One of the most important issues facing patients is hair loss. Over 6 years ago I posted a blog on my Google Blog spot, but the information still holds true with little variation and has become more and more mainstream and bears repeating. Plus there were a lot of spelling mistakes
Female androgenetic alopecia, also known as "hormonal" hair loss, or in the older days male ( testosterone) pattern hair loss affects WOMEN to and it can be very frustrating.
Over 12 years in my practice of dermatology I have had the pleasure of carrying for over 1000 distinct females battling female androgenic alopecia, and it is a serious matter.
This blog is to bring to light my experience in the off label usage of the FDA approved agent finasteride for female hormonal hair loss. At this point, we have treated right around 800 females with Avodart, Proscar and less often Propecia.
Please know that this blog is informational only and not meant as direct medical advice.
All of the above agents are contraindicated for the use in females based on their proven birth defect issues ( teratogenicity) that can occur if a female were to become pregnant while these medications are in their system.
Fortunately, most females that battle hormonal hair loss are 50 years of age and older and most are past menopause, have had tubal ligation or hysterectomies.
50% of females by age 50, and 40% by age 40 have the start of hormonal hair loss. As men we were all raised to believe that it was going to happen, and in time it affects approximately 85% of men. But for women it tends to catch them more off guard.
My recommendations include the following, after careful discussion and counseling, and verify their infertility ( although occasionally we will use it in younger females on contraception and proper education).
1. Rogaine 5% twice daily works. It is over the counter and incredibly inexpensive if bought at a big box store. 85% of patients that use Rogaine or generic equivalent long term get to keep the hair they had the day they started, and 60% grow more hair over time. 2% Rogaine in my experience is not as effective, although other studies suggest in females they are similar.
2 Finasteride, sold in two FDA approved versions or their generic equivalent. Proscar - a 5 mg tablet made for male prostates, and a 1 mg tablet FDA approved for male pattern hair loss sold as Propecia.
Propecia is approximately $65-80 a month and going forward long term that it quite expensive. Proscar is a generic and when the tablet is cut into 1/4 it equals about $8 a month, smilar to big box store 5% Rogaine.
Proscar is a small tablet and impossible to cut into fifths, plus the quarters do not have to be equal as studies in men showed that even less then 1 mg of finesteride helped their male pattern hair loss.
There is some evidence that 5 mg daily grows some extra hairs per square inch. which is true, but it is a mild increase in the real world. however, if patients don't see an improvement over 6 months to meet their satisfaction we often increase the dose.
It takes around 6 months to see a difference based on the average telogen and anagen phase of human hair growth.
3. Avodert , a medication approved for male prostate enlargement, it works via the same mechanism as finesteride - it blocks the conversion of testosterone to dihydroxy - testosterone (DHT).
I have used this in the early 2000s with great success at 2 pills a week. It binds "tighter" to the enzyme 5 alpha reductase found in the hair follicles, more affinity then finasteride has, and it ha a much longer half life.
Back in the early 2000s they sent their hair loss data to several physicians that wrote for Propecia frequently around the nation for our review. The data is now published in the last 1-2 years and it was one Avodart tablet daily. and the results show increased hair growth and even more hairs per square inch then finasteride 5 mg a day. But the cost of a pill daily is near or more then $150 a month, and one pill twice a week in my experience in 200 plus females showed most did well at this dose and the cost is closer to $40 a month.
One study in males showed combing Rogaine 5% twice a day, with Propecia 1 mg a day, achieved faster results, but no greater results then either alone. So occasionally I will have my patients start with both but after 6 months stop one or the other.
Important information out of Canada this year suggests that men that take Propecia for years have an increased risk of breast cancer. Double that of men that don't take Propecia - 8 out of 100,000 versus 4 out of 100,000. Still low but important to know.
The question is then is their an increased risk of breast cancer in women. Having most likely the highest number of female patients treated with these agents over the last 10 years compared to any other single practice that we know of ( approximately 800 plus separate females) I have not seen such as trend etc. but we have not been looking for this directly.
Over 12 years in my practice of dermatology I have had the pleasure of carrying for over 1000 distinct females battling female androgenic alopecia, and it is a serious matter.
This blog is to bring to light my experience in the off label usage of the FDA approved agent finasteride for female hormonal hair loss. At this point, we have treated right around 800 females with Avodart, Proscar and less often Propecia.
Please know that this blog is informational only and not meant as direct medical advice.
All of the above agents are contraindicated for the use in females based on their proven birth defect issues ( teratogenicity) that can occur if a female were to become pregnant while these medications are in their system.
Fortunately, most females that battle hormonal hair loss are 50 years of age and older and most are past menopause, have had tubal ligation or hysterectomies.
50% of females by age 50, and 40% by age 40 have the start of hormonal hair loss. As men we were all raised to believe that it was going to happen, and in time it affects approximately 85% of men. But for women it tends to catch them more off guard.
My recommendations include the following, after careful discussion and counseling, and verify their infertility ( although occasionally we will use it in younger females on contraception and proper education).
1. Rogaine 5% twice daily works. It is over the counter and incredibly inexpensive if bought at a big box store. 85% of patients that use Rogaine or generic equivalent long term get to keep the hair they had the day they started, and 60% grow more hair over time. 2% Rogaine in my experience is not as effective, although other studies suggest in females they are similar.
2 Finasteride, sold in two FDA approved versions or their generic equivalent. Proscar - a 5 mg tablet made for male prostates, and a 1 mg tablet FDA approved for male pattern hair loss sold as Propecia.
Propecia is approximately $65-80 a month and going forward long term that it quite expensive. Proscar is a generic and when the tablet is cut into 1/4 it equals about $8 a month, smilar to big box store 5% Rogaine.
Proscar is a small tablet and impossible to cut into fifths, plus the quarters do not have to be equal as studies in men showed that even less then 1 mg of finesteride helped their male pattern hair loss.
There is some evidence that 5 mg daily grows some extra hairs per square inch. which is true, but it is a mild increase in the real world. however, if patients don't see an improvement over 6 months to meet their satisfaction we often increase the dose.
It takes around 6 months to see a difference based on the average telogen and anagen phase of human hair growth.
3. Avodert , a medication approved for male prostate enlargement, it works via the same mechanism as finesteride - it blocks the conversion of testosterone to dihydroxy - testosterone (DHT).
I have used this in the early 2000s with great success at 2 pills a week. It binds "tighter" to the enzyme 5 alpha reductase found in the hair follicles, more affinity then finasteride has, and it ha a much longer half life.
Back in the early 2000s they sent their hair loss data to several physicians that wrote for Propecia frequently around the nation for our review. The data is now published in the last 1-2 years and it was one Avodart tablet daily. and the results show increased hair growth and even more hairs per square inch then finasteride 5 mg a day. But the cost of a pill daily is near or more then $150 a month, and one pill twice a week in my experience in 200 plus females showed most did well at this dose and the cost is closer to $40 a month.
One study in males showed combing Rogaine 5% twice a day, with Propecia 1 mg a day, achieved faster results, but no greater results then either alone. So occasionally I will have my patients start with both but after 6 months stop one or the other.
Important information out of Canada this year suggests that men that take Propecia for years have an increased risk of breast cancer. Double that of men that don't take Propecia - 8 out of 100,000 versus 4 out of 100,000. Still low but important to know.
The question is then is their an increased risk of breast cancer in women. Having most likely the highest number of female patients treated with these agents over the last 10 years compared to any other single practice that we know of ( approximately 800 plus separate females) I have not seen such as trend etc. but we have not been looking for this directly.
Posted 16th October 2012 by Dr. Tasso Pappas MD
