Hair loss is a difficult experience for both men and women. However, society has grown to accept balding men while not even acknowledging that balding in women is almost as common.
And if you’re one of millions of women worldwide who’s suffering from pattern hair loss, you’ll be happy to know that there are treatment options available to you.
This post will introduce the hair loss solution minoxidil including how it works, its possible side effects, and how to apply it most effectively.
But more importantly, we’ll discuss whether it’s a viable option for women. This will include a look at scientific studies, as well as possible alternative treatment options.
First, however, it’s important to understand what Female-Pattern Hair Loss (FPHL) is and why it happens.
What Causes Female-Pattern Balding?
Hair thinning and balding is often seen as an unavoidable part of aging for men.
That’s because it’s estimated that 30 to 50 percent of men will begin balding by the age of 50, and these odds only increase with age (1).
Hair loss isn’t exclusive to men only, though.
The condition colloquially known as Male-Pattern Baldness (MPB) is more accurately described by the medical name of Androgenetic Alopecia (AGA).
This condition affects both men and women, and there’s a significant genetic factor that plays a role in development.
An overall prevalence is believed to range from 19 to 32 percent of women (2).
And just as with MPB, this prevalence is believed to increase with age.
But what exactly causes AGA, and how does it affect women differently than men?
There are many factors that contribute to AGA.
The main contributing factor for years was believed to be sensitivity to the androgen hormone Dihydrotestosterone (DHT).
This hormone is synthesized from testosterone and the enzyme 5-alpha-reductase (5AR). And while it’s presence at the follicles is normal, those with AGA have follicles that are sensitive to it.
These tends to lie in the frontotemporal region of the scalp, which is where the typical balding pattern comes from.
As the sensitivity goes untreated, the follicles miniaturize due to inflammation. This then leads to premature shedding, thinning, and hairline recession.
But in recent years, there has been an increase in the condition which has led to further understanding of the condition.
One of the latest theories holds that tension of the scalp muscles is the main contributor (3).
As the muscles become strained, either due to skull bone growth or chronic muscle contraction, they trigger a “pro-inflammatory cascade in GA-fused tissues – upregulating signaling proteins and androgens involved in fibrosis and calcification pathogenesis.”
This hypothesis takes DHT almost entirely out of the picture, but there are those who also believe the two contributors are linked.
Male-Pattern Baldness Versus Female-Pattern Hair Loss
It’s good to know how AGA is likely to develop, but how does its presentation differ between sexes?
The typical balding pattern seen in men with AGA is that of frontotemporal hair loss that eventually extends to the crown.
At the final stage of AGA, there is often a strip of hair left surrounding the base of the scalp but that’s it.
FPHL presents quite differently in that most women begin to see thinning at the crown and inside the hair part (the section at the top of the head that separates the sides of the scalp vertically).
Women are also more likely to experience diffuse (all over) thinning as opposed to men.
So, if AGA is caused by the same thing in men and women, why is there a difference in presentation?
There is evidence to suggest that hair growth rate differs significantly between men and women.
A 2016 study looked to measure Linear Hair Growth Rate (LHGR) in two groups of individuals (4):
- Men and women without pattern hair loss; and
- Men and women with pattern hair loss.
The researchers did so by studying a total of 59,765 anagen hairs (with 24,609 from controls and 35,156 from patients).
What did they find?
The first significant finding is that thinner hairs grow more slowly than thicker hairs.
This correlates with what we see in AGA. Namely, miniaturized hairs take longer to penetrate the scalp.
The second finding was that women naturally had a higher LHGR than men.
The growth rate slowly significantly in both men and women who were diagnosed with pattern hair loss. But the difference in natural LHGR may explain why men tend to experience worse hair loss than women.
Hair Loss Treatments for Women
There are many hair loss treatments on the market.
The two which are currently approved by the Federal Drug Administration (FDA) are Rogaine (minoxidil) and Propecia (finasteride).
