What is Women’s Hair Loss?
At MSI, every treatment option begins with a complimentary video-microscopic hair density test and digital documentation to calculate and monitor results. MSI offers two drug molecules (i.e., 5% minoxidil solution and finasteride) to stop hair loss and regrow hair.
Several-time weekly application of a laser-emitting device (LED) to “stimulate” hair growth of existing miniaturized hairs is one of the new light therapies for hair loss. Minoxidil, finasteride, vitamins, and trace elements are injected during a mesotherapy treatment session. Growth Factors for hair regrowth are added to our cocktail when mixed with Platelet-rich plasma (PRP).
The most recent hair preservation and restoration treatment is mesotherapy, infrared technology, oxygen therapy, platelet-rich plasma (PRP), and nano fat or micro fat (stem cell therapy). Penetration of PRP and nano fat or micro fat is eased with micro-needling, dermal roller, or fractional radiofrequency. Hair transplantation is at the forefront of developing these applications.
Recently an increase in female patients requesting lowering the frontal hairline or lowering the height of the forehead is in demand. Besides, I can successfully treat a variety of conditions with hair transplantation. I can repair scarring of the scalp and hair loss due to traction with hair transplantation. Finally, hair transplantation can successfully restore hair to the eyebrows, eyelashes, or pubis.
What are the Causes of Women’s Hair Loss?
Androgenetic Alopecia
Most females with androgenetic – also called androgenic – alopecia or (baldness) has diffuse thinning on all areas of the scalp. Men rarely have diffuse thinning yet, instead, have more distinct patterns of baldness.) Some women have a combination of two pattern types. Androgenic alopecia in women is due to the action of androgens, male hormones that are typically present in only insignificant amounts.
Androgenic alopecia can be caused by numerous factors tied to the effects of hormones, including some ovarian cysts, taking high androgen index birth control pills, pregnancy, and menopause. Heredity plays a significant factor in the disease. Just as in men, the hormone DHT appears to be partially to blame for the miniaturization of hair follicles in women suffering from female pattern baldness.
The hormonal process of testosterone converting to dihydrotestosterone (DHT), which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the testosterone level that men have, but even a lower level can cause DHT- triggered hair loss in women.
Scientists now believe that the amount of circulating testosterone is the problem, but the level of DHT is binding to receptors in scalp follicles. DHT shrinks hair follicles, making it impossible for healthy hair to survive. Indeed, DHT is even more of a problem when those testosterone levels rise.
DHT levels can be elevated and within what doctors call the “normal range” on a blood test, but they may be high enough to cause a problem. The levels may not rise and still be a problem if you have the kind of body chemistry that is overly sensitive to even regular levels of chemicals, including hormones.
Since hormones operate best when they are in a delicate balance, the androgens, as male hormones are called, do not need to be raised to trigger a problem. Their counterpart female hormones, when lowered, give an edge to these androgens, such as DHT. Such an imbalance can also cause problems, including hair loss. Hair loss can also be caused by an imbalance of thyroid hormones or pregnancy, disease, and certain medications, influencing hair’s growth and shedding phases.
The cyclic nature of both our hair and hormones is one reason hair loss can increase in a brief time even when you are having a long-term slowdown of hair loss (and a long-term increase in hair growth) while on a treatment that controls hair loss. Testosterone levels in some men drop by 10% each decade after age 30. Women’s hormone levels decline as menopause approaches and drop sharply during menopause and beyond.
Telogen Effluvium (TE)
Telogen effluvium (TE) is the second most usual form of hair loss dermatologists see. It is a poorly defined condition; little research has been done to understand TE. However, TE happens when there is a change in the number of hair follicles growing hair. Suppose the number of hair follicles producing hair drops significantly for any reason during the resting or telogen phase. In that case, there will be a significant increase in dormant, telogen stage hair follicles.
The result is shedding or TE hair loss. TE appears as a diffuse thinning of hair on the scalp, which may not be all over. It can be a bit more severe in some areas of the scalp than in others. Most often, the hair on top of the scalp thins more than it does at the sides and back of the scalp. There is usually no hairline recession, except in a few rare chronic cases. The shed hairs are typically telogen hairs, which can be recognized by a small bulb of keratin on the root end.
