I wanted to talk about female hair loss, female androgenetic alopecia.
I haven't talked about this for a long time for various reasons, and I'm going to tell you a bit about what seems to me, or my most optimal approach to treatment, the most optimal management that a woman with this baldness can do.
Let's remember that female androgenetic alopecia results in thin hair. And I say "let's remember" because usually women, the vast majority of them, are extremely confused, and it's very difficult to change that confusion. Hair loss in general has absolutely no relevance. Yes, you might be thinking, "But I'm losing a lot of hair, strands every day." You're not going bald. The issue is the thinness. That's what makes you go bald.
Whether the hair falls more before or after, or if there's more hair loss after childbirth, it's not related to this. That myth has caused a lot of harm in diagnosing and treating alopecia in women. In other words, all of us experience periodic hair shedding with no significance. But there's a small percentage of women who also have thin hair, and these women, let's say, are not usually well-diagnosed or well-treated because they're labeled with "hair loss." "Come on, take vitamins, take this." And obviously, in that context of the disease, it's not going to do anything, so we're not solving the problem.
In summary, if you're a woman and you're genuinely going bald, that is, your part is becoming wider, this post is for you. But if, on the contrary, your feeling is that your hair is falling, this post, I'll tell you, most likely, is not for you. It's highly probable that you don't have any problem and it's just small cycles of hair shedding with no relevance.
And I don't want to talk more about that issue, which has absolutely no medical importance. Let's talk about how important it is for women who are going bald. Although it's called the same as male androgenetic alopecia, female alopecia essentially is not the same, exactly. There's a certain common origin because it usually involves hormonal issues. But it has components that are different from male sex hormones.
In fact, I dare say that typically, when I see a young patient, a typical 15-year-old girl who starts with acne, with thinner hair, greasy hair, greasy face, and who's gradually becoming more bald, the parting widens, with more acne, that patient indeed has a masculine profile. It's much more manageable because it resembles more to a male, while that typical woman of 35 years, 40 years, who also doesn't have cystic acne, normal menstrual cycles, not much hormonal component, of course, will improve with medication, but will never improve as much as a man or a younger woman with that masculine profile.
Alright, so, right from the start, female androgenetic alopecia, many times I like to differentiate it if there's an identifiable cause that is worsening it. For instance, adrenal alterations, an altered BOP, polycystic, or a genetic basis, meaning that in the family, there are bald men and women. Or most commonly, a woman might have had thin hair in the family, both in men and women, but there's no underlying hormonal cause. That's the majority of women, and in both groups, the prognosis is going to change quite a bit whether all of this appears before the age of 25 or appears after menopause.
Obviously, the impact, the prognosis is good because alopecia, even if it continues to progress, if treated, improves and remains quite well in the long term, although the treatment's effectiveness is less than if you're younger, as it's evident. So, this group of patients who perhaps have genetic alopecia at a younger age, if not treated, have a regular or poor prognosis because they end up becoming bald over the years, like men, obviously. But, however, usually with treatment, they respond quite quickly.
Okay. I also think it's because there's a hormonal component underneath that is much more responsive to the medication currently available. Speaking of treatment, also, in my humble opinion, currently treating women, whether pre or post-menopausal, with pills is absolutely off-label use. In other words, topical estrogens, at least in my experience, because after many years in this, fall short for us. Which means your doctor has to know and has to be willing to give you oral medication, I insist, off-label. That is, these are medications that we know work and are safe to treat genetics, but they don't have an indication in the technical sheet for genetic alopecia.
It might have an indication for managing hypertension or as diuretics, or have indications, and the doctor has to use it just in that context. I'll also tell you that this video is a bit, I mean, a bit general, obviously, every woman is different, but I do say that, in general lines, my approach tends to be intensive treatment. Obviously, with pills. I recommend checking out my ranking video of female treatment, so you can see a bit about the different treatments. And generally, I suggest them for 18 to 24 months, starting from a year and a half or 2 years of treatment, the ideal improvements that can be achieved medically are already minimal. And that's the moment to take the next step, which would be the transplant.
Unlike men, where there are sometimes perhaps a few more complicated cases, I would say that, practically, in the entirety of women, it is possible to stabilize hair loss and improve it with medication. Although I insist, as I mentioned before, I refer you to the beginning of the video that improvements can vary depending on age and the type of hair loss you have based on your genetics. Let's say, a problem that many women face is that in view of the transplant, for instance, the adjacent area is usually worse than in men. And that's why I insist so much on providing medication to the girls, so that the adjacent area improves in the hypothetical case that a transplant is considered, maybe in the best possible situation.
I'll tell you that over the years, I've come to realize that although the basic treatment for women always involves medication because there's no alternative, I believe, unlike men, I'll say here a bold comment: all women benefit from a hair transplant. Be careful, do you know why? Because the frontal area, which is what women usually complain about the most, that area improves with medication, but usually improves less than the rest. I often tell the girls that it's like men's receding hairlines, they need to be transplanted. So, regardless of whether the transplant is minor or major, I believe that if, after two years of medical treatment, they're not happy, they should at least consider a transplant in consultation, each with its characteristics. I think all of them would benefit.
Generally, transplants in women have a small peculiarity, it's usually not shaved, or at least the area where the hair is received isn’t shaved, and the adjacent area, the frontal area, I like to shave or do a small shave that's covered with the hair on top, which then recovers quite quickly.
Currently, the FUE, you know, hair by hair, is the technique of choice in most cases, over the strip, which might be a slightly older and perhaps a bit more painful technique, which can sometimes be done simultaneously. Unfortunately, the result is always a bit delayed, around 9-12 months.
So, ladies, in summary: obligatory medical treatment for everyone, usually at least two years. In two years, an evaluation can be done to assess if it makes sense to consider a long-term medical transplant, even reducing pills to maintain hair forever. Because, unlike men, women, in this day and age, 21st century, are still enslaved to taking pills. Because if not, the improvement they’ll have, they’ll lose it, and completely stopping pills in men, this doesn’t happen entirely.
I'll leave the link here to the video of treatments for female alopecia that I mentioned.
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