Female Pattern Hair Loss Treatment
Topical minoxidil is the treatment of choice for FPHL. Start therapy with 2 % minoxidil twice daily. It is important to counsel the patient as to the proper method for application. The solution needs to be applied to the scalp (not just the hair!) in the areas of thinning. This can be accomplished by parting the hair and using a dropper or applying the solution with a large Q-tip. Most women do not like using the rolling applicator currently attached to the brand name product (Rogaine). The hair should be dry or mainly dry to avoid diluting the medication. The second application of the day should be performed at least 2 hours before bedtime to avoid getting the minoxidil on the pillowcase with subsequent transfer to the face (and the risk of increased facial hair). Application just after dinnertime is often convenient for the patient and easy to remember.
The main side effects with 2 % minoxidil are scalp irritation and increased facial hair, both of which occur in about 5% of patients. True contact allergy to minoxidil is uncommon and occurs in <1% of patients. If irritation occurs, a trial of a preparation of propylene glycol (PG)-free minoxidil can be beneficial. This can be obtained from a compounding pharmacy. An initial six month trial of topical 2% minoxidil is given. If there has been no improvement in the patient’s hair loss (determined by measuring part widths or possibly photography), another 6 months of minoxidil therapy is given. A decision should be made as to whether to continue the 2% solution or increase to the 5% solution. Patients can definitely respond to the 2% solution during the second 6 months of therapy. However, some patients will request an increase to the stronger minoxidil.
There are some drawbacks to the stronger solution including worse irritation, an increased chance of irritation (about 10%) and an increased chance of developing facial hair (about 10%). The irritation is usually caused by increased amounts of propylene glycol in the 5% product and therefore 5% PG-free minoxidil is often needed. Additionally, there may be some absorption of the stronger minoxidil and therefore it should not be used in patients who are pregnant or nursing. The 5% minoxidil solution often feels greasy to women and therefore patients often use the 2% in the morning and the 5% in the evening. In my experience, approximately 60 to 70% of women with FPHL respond to minoxidil therapy.
Minoxidil is the only FDA-approved therapy for FPHL and the most beneficial. Other medical therapies have been tried, but have either not been well-studied or have not shown significant benefit in studies. These include finasteride, spironolactone, oral contraceptives, cyproterone acetate (not available in the United States) or flutamide. Hair transplantation plays a role in the treatment of significant FPHL.