Day: January 1, 2023

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Woman with Handfuls of Hair That Come Out Every Morning

(female)
I am 35 years old. My hair has been falling out for 2 years now and has become extremely thin. It comes out in HUGE handfulls every morning. It has pretty much stopped growing as well. Now the hair on my legs stopped growing and some eye lashes have fallen out and will not grow back. My cycles are regualr, dead on every month to be exact. My doctor says he sees no signs of disease in my scalp and my thyroid has come back normal. I am convinced this is not just a “cycle” of hair loss I’m going through. What else could it be? Please help. I am devistated.

Female hair loss is a difficult analysis and requires many tests, not just thyroid testing. I simply can not write a textbook on the subject on this site, but here’s a list of past posts that may help you understand what you’ve got going on:

  1. Female Genetic Hair Loss Is Different From Male Genetic Hair Loss
  2. Birth Control Pills and Hair Loss
  3. Woman With Thinning Hair After Family Tragedy
  4. Diseases Causing Women’s Hair Loss
  5. Female Hair Loss

The first step in evaluating hair loss in women, after a detailed history and physical exam, is to rule out any underlying medical causes of hair loss which can be treated. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. Furthermore, over 50% of women going through change of life hormone fluctuations (menopause) experience significant hair loss. It is also important to review the use of medications that may cause hair loss, such as (but not limited to) oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin, and prednisone. The following laboratory tests have been recommended to rule out the aforementioned medical conditions:

Some common blood tests for female hair loss:

  • Sex Hormone tests
  • SHBG (Sex Hormone Binding Globulin) used to test status of male hormones
  • Estradiol is a sex hormone
  • FSH (Follicle Stimulating Hormone) *not hair follicle but follicle in the ovary*
  • LH (Luteinizing Hormone) is a sex hormone
  • Free Testosterone
  • Total Testosterone
  • ANA (Anti Nuclear Antibody) used to test for Lupus or other autoimmune diseases
  • TSH (Thyroid Stimulating Hormone) used to test for hyper or hypo-thyroid disease
  • Test Iron status
  • TIBC (Total Iron Binding Capacity)
  • Ferritin
  • Iron

I also discuss female hair loss in my book, Hair Loss and Replacement for Dummies — available in all good bookstores.

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Woman with Corner Balding — Two Weeks After Hair Transplant (with Photos)

This patient has 1235 grafts placed into the corners of her hairline. The After photo was taken when she was 2 weeks post surgery. She showed many people and most people did not believe she had a transplant. None of the hairs have fallen out yet, although I would expect that the shedding of the transplanted hair would occur at between 2-3 weeks.

One of the most frequent requests we get are about how you can expect to look after a hair transplant, and many people imagine a deformed, scabby area. But our post surgical patients usually have no scabbing if they wash their hair diligently as we’ve defined it.

I’m sorry about the slightly different angles on the before and after photos. I messed up when taking the after photo so this is the best I’ve got until I see this patient again… but this still gives a good idea of what one can expect just a couple weeks after surgery. Click the photos below to enlarge.

Before on the left; After 1235 grafts on the right:

 

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Woman with Chronic Telogen Effluvium

Hi I am a 44 year old female with chronic TE and a positive hair pull. I had 2 brief incidents in my 30s but this latest one has been continuous for 18 months and I have lost a significant amount of my hair with little or no visible regrowth. All of my hormone tests are normal including thyroid, FSH, LH, estrogen, my testostone is even slightly below normal and my ANA is negative. The only issue I have is low ferritin and I have been taking iron for about a year but can’t seem to get the levels above the low end of normal.

My condition continues to deteriorate despite rogaine and topical steriods. I don’t know where to turn. Any advice would be welcome.

Thanks

There are people who specialize in this. Please let me know where you live and I will try to find someone in your area. For more information see Telogen Effluvium by Elizabeth CW Hughes, MD.


2006-04-11 09:32:39Woman with Chronic Telogen Effluvium

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Woman with Androgenic Alopecia Being Treated with Avodart

I am a 42 year old female with diffuse hair loss diagnosed as androgenic alopecia from a scalp biopsy. I am currently being treated with Yazmin, continuous active pill, spironolactone 200mg and Avodart since May 2006. I have had significant progress but some reaction (dry and itchy) to the spiro. I am considering trying a different protocol because I don’t like being on 3 meds especially when I am not gettin as much improvement as I would like, and some concerns about being on 3 medications. I looked in to a hair loss clinic that uses the following combination – 1. An herbal DHT blocker that includes many supplements I have read about for hair loss, 2. A topical treatment that include minoxidil in a carrier solution to neutralize the negative effects of etoh on the scalp, 3. Regular in clinic laser therapy that has 70 lasers (as opposed to 1 used in the comb) 4 A co-enzyme to stimulate hair growth. Do you think this regime is a viable alternative to the three medications? I know any of these treatments takes months to show effect so I am trying to make as informed a decision as possible since the prospect of counting 250 hairs in the shower again is very scary to me.