Whether the keratinized lump is pigmented or unpigmented makes no difference; the hair fibers are still typical telogen hairs. While TE is often limited to the scalp, TE can affect other areas, like the eyebrows or pubic region, in more severe cases. Whatever form of hair loss TE takes, it is fully reversible. The hair follicles are not forever or irreversibly affected; there are more hair follicles in a resting state than.
There are three primary ways TE can develop.
- There might be an environmental insult that “shocks” the growing hair follicles so that they decide to go into a resting state for a while. This results in an increase in hair shedding and a diffuse thinning of hair on the scalp. This form of TE can develop rapidly and may be noticeable one or two months after receiving the shock. If the trigger is short-lived, the hair follicles will quickly return to their growing state and start producing new hair fiber. This form of TE usually lasts less than six months, and the affected individual has a healthy scalp hair density within a year.
- The second form of TE develops more slowly and persists longer. The hair follicles may not all suddenly shed their hair fibers and enter a resting telogen state. Instead, the follicles may enter a resting state as they usually would. Still, instead of returning to a new anagen hair growing phase after a month or two, they stay in their telogen state for a prolonged period.
- In this form of TE, there may not be much noticeable hair shedding, but there will be slow thinning of the scalp hair. In this form of TE, there may not be much noticeable hair shedding, but there will be slow thinning of the scalp hair. This results in a gradual accumulation oThis form of TE is more likely to respond to a persistent trigger factor.
- In the third type of TE, the hair follicles do not stay in a resting phase but cycle through truncated growth cycles. The individual experiences thin scalp hair and persistent shedding of short, tiny hair fibers when this happens.
Anagen Effluvium (AE)
Anagen effluvium is a diffuse hair loss like telogen effluvium, but it develops much more quickly and can cause individuals to lose all their hair. Anagen effluvium is most frequently seen in people taking cytostatic drugs for cancer or those who have ingested toxic products like rat poison. Substances of this type inhibit rapid cell proliferation.
This is a desirable factor if you are trying to block the development of cancer, but the cells of hair follicles are some of the most rapidly increasing, noncancerous cells the body has. Hair fiber from scalp hair follicles grows at up to 0.4mm a day, and that growth rate requires a lot of cell proliferation. Cytostatic cancer drugs and various toxins and poisons inhibit rapid cell growth, including the spread of cells in the hair follicles. The result is a sudden shut down of hair fiber production.
The onset of anagen effluvium is very rapid. Some individuals who start taking anti-cancer drugs can pull their hair out in clumps within the first two weeks. Because these drugs act so quickly and are so potent, the hair follicles have no time to enter a telogen resting state, as with telogen effluvium, a response to a more moderate environmental challenge.
Instead, in anagen effluvium, the hair follicles enter a state of suspended animation, frozen in time. The hair fibers fall out quickly, but instead of looking like typical telogen hairs with tiny bulbs of keratin at the root end, the hairs that fall out are mostly dystrophic anagen hairs with a tapered or sometimes feathered root end.
With cytostatic anti-cancer drugs, hair loss varies from person to person. Some people may have a mixture of anagen effluvium and telogen effluvium and have more temporary hair loss. Some cancer treatment centers try to block hair loss using cold therapy. Cold treatment is more prevalent in Europe than in North America; cold treatment involves covering the scalp with ice packs or using a unique hood filled with chilly water while the anti-cancer drugs are given.
The cold sends the hair follicles into suspended animation before contact with the drug. This stops the hair follicle cells from taking up the medicine and being damaged. The result is much less drug-induced hair loss. However, doctors worry that any cancer cells in the skin may also avoid anti-cancer drugs if cold therapy is given during drug treatment.
Some experimental drugs to block drug-induced hair loss are under development, but the same fear applies. The treatments to stop hair loss may also protect any cancer cells in the skin. While the development of anagen effluvium is rapid, the recovery is also equally fast. Because the follicles are frozen in time, they are ready to grow once the factor causing the anagen effluvium has been removed.
On completing an anti-cancer drug treatment course, a person may start to see new hair growth within a month. The hair follicles are not destroyed, so It should achieve average hair growth density. However, some people notice a change in the hair fiber produced. Some people find their hair changes from straight to curly or vice versa, or sometimes there is a change in hair color. These changes may be permanent.
Traction Alopecia
This condition is caused by localized trauma to the hair follicles from tight hairstyles that pull at the hair over time. If the condition is detected early enough, the hair will regrow. Braiding, cornrows, tight ponytails, and extensions are the most common styling causes of traction alopecia.
