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Hair Loss in Women

Androgenetic alopecia the technical term for male pattern baldness also occurs in women. However, in women the process is milder resulting in less hair loss. Women usually retain a rim of hair along the frontal hairline. There is increased spacing between hairs so that the scalp becomes visible.

Most women with hair loss (androgenetic alopecia) have normal hormonal function thus extensive testing is usually not required unless other symptoms of hormonal imbalance are evident. Nevertheless, if you are losing your hair it is important to be sure that there are no underlying treatable medical conditions before you take hair growth medications

There is only one medication with proven treatment results for women - minoxidil (brand name Rogaine®). Finasteride has been tested and found not to work in women.

Use of Minoxidil

The evidence that minoxidil works comes from at least two placebo controlled trials. In one trial, which lasted 32 weeks, 550 women, aged 18 to 45, applied either minoxidil 2% or the lotion without minoxidil (placebo). In the women who received 2% minoxidil for 32 weeks, the hair counts on the scalp were significantly higher than in the women who received placebo. In a second study, hair growth was measured by weight. The treated group grew 45% more hair than the placebo treated group.

In women, minoxidil strengths greater than 2% were not more effective. In men, minoxidil 5% worked better than minoxidil 2%.

The exact mechanism by which minoxidil causes hair to re-grow is unknown. It is believed that minoxidil improves the microcirculation of the hair follicle and thus encourages the follicle to grow new hair. Direct stimulation of the hair follicle cells causing them to enter into a growth phase is a second possible mechanism.

Use of Finasteride

There are two problems with the use of finasteride in women. The first is that finasteride does not work. A study of 136 women who received finasteride or a placebo for 1 year showed no benefit from taking finasteride. The second problem: finasteride may cause abnormalities in the male infants should a women taking finasteride become pregnant. With only risks and no benefits there is no reason for women to take finasteride.

Questions & Answers

1) Is a prescription required to obtain minoxidil?
Minoxidil in a 2% concentration does not require a prescription. Higher concentrations can only be obtained with a prescription.

2) What are the most common side effects of minoxidil application?
The most common side effects of minoxidil include irritation of the scalp, dryness, itching and redness. Allergic contact dermatitis is also possible.

Because minoxidil is applied topically and has relatively poor skin penetration, little gets into the blood stream. Systemic side effects such as an increase in heart rate is unusual.

In some women, hair above the eyebrows and over the cheek bones may become more prominent. This usually disappears after one year even with continued use of minoxidil 2%. If the minoxidil is stopped the extra facial hair usually disappears in one to six months.

3) Can hair loss occur due to disease?
Yes. Hair loss can be caused by fungal infections, HIV infections, hypo and hyper thyroidism, lupus, syphilis, nutritional deficiencies and also some medications. In these cases, the hair loss is not the typical male or female pattern baldness.

4) Is minoxidil covered by extended health insurance?
Minoxidil is an over the counter medication and is not usually covered by drug plans.


Price Vera H. Drug Therapy: Treatment of Hairloss. The New England Journal of Medicine 1999; 341:964-973.

CPS Compendium of Pharmaceuticals and Specialties Thirty-fourth Edition 1999 Canadian Pharmacist Association

Rogaine® is a registered trademark of Pharmacia Upjohn Propecia® is a registered trademark of Merck & Co. Inc.

Last reviewed/updated: May 1, 2010

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