You are on several treatments and are considering more. Of those treatments, some are not proven effective for women with male pattern baldness and some have exclusive and limited indications. The DHT blocker finasteride has been studied in women with androgenetic alopecia. Although effective for men, this medication was not proven to be effective for women. Dutasteride (Avodart), another DHT blocker, has never been studied for this purpose in women.

Using lasers for treatment of hair loss has been controversial and although advertised extensively, is not yet (in my opinion) proven to be effective. If it helps at all, the benefit will be new hair growth in the 10% range. Application of spironolactone for treatment of alopecia is limited to some patients with elevated levels of androgen. Topical DHT blockers have a theoretical value in men, but they have not been studied and should be no better in women than systemic DHT blockers like finasteride.

You seem to be determined to fight the baldness, an admirable trait. The best thing you can do is to find a good dermatologist for a thorough evaluation to be assured that you do not have a medical cause of hair loss which is common in women. Using anecdotal modalities for treatment of your condition may be disappointing at the end, let alone the money and time that you lose.


2007-03-19 16:02:55Woman with Androgenic Alopecia Being Treated with Avodart

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Woman Wants Propecia — Medical Community Needs to Think Outside the Box!

I have been losing my hair for the past 8 years. My nature pathic doctor would like to prescribe propecia but isn’t authorized because my test results indicate a great benefit. I have 3 teenagers and my husband had a vascetomy ten years ago. I also have hirsutism. How can I get a prescription for propecia when the medical community won’t think outside the box???

I am confused what a “nature pathic” doctor is and how he/she is credentialed. Is he/she a medical doctor? Do you possibly mean naturopathic doctor, which is a specialty (does not have to be a person with an M.D. degree)? See Naturopathic.org for more on that.

I disagree with your statement that the medical community is not thinking outside the box. On the contrary, there are a few studies and some women who do take finasteride (Propecia). However, the studies are not well designed and not all women respond to finasteride, because women have a different mechanism of hair loss (see Treatments Available for Female Hair Loss)

Most importantly, there is no study that looks at the potential dangers of finasteride (Propecia) on women with respect to the risk of women’s cancer (such as breast, ovary, cervical). This is more relavant, because finasteride affects certain hormone pathways. Are you willing to risk a potential long term negative consequence (like cancer) for a possible (no guarantee) hope of hair growth? In summary, the medical community is looking out to protect your health, rather than your vanity.

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Woman Wants Chest Hair

I am a woman who once had lots of chest hair. I still have belly hair and lower back hair. This may sound odd, but my hairy chest did wonders for my sex life. My chest hairs disappeard at 38. I really want my chest hair back. Is there a prescription that I can get from my doctor to regrow it? Is there any OTC that works? Thank you.

I don’t know why you had chest hair to start with or why you eventually lost it. This condition is called hirsutism. Many hormonal imbalances can increase hair in the female body. There are a wide range of medications and disorders that can cause this condition, including:

  • Obesity
  • Exogenous androgens
  • Polycystic ovarian syndrome (PCOS) — most common
  • Congenital or delayed-onset adrenal hyperplasia
  • Cushing syndrome
  • Hyperinsulinemia
  • Hyperprolactinemia
  • Excess growth hormone
  • Hypothyroidism

Since you lost your body hair, it seems that whatever had been giving you a hairy chest is not in the picture anymore, so I don’t know whether or not an internist or an endocrinologist can help you figure out what gave you your hairy body. Also, there is no OTC that can give you your chest hair back.

We have transplanted hair in the chest area, although I can’t recall a case where this was performed on a woman. I might consider doing a procedure of this type if that is what you want, if I find you reasonable and mentally stable, and if a good patient/doctor relationship exists.

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Woman Took Dutasteride and Got Acne

(female)

Hi Dr. Rassman! I have a quick question for you. While I found a combination of Rogaine, Diane 35 birth control, and 200 mg spironolactone just about completely reversed my AGA hair loss, I was stupid enough to begin taking Dutasteride (Avodart) which I ordered from the internet at a dose of 0.5mg/ every other day. The predictable shed started recently as is common, but what really got me was my skin started getting filled with pimples (I take pride in having good skin) and I decided it wasn’t worth it, since my hair had already become pretty good before I started it, and who knows if the acne would be temporary, or even get worse. I stopped it about 5 days ago.

Now I am wondering if you have any idea, even a vague one, as to when my hair will return to how it would have been pre-Dutasteride use, since I stopped using it during a hair shedding phase which was induced by the drug. (weeks/months/ever?)