But there are plenty of other drugs which are used off-label (Adovart, for example), and even many herbs and supplements are used in the hair loss community.
As hair loss is seen as a largely male issue, though, there don’t seem to be as many options for women.
Fortunately, the number one hair loss drug, Rogaine, has been approved by women and even used successfully to stop FPHL.
Rogaine for Women: A Viable Option?
Rogaine, also known by its generic name of minoxidil, is a topical hair loss solution that was approved by the FDA in the 1980s.
The drug was initially developed as a treatment for hypertension – high blood pressure (R). However, the side effects of hypertrichosis (hair growth) was quickly noted and further research was carried out on minoxidil for hair loss.
Initially, minoxidil was released as a hair loss topical (Rogaine) for men only. But women, too, soon showed hair growth progress with the drug.
So, how effective is it in treating FPHL?
Study: Androgenetic alopecia in the female. Treatment with 2% topical minoxidil solution (1994)
An article was published in 1994 which outlined the results of a study carried out on 308 women from 11 centers across the United States (5).
All women who participated in the study were diagnosed with AGA.
The women were split into two groups: the first would receive 2% minoxidil daily, while the second would receive a placebo treatment.
This continued for 32 weeks.
How were results measured?
Researchers took photographs of a 1-cm2 evaluation site both at the beginning of the study and at the end.
At the 32-week mark, the number of nonvellus hairs had increased by an average of 23 hairs in the 2% minoxidil group.
The placebo group did see some increases in nonvellus hairs, but only by an average of 11.
The investigators determined that 13 percent in the minoxidil treatment group had moderate growth and 50 percent had minimal growth. This compared with 6 percent and 33 percent, respectively, in the placebo treatment group.
How to Use Rogaine for Women
If you think that Rogaine may be a viable option for your hair loss woes, then it’s important you learn how to use the solution most effectively.
How to Apply the Liquid Formulation
You may begin with either dry or damp (towel dried) hair. To complete the process, follow these steps.
- Part your hair into sections to ensure equal distribution throughout the scalp.
- Fill the dropper with 1mL of liquid, and apply evenly to the scalp.
- Use your fingertips to gently massage the solution into your scalp.
- Wash your hands thoroughly.
- Let the solution air dry before styling.
For best results, repeat this process twice per day.
How to Apply the Foam Formulation
First, rinse your hands with cold water and dry completely. Then, follow these five steps:
- Dispense one-half cupful of foam onto a dish, or directly onto a dry, non-porous surface (like a bathroom sink).
- Part your hair to expose more scalp.
- Dip your fingers into the foam. Begin applying at the back of your scalp and working forward.
- When done applying all of the foam, wash your hands thoroughly.
- Let it dry completely before styling.
Unlike the liquid solution, you only need to apply minoxidil foam once per day. You should repeat this process each morning for best results.
Side Effects and Considerations
Before you begin any treatment – either prescribed or over-the-counter – it’s important that you understand the potential risks.
As with any drug, minoxidil does have numerous side effects associated with its use.
The most common side effect of the liquid solution is scalp irritation and itching (6).
This is believed to be caused by the presence of the alcohol propylene glycol and not the minoxidil itself.
So, what can you do if the side effects are too much to bear? Consider minoxidil foam!
Minoxidil foam is a hair loss foam that was developed as a way to reduce the risk of side effects. That’s because the foam formulation does not contain propylene glycol.
For many people, the foam formulation is also easier to apply. It also dries more quickly which is great for women with longer hair.
While rare, systemic side effects also exist.
These may include headaches, lightheadedness, and flushing of the face. These symptoms may improve over time, but it’s best to speak with your doctor before continuing minoxidil use.
Are There Alternatives to Rogaine for Female Pattern Hair Loss?
As mentioned above, there are many hair loss solutions available on the market. But a lot of these are targeted at men.
So, what other options do women with pattern hair loss have?
Finasteride, more commonly known by its brand name Propecia, is an oral drug that was first developed as a treatment for Benign Prostatic Hyperplasia (BPH) (7).
