What causes hair loss?
The precise cause of the hair loss is unclear, but it appears to be genetically determined in the majority of cases. The most common cause is an inherited alteration in the way individual hair follicles metabolize the sex hormone testosterone. Most women experiencing this type of hair loss actually have normal hormonal function including, normal testosterone levels, normal menstrual function, and fertility. Those affected are believed to experience a higher rate of conversion of testosterone to dihydrotestosterone, or DHT. It is the effect of DHT on the hair follicles that is thought to be the mechanism responsible for the hair loss.
This process is referred to as androgenetic alopecia, or genetic balding. While most assume balding is almost always a male problem, it occurs about equally in both sexes, affecting 50% men and 40% of women by age 50. The problem usually begins between the ages of 12-40 years of age. It is usually milder in women. This is attributed to differences in (1) the level of 5 alpha-reductase and cytochrome P-450 aromatase, the enzymes responsible for the conversion of testosterone to dihydrotestosterone and (2) the number of testosterone receptors in the individual hair follicles of the scalp.
Are there non-inherited forms of hair loss in menopausal women?
Women who have abnormally high levels of male sex hormone may also experience thinning of scalp hair. Signs of abnormally high levels, include an increase in body, or facial hair especially if appearing in a masculine pattern of distribution, severe cystic acne, abnormal menstruation, breast secretions and clitoral enlargement. Women who are experiencing these problems should speak to their doctors about a referral to a physician who is experienced in diagnosing and treating these problems.
Additional problems that have been associated with hair loss in menopausal women include anemia, thyroid disorders, syphilis, fungal infections, connective tissue diseases such as Lupus, hormone secreting tumors, significant weight loss and stressful life events. Alopecia areata, a condition of localized balding is considered by many to be an autoimmine disease. Traction alopecia is a form of hair loss associated with excess traction on the hair either during styling, or by habitual tugging by the woman herself.
What about poor scalp circulation and clogged hair follicles?
Commonly used explanations for hair loss put forth by those selling over-the-counter remedies for hair loss, such as poor scalp circulation and clogged hair follicles have been found to have no role in hair loss. To my knowledge the products they sell are of no benefit.
Can medication cause hair loss?
Treatment with cancer chemotherapy is well known to be associated with hair loss. Medication-related hair loss is not fully understood, but thought to be due to a disruption of the normal anagen/telogen phases of hair growth. The hair loss may be reversible when the medication is discontinued. One research study evaluated the reasons and rates of removal of subdermal levonorgestrel implants (Norplant) a medication used for contraception. Among those desiring removal, hair loss was cited as the reason 13.6% of the time. Medication-induced hair loss is an occasional side effect of antidepressants and other psychoactive drugs. In these cases stopping the medication usually results in regrowth of the lost hair. Other medications that have been implicated by some in hair loss include cholesterol lowering medication, oral contraceptives and blood thinners.
Testosterone replacement at appropriate levels is rarely associated with hair loss, but may be a factor in some susceptible women. Women who experience this problem, but desire to use testosterone replacement because it enhances their quality of life may find that taking spironolactone while on testosterone replacement prevents the problem.
Hair Loss Treatment Options
Topical minidoxil solution (Rogaine) is FDA approved for the treatment of hair loss in women with androgenetic alopecia. Finasteride (Propecia), is presently the most effective medical treatment for men. Given orally at prescribed doses it promotes hair growth and prevents further hair loss in a significant proportion of men with androgenetic alopecia. It is thought to work by inhibiting the conversion of testosterone to DHT. Although some research suggests it is effective for this type of hair loss in women it is not FDA approved for this use because of a known risk of fetal malformations. Regardless, some physicians currently use it in women who are not at risk of pregnancy. Spironolactone (Aldactone), a medication with mild diuretic properties has been used with success in some cases. The rationale for its use is based on the belief that it interferes with the ability of androgens to bind to the receptors in the hair follicle thereby not allowing DHT to exert its effect.
If a form of treatment is found to be effective it should be continued indefinitely assuming there are no negative side effects, or advised to do so by a knowledgeable physician as stopping the treatment results in a return of hair loss.
Hair replacement surgery is an option for some women. The best candidates for this type of treatment should have areas of dense hair growth at the back or sides of the head available for transplantation. Women in whom a medical or surgical approach is not effective, not feasible, or not desired may choose to use a wig, or hair extensions.
Do I need to see a doctor if I am having some hair loss?
Hair loss in menopausal women is perceived uniquely by the individual woman experiencing it. Nonetheless, in some it is capable of negatively impacting self-esteem and quality of life. Every woman affected should address the problem in the manner she feels is most appropriate for her. However, it is important for women with undiagnosed hair loss to be appropriately evaluated by a physician for causes of hair loss other than androgenetic alopecia as there are a number of underlying medical conditions that may mimic this condition.
Dr Nosanchuk is currently in practice in Southeastern Michigan and is accepting new patients. His office is located in Bingham Farms, Michigan, a suburb of the Detroit Metropolitan Area. Dr N specializes in the care and treatment of menopausal women and has a special interest providing hair loss treatment to women whose lives have been altered by their menopause, hysterectomy, or both.
To make a doctor appointment, contact Sherri at 1-248-644-7200 from 10AM - 6PM M-F EST.
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