Female Pattern Baldness

 Introduction

A hair is a non-living filamentous structure made from a protein, keratin and grow out of follicles found on the skin. Hair has played an important role in shaping the society we live in. During earlier times quality and length of hair was used as important parameter to judge a woman’s health by the males and those with a healthy mane were chosen for child bearing. Back then hair symbolized fertility and youthfulness in women.

Even today, when there is so much progress in all fields of life and the outlook of the society has changed drastically, hair is still perceived as an important tool for assessing the potential mate. Hair and its quality still determines how a person will be perceived in the society and it really has a huge impact on a person’s self-confidence.

An average person has nearly 100,000 strands of hair on scalp, out of which nearly 50-100 strands fall every day. When this number increases dramatically, only then hair loss becomes a problem. It is highly unlikely for women to go completely bald in their lifetime.However, they might experience hair thinning.

Medically, hair loss is referred to as alopecia, which is classified into different categories, depending on the reason behind hair loss. Female pattern hair loss can develop in women due to various reasons like menopause, genetics, PCOS and many other factors.

Female pattern baldness is one of the leading causes of hair loss in women. It is found in nearly 6% of the women less than 50 years of age and nearly 38% in women aged 70 years and above. As with any other type of hair loss, it is accompanied with depression and lower self-esteem issues. The frequency of such psychological issues has been found to be more in females with female pattern baldness than in males with male pattern baldness.

Symptoms

Symptoms of female pattern baldness appear gradually. Diffused hair loss is seen over the crown which produces a gradual thinning of hair. No bald spot is observed and the front line is often preserved. Hair loss from both the temples is also observed, but rarely.

Treatment

One of the major goals of the treatment is to correctly address the requirement of the patient. Most of the treatments available today can help in slowing down the hair loss and most probably stop it altogether. However, stimulating hair growth and thickening the already existing mane is a difficult task that can only be achieved in a few cases. It requires early initiation of treatment and using combination of medicines for approaching the condition. Sometimes, the patient might also require psychological counseling for overcoming the psychological effects of hair loss.

Treatment for female pattern baldness can be done by using the below mentioned drugs:

1. Androgen independent hair growth stimulator

Vasodilators are the drugs that dilate blood vessels and increase blood. This property can be used for increasing the blood supply to the hair follicles for increasing their growth. Minoxidil is a vasodilator that is used in the treatment of female pattern baldness. It also helps in elongating the active phase and size of hair follicle, aiding hair growth.

However, minoxidil only offers a temporary solution and the symptoms return on stopping the medicine. It is available in the concentration of 2% and 5%, out of which 5% concentration is more potent.

Available as: Topical solution

• Generic Name: minoxidil
  Brand Names: Rogaine (2%), Avacor (5%), Good Sense (5%), Rogaine Extra Strength (5%)
  US FDA Status: Approved.
  Availability: Prescription and OTC
  Dosage Form: Topical solution
  Indicated in Pregnancy: No, unless benefits outweigh risks
  Alcohol Content: Traces

Side Effects: Hives, swelling on face ,lips ,tongue and throat, scalp irritation, change in color or texture of your hair, unwanted facial hair growth and flushing

2. Antihistamine as anti-androgentic agent

Anti-androgens are the agents that oppose the actions of sex hormones, androgens in the body cimetidine, although an antihistamine, has shown some anti androgentic property. It has been found to mask the effect of male sex hormones in females with hormonal imbalance. In diseases like polycystic ovary syndrome (PCOS), the levels of male sex hormone, testosterone, can increase, causing a further increase in dihydrotestosterone (DHT) levels, which is detrimental to hair growth. In the presence of DHT, the size of hair follicles decreases, which causes hair loss. Therefore, by decreasing the levels of DHT in the body, hair fall can be prevented. The result shown by these drugs has been promising but is strictly restricted to females only.

Available as: Tablet

• Generic Name: cimetidine
  Brand Name: Tagamet HB
  U.S. FDA Status: Approved
  Availability: OTC
  Dosage Form: Tablet
  Indicated in Pregnancy: Yes, under careful monitoring
  Alcohol Content: No

Side Effects: Headache, diarrhea, somnolence, slurred speech, dizziness and lethargy

3. Oral Contraceptives

Polycystic ovary syndrome is a condition in which the levels of male hormone, testosterone, increases in a woman. Testosterone is converted into another androgen, dihydrotestosterone (DHT), which is responsible for causing baldness in such females.

PCOS can be managed by following a healthy lifestyle, regular exercise, good diet and nutritional supplement along with medicines. In order to keep the hormone levels in check, oral contraceptive pills (OCPs) are prescribed. These medicines reduce the production of testosterone, other androgens and sex binding globulin (SHBG). The liver synthesizes SHBG, which is a protein that binds the three sex hormones, namely, estrogen, dihydrotestosterone and testosterone in both males and females. SHBG levels become extremely low in women with PCOS and therefore, free testosterone levels in the blood increases. This results in baldness and other symptoms.

Available as: Oral preparation
Side Effects: Nausea, weight gain, decreased libido, headache, intermenstrual bleeding, mood changes, abnormal vaginal discharge and breast tenderness
Drugs: Following drugs are generally present in combination in OCPs:

• cyproterone acetate
• ethinyl estradiol
• desoestrol
• drospireone
• norgestimate

• Drug Combination: desogestrel and ethinyl estradiol
  Brand: Desogen
  The U.S. FDA Status: Discontinued
  Dosage Form: Tablet
  Indicated in Pregnancy: No
  Alcohol Content: No
• Drug Combination: desogestrel and ethinyl estradiol
  Brand: Ortho-Cept
  The U.S. FDA Status: Discontinued
  Dosage Form: Oral
  Indicated in Pregnancy: No
  Alcohol Content: No
• Drug Combination: ethinyl estradiol and norgestimate
  Brand: Ortho Tri-Cyclen
  The U.S. FDA Status: Approved
  Dosage Form: Tablet
  Indicated in Pregnancy: No
  Alcohol Content: No

4. Androgen Receptor Inhibitor

Testosterone and dihydrotestosterone (DHT) are called androgens or male sex hormones. DHT binds to the androgen receptors found on the hair follicle and suppresses its growth. Anti-androgens or androgen receptor inhibitors are drugs that either stop the production of androgens in the body or prevent androgens from binding on to the androgen receptors. This helps in decreasing the rate of hair fall.

Available as: Tablet

• Generic name: spironolactone
  Brand Name: Aldactone
  The U.S. FDA Status: Prescription only
  Dosage Form: Tablet
  Indicated in Pregnancy: No. Prescribed only if there is edema during pregnancy
  Alcohol Content: No
  Side Effects: Abdominal cramping, chills, dizziness , breast pain, bleeding gums, chest pain, and headache
• Generic Name: cyproterone acetate
  Brand Name: Androcur
  U.S. FDA Status: Unapproved
  Availability: Not available in the U.S.A.
  Dosage Form: Tablet
  Indicated in Pregnancy: No
  Alcohol Content: No
  Side Effects: Symptoms of osteoporosis, dryness of skin, scalp and hair, lightening of hair color and formation of blood clots

OTC Drugs Used

Different agencies control the prescription status of drugs in different countries. Some of the drugs that are available over-the-counter in various countries across the world for managing the symptoms of female pattern baldness are given below: