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Female Hair Loss - Any options?

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So I'm almost 30, female and I have what I'm told is female pattern hair loss. My hair thinned dramatically in my early 20's mostly on the top and while the loss has slowed, it has continued since then. I was going to go see one of the Bosley docs for a consult but then I started doing research and the results of that research indicate that either the surgery would be pointless and/or that Bosley is maybe not the facility I want to trust my head to. That said, what I'm reading doesn't bode well for my type of loss. I'm wondering if there are any suggestions for anything I haven't yet tried?


I went to my dermatologist. I think he (and my pcp) tested me about three times over for lupus but I don't have that. Then the derm had me try the minoxidil and it seemed to do nothing. He said I could either continue with it in the hopes that it was somehow slowing the rate of loss (though there was no evidence of that) or I could give it up, basically, and accept the situation.


And I thought I could do it. Did do it. I think it's been about 5 years from that dooms-day discussion with the doc. I don't generally consider myself a vain woman. But I'm not even 30 and I could do the whole sob story thing but I'm sure you've heard it...it's not fun being a balding woman.


And, is there anything else? Reading what I've read about shock loss and botched transplants and the poor results for women with my type of hair loss in general...the idea of a hair transplant is somewhat disturbing.


Is there anything else to try first? Or have I exhausted everything but the rather iffy prospect of surgery?


Thanks in advance for any suggestions and/or advice.

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  • Regular Member

I'm also a female. I had HT (FUT) with Dr Rahal in December 2008 (1925 grafts) and I'm extremely pleased with the results. I had thin hair all over my head ...but mostly on top which is where the HT was done. (42 sq inches) After 8 months, my "new" hair is still growing and it really is making a diffference. My hair is not as see-through as it was...

I too thought that I was not a good candidate for HT but Dr Rahal felt he could help me.

Feel free to ask me questions as there are not too many females here..

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I think u have done a lot of research on our hair. And i also cant exactly figure out the reason for the hair loss. I think you should go for hair transplant, but be sure that you consult a good professional before doing any thing.


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I really feel for ya...as a somewhat vain, slightly narcissistic, pretty sensitive guy dealing with hairloss I can appreciate what a quagmire it must be for a normal woman dealing with it. icon_wink.gif


It's good that you're taking time with things. Not having any real clue as to your exact situation, what I can say is this: if you do get a HT, plz, plz, plz, ensure that you are doing it with a truly elite clinic. Leading up to getting (or not getting) a HT, even just who you're getting advice from is equally important as to arm yourself with as much honest, expert opinion as possible. I don't know where you live, but a sampling of docs that I'd recco consulting with: SMG (Ron Shapiro), Feller, Hasson&Wong. Feller is in the east coast, SMG is in the mid-west I'm pretty sure, and H+W are in Canada.


Also, I'd look into PRP treatment....it's pretty new to the scene, but it's virtually non-invasive and some very respected people have begun to use it for patients.


*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

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Dear Avolat,

I sympathize with you. We don't have really good medical treatment for female pattern hair loss at this time. I will try to review the various options for you in this note in hopes it helps give you a little better view of your choices.

As you know finasteride and dutasteride have not been proven at all to help women's hair loss, as it is not affected hormonally the same way a man's is. I hope you gave the minoxidil at least a good year's trial before giving up on it also. You can't take it for 2-3 months and make a judgement about it's effectiveness for you. Also, many experts recommend for women to work up to the 5% level strength if they tolerate it, or alternate 2% with 5%, as I often do. It works better for preventing future hair loss than it does for actually growing any new long hairs.

Other medical approaches are: spironolactone, which has to be used in high doses, at least 100-200mg a day. I have heard a few cases in which it worked wonders. Many doctors are uncomfortable prescribing it, as it raises the potassium and can make the lupus antibody go positive (no proof it causes lupus though). I have avoided prescribing it for women but have encouraged some women to consult with an endocrinologist about possibly considering it under their medical supervision.

I am not a big fan of the laser therapy. My gut feeling, after all the talks I've heard and the hundreds of patients I have spoken with who have used it, is that perhaps 15% of patients realize a benefit, which is short-lived over a couple of years. That's an awful lot of bitterly disappointed patients and a lot of money spent. There was one talk at our ISHRS meeting in Amsterdam though which was a little more encouraging, so it might be worth a try.

