Women go through very difficult paths before seeing a hair loss specialist plastic surgeon or a dermatologist until they are diagnosed with genetic type alopecia. They consult with internal disease specialists, obstetricians and endocrinologists, and even herbalists who are “authorized” in hair loss, and take opinion of their neighbors. As a result of all these conversations, they get information regarding that their hair loss is related to the reasons such as daily stress, tiredness, low thyroid gland function and low adrenal gland etc., however, even though these diseases diagnosed are treated, the hair loss sometimes continues! When they find us finally, we can diagnose them by looking for a couple of seconds at their hair that have been miniaturized and thinning. Female type genetic alopecia!

Even though the American Food and Drug Administration (FDA) only approves minoxidil as a medicine for genetic type hair loss that is seen in women, some blood pressure medication, birth control pills and even finasteride are used in women in order to eliminate this problem.

Minoxidil : Among the medication that are used in female genetic type alopecia, minoxidil form 2% takes the first place. Using twice a day is advised. As a result of minoxidil use, the hair loss in 60% of women stops and better results are achieved in 5% of them. Among its rare side effects, we can list itchiness, hair growth in the body (at the rate of 8%), rash in the application area and dandruff development.

The most important point in the use of minoxidil in women is to convince the women that the medicine will really work and to provide confidence against the medicine. Most of the users quit the medicine after a couple of months without completely seeing its effects, and do not use it again as they think that it won’t work. And some may think that they will lose their hair completely and it is necessary for them to use it in order to prevent this. As a matter of fact, the hair starts to thicken only after 5-6 months after using minoxidil and the effect continues during the usage. When it is quit, the hair loss goes back to the loss line that occurs due to genetic causes. When it is started to be used again, the same curative effect may be seen again. In other words, when women use Minoxil for long terms at intervals, it provides a serious and permanent effect. Women with hair growth in their bodies due to polycystic ovary disease should pay more attention to Minoxil use.

Spironolactone: It is a diuretic with anti-androgenic features and is originally used as a blood pressure medicine. Women have both androgen and estrogen hormones, and these hormones are actually at normal levels in female type alopecia cases. However, in female genetic type alopecia cases, especially the hair follicles in the front 1/2 and 2/3 areas are more sensitive against androgens. Spironolactone gets on the androgen receptors in these follicles, and prevents and stops the thinning in the hair by blocking the androgen hormones effecting the hair bulb. In female patients with polycystic ovary syndrome, an increase in androgen hormones and accordingly symptoms like hair growth in the body and acnes are seen. In these cases, using spironolactone with anti-androgenic effect for the hairs that are thinning both stops the hair loss and treats the symptoms such as hair growth and acne. As spironolactone is a potassium sparing medicine, the amount of daily potassium taken should be paid attention to, and over consuming bananas should be avoided. There may be side effects between menses, such as mild bleeding, breast tenderness, increase in sodium sparing and mild headache. Blood electrolytes during the use should be checked under the supervision of a doctor.

Due to its anti-androgenic effects, spironolactone may cause a genital anomality in the fetus, this is why it SHOULD NEVER BE USED IN PREGNANT WOMEN.

Finasteride: It is known that daily use of 1 mg finasteride has no benefits in women. A study conducted in South Korea reported that there was an increase in the hair thickness and volume when high doses of finasteride (daily 5 mg) is used in women with normal hormone levels. In the medical literature, no significant side effects have been seen in the daily use of 2,5-5 mg finasteride in women. While side effects like breast tenderness and enlargement can be seen in males, there has not been seen any relationship between the development of breast cancer in males and finasteride use. Nevertheless, during the use in women, especially in the ones that have a breast cancer history in their family, it should be paid attention and monitored with annual mammography.  For the patients who have to use many medication at the same time and whose medicine regime we do not want to disturb, and for women who have cardio vascular problems, finasteride may be preferred instead of spironolactone in hair losses. During this medicine use, one should not donate blood and SHOULD IMMEDIATELY QUIT IN CASE OF A SUSPICION OF PREGNANCY.

Dutasteride: While this medicine that 90% decreases the dihydrotestosterone levels is greatly decreasing the number of sperms in males, the studies on its reliability of use in women are inadequate.

Birth control pills and other anti-androgens: As the birth control pills that contain drospirenone and estradiol have an anti-androgenic effect that is similar to spironolactone’s, they can be used in female type alopecia. Even though birth control pills that contain cyproterone acetate and systemic anti-androgens that contain flutamide have a potential of being useful in the female type alopecia, they cannot be used as they can lead to hepatotoxicity.

Shampoos that contain ketoconazole: Greasy and scurfy scalp triggers the genetic type hair loss and forms a good basis. When seborrheic dermatitis treatment is applied with shampoos that contain 2% ketoconazole, a decrease in the thinning in the hair has been determined. Even though the mechanism of its hair growing and healing effect is not completely known, it may be related to the anti-inflammatory, anti-fungal or anti-androgenic effect of ketoconazole. It is a supplementary shampoo type that may be added to the medical treatment in hair loss cases.

Topical estron cremes: In a study in Greece on female type genetic alopecia, the anagen phase was extended within 12-24 weeks in 65% of women with the topical estradiol lotion applied on the scalp, and a decrease in the hair loss has been observed. Women with breast and uterine cancer history in their families should be paid attention to. However, a further examination and study is necessary for such a topical use of estron cremes.

Cimetidine: This medicine that is used in the treatment of gastric ulcer as histamine blocker also has the anti-androgenic effect, and prevents dihydrotestosterone from starting miniaturization by hanging on to hair follicles. Due to its anti-androgenic effect, cimetidine is used for the treatment of hirsutism in women, which means excessive hair growth in the body and face. When used in high doses, satisfying results have been achieved in genetic type alopecia. Since the administration in such high does would cause the development of feminisante effects, it cannot be used in males.

Women who plan to get pregnant should never use finasteride and spironolactone. Minoxil can be used until pregnancy; however, as congenital anomalies have been reported, Minoxil use should immediately be stopped in case of pregnancy. Since the anagen phase is extended during the pregnancy, a recovery and thickening is usually seen in women’s hair; the hair enters into the telogen phase after the delivery and no loss is seen until 3-6 months after the delivery.

Hair loss treatment in women is a long and thin road, and it should definitely be monitored by photos and devices that measure the hair mass; once in every 6-12 months, the patient should be invited for an examination.

Shampoos and serums that are advertised in the market and claimed to stop the hair loss do not have a real activity in hair loss. They only create illusions. Products like hair thickeners etc. are actually false products that can only show effect until the next wash, which means their effects are gone after the first wash. These may be the shampoos and serums that surrounds hairs and stick on to them, and may show a temporary thickening effect on the hair. They do not thicken the hair in reality and do not make it better.