The good news is there are things women over 50 can do to stop or minimize hair loss and help jumpstart re-growth. The bad news is not everything works for every woman. With all the choices available, it’s helpful to get feedback from experts about remedies that work — and those that don’t.
The experts weigh in on Rogaine, Propecia, spironolactone, corticosteroids, and biotin
The doctors I spoke with give the green light to these five most-talked-about solutions, but emphasize that any treatment should be under the guidance of a medical specialist. All agree there is still plenty of room for new developments and concrete evidence from clinical trials in progress. Cloning anyone?
Dr. Joshua Zeichner, Director of Cosmetic and Clinical Research in the Department of Dermatology at Mount Sinai Medical Center in New York City, gets it just right: "Treatment for female pattern baldness is a challenge and we need more clinical trials to assess which medicines really do work. There is no single solution and many different treatment options."
Rogaine is the brand name for the topical over-the-counter drug minoxidil and is available in 2 % strength for women and 5 % strength for men. It seems to work best for women with thinning hair in the crown area and those with early hair loss. It's proven to reverse hair loss by increasing the blood supply to the scalp and revitalizing shrunken follicles. You have to use it daily for life to maintain growth although it can plateau and stop working or not work at all for some women. It is the only OTC topical drug approved by the FDA for hair loss and regrowth. Dermatologists often direct female patients to try the 5% male version in the newer foam formula. Be careful not to get any on your face! Although the market is clogged with other generic brands of 2% minoxidil hair regrowth topicals marketed to women, Rogaine is the only one actually approved by the FDA to date.
Propecia is the brand name for finasteride, a daily prescription-only pill that is a DHT blocker. It works by inhibiting the enzyme 5-alpha reductase which in turn inhibits production of the hair follicle killer DHT. And again the benefits stop if you stop taking it. Propecia is approved by the FDA for hair loss in men but is only prescribed cautiously for women who are past menopause since it can cause serious birth defects in male fetuses. Sometimes Rogaine and Propecia are suggested as a duo solution. Either one or both as a team work for some women although they are far from being a surefire solution.
Some drugs are prescribed "off-label" to deal with hair loss. One of these is spironolactone (Aldactone is the brand name), a diuretic or water pill used to reduce excess fluid in the body without causing potassium loss. It's also used to treat high blood pressure. Off-label it slows down production of androgens in the adrenals and ovaries of women and blocks DHT from binding to the hair follicles, thereby preventing shrinkage of the follicles and ultimate loss. Another off-label DHT inhibitor sometimes prescribed for women (but more often for men) is Avodart, the brand name for dutasteride.
Monthly injections of cortisone- an anti-inflammatory- directly onto the scalp are a treatment for alopecia areata, hair loss in quarter size bald patches. This is usually an autoimmune disorder. This procedure does not work for genetic female pattern baldness.
Biotin, B-vitamins and other vitamin supplements
While supplements are no substitute for a healthy hair-friendly diet, most dermatologists say extra biotin (vitamin B7) is a good idea. The recommended daily intake (RDI) for biotin is 300 mcg but higher dosages are often suggested by doctors as being more effective. Dr. Fredric Brandt, with dermatology practices in N. Y. C. and Coral Gables, Florida, says, "Biotin supplements of 5,000 mcg a day do help promote healthier hair.” A diet that is inadequate in B vitamins, iron or protein can trigger shedding although a trendy high protein diet can also be a culprit.
Dr. Joshua Zeicher adds, “Low levels of vitamin B12 have been associated with alopecia for years, and I treat some patients with female pattern hair loss with vitamin B-complex shots every two to four weeks. The patients are satisfied and feel that they are not only losing less hair but also growing hair in some cases. Biotin is another vitamin in the B family that is important for hair and nail growth. It is not in the complex we inject here at Mt. Sinai and we sometimes recommend patients take biotin supplements. Some women do report that their hair has improved with the addition of these vitamins to their diet.”
No one-size-fits-all solution
If you're thinking hair loss treatments are still pretty much a case of trial and error, you're absolutely right. Every woman experiencing hair loss is an individual, personal case. There is no one-size-fits-all answer — your treatment choice depends on factors unique to you.
