Hair Loss in Women: Finding a Treatment
The underlying reason for hair loss must be determined before a treatment can be recommended. The starting point for this process is to find a doctor who specializes in hair loss problems, and this is sometimes much more difficult than it would seem.
Finding a Doctor to Help With Hair Loss
The following types of doctors are the usual starting points in the search for the reason for a hair loss problem:
Dermatologist: a physician who practices the branch of medicine involving the skin, its structure, functions and diseases is the specialist most hair loss sufferers will refer to first as a dermatologist’s training also includes the study of nails and hair. But when searching for this type of doctor, it is important to insure that the dermatologist specializes in hair loss issues.
Endocronologist: a physician who specializes in the diagnosis and treatment of conditions affecting the endocrine system, which involves the organs whose primary function is hormone secretion. This is the specialist most likely referred to by someone who is experiencing not only hair loss but other hormone related symptoms as well. Again, finding an endocrinologist who specializes in hair loss problems is advised.
General Practitioner: sometimes a general practitioner knows enough about hair loss to order the blood tests that will rule out simple underlying causes, such as a vitamin deficiency or overdose, or give directions for the next steps to take. If a woman has a good relationship with her GP and the doctor is interested in and knowledgeable about hair loss, it might be best to start here.
Trichologist: a para-medical health specialist who belongs to a branch of medicine that specifically studies the structure, function and diseases of the human scalp and hair. This specialist, while not a licensed physician, should work closely with a medical doctor to find a solution to the hair loss. Finding a trichologist is not always easy as there are not many who practice in the field.
Unfortunately, it may be necessary to see more than one of these doctors depending upon symptoms and the success in finding a doctor who is knowledgeable. A physician who does understand hair loss problems will recommend some, if not all, of the following tests.
Tests Used to Determine Type of Hair Loss
Be aware that the following tests may or may not paint a full and accurate picture of a hair loss problem and are sometimes only a starting point. On the other hand, not all of these tests may be required. It will depend on the severity of the hair loss and other symptoms present.
• Physical examination: although not a test, a doctor might be able to tell what type of hair loss is present simply by visible symptoms.
• Blood tests:
- for hormone levels: DHEA/Sulfate, Total and Free Testosterone, Androstenedione, Prolactin, Follicular Stimulating Hormone, Leutinizing Hormone
- for anemia and deficiencies: TIBC (Total Iron Binding Capacity), Serum Ferritin and Serum Iron
- for thyroid disease: T3, T4, TSH
- for syphilis: VDRL/STS
- for anemia, blood loss and certain vitamin deficiencies: CBC (Complete Blood Count)
- for lupus: ANA
• Skin scraping/hair pluck: a small amount of skin is lifted from the scalp and/or several hairs are plucked and used as samples for testing.
• Scalp biopsy: also called a punch biopsy, is a procedure whereby a small section of the scalp, sometimes from several different areas, is taken and examined.
• Hair pull: this test is exactly what it sounds like – hair is gently pulled to determine how many hairs fall freely. A person with a healthy scalp will lose one to three hairs; a person who has hair loss issues will lose numerous hairs.
• Densitometry: a test used to count the number of hairs in a fixed area and the diameters of those hair shafts.
Treatments for Hair Loss
Once enough tests have been taken and analyzed to determine the underlying reasons for a woman’s hair loss, treatment can begin. Unfortunately, treatments for alopecia are rather hit or miss affairs. It is estimated by the American Hair Loss Association that although sufferers spend billions on possible remedies, 99% of the products being touted as the newest cure are actually ineffectual for most people.
However, there are a wide variety of possible options for treating hair loss and some of them have helped people at least partially, if not fully, recover their hair. Viable treatments range from completely holistic, natural remedies to those that require actual surgery.
