Treating Hair Loss

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Hair loss is something usually associated with men (and the infamous term "male-pattern baldness"), but it can be a frustrating and embarrassing challenge for women, too. Losing hair can have a big impact, not only on a woman's appearance, but also on her self-confidence!

There are a variety of reasons behind female hair loss, from stress to medical conditions (such as thyroid problems) to menopause, and even pulling your hair back too tight or having heavy braid extensions woven into your hair. Regardless of the cause, there is one question most women have: Can I grow my hair back? The answer is yes, but with some caveats.

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Minoxidil: The Best Option

Minoxidil is the active ingredient in Rogaine®, and is also available as a generic and sold under many "house brand" names at stores such as Walgreens and Costco. In early 2014, Pantene released their own minoxidil product, Hair Regrowth Treatment for Women ($24 for a 1-month supply or $44 for a 3-month supply). Although it seems exciting, their product is no different from other types of minoxidil. The formula contains 2% minoxidil along with water, propylene glycol, and alcohol. We were hoping Pantene would have at least added some conditioning agents or anti-irritants...something to make their product stand out, but that's not the case.

But back to minoxidil: It's not only the most researched hair-growing product, but also the only one to have any data showing it prompts actual hair growth. Every other product with claims of other ingredients (typically an exotic plant) growing hair is either false or misleading. In fact, many so-called miracle hair-care products often contain minoxidil! Minoxidil is by far a woman's best friend when hair loss or thinning hair is the concern.

According to Harvard Women's Health Watch (June 2009), "Two double-blind studies of women ages 18 to 45 demonstrated its effectiveness. In one study, 13% of female minoxidil users had moderate hair growth, and 50% showed minimal growth (compared with 6% and 33%, respectively, in the placebo group). In the second study, 60% of women in the minoxidil group reported new hair growth, compared with 40% in the placebo group."

Minoxidil comes in two strengths: 2% and 5%. For women who have not seen satisfactory results with 2%, 5% might be a viable option. (Paula has been using the 5% regularly for years to prevent a receding hairline). As with any over-the-counter drug, you should familiarize yourself with the potential side effects (the most common is an itchy, flaky scalp) and follow the directions on the label.

How to Use Minoxidil

First, you need to know that using minoxidil, whether you buy the brand name Rogaine, Pantene's version, or a generic form, is a lifelong commitment. This drug works only as long as you continue to use it on a regular basis. If you stop using it, your hair will gradually go back to the way it was before treatment began.

Generally, you should apply minoxidil directly to your scalp twice daily. It can be applied while your hair is dry or damp, but not when it's soaking wet (towel-dry first). It's important to apply it directly to the scalp, because it must be in direct contact with the scalp to work as intended. After you apply, gently massage the treated areas with your fingertips to ensure even coverage. Next, style your hair as usual. That's all there is to it!

The directions for products containing minoxidil mention that you should wait until the product has dried before applying styling products. You can wait if you wish, but for those who don't want (or don't have time) to wait, it's OK to apply styling products—just take care to avoid rubbing the areas where you just applied the minoxidil. Heat-styling is fine provided you don't use intense heat near the scalp, but that's good hair-care advice whether you're using minoxidil or not!

Note: Just like with the vitamin A drug tretinoin, taking a "more is better" approach with minoxidil can backfire. A small (1 ml) dose twice daily is plenty to see results. Applying more than that or using it more than twice a day will not get you better, faster results.

Minoxidil Tips

We're betting that if you haven't used minoxidil in the past, you have some questions. Here's what you need to know before committing to this treatment:

  • Results typically appear after 4 months (16 weeks) of twice-daily use.
  • The first 2 weeks of treatment may result in more hair shedding. This is normal and almost always subsides.
  • Early hair growth from minoxidil may resemble soft, downy hair. It usually will become your natural hair color and texture, but it may remain soft and downy—at least you will have hair where once there was practically none.
  • Minoxidil must be used on an ongoing basis to maintain results.
  • Minoxidil is safe for use on color-treated or permed/straightened hair (but the goal is to get it on the scalp, not the hair).
  • Do not use minoxidil if you are pregnant or breast-feeding.
  • Ask your doctor before use if you routinely apply other topical medications to your scalp.
  • If you sometimes miss a dose, don't worry, it won't affect your results or reverse your progress.
  • Not everyone responds well to minoxidil; it's possible you won't see results at all. Keep applying for at least 6 to 8 months before giving up.

