Hair Loss in Women

Women who have female pattern baldness, or androgenetic alopecia, lose about 150 hairs a day, more than the 50-100 hairs that women without thinning hair lose daily. Unfortunately, once those hairs are lost, it takes a long time to grow them back, so getting hair loss treatment early is the best strategy. The telltale sign of androgenetic alopecia is an overall thinning of your hair. For many women, hair loss happens on the top of the front of the head.

Minoxidil as Hair Growth Treatment

Rogaine is the brand name for minoxidil, which is a drug that scientists originally developed to treat high blood pressure. During clinical trials, however, people also noticed that it seemed to promote hair growth. Later, scientists developed a topical application of minoxidil, which the manufacturers now call Rogaine. Rogaine allows people to apply minoxidil directly to areas where they are experiencing hair loss, from the back of the head to the beard.

How It Works

Scientists have not worked out exactly how Rogaine helps promote hair growth and slow hair loss. A common explanation is that it opens up the blood vessels in the scalp, which allows more oxygen, nutrients, and blood to reach the hair follicles. It may also enhance the ability of cells in the scalp to produce DNA. Rogaine was developed to minimize the effects of male pattern baldness by promoting new growth for pigmented, terminal hairs, and limiting the scope of future hair loss.

However, minoxidil, which is the active ingredient in Rogaine, was originally developed as an oral medication to treat high blood pressure. While the medication could lower blood pressure for hard to treat individuals, people taking it also noticed that a side effect was the promotion of hair growth, although sometimes in undesirable places.

For Female Pattern Baldness

The development of a topical application made it possible for individuals to put the medication in specific locations. Now Rogaine is available as a 2% or 5% solution, or 5% foam. A study found that applying Rogaine helped stop hair loss for roughly 50% of men with male pattern baldness. Hair began growing back for a much smaller percentage of individuals, the report said.

Fortunately, minoxidil (Rogaine) can help stop the hair loss in its tracks. In some cases, it can even help regrow new hair. However, there are disadvantages to using the medication, which comes as a topical lotion or foam, especially for women. Rogaine applied topically to the scalp only works if your hair loss is a result of female pattern baldness and not some other condition, says Clarissa Yang, MD, a dermatologist at Brigham and Women's Hospital in Boston.

Normally, hair grows about half of an inch each month. Each hair grows for up to six years, and then it stops growing, rests for a while, and eventually falls out and is replaced by a new hair that grows for six years. If your hair is growing normally, about 85 percent of it is growing at any given time and 15 percent of it is resting. However, if you have female pattern baldness, your hair follicles get smaller and smaller over time, Dr. Yang says. The smaller they are, the shorter the amount of time your hair grows. Eventually, when strands of hair fall out, they are not replaced with normal new hair, but instead by thinner, finer strands of hair.


Doctors think that, among other possible causes, aging, genetics, and androgens, after menopause may be part of what brings on female pattern baldness. That is why female pattern baldness is also called androgenetic alopecia.

Minoxidil is the only drug that is FDA-approved to treat female pattern baldness. It works by prolonging the growth phase of the hair follicles, Yang says. It is recommended that women use minoxidil 2%, while men can use the 5% formula.


In most women, minoxidil slows down or stops hair loss. In addition, in up to a quarter of the women who take it, minoxidil can actually encourage new hair to grow. It works best when you use it as soon as you notice that you are losing hair, Yang says.

It is available over the counter, so you do not need a prescription from a doctor to get it. However, Yang encourages everyone to see a primary care doctor or a dermatologist before beginning treatment, because there could be a medical problem that is causing the hair loss, such as thyroid dysfunction or nutritional abnormalities.

A study of 11,000 people who used the topical application for at least 1 year found that 92% said Rogaine achieved fair to excellent results for slowing or stopping hair loss. The Food and Drug Administration (FDA) initially approved an over-the-counter formula that contained a 2% solution of minoxidil. A 5% solution is now available for tough to treat conditions.

Rogaine is most helpful for people with recent hair loss who are under 40 years of age. New hair growth is usually lost when people stop applying the medication.


Experts consider Rogaine mostly safe, although the alcohol in the topical application can irritate the skin. In addition, Rogaine may lead to the following side effects:

  • increased sensitivity to sunlight
  • dry and irritated scalp
  • burning and itching scalp
  • scaling and flaking scalp

Due to Rogaine increasing a person's sensitivity to sunlight, there is also a greater likelihood of them experiencing a sunburn. So users should take precautions to prevent overexposure. Some people using the higher strength, 5% solution have reported excessive hair growth in places they do not want it, such as the forehead or cheeks. People can also be allergic to minoxidil or other ingredients that the manufacturers use in the medication.

If any of the following symptoms develop, a person should seek medical help and discontinue using the medication:

  • swelling in the face
  • heart palpitations
  • dizziness
  • nausea
  • weight gain
  • chest pain

Due to Rogaine increasing a person's sensitivity to sunlight, there is also a greater likelihood of them experiencing a sunburn. So users should take precautions to prevent overexposure. Some people using the higher strength, 5% solution have reported excessive hair growth in places they do not want it, such as the forehead or cheeks. People can also be allergic to minoxidil or other ingredients that the manufacturers use in the medication.

