I have often told patients picking up prescriptions for hair loss that if they could come up with a foolproof, quick way to regrow hair, they could be a billionaire. I further explain that hair loss is a complicated problem – it has hormonal, behavioral and genetic factors that cause it. We can address hormonal and behavioral issues, but (at least for now) there is not much we can do for genetic issues. For this blog, we will focus on the hormonal causes and therapies tied to hair loss in both men and women.

The largest segment of the population that experiences hair loss is the male population. Many men who go bald have androgenic or androgenetic alopecia. This is sometimes referred to as “male pattern hair loss”. This results in a receding hairline, and a loss of hair thickness around the crown of the head. The main mechanism for this is the action of a hormone called dihydrotestosterone (DHT) on the hair follicle. DHT is the superpotent big brother of testosterone. DHT is produced by an enzyme in both males and females called 5-alpha reductase. 5-alpha reductase takes testosterone that is produced by the body (or added in via Hormone Replacement Therapy) and converts it to DHT. DHT is 10 times more potent than testosterone. This DHT has detrimental effects on the hair follicle, and results in hair loss.

This mechanism is significant in many patients. There are going to be men that, due to their genetics, produce more DHT than others. They may have a more active version of 5-alpha reductase due to their genetics, or they may produce more testosterone than other men, so there is more “raw material” able to be converted to DHT. These men can combat hair loss through both natural and pharmaceutical products. Pharmaceuticals that are often used are the drugs finasteride, a 5-alpha reductase inhibitor, in a 1 mg oral dose, and minoxidil topical products. Minoxidil was first used as a blood pressure lowering medication, as it dilates the blood vessels and reduces the pressure. Scientists discovered that when minoxidil is used topically, this blood vessel dilation allows more nutrient rich blood to flow to the hair follicle, and can allow hair to regrow. In the compounding pharmacy world, we used topical finasteride spray in a 0.1% concentration. This is a great product, as it allows the 5-alpha reductase inhibition (and subsequent anti-androgen effect) to occur directly at the site of the follicle. When we swallow drugs like finasteride, that anti-androgen effect takes place amongst ALL of the 5-alpha reductase enzymes. This has been found useful in men with enlarged prostate, but in men who are not having prostate issues, the drug could interfere with their normal androgen function. Natural products that can help men experiencing hair loss include saw palmetto, biotin (vitamin B7), and optimization of vitamin D levels.

In female patients, hair loss is often associated with thyroid dysfunction (either too high or too low), menopause, and high dose testosterone therapy. The mechanism relating to testosterone replacement is very similar to what happens in men, except in female patients, the testosterone is usually coming from an exogenous (outside) source. This is why it is important for female patients undergoing HRT to go to a provider who truly understands testosterone dosing in women. High doses of testosterone in females can make her feel like Wonder Woman in the short term, but there are many consequences to this type of therapy, including male pattern baldness. Thyroid dysfunction should always be corrected in both male and female patients as a first step. It is impossible to balance the sex hormones (estradiol, progesterone, testosterone etc.) unless the thyroid dysfunction is addressed. Relating to menopause, HRT can be beneficial on hair health. Adding in bioidentical estrogen and progesterone in a natural, therapeutic dose can have beneficial effects on hair. Finasteride sprays & tablets and minoxidil can both be used in female patients as well, however the finasteride dose proven effective for alopecia in females is 5mg, as opposed to 1mg in males. Minoxidil and finasteride can both be used in combination with one another, and we have often compounded the two in combination with one another for male and female patients.