What About Finasteride?

Finasteride is the active ingredient in the male hair-loss drug that is taken orally, called Propecia. Higher doses of finasteride were originally (and still are) prescribed to treat prostate issues in men (it blocks male hormones linked to prostate enlargement). As it turns out, those same hormones can have an impact on male-pattern baldness—but here the operative word is "male"; finasteride typically is not prescribed for women (see Risks and Side Effects below to find out why).

Although 1-mg doses of finasteride are a common treatment for male-pattern baldness, it's not approved for hair growth in women of any age, although in some circumstances it has been used off-label for female-pattern hair loss (FPHL). According to the Annals of Dermatology (August 2012), "A pilot study done on postmenopausal women showed that 1 mg of finasteride had no effect on FPHL."

Following that report, it was revealed that stronger doses (2.5 mg or 5 mg) of finasteride in FPHL were shown to be effective in several case reports and a few studies. This suggests that finasteride may be effective in FPHL, but the optimal dosage remains to be clarified. Basically, more research is needed to see how truly effective this treatment can be for women who are looking for another way to combat hair loss. In the meantime, we advise you to try minoxidil first, and discuss finasteride with your physician if minoxidil doesn't work, and only then if you are past child-bearing years, which means post-menopause.

Risks and Side Effects of Minoxidil and Finasteride

As with most medications, there are risks and potential unwanted side effects that come with treatment. A study published in the Journal of the European Academy of Dermatology and Venereology (May 2003, pages 271–275) found that in a review of 1,333 women who were using either 2% or 5% minoxidil, 4% experienced unwanted hair growth, and that there was a higher incidence of unwanted hair growth in the group using the 5% strength. The study also pointed out, however, that a large percentage of the women in part of this study (27%) reported that they experienced facial hair growth before they began using minoxidil, so it's possible that the women who reported the unwanted hair growth before applying minoxidil were more prone to the potential for that growth when using minoxidil. The unwanted hair growth is not permanent; it reverses itself once you stop treatment.

With finasteride, the risks are much more serious; Consumer Reports says, "Our medical consultants advise against the use of finasteride during pregnancy or in women who may become pregnant. Finasteride can cause genital abnormalities in the male fetus. Women who are pregnant or possibly pregnant shouldn't even handle crushed or broken tablets of finasteride because it can be absorbed through the skin." For this reason, finasteride's effects have been tested primarily on postmenopausal women, because the potential risk to a fetus is nonexistent for them and because finasteride is most effective in the type of baldness associated with increased male hormones, which is a problem experienced more often by women who've gone through menopause.

What About Shampoos and Conditioners for Hair Loss?

Some companies sell thickening shampoos or conditioners that may appear to work, albeit to a very minor degree, by adding bulk to each hair shaft via film-forming agents. Although such products can help thinning hair appear fuller, the film-forming agents do not in any way increase hair growth. If anything, these kinds of ingredients can build up over time, leading to flat, lifeless hair. For best results, alternate such products with a clarifying shampoo, which will remove the buildup and allow the thickening products to work as intended.

Although there are lots of hair-care products that claim to re-grow hair or stop hair loss, we want to remind you that they don't work unless they happen to contain minoxidil. You will come across dozens of products claiming to reverse, stop, or cure hair loss, but if any of them worked as claimed, drugs such as minoxidil wouldn't be needed, and there would be few women bemoaning the state of their thinning hair. Please, don't waste your money or time searching for such products—stick with what research has shown are the most helpful options.

Although there are options to re-grow hair, they're not plentiful, and their potential side effects and risks must be taken into consideration. A full head of hair is definitely desirable, but do the benefits for you outweigh the risks? The best way to make sure, of course, is to speak with your doctor and ask what treatment might work best for you.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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