Unfortunately, there has been little research into female-pattern baldness. The AHLA says, "While many drugs may work to some degree for women, doctors are reluctant to prescribe them, and drug companies aren't exactly falling over themselves to test existing or new drugs specifically for their ability to prevent and treat female-pattern baldness." The only FDA-approved treatment for hair loss in women is 2 percent minoxidil, although some doctors will prescribe other drugs off-label.
Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. The U.S. Food and Drug Administration (FDA) has approved minoxidil to treat hair loss. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
Minoxidil (Rogaine, generic versions). This drug was introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it. Research confirmed that a 2% solution of minoxidil applied directly to the scalp could stimulate hair growth. How it works is still not clear. Two double-blind studies of women ages 18 to 45 demonstrated its effectiveness. In one study, 13% of female minoxidil users had moderate hair growth, and 50%, minimal growth (compared with 6% and 33%, respectively, in the placebo group). In the second study, 60% of women in the minoxidil group reported new hair growth, compared with 40% in the placebo group. As a result of these studies and others, over-the-counter 2% minoxidil is FDA-approved for treating androgenetic alopecia in women.
Skeptics (among them, Dr. Wesley) are starting to come around after a 2014 randomized double-blind study published in the American Journal of Clinical Dermatology found a “statistically significant” difference in hair density for women who used a laser comb compared with those who used a sham device. (“Comb” is something of a misnomer. The device looks like a hairbrush crossed with a cordless phone; it is glided back and forth across the scalp, roughly a half-inch at a time, usually about 15 minutes three times a week.)
The best option for many patients with significant hair loss is hair transplantation. Not your father’s “hair plugs” anymore, advances in artistry and minimally-invasive surgical techniques can comfortably undetectably restore hairlines and coverage. Hair transplants are used to permanently restore living and growing hair to an area of the scalp that is depleted of hair follicles.
Other medical conditions — most commonly telogen effluvium and seborrheic dermatitis — can also cause hair loss, but most people can trace their follicular woes back to androgenetic alopecia, so we focused our search there. We started with more than 200 products, including all-natural solutions and high-tech gadgets, while skipping treatments that focus only on volumizing or thickening hair. We also limited our scope to the scalp, and left out specialty products designed only for eyebrows or beards.
Like the long-suffering friend who inspired her to undergo the procedure, Ms. Telford quickly saw an improvement in her hair. New hair growth usually take at least four months, but at the two-month mark, she has already spotted some baby hairs. “Not a gazillion,” she said, “but it’s a start.” She’s planning to return for follow-up treatments every six months, and has high hopes of ditching the wigs and wearing her hair in a pixie.
During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of tiny grafts, each containing just a few hairs. Each graft is planted in a slit in the scalp created by a blade or needle in the area of missing hair. Hair grows naturally this way, in small clusters of one to four follicles, called follicular units. As a result, the graft looks better than the larger "plugs" associated with hair transplants of yesteryear.
The truth is, the amount of propylene glycol in hair loss treatments is not likely to cause any real harm and the FDA has given the chemical approval for many uses. But even though it is safe, we wanted to ensure that our top picks would be as comfortable to use as possible. So when Dr. Khadavi told us that “a third of my patients get irritated from minoxidil products because of propylene glycol,” we decided to cut any treatments with it. In any case, it’s the minoxidil that helps curb hair loss and not the propylene glycol.
In February, though, Ms. Telford, 46, flew from her home in London, Ontario, to Sarasota, Fla., for a new $1,400 hourlong treatment known as platelet rich plasma (P.R.P.), which is said to stimulate dormant hair follicles. The procedure involves drawing blood, spinning it in a centrifuge to extract the plasma, adding various nutrients (like more protein), then injecting the resulting mixture in one-inch intervals in a grid on the top of the scalp, which has been numbed with a local anesthetic.
The dermatologist also will 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.
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