A Guide to Women’s Hair Loss Part 2: What to do

Last week we talked about the 6 main causes of women’s hair loss and why it’s so crucial for women experiencing hair loss to make note of the patterns and get a diagnosis. This week, in Part 2, we’ll talk you through the tests that can help make that diagnosis and what treatments are available for the specific hair loss conditions that women experience.
Women’s hair loss is complicated and multifaceted. So how do you diagnose and treat it? 
The Tests
So now that we’ve got a grasp on the most common types of hair loss that affect women, how do you diagnose them? Below are some of the tests used to diagnose a hair condition and determine next steps:
Trichoscopy and Dermatoscopy – microscopic picture of hair/surrounding skin. It’s not the best for determining how to move forward, but it can be important in the right clinical scenario. 
Photography – Basically a picture of the hair to track progress/loss. It’s tough to standardize an image as many things can alter how hair looks – lights, styling, angles. Photos can be designed to mislead and it’s a clinical thorn in my side when I see it happening across the internet. 
Pull tests – Exactly what it sounds like and is particularly useful for women and men with longer hair. A section of hair is taken (while still attached to the head) and gently pulled. If more than 5 hairs come out, the test is positive and indicates active hair loss.
Punch biopsy – This is where a portion of the scalp is ‘punched out’ and examined under a microscope by a dermatopathologist. It can be an important step for confirming active inflammation and pathology – the underlying cause. Be warned that this test comes with sutures. 
This isn’t an exhaustive list. There are other tests out there that I don’t typically use, including daily hair counts, hair breakage, densitometry, wash test, hormone tests – but some doctors do and find them useful. 
Treatment Options
Once hair loss is diagnosed, it’s easier to explore which treatment is best for an individual patient’s hair loss: 

Minoxidil – Available in a 2%-5 % topical foam or solution and an oral tablet (1.25 mg dose usually to start), minoxidil works by increasing the anagen growth phase and ushering small, fine vellus hairs to maturation. Low dose oral tablets tend to be more effective than the topical solution and are extremely well tolerated. One potential side effect of taking minoxidil is hirsutism – hair growth elsewhere (especially the sideburns). Note that minoxidil will not work on scarring alopecia. It can’t make hair grow where there isn’t already an active hair follicle. Like the next two medical therapies, it takes 3 to 6 months to see results.
Finasteride – Finasteride and minoxidil are the one two punch of medical hair loss therapy for androgenic alopecia and complement each other. Finasteride is a 5 alpha reductase inhibitor that decreases levels of DHT, helping patients maintain the hair they have. Finasteride is only appropriate for post-menopausal women as it can cause birth defects in male fetuses. The starting dose for women is typically 1mg. Just like with men, decreased libido is a potential side effect.
Spironolactone – This is a blood pressure medicine that also decreases the overall levels of testosterone. It’s often prescribed for acne in young women due to its androgenetic receptor blocking ability (blocks testosterone receptors). It’s a diuretic and low blood pressure is a potential side effect. Electrolytes need to be monitored and the dosage can vary from 25 mg once a day up to 100 mg twice a day depending on how you react. 
Vitamins – Malnutrition can play a role in hair loss – B12, Viviscal, Nutrafol, and other biotin rich supplements – can be used to potentially help the overall state of your hair. The degree of improvement is small – you can’t rely on vitamins to regrow hair, but it’s also very low risk. There’s no harm in adding these as an adjunct to your routine. 
Low level laser light therapy – This treatment can increase blood flow to the scalp, helping support hair growth. The problem is that we still don’t know the optimal frequency, power, diode count, and duration of use. It should go without saying that these devices are relatively new and, like with all new technologies, we also don’t know the long-term effects (though they’re considered quite safe). They’re best used as a support to other hair loss therapies. If you want to learn more about low level laser treatments for hair loss (benefits, side effects, recommended devices) I have a dedicated video
Steroids – Steroids are useful to bring down inflammation in scarring alopecia or active telogen effluveum, especially if there is a lot of active hair loss. The tricky thing with steroid creams is that they’re really not a great long-term solution. Depending on them for too long use can be very problematic, given the systemic

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Platelet Rich Plasma (PRP) – PRP is beneficial for hair loss because it’s a way to introduce a high concentration of your own growth factors, like VEGF, into the scalp. During a routine blood draw platelets from blood are concentrated in a centrifuge then injected into the scalp (newer air 
propelled systems are less invasive). It takes 3 treatments, about 1 month apart each, to see improvement. This, like light therapy and vitamins, is more of an adjunct therapy. Stopping treatment leads to a reduction of hair gains.
Fat injection – Fat is anti-inflammatory, antiandrogenic, and can help enhance blood supply via leptin. Sometimes you can inject fat into the scalp to help with scarring alopecia.
Micropigmentation – This is a masking technique, where fine pigment is tattooed into the areas where hair is sparse. On the right candidate it can look fantastic and be a great option. This is a case-by-case option. 
Surgical Hairline Advancement (SHA)Forehead reduction surgery (a feminizing procedure) can be an option for some women to balance the face and make the forehead appear smaller, improving appearance and contour. However, it’s not typically an option for women experiencing hair loss.
Last but certainly not least… 
Hair Transplants
Before considering a hair transplant, hair loss needs to be under control. Trying to perform one sooner puts your transplanted (and nascent) hair at risk. For scarring alopecia patients, you need to be stable for at least 2 years before you consider transplanting into those areas. You also need a good donor area.  Make sure that you have a good understanding of what results are possible – it’s an important conversation that you need to have with your surgeon. 
To see examples of my hair transplants or to book a consultation, visit City Facial Plastics
Final Thought
If you’re a woman experiencing hair loss, remember there may not be one single causative factor. Seek out a diagnosis – it’s important. You can’t really get hair loss under control and treat it without knowing the root cause(s). 

If you are experiencing hair loss and want to explore affordable hair loss therapy, visit Feel Confident to find out about your options. Don’t let your hair loss define you.
Written by
Kristi Charish
Edited by
Dr. Gary Linkov
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.


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