Treatments: Holistic Remedies
Some women who suffer from hair loss may only require and/or feel more comfortable taking a natural route in their effort to regrow their hair. For those women, several options are available:
NOTE: the B Vitamins include all of the following:
- Vitamin B1 (thiamin)
- Vitamin B2 (riboflavin)
- Vitamin B3 (niacin or niacinamide)
- Vitamin B5 (pantothenic acid)
- Vitamin B6 (pyridoxine, pyridoxal, or pyridoxamine, or pyridoxine hydrochloride)
- Vitamin B7 (biotin)
- Vitamin B9 (folic acid)
- Vitmain B12 (various cobalamins)
• Vitamins/Minerals: taking a vitamin/mineral supplement if tests have determined that there is a deficiency or discontinuing a vitamin/mineral supplement if tests indicate there has been an overdose may be the easiest resolution to a hair loss problem. The following vitamins and minerals, especially, can cause hair loss:
- Iron (deficiency)
- Vitamin A (overdose)
- Vitamin D (deficiency)
- Vitamin B (deficiency)
- Zinc (deficiency)
While it may be hard to imagine that anyone could be deficient in any of these vitamins or minerals with all of today's hype regarding nutrition, a deficiency may appear in someone who believes they are taking good care of their health. A vegetarian or vegan may not be getting as much iron as they thought and need; a woman who engages in strenuous exercise or is a long distance runner may not realize that her physical activity could be depleting her zinc levels.
NOTE: the herbs to the left are only a partial list. And do not forget to research herbs used by other cultures for centuries in their treatment regimes for hair loss. The Chinese herb, Fo-ti, and Indian herb, Bhringraj (Eclipta Alba), are just two possibilities.
• Herbs: the following herbs taken in capsule form or applied as an essential oil to the scalp have all reportedly helped hair grow:
- Saw Palmetto
- Aloe Vera
- Stinging Nettle
- Ginko Biloba
- Panax Ginseng / Korean Red Ginseng
• Foods: nutrition, of course, directly affects the health of hair. The following food/food types can have a negative or positive impact on hair:
- Pumpkin seed oil: new studies show this oil, taken in capsule form, may actually reverse hair loss.
- Green tea: the jury is still out on whether this tea will actually stop some types of hair loss and/or encourage hair growth.
- Protein: a severe deficiency in this area of the diet can lead to hair loss.
- Apple cider vinegar: used as a hair rinse, it is believed by many to promote hair growth.
NOTE: WebMD considers the following to be the top 10 foods for healthy hair:
- Sweet Potatoes
- Dark green vegetables (spinach, broccoli)
- Greek Yogurt
- Poultry / lean red meat
- Essential fatty acids: deficiencies in omega-3 and omega-6 fatty acids may not cause hair loss but will result in dry, brittle hair and dandruff.
- Dairy, eggs, wheat, soy, seafood and peanuts: those with food allergies to these items may experience hair loss if the allergy is severe enough.
- Foods with a high glycemic index (such as bottled/canned fruit juices and white rice): studies are showing these foods have the potential to overload the body with insulin, which may trigger hair loss.
• Scalp massage: massaging the scalp with a carrier oil mixed with different types of essential oils may not stimulate noticeable hair growth but is believed by some to slow hair loss. Massaging the scalp:
- improves blood circulation to hair follicles, conditioning the scalp and strengthening the roots.
- reduces stress (which can cause hair loss) and promotes relaxation.
- relieves the dry, itchiness associated with many types of hair loss.
• Shampoo / tonics: it is highly unlikely that these options will be the answer to anyone's hair loss problem - the science is against it. Yet there are rave ratings on different websites for various products. The only valuable advice regarding these options: buyer beware!
Treatments: Pharmaceutical Alternatives
Some medications used to treat hair loss are meant to be topical applications, in cream or ointment form, while others have to be taken internally as a pill or injection. Most pharmaceuticals are not very effective when it comes to treating hair loss as the majority were originally developed to address a particular disease, not the hair loss itself, and therefore tend to address symptoms versus the underlying causes.
The following are common topical applications prescribed by hair loss specialists:
- Minoxidil (Rogaine)
- Ketoconazole (Nizoral)
The following are common drugs prescribed by hair loss specialists:
- Spironolactone (Aldactone)
- Cimetidine (Tagamet)
- Estrogen/Progesterone (Hormone Replacement Therapy - HRT)
- Oral Contraceptives (low androgen)
- Finasteride (Propecia)
The following hair loss drugs are not available in U.S. but can be found online:
- Aminexil (specifically Dercos Aminexil S94)
- Cyproterone Acetate (Androcur)
- Cyproterone Acetate with Ethinyloestradiol (Diane 35 and Diane 50)
The drawback to taking most of these medications is that they must be continued for the rest of a woman’s life or hair loss will begin again once they are stopped. Some of them also have various, and sometimes severe, side effects.
Treatments: Non-Surgical Options
There are more non-surgical hair replacement alternatives than probably many people realize. The following are some of those options:
• Dyes: the easiest to apply, dyes simply color bald patches on the scalp to match existing hair. Popular options are:
• Tattoos: provide a more permanent alternative to dyes.
