Dutasteride is a 5-alpha-reductase inhibitor that binds both types I and II enzymes. Compared with finasteride, its inhibition of type II enzymes is three times more potent; its inhibition of type I enzymes is 100 times more potent (Clark et al., 2004). Dutasteride is not approved for the treatment of FPHL by the FDA, and ongoing studies on the efficacy of the inhibitor are promising but largely focus on male patients (Gupta and Charrette, 2014, Olsen et al., 2006). A study of women after 3 years of therapy showed that dutasteride may be more effective than finasteride in women under 50 years of age as measured by hair thickness (not hair density) at the center and vertex scalp (Boersma et al., 2014). One case report of a 46-year-old female with FPHL showed some response after 6 months of treatment with a dose of 0.5-mg dutasteride daily despite a minimal response to treatment with finasteride and minoxidil (Olszewska and Rudnicka, 2005). Data with regard to the treatment side effects in women is extremely limited. Dutasteride is classified as pregnancy category X because of teratogenicity and should have the same theoretical risk of breast cancer as mentioned in relation to finasteride (Kelly et al., 2016). 

It’s not the amount of testosterone or DHT that causes baldness; it’s the sensitivity of your hair follicles. That sensitivity is determined by genetics. The AR gene makes the receptor on hair follicles that interact with testosterone and DHT. If your receptors are particularly sensitive, they are more easily triggered by even small amounts of DHT, and hair loss occurs more easily as a result. Other genes may also play a part.
Sara Gottfried, MD is the New York Times bestselling author of the new book, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years. Her previous New York Times bestsellers are The Hormone Cure and The Hormone Reset Diet. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify, and slow down aging. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.

You basically have two major choices here: hormone replacement therapy (HRT) or phytotherapy (herbal remedies). You may wish there were more options, but there really are not. You can of course take other approaches to treating hair loss, but if low estrogen levels are one of the major causes of your hair loss, the results you will see treating the problem through other means are going to be quite limited if you are failing to treat the cause.


Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting the use of flat irons (these straighten hair by using high heat) and curling irons.
Skin infections can cause hair loss at the affected area. One of the more common causes is a fungal infection of the skin, also sometimes referred to as a ringworm. Eyebrow fungus is more likely to be related to a scalp fungus (tinea capitis) and both areas are often affected at the same time. A bacterial infection is another possible cause. Folliculitis for example is a condition where the hair follicle becomes infected usually with bacteria like Staphylococcus aureus. Eventually this can lead to loss of the hair in the infected follicle.
Hansen's disease, also known as leprosy, is an infection of the skin and nerves caused by the bacterium Mycobacterium leprae. The disease often affects the skin of the eyebrow region, leading to loss of sensation and permanent loss of the eyebrow hairs. There are numerous other rare and uncommon causes of eyebrow hair loss, including vitamin A toxicity, nutritional disorders and other dermatological disorders. If you experience loss of eyebrow hair, see your doctor to evaluate the cause and to discuss a treatment plan.
Interestingly, 40% of the genes causing male pattern baldness were located on the X chromosome. You inherit that chromosome from your mother. By analyzing all these genes, researchers could also make a “scorecard” which predicts what risk a man runs for experiencing hair loss based on his genes. The hope is that in the future, this could be refined and used to prevent early signs of hair loss.
Hansen’s disease – Hansen’s disease, popularly known as leprosy could cause loss of eyebrows. This condition is cause by infection of a bacterial known as mycobacterium leprae and if it affects your eyebrows region, you expect to lose some eyebrows i.e. if it affects your eyebrow skin region, a place it often afflicts, you could suffer from permanent eyebrow hair loss as ‘Tulay Cakiner-Egilmez, Ph.D., R.N’ reports in ‘Journal of the American Society of Ophthalmic Registered Nurses’. This and other infections that can cause loss of eyebrows.
The tricky part is that it is believed that the cause of hair loss most likely happened three months prior to beginning to see hair fall out. So, the underlying cause may not be easy to pinpoint. Natural hair re-growth will take time. Just as it can take 3 months after an event to realize that hair is falling out, it can take just as long, or longer, to begin seeing hair re-growth if the cause has been addressed. It is important to be patient! There is hope!
Insulin regulation is also a big factor in hair health, as an imbalance can lead to various hormonal effects. Insulin helps to regulate blood sugar levels, which effects fat storage and hormone balance. Fat storage and hormone balance play a role in hair growth because fat storages will secrete excess estrogen in the body, and can desensitize hormone signals.  
No one wants to lose their hair, but for a woman it is particularly distressing. While men can look perfectly presentable — even sexy — with their exposed scalp, no such options exist for the 30 million American women who grapple with thinning tresses. Dr. Maria Colavincenzo, a dermatologist at Northwestern University Feinberg School of Medicine, has a practice that specializes in preserving those precious strands — especially in cases of androgenetic alopecia, a hereditary condition that causes hair loss, mainly on the top and crown of the scalp. Without an appointment, she answered some of our questions:
Women using oestrogen supplementation or taking birth control pills will also experience hair loss when they cease supplying their body with extra oestrogen. These forms of hair loss may be temporary but this, however, does not mean that there is no link between oestrogen and permanent hair loss. Scientists have noted up to 30 hormones that could play a role in female pattern hair loss – the genetic kind of hair loss – and oestrogen, whilst poorly explored, may be one of them. It’s alright if the excess hairs are the ones that are lost but when normal hair falls out, there’s a problem.
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A. I think it's a personal preference, but why is a cosmetic solution such a big deal? To use sprays, powders and hair extensions? It doesn't address the problem, but it can do wonders for your self-esteem. I see patients who are extremely depressed, and this is ruining their life. We always have hope for that miracle solution, but it's very hard to do research studies. … As much as this affects people's mentality, there's not a lot of (National Institutes of Health) funding because hair loss isn't killing anyone.