Central centrifugal cicatricial (scarring) alopecia:
This type of hair loss occurs most often in women of African descent. It begins in the center of the scalp. As it progresses, the hair loss radiates out from the center of the scalp. The affected scalp becomes smooth and shiny. Hair loss can be slow or rapid. When hair loss occurs quickly, the person may have tingling, burning, pain, or itching on the scalp. Treatment may help the hair regrow if scarring has not happened.
How Do Dermatologists Diagnose Women’s Hair Loss?
Hair loss in women isn’t always as straightforward as in most men. About 90% of all cases are caused by hereditary male pattern baldness in men. However, hair loss can be triggered by many conditions and circumstances in women. Because so many things can cause hair loss, a dermatologist acts like a detective. A dermatologist may begin by asking questions.
The dermatologist will want to know whether the hair loss happened suddenly or gradually. Knowing this helps to eliminate causes. A dermatologist will also ask what medicines you take, your allergies, and whether you have been dieting. Women may be asked about their periods, pregnancies, and menopause. It is essential to give the dermatologist accurate information. Like a murder mystery, the slightest clue can solve the case.
The dermatologist will also carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes, a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.
Sometimes the evidence lies in your scalp. The dermatologist may remove a small piece of the scalp. This is called a scalp biopsy. A dermatologist can quickly and safely perform a scalp biopsy during an office visit. A scalp biopsy can be essential to solving the case. Sometimes, a blood test is necessary. Because so many things can cause hair loss, it can take time to find the cause. You may need to make a few appointments.
I should perform the diagnostic tests below to help pinpoint the hair loss trigger. The truth is that these tests usually come back with readings within the normal range for many patients. Still, these tests can, at the very least, eliminate the possibility of individual disorders causing your hair loss. It’s important to remember that the proper diagnosis of female hair loss usually starts with the process of elimination.
- Hormone levels (DHEA, testosterone, androstenedione, prolactin, follicular stimulating hormone, and luteinizing hormone)
- Serum iron, serum ferritin, and total iron-binding capacity (TIBC)
- Thyroid levels (T3, T4, TSH)
- VDRL (a screening test for syphilis)
- Complete blood count (CBC)
A small section of the scalp, usually 4 mm in diameter, is removed and examined under a microscope to help determine the cause of hair loss. A doctor lightly pulls a small amount of hair (about one hundred strands) to determine if there is an excessive loss. If more than three hairs come out, the patient suffers from excess hair loss. The typical range is one to three hairs per pull. The densitometer is a handheld magnification device used to check for miniaturization of the hair shaft.
What Does MSI Offer Women Hair Loss Patients?
At MSI, every treatment option begins with a complimentary video-microscopic hair density test and digital documentation to calculate and monitor results. MSI offers two drug molecules (i.e., 5% minoxidil solution and finasteride) to stop hair loss and regrow hair. Minoxidil, finasteride, vitamins, and trace elements are injected during a mesotherapy treatment session.
Growth Factors for hair regrowth are added to our cocktail when mixed with Platelet-rich plasma (PRP). Several-time weekly application of a laser-emitting device (LED) to “stimulate” hair growth of existing miniaturized hairs is one of the new light therapies for hair loss.
The most recent hair preservation and restoration treatment is mesotherapy, infrared technology, oxygen therapy, platelet-rich plasma (PRP), and nano fat or micro fat (stem cell therapy). Penetration of PRP and nano fat or micro fat is eased with micro-needling, dermal roller, or fractional radiofrequency.
Hair transplantation is at the forefront of developing these applications. Recently an increase in female patients requesting lowering the frontal hairline or lowering the height of the forehead is in demand. Besides, I can successfully treat a variety of conditions with hair transplantation. Scaring of the scalp and hair loss due to traction can be repaired with hair transplantation. Finally, hair transplantation can successfully restore hair to the eyebrows, eyelashes, or pubis.
Hair loss is harder to treat when a person has a lot of hair loss. Just as there are many causes and treatments for hair loss, Prof Moawad recommends treating hair loss early. Early means before you lose a lot of hair.
At MSI, every treatment option begins with a complimentary video-microscopic hair density test and digital documentation so that results can be calculated and monitored by patients. themselves. One or more of the following treatments may be part of your treatment plan.
