How can women really be empowered

Hair loss in women - what really helps

About every fourth woman is prone to androgenetic hair loss, the lifetime incidence is said to be between ten and 30 percent. No wonder that not only men but also women are offered all sorts of remedies, some of which are pseudo-scientific. However, only two methods are really helpful, says the dermatologist Professor Hans Wolff from LMU Munich: systemic antiandrogens and estrogens or topical treatment with two percent minoxidil solution.

Hair loss increases during menopause

Androgenetic alopecia in women is based on a genetic predisposition that is already visible in moderate severity when the hormonal changes take place during the menopause. If the women had already had hair loss before, it increased during this time. In contrast to men, however, the role of dihydrotestosterone (DHT) in women is not so clear, writes Wolff in the journal "Gynäkologische Endokrinologie" (7, 2009, 5). In addition, there is insufficient aromatase activity. As a result, androgens that arise are not sufficiently converted into estrogens.

However, serum androgen levels that are too high are almost never found in women. Rather, certain scalp hair follicles - not all - are genetically particularly sensitive to androgens. It is also noticeable that women almost never become completely bald, but their hair falls out, especially on the top of the head and especially in the middle parting area. The affected hair follicles are genetically miniaturized compared to normal hair follicles.

So what can a woman do? Wolff classifies all non-medicinal waters and food supplements that contain caffeine, vitamin H, millet extracts or taurine as "completely ineffective". Topically applied estrogen solutions, even if they are apostrophized as "biologically active", actually have no estrogen-like properties, according to the Munich specialist. If valid study data were available at all, they would have proven to be ineffective.

On the other hand, treatment with androgen receptor blockers such as cyproterone acetate and spironolactone appears plausible. Wolff cites a study published in 2005 in which the two oral antiandrogens proved to be very effective. However, high doses were required for this. Unwanted effects must be expected, especially before menopause. Safe contraception is also required because male fetuses could otherwise develop genital disorders. In Germany, antiandrogenic contraceptives such as Diane-35® and Neo-Eunomin® are approved for hair loss in women. The 5-alpha reductase inhibitor finasteride as Propecia® is not approved for women, but there have been positive case reports with finasteride doses of 1.25 to 5.0 mg per day.

Wolff describes minoxidil as the best locally effective agent, proven in controlled studies. He advises against having minoxidil formulations made in pharmacies because the substance is difficult to dissolve. Instead, Regaine® Frauen, a two percent minoxidil solution, which has been available without a prescription since 2005, should be used. This stops the progression of androgenetic alopecia in most women, and a gradual increase in hair density is observed in around half of the women. The mechanism of action is still not clear. Minoxidil is believed to stimulate microcirculation

Among other things, one assumes improved microcirculation and hair growth-stimulating effects.

Dark-type women should be advised before treatment that increased hair growth may occur on the forehead and face. However, it is even more important to educate patients about the shedding phenomenon: four to eight weeks after the start of therapy, the hair falls out more and more. This may induce women to discontinue therapy, but it indicates a particularly good response of the hair follicles to the treatment.

Hair follicles grow completely independently of each other

What at first seems paradoxical can be explained with hair biology. Hair takes two to six years to grow before the hair follicle is broken down within a very short period of time with precisely coordinated cell apoptosis.

The "dead" hair that is still stuck in the scalp (telogen hair) usually falls out within two to four months. When minoxidil comes into play, dormant hair follicles are stimulated. Newly growing hair pushes the telogen hair out of the hair follicle more quickly, and at the same time. Normally, the approximately 100,000 hair follicles that a person owns grow completely independently of one another.