Mistakenly thought to be an exclusively male disease, women make up a significant percentage of hair loss sufferers all around the world. Forty percent of women have visible hair loss by the time they are age 40. After menopause, that number increases even more. Hair loss in women can be absolutely devastating for self-confidence, self-image and emotional well-being. Although it is not a life threatening disease and sometimes underestimated by physicians, hair loss can take an emotional toll that directly affects physical health. Hair is an important part of woman’s face and beauty, therefore it is not easy for any woman to face changes that affect the quality and especially the quantity of her hair. Hair loss in women is a serious life-altering condition that shouldn’t be ignored and has to be diagnosed and treated in the best possible way.
Hormone Replacement Therapy: You may be advised to go for hormone replacement therapy or may take supplementary estrogen in case your doctor suspects that the hair loss is caused because of low or lack of estrogen hormone. These supplements may either be taken orally or may be applied topically to the skin as a gel. However it must be mentioned that not all women are benefited with this type of treatment for low estrogen levels causing hair loss.

This is an autoimmune disorder that is also known as “spot baldness” and can result in hair loss ranging from just one location (alopecia areata monolocularis) to the entire scalp (alopecia totalis), or to every hair on the entire body (Alopecia areata universalis). Although it is thought to be caused by hair follicles becoming dormant, what triggers alopecia areata is not exactly known. In most cases, the condition corrects itself.


Some cancer chemotherapy drugs cause temporary hair loss, which affects all body hair. Along with the loss of scalp hair, people undergoing chemotherapy also commonly lose their eyebrows and eyelashes. Chemotherapy drugs that frequently cause hair loss include paclitaxel, 5-fluorouracil, carboplatin, cisplatin, actinomycin-D, bleomycin, vincristine, cyclophosphamide, altretamine, etoposide, docetaxel and doxorubicin. Hair loss typically begins 2 to 3 weeks after the start of chemotherapy. Lost eyebrow hair regrows in the weeks to months following completion of treatment.
Cyproterone acetate works in several ways. It not only competitively blocks DHT from binding to its receptors at target tissue (Gilman et al., 1990), but it is also a progestogen that lowers testosterone levels by decreasing the release of luteinizing and follicle-stimulating hormones through pituitary-mediated supression (Gilman et al., 1990, Varothai and Bergfeld, 2014). An open intervention study of 80 women who received treatment with spironolactone (200 mg daily) or cyproterone acetate (50 mg daily or 100 mg for 10 days per month if premenopausal) showed that three of four patients demonstrated an improvement or stabilization of their disease with no difference of effect between the therapies received (Sinclair et al., 2005).
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There’s no doubt that estrogen and hair loss are connected, but there are certain factors that determine how much of an effect estrogen levels have on your hair. As one of the main visible measures of your health, hair growth is often one of the first areas affected when hormones are off-balance. Let’s take a look at the links between estrogen hormonal imbalance and hair loss.
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