The Latest on Treatments for Hair Loss, Hair Thinning and Alopecia

The Latest on Treatments for Hair Loss, Hair Thinning and Alopecia

By: Holly L. Thacker, MD • Posted on June 03, 2024

Hair Thinning, Hair Loss, Alopecia - What Can You Do?

As we celebrate Father's Day, it’s a time to celebrate Dads everywhere and those male relatives who help raise the next generation. A common issue most males experience with age is “male pattern alopecia.” Alopecia is the medical term for hair loss. It is also termed “androgenic alopecia.” This same process can occur in genetically sensitized females and we term it “female patterned hair thinning.” Female patterned hair thinning is the same physiologic process of the normal human androgens hormones (made in adrenal glands and ovaries in females and testis in males) acting on genetically susceptible hair follicles, which is usually the temples and the top crown part of the head.

Luckily, women don’t become bald (like many men do) from this androgenic hair thinning. However, women can lose their hair especially at the time of midlife when there are dips and eventual absence of estrogen, which is made in the eggs in the ovaries.

Most women will see some hair thinning with age

For centuries, long, plush, shiny hair has been a mark of female. Some females seem to be so attuned to hair like my granddaughter Artemis, who from a young age commented on hair quantity and hair length. So when women, who are genetically predisposed to androgenic hair thinning, note excessive hair shedding, many panic and have visions of being bald. This panic can increase the stress hormones made in the adrenal glands which in turn worsens the hair shedding which in turn worsens the panic. A vicious cycle ensues. 

Part of the treatment for women with hair loss includes controlling stress and anxiety. Rest assured, complete hair loss, called alopecia totalis, is very rare in women. However, just like our bodies change with age, most women will note some hair thinning with age. I set the expectation that 40 percent of women will lose at least 40 percent of their hair.

Causes of hair loss

If you notice more than 150 hairs shed per day (compared to the usual 100 hairs), it is time to be evaluated by a physician and/or trained Advanced Practice clinician like a Certified Nurse Practitioner (CNP) or Physician Assistant (PA) who is sensitive to your concerns.

  • Sometimes hair loss is just transitory from "telogen effluvium" which occurs when the resting and growing phases of hair growth are out of synch.
  • Nutritional deficiencies are another cause. Conditions that result in low iron stores contributes to hair loss. Optimal ferritin/iron stores are around a level of 50-70.
  • Low zinc levels under 60 are another contributing factor for hair loss.
  • Vitamin D levels optimally should be around 75 (high normal) to promote hair growth.
  • Lack of good quality protein in the diet impairs hair growth.
  • Low vitamin E levels and trace mineral deficiencies can also contribute to hair loss.
  • Some medications are associated with hair loss (like chemotherapy) while some oral and topical minoxidil is associated with hair growth.
  • Autoimmune conditions like scarring alopecia can occur and these patients need specialty dermatology evaluation and treatment.
  • Alopecia areata which can cause circular patches of hair loss can be managed with steroid injections by a trained dermatologist.

As far as female patterned hair loss, 90 percent is genetic and 10 percent is hormonal. At menopause, estrogen levels plummet and this can unmask the androgen driven hair loss in women as androgens are still made even when female eggs run out and thus estrogen production virtually stops.

Postmenopausal estrogen therapy (particularly oral estrogen) is beneficial to the skin, hair, the mucosal membranes like the vagina, and the bones which are very sensitive to estrogen loss. Oral estrogen reduces androgen levels whereas transdermal Hormone Therapy does not.

Should you start on expensive vitamins and hair care products?

It is most important to optimize your health habits and diet before spending hundreds of dollars on products that may or may not be helpful to you. Many vitamins and “hair care vitamins” contain Biotin (also known as B7), which may or may not help you but will certainly interfere with hormone lab work, thyroid labs and cardiac testing. In general, biotin helps with fingernails far more than the hair on our heads. Gelatin capsules, collagen supplements and increasing protein in your diet may help improve nails and hair.

Ask your physician for recommendations

Our dermatology group has a small shop that is staffed by our terrific skin care aestheticians that offer medical grade skin products and some hair care vitamins. It is best to get a recommendation from your family physician or dermatologist as to what expensive hair vitamin might be worth trying.