• Hair weaves: for those whose hair loss is a little more visible, hair weaves, also called extensions, might be an option. Hair weaves are also used to cover bald spots but by sewing or braiding long pieces of hair into existing hair. The drawback to this procedure is that, over time, the hair weaves themselves can cause hair loss.
• Turbans: a very attractive option for those who suffer from serious hair loss that is very obvious (or even those who don't!).
• Hairpieces/wigs: also an option for those who suffer from serious hair loss. Hairpieces and wigs are made from synthetic or human hair implanted into nylon netting which is then attached to the scalp with glue, tape or metal clips. Unfortunately, the hairpiece industry is rife with fraudulent products and those willing to take advantage of people desperate to feel better about their looks. Good products are out there and are becoming better all the time but it is important to research available options.
• Laser treatments: whether applied in the form of laser caps, laser combs or in a salon, these treatments expose a user's scalp to multiple low powered laser beams which are said to activate the cells within hair follicles that cause hair to grow. Some customers have seen positive results with these products while others have not found them to work at all.
• Henna crowns: a unique and beautiful way to cope with complete hair loss! A henna paste is hand painted onto the scalp in an intricate design. Once the paste has dried and flaked off it leaves a terra cotta colored version of the design which lasts approximately two weeks.
• Platelet Rich Plasma (PRP) therapy: a procedure that has been used by hospitals during surgeries for decades and more recently to speed the recovery of injured professional athletes, it is now being considered a possible remedy for hair loss. PRP therapy is a procedure in which a person's blood is drawn and then injected back into balding areas of the scalp, a process believed to encourage hair growth although no clinical trials have been done to prove this.
Treatments: Surgical Hair Restoration
For those most seriously afflicted by hair loss, there are surgical alternatives. However, these options can be expensive and painful. Scarring and infection are possible, and it can take six to eight months to realize the outcome of the surgery.
- Hair transplant surgery: also call Follicular Unit Transplantation (FUT), is the most common type of surgical hair restoration today. The procedure requires a surgeon to remove small grafts of scalp that contain a single or multiple hairs and implant them into a bald area of the scalp. These grafts are typically taken from the back or sides of the head, both areas of the human scalp that are genetically resistant to baldness even if relocated.
- Scalp reduction: this procedure involves removing bald portions of the scalp. Parts of the scalp that still have hair are then stretched over those removed portions and sewn together. This method of hair restoration is not used very much anymore as hair transplantation has taken its place and is considered to be a superior option.
- Scalp flaps: this type of surgical hair restoration involves cutting strips of scalp with hair (allowing one end to remain attached) and rotating them onto areas of the scalp that are bald. This method of hair restoration has also become rare as hair transplantation is considered a superior procedure with less chance of scarring.
Unfortunately, surgical hair restoration is an area of cosmetic surgery that seems to attract those with fraudulent intentions. While there are very qualified and ethical hair transplant surgeons, there are also many more physicians who do not know what they are doing and should not be allowed to practice in this area of medicine. Incredibly, the industry is unregulated by the government or medical community. If interested in this type of procedure, do your research very thoroughly!
Future Remedies for Hair Loss
Although studies in diseases such as cancer, diabetes and other more prominent illnesses are typically given priority, research is slowly growing in the area of hair loss. While the common attitude towards hair loss has been that it is not life threatening and therefore not an “important” specialty to study, that view is slowly changing. Scientists are beginning to realize that the construct of hair follicles opens a previously unknown window into human cell biology which may very well lead to the understanding and cure of other more serious diseases. If researchers continue their pursuit of remedies for hair loss, the following may also become viable alternatives for women with alopecia:
- Hair follicle cloning: a procedure in which a specimen of a woman's germinative hair follicle cells are multiplied in vitro and then implanted back into the scalp, the goal being that they will grow new hair follicles.
- Gene therapy: a procedure still barely in its infancy but showing great potential as a treatment for hair loss. Gene therapy involves changing the genes of existing cells in the body thereby changing those cells that are causing the hair loss into cells that grow hair.
- Ruxolitinib (Jakafi or Jakavi): a new drug used to treat a bone marrow condition appears to also cure alopecia areata.
The above information is meant solely as a starting point for those needing assistance with hair loss issues; its only purpose is to make the reader aware of various options, not to promote any one in particular. Retain the advice of a doctor and/or hair loss specialist before determining the best route to take for your particular hair loss problem.
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