Q: Are there any treatments that actually work for women with thinning hair?
A: Topical minoxidil, often known by the over-the-counter brand name of Rogaine, is my first go-to treatment for the most common cause of thinning hair in women: female androgenetic alopecia (AGA).
Not only is topical minoxidil the most well-studied treatment available, it’s also the only topical product that’s been approved by the FDA for the treatment of AGA.
If you’ve noticed hair loss, the first step you should take is getting a diagnosis from a primary care physician or a dermatologist, who may do a scalp biopsy and order bloodwork to look for potential causes, such as anemia or thyroid disorders.
But if your hair loss has been gradual and started as widening at your part, with your frontal hairline still intact, you likely have AGA. It can start any time after puberty and becomes more common as women get older. By age 70, up to 50 percent of women have some degree of AGA. White people are more likely to be affected, followed by Asian and Black people. If either your mother or father has AGA, you’re more likely to develop it.
When it comes to treatments, patience and managing expectations are important. You have several options, including topicals, prescriptions, supplements and procedures. But I advise my patients to wait at least six months before deciding if any of them are working.
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Unfortunately, many women will still have hair thinning even after trying multiple treatments: There isn’t a one-size-fits-all solution, and the odds of success vary in each case.
Here’s what you need to know about your options for treating AGA.
How should I use topical minoxidil?
Topical minoxidil is available in either 2 percent or 5 percent concentrations over the counter and can be applied once or twice daily. I usually recommend the 5 percent version since it’s been shown to be more effective, but it also has an increased likelihood of side effects, such as scalp irritation, flaking, itching and facial hair growth. Higher concentrations are available by prescription.
You can choose between a solution or a foam. The solution, which is applied with a dropper, can sometimes drip onto your face or leave your hair looking greasier. The foam has more of a controlled application with your hands, and it doesn’t have propylene glycol, which can cause irritation or an allergy in rare cases. Both should be gently rubbed into the scalp — just make sure to wash your hands afterward.
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You do need to keep applying topical minoxidil even after seeing results. If you stop, you may notice hair shedding of the new growth within four to six months.
What about oral minoxidil?
Oral minoxidil has traditionally been used to treat high blood pressure, but it’s been getting a lot of buzz lately as an off-label treatment for hair loss in low doses. More rigorous research is needed to confirm its overall safety and efficacy, but in my practice, I’ve been using it more and more in both men and women, with most of them experiencing at least some degree of noticeable hair growth.
Studies have been promising so far. A 2020 review of the medical literature found that 17 studies with 634 patients showed it can help, but the reported efficacy varied widely: from 10 to 90 percent in terms of stabilization of hair loss, increase in total hair density, improved hair thickness and decreased hair shedding. Topical minoxidil has been shown to have a reported efficacy in treating AGA in women ranging from 13 to 63 percent.
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If you don’t like the messiness of applying topical minoxidil or have experienced a reaction to it, talk to your dermatologist about taking the medication orally. I usually start patients with 1.25 milligrams or 2.5 milligrams daily, with room for higher doses if needed. It’s only available by prescription, and there are possible side effects, including hair growth in places besides the scalp (such as the face), low blood pressure and lower-leg swelling.
Other oral prescription medications have been used to treat hair loss over the past 10 to 20 years: spironolactone, finasteride and dutasteride. They haven’t been compared directly to oral minoxidil, so it’s unclear which is more effective, and women who can get pregnant shouldn’t use these medications unless they’re using strict birth control methods since they can cause fetal abnormalities. Finasteride and dutasteride are generally reserved for women who are postmenopausal for this reason.
Do supplements work?
The evidence isn’t as strong for supplements as it is for topical minoxidil.
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My patients often ask me about two popular oral supplements: Nutrafol, which contains saw palmetto, and Viviscal, which contains a compound of marine extracts and polysaccharides. Several of the studies on these components and supplements have funding or interests linked to the industry, but they have suggested some efficacy with few adverse effects.
Oral biotin supplements have long been touted to help with hair growth. But these supplements at high doses have actually not been shown to be effective.
Large-scale randomized clinical trials from independent researchers are still needed on supplements, but I occasionally mention Nutrafol and Viviscal — instead of plain biotin — to patients who want to try a nonprescription supplement, though I can’t promise they’ll see significant results.
Make sure to check with your doctor before trying any supplements, even if they’re labeled as natural. For example, for breast cancer survivors taking long-term estrogen inhibitor medications, such as tamoxifen, certain supplements may interfere with the metabolism of the estrogen inhibitor, potentially making it less effective.
What if none of these other options work?
You may want to consider trying one of these therapies or procedures, but they usually aren’t covered by insurance and can get quite expensive. There also isn’t rigorous evidence yet that they’ll work.
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Red light devices: These devices use low-level light therapy (LLLT) and come in different forms, such as a comb, hood or helmet. The HairMax LaserComb is a handheld, noninvasive device that was approved by the FDA for the safe treatment of male and female AGA with a starting cost of $199. I’d recommend this treatment to highly motivated patients who can commit to using it at least three times a week — preferably in combination with another treatment, such as minoxidil — since it’s easy to use, relatively affordable and is generally considered safe.
Platelet-rich plasma: Platelet-rich plasma (PRP) is a preparation of plasma that comes from your own blood. Some small studies have suggested that scalp injections with PRP might help certain patients, but more rigorous evidence is needed, especially since the cost can be so high and the procedure can be painful. Three monthly sessions, followed by a three- to six-month maintenance period, is typically recommended. The cost of each session is usually around $250 to $750. PRP also tends to be used as an adjunctive therapy in combination with other treatments, and not everyone is a candidate.
Surgical hair transplantation: If any of the therapies don’t work, surgical hair transplantation is another option. Intact hairs are surgically removed from a part of your scalp that still has thick hairs, separated into individual hair follicle units and surgically transplanted into tiny holes on the part of the scalp affected by hair loss or thinning. This procedure usually takes several hours at a time, requires local anesthesia and can be very costly — ranging from $6,000 to $60,000, depending on the amount of hair transferred, the technique used and the surgeon’s experience — but many of my patients have achieved great long-term results.
Jennifer N. Choi is the division chief of medical dermatology and oncodermatology at the Northwestern University Feinberg School of Medicine.
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