For example, Beverly Hills hair restoration surgeon Dr. Gary Perrault says, "For some patients a prescription for the drug spironolactone stops female pattern baldness cold. For others, it doesn't work at all." He adds, "Rogaine can be very helpful in prolonging the growth cycle of the hair but some women find it a chore and say it interferes with their styling routine. I encourage even transplant patients to use it once a day before bed. However, I'm not a fan of vitamin supplements that claim to combat hair loss — a healthy diet should be the basis for getting nutritional benefits."
Dr. Catherine A. Orentreich of the Orentreich Medical Group in New York City is a female hair loss specialist who sometimes finds patients resistant to using topicals like minoxidil. She notes, "Rogaine can be sticky and if you don't wash your hair every day your scalp can feel itchy. Women say they don't want to mess up their hair by using it. I see attractive women in their 50s all the time with recession so advanced you can see through the hair to the scalp. Even when I suggest topical treatments and oral medication they sometimes resist. What any hair loss doctor hopes to accomplish is to stabilize the loss and minimize it- stop the shedding. What works best is different for every patient depending on the cause and degree of shedding. But patients themselves need to be open to treatment and trying different solutions to achieve the best results."
Dr. Joshua Zeichner agrees that not everything works for everyone: "Hair loss in women is a complex issue without an easy solution. Some doctors are actually injecting minoxidil along with other active ingredients directly into the scalp to stimulate the roots of the hair. Some dermatologists treat female pattern hair loss with a hormonal approach. Some give their post menopausal patients the drugs finasteride or dutasteride to block the conversion of testosterone to dihydrotestosterone (DHT) which is a more powerful androgen. Others prescribe spironolactone, a pill used at high doses to treat blood pressure which can be used at lower doses to decrease production of testosterone and block DHT."
Other supplements and vitamins to nourish thin hair and combat hair loss
Nutritional deficiencies can play a role in hair loss and doctors agree that extreme diets and inadequate nutrition are a bad idea for overall hair health. Dr. Deborah S. Sarnoff, Director of Dermatologic Surgery at Cosmetique in New York City and Clinical Professor of Dermatology at New York University Medical Center says diet matters: "You can't beat a healthy balanced diet for maintaining healthy hair. Supplements should not be viewed as a replacement for the protein we get from eggs, fish, poultry and soy or the vitamins and minerals we get from fresh vegetables and fruit. However, I do think omega-3 fatty acids help. So can biotin — it strengthens hair and nails."
A balanced diet is a good idea for overall health, but just switching from a fad diet back to good nutrition won't improve your hair quality overnight, especially if your dieting has been extreme and long-term for years. Malnutrition can produce hair loss. Dr. Catherine A. Orentreich says, "Extreme protein diets and acute weight loss can trigger hair loss, so we test for iron and vitamin D deficiency."
Vitamins created specifically for hair are as common as calcium supplements. Just check out any drugstore, mass retailer or look online under hair vitamins. Some are complexes of B vitamins, botanical and marine extracts, fish oil and minerals especially zinc and selenium. Biotin does seem to keep cropping up with the doctors — well, it can't hurt — although if your diet includes salmon, egg yolks, red meat, carrots, sardines and bananas, you're not likely to be biotin-deficient in the first place. You can find fancy French brands like Phyto Phytophanere with biotin, marine gelatin and fish oil ($42.90, click here to buy), or the Finnish Viviscal with vitamin C, silica and marine proteins ($40.32, click here to buy).
I have to confess here that even I, the beauty editor skeptic, have been taking Viviscal daily for three years. I swear it works. It's one of those cult beauty editor products that caught on. My hair was thinning, breaking and now (knock wood) it's thick as Barbie hair. So who knows? It's worth a shot. Others I keep hearing good things about are Provillus Hair Support For Women Capsules with horsetail silica, biotin and B-6 ($24.99, click here to buy) and Sephren Hair Loss Dietary Supplement with biotin, B6, amino acids, magnesium and horsetail silica from the makers of Procerin for Men ($34.95, click here to buy).
For more great information, purchase and download Great Hair after 50: Hip hairstyles, best products for healthy hair, coloring secrets, whether (and how) to go gray, managing fine or frizzy hair, and solutions for thinning hair and hair loss and you'll be looking fabulous by tomorrow!