Most women with pattern hair loss don't get a receding hairline or bald spot on top of the scalp as is common in men. Instead, there is visible thinning over the crown. In men and women, hairs are miniaturized because of a shortened growth cycle where the hair stays on the head for a shorter period of time. These wispy hairs, which resemble forearm hairs, do not achieve their usual length.
Once male-pattern baldness starts, it’s not going to stop until every last hair on your head has shrunk or shed, though the rate at which this happens differs from person to person and depends on genetics. And since the grind of hair loss is unending, it’s important to start treatment as soon as your hairline starts bothering you. If you’re looking for a more quantitative metric, Dr. Paul McAndrews, clinical professor of dermatology at the USC School of Medicine and member of the International Society of Hair Restoration Surgery, assures me that “you have to lose half your hair before the human eye can tell.” (Of course, if you don’t care about losing your hair and are fine with going full Prince William and shaving your head, go for it. We’ve got some recommendations for razors and hair trimmers to help you out on that front.)
Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic, said that Rogaine works better on the top and crown (for reasons not fully understood, the frontal hairline tends to be more resistant to treatment) and ideally should be started as soon as women notice thinning. “Any regrowth you get is a minimal amount,” Dr. Piliang said. “So the more density when you start, the better results you get.”
The follicles on the sides of the scalp are more genetically resistant to DHT, which is why male pattern baldness often results in a “crown” of hair. But its downsides are serious. “With women, finasteride is not an option,” says Dr. Wolfeld. “It’s not FDA-approved for women to take, so we don’t prescribe it.” In fact, due to the drug’s effect on hormone levels, pregnant women are advised to not even touch broken or crushed tablets.
Anti-androgens. Androgen receptor–blocking drugs such as spironolactone (Aldactone) and finasteride (Propecia) are not approved for the treatment of female pattern hair loss, and there is little reliable evidence that they are effective. However, some case studies suggest that women who don't respond to minoxidil may benefit from the addition of spironolactone. In the relatively uncommon cases where there is an excess of androgen, a clinician may prescribe 100 to 200 milligrams of an androgen receptor–blocking drug daily, together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.) Possible side effects include weight gain, loss of libido, depression, and fatigue.
Testosterone replacement is becoming popular for men. Cotsarelis warns that this may accelerate hair loss. Propecia might help -- but because it prevents testosterone breakdown, it might affect the dose of male hormone replacement therapy. Cotsarelis warns men taking both Propecia and testosterone replacement to make sure their doctor carefully monitors their testosterone levels.
Not surprisingly, treatments with 5 percent minoxidil work better than treatments with 2 percent minoxidil. A randomized clinical trial published in the American Journal of Clinical Dermatology in 2002 found that, in men with androgenetic alopecia, “5 percent topical minoxidil was clearly superior to 2 percent topical minoxidil and placebo in increasing hair growth.” The difference was actually pretty astounding — after 48 weeks, the men who used 5 percent minoxidil experienced 45 percent more hair growth than the men who used the 2 percent treatment.
Acupuncture is a form of Chinese medicine that has been practiced for thousands of years. Its applications are many, and some researchers believe that it may help with hair loss from alopecia areata. How? The needles inserted into the scalp may help stimulate hair follicles and promote regrowth. More research needs to be done in this area, but consider asking your doctor for a referral to a licensed acupuncturist if this treatment sounds appealing to you. (Learn more about acupuncture for hair loss.)