Hair loss question

[mjl1717]

For men, I know 5% Minoxidil and low dose Finasteride are the big two for hair loss and to retain hair.
But for women, which are considered the big two for hair loss and to retain hair??
(I know sometimes different doses of Minoxidil 2% or 5 % is used)
So which would be the 2 most common meds for female hair loss (androgenic alopecia)?? Thank you in advance.

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[asmallchild]

For men, I know 5% Minoxidil and low dose Finasteride are the big two for hair loss and to retain hair.
But for women, which are considered the big two for hair loss and to retain hair??
(I know sometimes different doses of Minoxidil 2% or 5 % is used)
So which would be the 2 most common meds for female hair loss??

Depends on the cause of the hair loss.

It's difficult to tell when people want to start a conversation on the science of hair loss vs asking for medical advice so this thread is going to be on a tight leash.

 

[dermie1985]

I recommend men's strength for women and to only cut to women's strength if they develop hypertrichosis. If you're going to do something as laborious as topical minoxidil, it might as well be the higher strength. They also save money that way as (for whatever reason) the women's strength is paradoxically more expensive.

Some people actually do oral minoxidil in baby doses for androgenetic alopecia - I've always wanted to try this but oral minoxidil has been prior associated with a higher risk of pulmonary hypertension and I haven't found a PCP who's willing to prescribe it in coordination with me.... mostly because the unfamiliarity with it for treating blood pressure. Also, not really an option for women as it grows hair "everywhere".

The light-based devices are also becoming very popular, though I feel like the quality evidence isn't quite there yet.

There's also PRP. But it's expensive and I still consider it "voodoo" so don't recommend it generally.

 

[ERDOC555]

Depends on the cause of the hair loss.

It's difficult to tell when people want to start a conversation on the science of hair loss vs asking for medical advice so this thread is going to be on a tight leash.

As a student, I'd love to get some general thoughts from experienced physicians on your approach to hair-loss patients in general, as well as male/female specifics.

I'm familiar with minoxidil and finasteride, but I'm curious to get an idea of the algorithm/approach you go through as well as other treatment options that you frequently use when dealing with a hair-loss patient.

For example, a patient comes in complaining of hair loss. How do you figure out if you'll use minoxidil vs finasteride vs other, etc. What types of factors do you need to take into consideration when making this decision?

 

[username456789]

As a student, I'd love to get some general thoughts from experienced physicians on your approach to hair-loss patients in general, as well as male/female specifics.

I'm familiar with minoxidil and finasteride, but I'm curious to get an idea of the algorithm/approach you go through as well as other treatment options that you frequently use when dealing with a hair-loss patient.

For example, a patient comes in complaining of hair loss. How do you figure out if you'll use minoxidil vs finasteride vs other, etc. What types of factors do you need to take into consideration when making this decision?

It’s fairly straightforward in the majority of cases.

[this all assumes the patient indeed has a dx of AGA and is male]

If someone comes in already having been using minoxidil and wants something more, we will talk about adding finasteride.

If the patient is treatment naive and wants to avoid pills and/or is wary of the numerous sexual side effects, we just do minoxidil.

If the patient is treatment naive and is willing to accept the risk of sexual side effects and wants a pill, we talk about doing finasteride +/- minoxidil.

 

[mjl1717]

Agree, treatment is pretty straightforward for males with AGA!
**How and why is it different for postmenopausal females with AGA?

Biochemically. I believe its that conversion of testosterone to the dihydrotestosterone that causes baldness. Females have a little testosterone. Correct me if I am wrong.
The finasteride blocks this step. Any thoughts on this. Any other thoughts about treatment.

 

[PatsyStone]

These are the keys to treating female AGA:

1. Set realistic expectations. No one wants to hear their hair is not coming back, and if it does, it won’t be as thick as it once was. However, if you don’t explain this at the beginning, you’re not helping yourself or the patient

2. Women with hair loss are the worst patients. Avoid them if you can (doing step 1 helps get rid of a lot of them, or at least the difficult ones).

 

[mjl1717]

True. As far as Minoxidil, if it works it grows the thin peach fuzz hair.

 

[cableguy555]

I know its a bit off topic, but in my cosmetics rotation a lot of women are opting for PRP in addition to laser based treatments such as theradome. Usually the first line treatment we suggest is minoxidil combined with 10,000mcg biotin. Other options include Viviscal, spironolactone, and iron supplements. Most of these treatments are not supported by much evidence but if a patient is really desperate, its hard to just tell her no clinical options exist after she's paid $200 for a consult.