Unlike minoxidil, finasteride targets DHT directly by inhibiting the enzyme 5AR.
With less activity, there is less DHT production. And this means less irritation at the follicles.
Officially, finasteride is only available by prescription for male hair loss sufferers. However, this drug has been prescribed to women over the years.
There have even been studies performed which suggest that it’s a viable treatment option.
Study: Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women (2013)
A study performed in 2013 followed 40 post-menopausal with AGA over a period of 18 months (8).
All of the women were treated with 5mg/day of finasteride, and all 40 women completed the trial.
There were three measures of efficacy used throughout this study: patient assessment, clinical assessment, and global photography.
After six months of treatment, 22 patients saw significant improvement, 12 saw moderate improvement, and six saw no improvement.
These were in comparison to the global photography results of eight patients with no improvement, 16 with moderate improvement, and 16 with significant improvements.
These improvements continued up to the end of the 18-month study, though the most drastic improvements were noted at the 6-month mark.
There were a few notable side effects, namely loss of libido and elevated liver enzymes. It appears that the risk of adverse effects increases with age and, as such, treatment with finasteride over the age of 70 is not recommended.
So, is finasteride right for you?
Well, if you’re still pre-menopausal, there are a few considerations to make.
As an anti-androgen, finasteride can have an effect on male sexual development. This can result in defects of male fetal genitalia.
If you are pregnant, or planning to become pregnant, it’s important that you not use finasteride.
If you intend to take finasteride during your child-bearing years, your doctor will likely prescribe a birth control pill alongside the hair loss drug.
If hair loss drugs aren’t for you, or if you’d like to improve results, then you may want to consider microneedling.
Microneedling, also known as Collagen Induction Therapy (CIT), is a procedure that involves puncturing the scalp with tiny needles.
These needles create wounds which then triggers the wound healing process (9).
This process involves three steps, which are: 1) inflammation; 2) proliferation; and 3) wound remodelling with scar tissue formation.
And while it may seem counterintuitive to wound yourself so that your hair will grow, there is actually quite a bit of research and scientific evidence to back up this technique.
Study: A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study (2013)
A study published in 2013 considered the effect of microneedling, in addition to daily minoxidil, on patients with androgenetic alopecia (10).
The researchers recruited 100 men with diagnosed AGA, and the study was split into two groups.
The first group consisted of 50 men who received daily application of 5% minoxidil lotion. They were also given once-weekly microneedling treatment.
The second group consisted of 50 men who received just the daily application of 5% minoxidil.
Global photographs were taken of a 1 cm2 targeted fixed area (marked with tattoo) at baseline and at the end of the study (week 12).
The hairs were also shaved to ensure equal length of hair shaft in all participants.
So, how did each group fare?
As was expected, the group to receive minoxidil only did see a positive change in hair count by the 12-week mark. This change in hair count was an average of 22.2.
The microneedling + minoxidil group, however, performed significantly better.
At 12 weeks, the group had an average hair count increase of 91.4.
That’s a 76 percent difference in results!
As the researchers concluded, “[t]he results of this study show that Microneedling is a safe and a promising tool in hair stimulation both for male and female AGA and also is useful to treat hair loss refractory to Minoxidil therapy.”
But if you’re new to microneedling, the idea of getting started may be daunting. There are tools available, though, that make the process very simple.
The dermaroller and the dermastamp are the two most popular at-home microneedling tools. And best of all, they’re cheap and easy to find online.
Rogaine is often touted as a viable treatment option for men. But as you’ve learned, women can benefit from its use, too.
That’s not to say that Rogaine is the best option for everyone, though.
There are women who prefer to take a different route, including another medication like Propecia or a natural procedure like microneedling.
And there are even those who choose to forgo treatment altogether and just let nature take its course.
So, is Rogaine right for you?
Only you can decide. However, if you have questions about the topical solution or any other topics covered in this article, be sure to leave a comment down below.