Once you get past medical treatment, you are looking at four choices: doing nothing, using camouflage products (Toppik, Dermmatch, etc), non-surgical hairpieces, or hair transplants. Usually the decision comes down to the last two choices.

The simplest way to help make that decision is to have a hair expert, who has the capability of examining your hair under high magnification, carefully examine the hairs on the back of your head. If there is significant "miniaturization" of the hairs there, then you will probably not be real happy with the results of a transplant, although some of these women can be made reasonably happy for 10-15 years by moving this hair. Most of these women are best served with one of the modern, human-hair, lightweight hairpieces that are getting better and better. Most hair surgeons are able to recommend who in your area does high quality work.

If the hair in the occipital (rear) area is of high quality with minimal or no miniaturization, then you most likely could be significantly helped with hair transplantation. You will probably have to commit to a certain styling pattern, so that the surgeon can "cheat" and load up certain areas more than others. The reason this is necessary is that most women with female pattern hair loss do not have really high quality donor hair on the sides of the head as men do, so we are limited to harvesting the good donor hair from the flat back area of the scalp. Usually 1600-2200 FU's can be obtained in a single session in most women, using a slightly wider strip. It takes a minimum of two sessions and there is a 20-30% chance of some mile "shocking" to some of the weaker, vulnerable hairs presently on top, such that you take a small backward step the first couple of months, but then head into positive territory usually by 4-5 months. I find that 80% of the women who consult with me are good candidates. The only things that disqualifies a woman as a patient is a poor donor area or unrealistic expectations.

I wish you the best with your problem.

Mike Beehner, M.D.

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Dr. Beehner made some very good points I would just like to add a few more comments.

Even though you have had a medical work up there are a few more points that may be helpful. Sometimes sub-clinical Iron Deficiency Anemia or Sub-Clinical Thyroid problems can cause hair loss. I suggest that all young women with significant hair loss go to an endocrinologist to have a complete thyroid panel done and also to consider going on spironolactone as Dr. Beehner mentioned. Also, did your PCP take lab test for Iron Deficiency Anemia? There is a lab test called the Ferritin level. Some women will have normal Iron levels and with low normal Ferritin levels. The Ferritin level is reported as normal even when it is as low as 30. I suggest that all young women experiencing hair loss have a Ferritin level of greater the 70. If your level is less then 70 you should take Iron supplements until it is above 70.


After all medical causes have been ruled out and/or treated hair transplant surgery may be an option for you. But as Dr. Beehner pointed out it is very important to have realistic expectations and to know what a hair transplant can accomplish for a female patient with female pattern hair loss. Women tend to have a lower donor density and a smaller safe donor area to take hair from then men. So it is very unusual to get a session greater then 2,500 grafts in a female patient and as Dr. Beehner pointed out it is not unusual to get sessions of 1,600 to 2,200. Also most women with genetic hair loss have very fine hair. When using such fine we get better results when combining Multi Unit Grafts (MFU) with Follicular Unit Grafts (FU) Not all donor hair has the right density and quality to use MFU's but if you decide to get a hair transplant I would suggest you go to a doctor who is skilled in both FU and MFU grafting.


It is almost impossible to cover the total area of hair loss so there is not any see through scalp in women with female pattern hair loss. So as Dr. Beehner pointed out the goal of the transplant should be to get enough hair so that the patient can style her hair to better cover up the scalp, and/or to have less areas of see through scalp. As Dr. Beehner mentioned this often times takes two hair transplants. With these realistic expectations transplants can be very helpful in the female patient.


I have included a few photos of female patients in which I would consider the transplant successful. As you can see in the top views, there is still see through scalp, but all the patients were very satisfied with there results.

Each photo has the before on the left and a one year after photo on the right. Both patients have had only one hair transplant and could benifit from a second one.


This patient has siginificant female pattern hair loss:

Top View, Before, at 6 months, and at 14 months




Front View



This patient has moderate female pattern hair loss:

Top view


Front View




I hope this is helpful


Dr. Paul Shapiro

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