Hair Transplants and Medical Therapy in Women

Attendee: Men can use Propecia, why can’t women take it?

Dr. Bernstein: That is a good question. Propecia blocks DHT and DHT is the cause of androgenetic hair loss in men. As we just said, in women, the mechanism is not only related to DHT, it is also related to aromatase, so Propecia is not as effective in women. And we know in post-menopausal women, it is not effective at all.

It may be effective in a subset of pre-menopausal women, because some women have increased androgens causing the hair loss. However, even if it were effective, pre-menopausal women cannot take Propecia because it causes birth defects.

In other words, if women ingest Finasteride during pregnancy, it can cause birth defects, if there is a male fetus. 5-alpha-reductase, the enzyme that Propecia blocks, allows for the development of the male external genitalia in the late first and early second trimester.

On the other hand, men can take it, impregnate a woman, and continue to take it during the woman’s pregnancy and there is no problem, there is no risk. However, it is not okay for the woman to take it; it is just okay for the man to take it during the pregnancy.

Attendee: And, so you are saying that in post-menopausal women it doesn’t work?

Dr. Bernstein: No it does not, which leads us to the third type of hair loss, which we did not mention yet. We have the DHT- dependent hair loss that produces the pattern in men, the more diffuse hair loss that we see more commonly in women, and the hair loss of aging. Hair loss associated with normal aging is not discussed much, but what happens over time is your hair gets gradually thinner all over and this happens in both men and women.

Patients often ask, “Is my hair transplant permanent?” The answer is, yes. The hair restoration, if done properly, i.e. is taken from the permanent zone, will be permanent. However, the texture of one’s hair changes over time and so the texture of hair transplants will change over time too. That is not necessarily a bad thing because you do not want to have hair in one part of the scalp that does not match the hair in another.

Attendee: If a particular woman is not a good candidate for a hair transplant and she cannot take Propecia, is there anything else that she can do?

Dr. Bernstein: There are actually a lot of things that she can do.

The most common thing to do to camouflage baldness is to lighten your hair. Often women that are thinning darken their hair as they think that this will make them look younger. Although this may be the case, darkening the hair also makes it appear thinner. If you lighten it, it actually reflects more light and it looks fuller. Streaking your hair, coloring your hair, highlighting your hair, all will actually make the hair look full. Waving, curling or perming one’s hair will give the hair more body and make it appear fuller.

The next thing one can do is to part the hair off to the side. Usually people do not bald completely symmetrical, so usually one side is slightly thicker. People usually part their hair on the thin side, because that is where the hair falls. If one parts their hair on the other side then it often will look fuller. So lightening your hair, changing the part, perming it, or adding a wave are all things that you can do if surgical hair restoration is not appropriate.

Another useful technique is cosmetic camouflage. There are a number of products that one can add to the scalp to make it appear more full. They come in powders, creams, lotions, and gels that add both thickness to the hair and leave a residue on the scalp – making the hair look much thicker. They are extremely effective in women. In men that are shinny bald, it can look strange or unnatural. However, in women who have some hair coverage, it can look great. You don’t need that much hair for it to be effective.

The other thing that you can do is use a hairpiece, but his should be reserved for the most extensive hair loss.

There is a drug called Spironolactone, which is a diuretic used for blood pressure control, that blocks androgens that can sometimes benefit women with hair loss, but I generally do not think the risk benefit for this medication is worthwhile.

Rogaine does not really help that much and I think most people find it is a nuisance to use and it is a little bit sticky; it mats your hair down so you lose the fluffiness. You might gain a little bit of hair back from the Rogaine but cosmetically it does not look as good because of its stickiness, so it is kind of a wash.


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