What is Female Pattern Hair Loss (FPHL)?
In women female pattern hair loss (FPHL), or androgenetic alopecia, can present in either as diffuse thinning hair all over or thinning hair in a “Christmas tree” pattern. The “Christmas tree” pattern of hair loss refers to a widening hair part in women. The lack of hair in the part can widen as it worsens.
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Causes of Female Pattern Hair Loss
The causes of FPHL are multifactorial. Androgenetic means that there is both an androgen component as well as a genetic component to the hair loss. Approximately 38.5% of women with diffuse hair loss have excess androgens like DHT.1 Clinically, having excess androgens like DHT means that the blood levels of DHT are above the normal threshold for women.
DHT and Women Hair Loss
However, there is a phenomenon called “relative androgen excess.” Women can experience relative androgen excess even when their blood levels of DHT are normal. 2 This often occurs during menopause because their bodies stop producing the hormones estrogen and progesterone. Even though their bodies still have normal levels of androgens like DHT, DHT will make up a higher percentage of all sex hormones because the body is producing less estrogen and progesterone.
This will make the effects of DHT more apparent to the body. The decrease in estrogen and progesterone during menopause causes the effects of DHT to be more noticeable and may be the reason why many women complain of thinning hair during menopause.
Do Prescription DHT Blockers for Women's Hair Loss Work?
1mg/day of the prescription DHT blocker finasteride is normally prescribed for men with hair loss. However, this dose was not found to be helpful in women with hair loss.8 Researchers have found higher doses of finasteride to be helpful
A study involving 37 women with female pattern hair loss were treated with a dose of 2.5mg per day finasteride along with an oral contraceptive pill. The researchers found that after 12 months, hair loss improved in 62% of women.7
In a smaller study involving 5 postmenopausal women without hyperandrogenism oral contraceptives were not used. These 5 women were treated with either 2.5 mg or 5 mg of oral finasteride every day. Researchers evaluated the effects based on photographs and assessments by the patients and investigators. Hair loss improved in all evaluation techniques. Patient self-assessments reported decreased hair loss, increased hair growth, and improved hair appearance. This further suggests that higher doses of the DHT blocker finasteride are helpful in women with hair loss.9
In a larger study, 87 pre- and post-menopausal women with normal androgen levels exhibiting female pattern hair loss were treated with 5 mg of oral finasteride per day over a period of 12 months. Researchers measured the results based on changes in hair thickness and density from phototrichogram and global photographs. While one patient withdrew, 70 of the remaining 86 patients showed significantly increased hair density and thickness.
The study found that a dose of 5mg finasteride per day was helpful in 81.4% of women with female pattern hair loss and normal DHT levels. This provides further evidence that 5mg of the DHT blocker finasteride may be effective for women with hair loss.3
As these studies show, the prescription DHT blocker finasteride can be helpful for women with hair loss, but other causes of hair loss in women need to be ruled out first.
Side Effects of Prescription DHT Blockers for Women
Pregnant and nursing mothers are recommended to avoid DHT blockers. In fact, they are recommended to not even touch prescription DHT blocker pills because DHT blocker drugs can be absorbed through the skin and DHT plays an important role in the development of fetuses and infants.
Finasteride can cause headaches, menstrual irregularities in premenopausal women, dizziness, and increased body hair growth.6
Benefits of Natural DHT Blockers for Women
Natural DHT blockers are inherently weaker than prescription DHT blockers. However, this does not mean that they are ineffective for hair loss.
Unfortunately, all studies on herbal DHT blockers for hair loss have been done on men. One study involving 100 men with hair loss lasting for 2 years found that 320mg of saw palmetto powder daily improved hair growth by 38% while treatment with finasteride 1mg daily improved growth in 68%.4
A small double-blinded study involving 26 subjects with androgenetic alopecia found an improvement in 60% of men treated with twice daily administration of 50mg beta-sitosterol, 10 mcg biotin, 50mg lecithin, 100mg inositol, 25mg phosphatidylcholine, 15mg niacin, and 200 mg saw palmetto 85-95% liposteric extract.5 The blinded investigators evaluated and found improvement of 60% of the treatment group compared to an improvement of only 10% of subjects in the control group.
Based on the promising results of prescription DHT blockers for women’s hair loss and natural DHT blockers for men’s hair loss, natural DHT blockers could be beneficial for women’s hair loss as well.
Click here to read our next article on the side effects of natural DHT blockers.