What Is Pattern Hair Loss?
Pattern hair loss affects about 50% of all men and women, though with different patterns:
- Male pattern hair loss (androgenetic alopecia): Typically begins with recession at the temples and thinning at the crown.
- Female pattern hair loss: Usually presents as diffuse thinning across the central scalp while maintaining the frontal hairline. We call this an “inverted Christmas tree.”
- Women do not usually lose their frontal hairline, which does improve hair transplantation outcomes.
Both types result from a combination of genetic factors, hormones, and aging. Blood levels of hormones are generally normal in both men and women and not worth the expense to check. There are blood tests that are helpful to determine if you have adequate raw materials for hair growth (iron, zinc, vitamin D, and others), but those aren’t covered by insurance.
Treatment Options
Topical Treatments
- Rosemary and pumpkin seed oil. This can cause irritation and itching and is greasy, but it does have some evidence of modest improvement.
- Minoxidil (Rogaine® and generics).
- 5% solution/foam is recommended for both men and women.
- Apply once or twice daily to affected areas: twice is better but hard to remember.
- It can leave a bit of a residue and can be irritating with twice-daily use, so once a day is better than nothing.
- Time course:
- Initial shedding may occur in the first 2–4 weeks as it dislodges resting hairs.
- Improvement usually begins at 3–4 months.
- Maximum benefit at 12 months, which is maintained as long as you keep using it.
- Side effects: scalp irritation, unwanted hair growth elsewhere if the medication drips.
- The hairs that grow will be dependent on the medication: if you stop, you will notice shedding.
- It does NOT cause “all your hair to fall out” if you stop it: only those hairs it grew for you.
- Topical finasteride/dutasteride.
- Prescriptions needed; these need to be compounded. Topical application reduces the amount absorbed into the bloodstream.
- Compounds can also include other ingredients that help hair thinning: low-concentration tretinoin (Retin-A®), ketoconazole, latanoprost, and even may include your topical minoxidil. However, compounds are never covered by insurance and can run nearly $100 for a month’s supply.
- Side effects: may cause local irritation. Same time course as for topical minoxidil.
- It takes at least 3 months to see improvement and a year for maximum improvement, but it must be continued.
- Red light therapy (low-level laser light therapy).
- Devices vary in number of LEDs, output, how often to use, how often to replace, etc., and there are no head-to-head studies, so I cannot recommend a particular unit.
- Side effects: minimal; occasional scalp warmth, time investment.
Oral Medications
- Supplements.
- Saw palmetto: an anti-androgen, but dutasteride (Rx) is 3 times better at blocking the hormone receptor.
- Horsetail extract: an anti-androgen that is even less potent than saw palmetto.
- Biotin: biotin deficiency is associated with hair loss, but if you eat egg yolks, salmon, pork, nuts and seeds, sweet potatoes, mushrooms, avocados, legumes, and certain dairy products, then you aren’t biotin deficient. Biotin isn’t dangerous, but supplements over 2,500 mcg (same as 2.5 mg) can interfere with blood tests like thyroid and other hormone testing, and even the test that may help doctors detect a heart attack. I am not a fan of biotin supplements unless your diet is unusual.
- Creatine and other protein supplements: I do think that protein is important for muscle maintenance and perhaps for hair. Aim for about 1 g per pound of lean body weight per day.
- Oral minoxidil.
- Low-dose prescription (typically 0.25–5 mg daily).
- Very low dose (0.25 mg) has to be compounded, which ends up being more expensive, so generally we use 2.5 mg a day, which is the lowest commercially available dose.
- Side effects: increased body hair, fluid retention/leg swelling, dizziness.
- Finasteride/dutasteride.
- Blocks the male hormone receptor, which is important for both men and women with hair thinning.
- Pregnancy warning: contraindicated in women who are or may become pregnant due to birth defects.
- Side effects: depression, loss of libido, and sexual dysfunction.
- Controversy: post-finasteride syndrome. Some have claimed long-term sexual side effects from these medications. The study was flawed and I don’t see how a medicine could cause these issues years after taking it, but there are advocacy groups that are very vocal on social media.
- Spironolactone (for women).
- Technically used for blood pressure, but only affects it modestly.
- For hair loss, it blocks the androgen receptor.
- Safety: considered safe for women, including high-risk populations, with monitoring.
- Typical dose: 50–200 mg daily.
- Side effects: menstrual irregularities, hyperkalemia (requires monitoring).
Advanced Procedures
- Platelet-rich plasma (PRP). A series of injections, then regular maintenance sessions. Not covered by insurance.
- Hair transplantation. Underutilized, in my opinion; works great for men and women.
Have questions about hair loss, or want to talk through your options? You can book online or call the office at 423-528-8833. This page is for general education, not a substitute for a personal exam.