Hair vitamins

  1. Votesse® is a hair vitamin complex that does NOT contain biotin but does contain vitamins, trace minerals, 0.8mg of iron, 10mg of zinc B complex vitamins, 10mg of zinc, Ashwaganda root extract (which reduces adrenal stress) and probiotic hormones - at a dose of 2 capsules twice a day. 
  2. Nutrafol® is a hair vitamin complex with a different formulation for PRE-menopausal woman and POST-menopausal women. This vitamin dose contains a hefty dose of biotin 2,500mg which is enough to interfere with laboratory testing.
    • The postmenopausal version contains the herb saw palmetto which reduces androgen levels (sometimes used by men with enlarged prostate) and is also recommended by dermatologists to women with androgen excess. 
    • The premenopausal version does NOT contain saw palmetto. The vitamin complex contains zinc 20mg, vitamin E, vitamin A at 167% RDA (which over time can be toxic) and a Nutrafol blend of amino acids, collagen, resveratrol, liposomal curcumin and twice the RDA of selenium as well as fish components. It is 4 capsules daily and I would not recommend taking for more than 6 months straight without reassessment by a physician.
There are actually 4 types of Nutrafol: 
  1. Nutrafol Women/Women's Vegan (ages 18-44)
  2. Nutrafol Women’s Balance (45 years plus)
  3. Nutrafol Postpartum (includes 3,000 mg biotin, 15 mg zinc, omega 3 fatty acids, fish shatavari extract, nettle root, pea sprout extract and sea buckthorn powder)
  4. Nutrafol Men (has the highest concentration of saw palmetto). Many hair vitamins contain horsetail extract (silica) which is important for collagen and might support hair strength, shine and scalp health.

PRO-TIP - always bring in your vitamin bottles when seeing your physician, dermatologist or healthcare clinician. And if you have seafood allergies, you need to avoid marine collagen.

Other over the counter hair vitamin options

  • Topical minoxidil (High potency, 5% Rogaine foam) - can be applied to the scalp nightly and/or on the eyebrow with a Q-Tip
  • RevitaLash - contains topical peptides, biotin and conditioners
  • Topical castor oil and rosemary oil - these have been used topically for eyelash, eyebrow and top of head hair growth

Prescription products

  • Topical liquid (bimotoprost) - this is used for glaucoma (for example Latisse®) and can be applied to the eye lash line
  • Aldactone/Spironolactone® - this is a potassium sparing diuretic that blocks DHT's (di-hydrotestosterone) effects on the hair follicle and is used orally
  • Oral Minoxidil - in low dose this is sometimes prescribed by dermatologists for hair loss
  • Off label Proscar® (finasteride) - this is sometimes prescribed for hair loss in females
  • Propecia® - this is 1mg of finasteride and is FDA approved to treat male pattern alopecia

Other dermatologic options

  • Laser hair combs/caps/bands - look for one that offers a money back guarantee
  • PRP (Platelet Rich Plasma) scalp injections - these are cash pay and performed by hair dermatologists
  • Hair transplants - these are performed by dermatologic cosmetic surgeons

Tips, tricks and therapies for women suffering from hair thinning

While I can prescribe hormone therapy and treat vitamin deficiencies, I have not been trained in cosmetology. While some men with male pattern hair thinning simply shave their heads, most women do not want to do that. Some of my patients have taught me clever tricks that I have been able to share with other patients who suffer from hair thinning.

Styling tips to minimize the part line

  • Having hair color if possible approximate the scalp color
  • Using hair shampoos that contain silicone to coat the hair and thicken the appearance of the mane
  • Using a clever product that comes in several hair colors called TOPPIK that is put on hair and scalp to make the hair look instantly thicker
  • Experiment with wigs, hair pieces, hair extensions, and detachable hair band extensions as well as using stylish hats

When to see a dermatologist that specializes in hair loss

  • Hair loss is rapid, patchy and associated with other symptoms
  • If you are still seeing excessive hair shedding, when you have been assessed already for vitamin deficiencies and hormonal imbalances and have improved your diet, lifestyle and controlled your stressors
  • You have documented more than 150 hairs shed per day and have a family history of androgen hair thinning
  • You are interested in pursing out of pocket hair loss therapies such as PRP
  • If your primary care physician thinks you may need a scalp biopsy

So ladies, while I can not change what genetics you inherited from your dear ole' Dad and Mom, there are medical, hormonal, and cosmetic options that are available to help you feel and look good. Having confidence is an important part of being strong, healthy and in charge! Strength is something that needs to be fostered in everyone and many fathers help us develop our strength and fortitude.

Cheers to all of those devoted Dads who have helped their children Be Strong, Be Healthy, and grow up to Be in Charge!

Happy Father's Day!
-Holly L. Thacker, MD

About Holly L. Thacker, MD

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.

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