Any ideas would be so helpful in helping me feel reassured. Thanks so much for your time.

I hate to use you as an example, but this is exactly why you should not treat yourself with prescription drugs bought via the Internet. I can’t say this enough — you should not be self-treating your medical issues and you certainly should not be purchasing prescription medication without a physician’s prescription.

Unfortunately, I do not know anything about you to even begin assessing your medical issues. Sorry. You really need to see a doctor for an in-person examination. I realize the Internet is an easy way to try to diagnose and treat yourself, but you could be doing more harm than good.

Dutasteride (Avodart) is not recommended for women and it may have unforeseen long term side effects. I was able to find a forum where a woman took dutasteride and had a similar side effect that you had (acne breakout)… but beyond that, I really don’t know what it would do for treating female hair loss.


2012-03-20 21:12:45Woman Took Dutasteride and Got Acne

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Woman with Thinning Hair – She Wants to Know What to Do

This is exactly the type of hair loss I have, but I also have extreme total hairline recession and miniaturization. I first noticed the loss of nape hair, and thereafter loss of density and complete recession of every area of the hairline. I have miniaturization throughout my entire scalp, but the emphasis seems to be on the hairline and top of my head (especially that front area like this photo). I have tried Spironolactone 200mg, Cyproterone acetate 50mg, Diane35 birth control, 0.5mg Dutasteride, 5% topical Minoxidil, 2.5mg oral Minoxidil, microneedling, topical Estrogen, topical anti-androgens (RU58841, Darolutamide), every manner of oral supplement, iron infusions, sulfasalazine, and setipiprant. The list is endless. Nothing has stopped my hair loss or miniaturization. I have been diagnosed with hypogonadotropic hypogonadism as of 2015, but the hormone replacement therapy I am on addresses this issue. I have no other hormonal or autoimmune issues. I was diagnosed with androgenetic alopecia via scalp biopsy. It has been through my own research that I have come to understand that my hair loss is classed as retrograde with diffuse female pattern loss, or diffuse unpatterned alopecia. I frequent hair loss forums where a few others have this pattern, and we have all been non-responders to all treatments. I believe that there must be something more to this pattern than what we currently know.

You clearly have a difficult problem. There is a cosmetic treatment for thinning and hair loss for women; it is called Scalp Micropigmenmtation. This may be something worth considering to address what you look like. However, it will not fix the underlying problem.


2018-08-15 08:35:46Woman with Thinning Hair – She Wants to Know What to Do

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Woman Taking Propecia Is Experiencing Accelerated Hair Loss

I am a 42-yr old African American woman. I had hair restoration surgery in March 2006 for androgenic alopecia in the crown. For the last year and a half, I’ve been taking Propecia in pill form 2.5mg/day as well as topically. I’ve noticed since taking the meds, I’m experiencing diffuse thinning all over my head now. Have you heard of Propecia causing accelerated hair loss? Is this a temporary side effect? If I stop now, will my density return?

Propecia (finasteride 1mg) is an oral medication for the treatment of androgenic hair loss approved only for use in men. It blocks a hormone known as dihydrotestosterone (DHT) which is responsible for hair loss in men. Propecia is not approved for women, because female hair loss is not necessarily caused by DHT and it may cause birth defects when women take the medication. Finally, only 1mg of finasteride is recommended for the treatment of androgenic hair loss. Taking 2 mg or 2.5 mg is not necessarily twice as better or effective. It will however increase the potential for more unwanted side effects. I would recommend that you see your doctor and address these concerns to him/her and or see another physician for a second opinion. This website is NOT a second opinion.

The question should be: Will taking Propecia harm me if I am not going to get pregnant? We really don’t know the answer to that, as the appropriate clinical studies were not done on women so safety and effectiveness are still up in the air. I couldn’t possible know the cause of your hair loss without an examination and a detailed medical history.

Also worth noting, Propecia is not available in a topical form or available in 2.5 mg strength.

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Woman Suing Procter & Gamble Over Hair Loss

Many people seem to find a way to make a bundle in our litigious society. There is no doubt that hair dyes can cause problems such as skin allergy in some people, burns from improper applications of the dyes, etc. Television has many soap opera presentations of such litigations. A good company like P&G should have adequate disclosures on the products to cover the individual risks of particular patients. $12 million is a lot of money. The legal costs to pursuing such a case is high and for P&G, the cost is higher just to build and present a defense. Many times, companies like P&G will pay off the pursuers just to avoid the legal costs and internal management costs for nuisance cases. The lawyers that take on such battles know that, so this is like a game of Russian Roulette with money as the bullet in the chamber. As clearly stated in the article, “Once Ross’ firm determined the extent of Mack’s injuries, more formal negotiations began.”


2006-10-26 10:18:31Woman Suing Procter & Gamble Over Hair Loss