The hormonal process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women. And certainly when those levels rise, DHT is even more of a problem. Those levels can rise and still be within what doctors consider "normal" on a blood test, even though they are high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even its regular levels of chemicals, including hormones.
*Photograph used with permission of the Journal of the American Academy of Dermatology. This photograph was published in the Journal of the American Academy of Dermatology, Vol. # 60, Gathers RC, Jankowski M, Eide M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia,” 660-8. Copyright Elsevier (2009). Journal of the American Academy of Dermatology.
If you are in Maryland, especially in Rockville, Maryland, you could schedule an appointment with us and have your consultation. We would provide you with answers and treatments available for you and your skin condition. Contact us and let us know about your skin dilemma. Katz Dermatology has been serving Maryland for 40 years now and continues to provide quality of dermatology services especially in general dermatology, cosmetic dermatology, surgical dermatology and aesthetic dermatology.
You may have thought you were one up on men in the biological war but not only testosterone-strong males experience hair loss. In fact (and unfairly), up to 50% of women will experience some form of hair loss in their lifetime. You might have heard that pregnancy, the contraceptive pill and menopause are possible causes of hair loss, but are they really? Well, yes and no. An understanding of why female hair loss happens and what role estrogen plays in hair growth may help to make this answer clearer.
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.
Eating too many high-glycemic foods for too long (often in combination with other lifestyle factors, like being sedentary and experiencing chronic, unremitting stress) can cause an overload of insulin in the body—and too much insulin disrupts ovulation and signals the ovaries to make testosterone. More testosterone predisposes the body to more DHT conversion, and, hence, more hair loss.
There are numerous diseases that can affect the hair and scalp. Hair loss can be caused by a variety of conditions. Diseases such as alopecia areata, anemia, male/female pattern baldness, and infections of the scalp can all cause significant difficulty and loss of daily well-being. Stanford Dermatology has established a special clinic focusing on the diagnosis and treatment of these disorders of the hair.
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
Finasteride is a 5-alpha-reductase type II inhibitor, and although it is approved by the U.S. Food and Drug Administration (FDA) for the treatment of male androgenetic alopecia, it is not approved for FPHL. Finasteride is significantly teratogenic and has been shown to cause feminization of male fetuses (Bowman et al., 2003) as well as sexual side effects, depression, headache, nausea, and hot flashes (Varothai and Bergfeld, 2014). The decreased conversion of testosterone to DHT causes a build-up of testosterone, which subsequently converts to estradiol and creates a relative estrogen excess, and this could theoretically increase the risk of breast cancer (Kelly et al., 2016). Studies that use low doses (1 mg daily) showed no significant benefit (Kim et al., 2012, Price et al., 2000). However, one study of 37 premenopausal women who were taking a 2.5-mg dose of finasteride daily with an oral contraceptive pill showed improvement of hair loss in 62% of patients (Iorizzo et al., 2006). Another study of 87 pre- and postmenopausal normoandrogenic patients who were taking a 5-mg dose of finasteride per day for 12 months showed a significant increase in both hair density and thickness (Yeon et al., 2011). The effectiveness of finasteride does not seem to differ between pre- and postmenopausal patients (Yeon et al., 2011). Finasteride is classified as pregnancy category X.
Both benign and malignant tumors such as seborrhoeic keratosis, molluscum contagiosum, basal cell carcinoma, squamous-cell carcinoma, sebaceous cell carcinoma, and sclerosing sweat duct carcinoma have been shown to be associated with loss of eyelashes.[1,111–113,119,120] A sebaceous cell carcinoma very often presents as a recurrent chalazion. An associated madarosis (due to lid infiltration and follicle destruction) would help to differentiate the two.[121,122] Tsuji et al. reported a rare case of primary epithelioid hemangioendothelioma of the eyelid associated with madarosis. Primary leiomyoma of the eyelid has been reported with madarosis. Kuan described a case of lacrimal gland tumor masquerading as blepharitis with madarosis.
The real culprit appears to be dihydrotestosterone (DHT), a more potent form of testosterone. DHT is made from testosterone by a specific enzyme in the body, and while both testosterone and DHT are known to have a weakening effect on hair follicles, there appears to be something unique about the conversion process of testosterone to DHT that relates to thinning hair. This is why some drugs that are marketed for hair loss block the conversion of testosterone to DHT. (It’s important to note, however, that these drugs tend to be less effective in women than men, and that one of them—finasteride—is only approved for hormonal hair loss in men, not women. What’s more, the drug has been associated with increased risk of sexual side effects, depression, nausea, hot flashes, and increased estrogen levels—and too much estrogen is its own risk factor for thinning hair; more on that below.)
A. Steroids are not for female pattern hair loss but are sometimes used for alopecia areata (spotty hair loss that is different than hair loss due to genetics and aging). Laser combs? There are some reports that low-level light therapy could stimulate hair growth in some people. It's something to try when people feel like they have no other good options. At $350, it's expensive and I'm not sure it's worth the money, but it is safe.
"Dr. Yaker was extremely personable as well as knowledgeable on hair and hair health. With his treatment plan that was tailored to my needs and requests, I have noticeable thicker and fuller hair within three months! His enthusiasm towards his work was very comforting. He truly puts the patient at the center of care he delivers and it doesn't go unnoticed! I would highly recommend him as your physician if you are struggling with the appearance of your hair!"
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.
Madarosis is a clinical sign that has become pathognomonic of leprosy in countries like India. However, this apparently benign clinical sign has wider ramifications in many systemic and dermatological disorders. Hence, establishing a proper diagnosis and appropriate management is mandatory. Though management of the primary disease results in regrowth of eyebrows and eyelashes, many require surgical management. Thus, the management of a patient with madarosis requires a coordinated effort from the dermatologist, ophthalmologist, internist, and reconstructive surgeon.
“A scalp biopsy is the gold standard for diagnosing hair loss,” said Dr. Marc Avram, a dermatologist in private practice with offices in Manhattan and Brooklyn. “The test examines the follicles themselves and can help determine whether the hair loss is genetic, inflammatory, infectious or due to an unusual physical or emotional shock to the system.”
Although it’s generally only prescribed as a last resort for menopausal symptoms, hormone replacement therapy is a common and very effective hair loss treatment for some women — as long as they are menopausal or post-menopausal and are not at higher risk for adverse effects from HRT. It's most often prescribed for women who have androgenetic alopecia, also called pattern baldness. Hormone replacement therapy has a number of benefits for both general health and symptom management, but also a number of side effects — which range from unpleasant to dangerous.
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).