures women’s hair loss).
The issue is its side effects, which rarely include liver problems (sometimes fatal). Liver problems most commonly occur within the first three months of starting flutamide, but issues can happen anytime.
Due to it’s side effects, flutamide may not be the best first choice for dealing with female pattern hair loss (FPHL).
Oral Contraceptives For Hair Loss
Oral contraceptives are the most commonly prescribed treatment for the most common form of female hair loss, androgenic alopecia.
Usually prescribed along with another medication, spironolactone (Aldactone), birth control pills reduce the level of androgens in the body. Androgens are the male hormones that convert to dihydrotestosterone that attach to the hair follicle and cause hair to get thinner. As males have higher levels of androgens, their balding will cover most of the scalp. Women have lower levels of androgens in their bodies, so they usually get miniaturization-the process where hair follicles produce thinner and thinner hair.
Oral contraceptives contain the hormones progestin. Some formulas include estrogen, which reduces the amount of androgens in the body. Reducing the amount of androgens can reduce hair loss.
There are different types of birth control pills. Some birth control pills are low androgen index which will reduce hair loss. There are others that are high androgen index which would actually increase hair loss.
Low androgen contraceptives include:
- Estrostep Fe
Possible Side Effects Of Birth Control Pills
Birth control pills are not without risk, and may be too risky if you:
- Are obese
- Have high blood pressure
- Have had blood clots before, or have a family member under 50 who has had blood clots
- Recently undergone a recent trauma or surgery
- Suffer from migraines
- Have liver disease
- Are immobile
- Are taking a plane ride over 4 hours
The most serious side effects are an increased risk of some cancers, stroke, blood clots, and heart attack.
Less serious side effects include:
- Breast Tenderness
- Decreased sex drive
- Mood swings
Talk to your doctor about what is causing your hair loss, and if oral contraceptives are a good option for you.
If you start taking them, communicate with your doctor about any side effects. They will often recommend changing your prescription to reduce side effects.
Cyproterone Acetate (CPA)
You may have heard about one of the most powerful anti-androgens is cyproterone acetate (found in Androcur, Diane 35, Diane 50, Dianette, Andr0-Diane, Cyprone, and Cyprostate). It’s not approved for treating androgenic alopecia within the United States.
If you’re interested in taking cyproterone acetate for your female hair loss, and you’re thinking about getting it from outside of the United States, be careful. You should only use it under the supervision of a doctor. Also remember that in order to get the benefits, you have to keep taking it.
At higher doses than what is found in birth control pills, the most dangerous side effect is liver damage. The amount found in oral contraceptives is usually 2 mg. The range that starts to get dangerous is above 50 mg. If you’ve had issues with your liver in the past, you’ll want to discuss this with your doctor.
CPA can also dry out your skin and cause stretch marks. There’s also a risk of deep vein thrombosis (a blood clot deep in the legs). Users of birth control with CPA also have a higher chance of depression. Long-term use may lead to osteoporosis.
Have you used any of these products? What was the result? Please share your story below in the comments section – we’d love to hear from you!