Disadvantages of Rogaine for Women

rogaine for women

Image by StockSnap from Pixabay

There also are some disadvantages to taking minoxidil as a hair loss treatment. These include:

It is expensive

Buying Rogaine for women can cost about $30 for two ounces, but a generic form of minoxidil 2% costs almost half the price. It's also something you have to continue using indefinitely because the results go away if you stop the medication, Yang says.

It can be inconvenient

You have to apply it to the scalp two times a day.

It can cause unwanted hair growth

Some women may experience facial hair growth when they use minoxidil. That can happen if the medication trickles down onto your face or simply as a side effect when you apply it only to your scalp. The risk is lower for women who use the 2 percent concentration of the drug, as opposed to the 5 percent concentration that is designed for men.

It can cause more hair loss at first

You may notice an increase in hair loss during the first two to four weeks of using minoxidil, Yang says. That happens because new ones are pushing some of the old hairs out, she says.

It can take months to see results

You have to use it for at least four months — and possibly a year — before you see results. Even then, only about one in five women will have moderate hair regrowth, with a larger percentage noticing only that their hair loss seems to slow down or stop.

It can irritate your skin

You may experience some irritation, flaking, and redness.

It's not easy knowing you may never have the same long locks or hairstyles you had when you were younger, but minoxidil is a relatively easy, safe way to fight the loss of your hair.


rogaine for women

Photo by Tim Mossholder on Unsplash

When it comes to drug treatments for androgenetic alopecia, women are in a difficult position. While many drugs may work to some degree for certain women, doctors hesitate to prescribe them. What's more, drug companies are not falling over themselves to test drugs specifically for their ability to prevent and treat female pattern baldness.

Physicians are reluctant to prescribe systemic treatments (pills or other forms of treatment that affects your entire system) because they can tamper with your body's own androgen levels. The doctor will first want to confirm that the hair loss is due to an excess of androgen (another name for male hormones) in the system or a sensitized "over-response" to normal amounts of androgen. Therefore, physicians often choose topical treatments, which are applied directly to the scalp.

Beginning treatment as soon as possible after the hair loss begins gives the best results, because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will help prevent further damage. It also encourages some hair regrowth from follicles that have been dormant but are still viable. Stopping treatment will result in the hair loss resuming if the androgens are not kept in check in some other way. Maintaining your vitamin and mineral levels helps while you are on anti-androgen medications.

Treatment Options for Hair Loss in Women

Below, you will find a list of treatments used to treat hair loss in women. Currently, there is only one FDA-approved treatment for female pattern hair loss. Others have not been approved by the FDA for this particular application. However, they have been approved for other applications and are used "off-label" to treat hair loss.

The effectiveness of these agents and methods varies from person to person, but many women have found that using these treatments have made a positive difference in their hair and their self-esteem. As always, treatments have the best chance of being effective if they are geared to the cause of hair loss as well as to triggering hair growth.

Minoxidil (Rogaine)

Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil developed excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth.

Spironolactone (Aldactone) (Androgen Receptor Inhibitor)

Spironolactone, brand name Aldactone, is in a class of drugs called potassium-sparing diuretics (often called water pills). Spironolactone is typically used to reduce fluid in your body without causing the loss of potassium. It is also used to treat potassium deficiency, high blood pressure (hypertension), swelling (edema), and a hormonal disorder called hyperaldosteronism. Spironolactone acts as an anti-androgen in two ways. First, it slows down the production of androgens in the adrenal glands and ovaries. Second, it blocks the action of androgens in part by preventing dihydrotestosterone (DHT) from binding to its androgenetic receptors.

Cimetidine (Tagamet) (Androgen Receptor Inhibitor)

Cimetidine, brand name Tagamet, belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a powerful anti-androgenic effect and has been shown to block dihydrotestosterone form binding the follicle receptor sites. Cimetidine has been used to treat excess facial hair growth (hirsutism) in women. It has shown promising results in studies of women with androgenic alopecia. High doses are needed to achieve results. This means men should not take cimetidine to treat their hair loss due to possible feminizing effects. These include adverse sexual side effects.

Cyproterone Acetate

Cyproterone acetate is used to reduce excessive sex drive in men and to treat pronounced sexual aggression. It is also prescribed for severe hirsutism in a woman of childbearing age and for androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of dihydrotestosterone (DHT) to its receptors. Cyproterone acetate is not available in the U.S. Doctors consider it one of the last resorts for treating female pattern hair loss because of its possible toxicity and long-term side effects. As with any drug, side effects other than those listed on the package may occur. Contact your doctor if you notice a side effect that is unusual or particularly bothersome.

Estrogen and Progesterone

Estrogen and progesterone pills and creams may be an effective treatment for women with androgenetic alopecia who are going through menopause or whose estrogen and/or progesterone are lacking for other reasons.

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