Medical Treatment of Hair Loss in Women
Topical Minoxidil (Rogaine)
Minoxidil was first used in tablet form 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 minoxidil solution directly to the scalp could stimulate hair growth.
When applied topically, the amount of minoxidil absorbed through the bloodstream is usually too small to cause internal side effects. Widely available in generic versions and under the brand name Rogaine, minoxidil seems more effective for women suffering from diffuse androgenetic alopecia than men.
Product labeling recommends that women only use the 2% concentration of minoxidil, not 5%, because the FDA has not approved using a higher level in women. Many dermatologists 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 retaining and regrowing hair in women with androgenetic alopecia than the 2% solution.
Systemic Drugs
When it comes to drug treatments for androgenetic alopecia, women are in an awkward position. While many drugs may work for certain women, doctors hesitate to prescribe them. Physicians are reluctant to prescribe systemic treatments (pills or another form of therapy that affects your entire system) because they can tamper with your body’s androgen levels. Moreover, drug companies aren’t falling over themselves to test drugs specifically for their ability to prevent and treat female pattern baldness.
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 reasonable amounts of androgen. Therefore, physicians often choose topical treatments applied directly to the scalp.
Beginning treatment as soon as possible after the hair loss occurs gives the best results because prolonged androgenetic alopecia may destroy many hair follicles. The use of anti-androgens after continued 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 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. The effectiveness of these agents and methods varies from person to person, but many women have found that using these treatments has made a positive difference in their hair and self-esteem. As always, treatments have the best chance of being effective if geared to cause hair loss and trigger hair growth.
Spironolactone (Aldactone)
Spironolactone, brand name Aldactone, is in a class of 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 partially blocks the action of androgens by preventing dihydrotestosterone (DHT) from binding to its androgenetic receptor.
Cimetidine (Tagamet)
Cimetidine, brand name Tagamet, belongs to histamine blockers used 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 powerful anti-androgenic effect and has been shown to block dihydrotestosterone form 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
Cyproterone acetate reduces excessive sex drive in men and treats pronounced sexual aggression. It is also prescribed for severe hirsutism in women of childbearing age and androgenetic alopecia. Cyproterone acetate exerts its effects by blocking the binding of dihydrotestosterone (DHT) to its receptors.
Oral Contraceptives
Since birth control pills decrease the production of ovarian androgens, I can use them to treat women’s androgenetic alopecia. However, keep in mind that I must follow the same cautions whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers aged thirty-five and older who take the Pill are at higher risk for blood clots and other severe conditions.
Discuss your medical and lifestyle history thoroughly with your doctor. Contraceptive pills come in various hormonal formulations. Your doctor can determine which suits your specific needs, switching pills if necessary until you are physically and emotionally comfortable with the wording. I should use only low-androgen index birth control pills 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.
Ketoconazole (Nizoral)
Ketoconazole is currently used as a topical treatment by prescription to treat fungal infections. It curbs the production of testosterone and other androgens by the adrenal gland and reproductive organs (in women, the ovaries). I can use these anti-androgenic effects 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 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 congenital disabilities 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 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 the drug can 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.
Dermatologists Only Skin Care Products
Nowadays, two drug molecules (5% minoxidil solution and finasteride) stabilize hair loss and promote hair regrowth. These molecules stimulate, through various mechanisms, an increase in the diameter and length of preexisting fine hairs. Finasteride can also be given orally. We are proud at MSI to have formulated topical medications containing both molecules to stop hair loss effectively and, eventually, regrowth of hair loss.
Mesotherapy Injections (Mesohair)
Techniques used in mesohair treatment for hair loss are derived from mesotherapy. A tiny amount of active ingredients of minoxidil finasteride together with all vitamins and trace elements are injected via computerized mesogun into the mesoderm of bald areas. This helps to make mesohair faster and potentially less painful when compared with manual injection. It is an effective treatment for hair loss both in men and women.
The most recent hair preservation and restoration treatment is the newly introduced combination of mesotherapy, infrared technology, and oxygen therapy with or without platelet-rich plasma or (PRP) done only at the MSI hair care unit. It gives an excellent result in both Androgenic and pseudo androgenic alopecia. Using a specialized cocktail or PRP, your scalp is mostly given vitamins and essential growth factors that improve blood circulation, which will restore your hair loss.
PRP Injection
Platelet Rich Plasma (PRP) is an innovative therapy for cosmetic enhancements. Although the procedure is new in aesthetics, PRP has been recognized as an effective treatment in sports injury, diabetic ulcer treatment, and orthopedics, to name a few. Read More on PRP.
The hair follicle has an overly complex biologic structure, and the growth of the hair process is regulated by specific growth cycles. Many growth factors play a fundamental role in the life-long cyclic transformation of the hair follicle, functioning as biologic switches that are turned on and off during the distinct phases, controlling the active phase and promoting apoptosis to induce catagen and telogen.
The main growth factors involved in the establishment of the hair follicle are vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin 1-like growth factor, and fibroblast growth factor (FGF). Platelets release copious amounts of platelet-derived growth factors (PDGFaa, PDGFbb, and PDGFab), transforming growth factor-beta (TGFβ1 and β2), EGF, and VEGF.
The beneficial effects of platelet-rich plasma (PRP) in AGA can be attributed to various platelet-derived growth factors causing improvement in the function of the hair follicle and the promotion of hair growth. Read more on PRP.
A small amount (about 10cc) of blood is collected in a specially prepared test tube containing a separating gel that helps raise the precious platelets. The separation process, requiring a centrifuge, takes approximately 9 minutes. Once the PRP serum is ready, it’s placed in a syringe and prepared for injection. The same techniques used to deliver mesohair cocktails on the scalp provide PRP.
It can help PRP penetration with a Dermal roller or recently using fractional CO2 Laser in male patients. The newer platelet-rich plasma (PRP) modality has been active in androgenic alopecia (AGA) in both males and females. PRP is injected subcutaneously into the area of alopecia with many growth factors and stem cells. Hair transplantation is no exception, and MSI is at the forefront of developing these applications.
You may need as many as six sessions of mesohair done weekly or every other week before you see meaningful results. The results require at least six months. After obtaining the desired results, you need to maintain the results by additional sessions done every 3-6 months as maintenance therapy.
PRP is offered as a stand-alone procedure for male and female pattern hair loss, where it is occasionally helpful in slowing down shedding or progressive hair loss. You may need at least three sessions done three times each month before seeing noteworthy results. We advise our patients to incorporate PRP alternatively with mesohair for optimum results.
Moawad Skin Institute (MSI) is excited and continues to strive at the forefront of the most advanced aesthetic technology. Results vary from patient to patient, depending on age, overall health & nutrition, and genetics. In general, usually over a three to the 4-week interval, patients should see skin texture, complexion, and tone improvements. These improvements can continue for up to a year. Patients may need three separate sessions, two weeks-one a month apart.
As part of our commitment to state-of-the-art care, PRP provides hair transplant procedures for any patient who desires or is appropriate for it. To maintain the results obtained, another session is added each year. Furthermore, the addition to the scalp of PRP can thicken thinning hairs and help reawaken dormant hairs.
Moawad Skin Institute (MSI) offers and performs the latest cosmetic enhancements and offers PRP therapy to our patients. PRP is offered as a stand-alone procedure for male and female pattern hair loss, where it is occasionally helpful in slowing down shedding or progressive hair loss. Prof. Moawad can answer any questions you have about this therapy. We are excited to continue to strive at the forefront of the most advanced aesthetic technology.
Light Skin Treatment
A new treatment modality to receive FDA approval is low-level laser light therapy. We are proud to have this latest treatment that involves the several-time weekly application of a laser-emitting device to “stimulate” hair growth of existing miniaturized hairs.
While low-level light therapy can increase hair caliber in both men and women, any aesthetic improvement is more evident in women than in men. It is unclear whether this technique has equivalent benefits to medical treatments minoxidil or finasteride. Still, it does appear to be tremendously valuable, slowing down the shedding of hair.
Female Hair Transplant (FUE & FUT). The Difference
There are several critical differences between female and male hairlines. Understanding such differences and following specific guidelines will help Prof. Moawad to obtain beautiful and natural-appearing results. Patient choice, especially when treating female androgenic hair loss, is critical. At least a minimal donor site density is necessary to achieve acceptable results. A second procedure to achieve more density is performed in many of these patients, typically 12 or more months later.
Female Hair Loss Treatment Results (before & after)
