Strategy for hair maintenance and replacement
Pattern hair loss in both men and women is progressive. This statement is the most important thing I tell my patients during a consultation for hair loss. Understanding the impact of this statement is essential to the treatment of pattern hair loss. What does it mean for you the patient? It means that a good maintenance program should be part of your hair loss treatment plan.
For women, the cause of female pattern hair loss is not clearly established. It is believed to be an inherited sensitivity to circulating male hormones called androgens. These hormones are present normally in all women but do not cause hair loss unless a woman is genetically susceptible. Unlike in men where there is a specific hormonal cause, DHT – Dihydrotestosterone, there is no such specific cause in women. As a result, unlike in men where we have a drug that blocks DHT production, Finasteride, no such drug exists for women. Finasteride is generally not effective in women.
We often will prescribe Spironolactone to women. This medication is usually prescribed as a potassium-sparing diuretic for blood pressure control. Its beneficial effect in female pattern hair loss is to block androgen receptors on hair follicles which has the effect of slowing and helping to maintain against hair loss. In women, we need to use multiple modalities to maintain and improve the quality of hair. The sooner we start treating female pattern hair loss the better the results.
As in men, female pattern hair loss is progressive over time and needs to be maintained for a lifetime. In addition to Spironolactone, we use our own formula of topical Minoxidil, PRP – platelet rich plasma, laser cap, and nutritional supplements. We individualize therapy according to a patient’s needs. In some cases where hair loss has advanced too far, hair transplantation will need to be done in addition to the maintenance program.
Women do very well with hair transplantation because they are usually just thin and not completely bald as men often are. In addition, women usually do not lose their hairline. Although It may thin, it can easily be rebuilt using hair transplantation.
Overall, as in men, best results are obtained with early treatment, good maintenance and hair transplantation as needed.