When Hair Loss Strikes…

a doctor is a girl’s best friend, according to a recent article in The NY Times.

The author had what sounds like a case of tellugen effluvium, a temporary loss of hair that occurs when a large number of hair follicles decide to cycle together, usually as a result of stress or sudden hormonal shifts (like giving birth). Fortunately for her, the follicles all cycle back in eventually.

She then goes on to discuss on of the more frustrating causes of hair loss in women – androgenetic alopecia, or male pattern baldness.

I see androgenetic alopecia not infrequently in women who came convinced that they have a treatable hormonal problem. Unfortunately, I’ve yet to find any hormonal abnormalities in these women other than menopause and perimenopause. I have had limited success using hormone replacement for the problem, although I do offer it as a trial. I generally offer Minoxidil, but patients seem to have trouble following through on its use. I tend to avoid Propecia, a drug use in male baldness, since we have limited experience using it in women.

Some of my patients with androgenetic alopecia have had success stemming further hair loss with Spironolactone, a diuretic anti-hypertensive that has the added effect of blocking the testosterone receptor in the skin.  It’s not FDA approved for this indication, but we’ve been using spironolactone for years to treat hirutism, as well as for its diuretic effects on pre-menstrual bloating. Spironolactone can cause birth defects in male fetuses, so I never prescribe sprironolactone without concomitant hormonal contraception in women in their reproductive years.

Of course, there are other causes of hair loss – these are just the two most common ones. If you think you losing your hair, see your doctor. Sometimes hair loss can be a symptom of an underlying medical condition such as thyroid disease, although in my experience thyroid problems are more often diagnosed on routine screens before hair loss ever becomes a problem. Rarely, a testosterone-secreting adrenal or ovarian tumor can present with hair loss, though usually this is accompanied by other signs of androgen excess.

Other causes of hair loss are alopecia areata, (thought to be an autoimmune disorder), medications (chemotherapy of course being the worst offender), fungal infections, hair processing chemicals and treatments, and other rarer causes.

Finally, don’t forget that hair loss can be one of the side effects of the much touted testosterone therapy in women.