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Female Pattern Hair Loss

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Bernstein Medical Aids ISHRS’s ‘Operation Restore’ in Honor of Hair Loss Awareness Month

ISHRS Operation Restore

August was declared National Hair Loss Awareness Month by the American Academy of Dermatology (AAD) in 2001 in order to raise the public’s awareness of hair loss as a common problem affecting millions of men and women. In appreciation of this cause, Bernstein Medical – Center for Hair Restoration has launched a fundraiser for the International Society of Hair Restoration Surgery‘s (ISHRS) pro bono program, ‘Operation Restore.’ This program provides free hair transplants for those who experience localized hair loss due to trauma or illness.

Raising Awareness of Women’s Hair Loss

Now is the ideal time to bring awareness to women’s hair loss as the stigma of the topic has begun to diminish. Women’s hair loss is now frequently discussed in the media including television programs like the Dr. Oz Show and The Doctors, and in magazines such as Vogue, Cosmopolitan, The Wall Street Journal, New York Magazine, and New York Post.

Background

Androgenetic alopecia (common genetic hair loss) accounts for more than 95% of hair loss in both men and women. While some falsely believe that women do not experience hair loss, about 40 million women in the US alone are affected by hair loss, along with about 60 million men.

Other causes of hair loss include surgical and non-surgical trauma, congenital defects, auto-immune disease, and other medical illnesses. Radiation and cytostatic drugs or other forms of chemotherapy used in cancer treatments also causes hair loss. In cases where hair loss is localized, surgical hair restoration may provide benefit.

Our Cause

We understand the emotional toll hair loss can have on the individuals affected, especially when dealing with their other medical problems. Operation Restore and Bernstein Medical aim to help those who may benefit from hair transplant surgery by assisting in this process and covering expenses.

Dr. Bernstein has worked to advance the techniques of hair restoration and have helped tens of thousands of patients around the world. His pioneering work continues to make hair loss and its treatment more socially acceptable.

Click here to donate to Operation Restore! Bernstein Medical will match all donations made during this fundraising campaign. To qualify for the match, please ensure that you list “Bernstein Medical” in the “This Donation is Being Made on Behalf of:” box. Thank you for your support!

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Hair Restoration Research

Androgen Treatment May Boost Hair Regrowth in Women

A study published in the British Journal of Dermatology suggests that subcutaneous placement of testosterone pellets may boost hair regrowth in some women. ((Glaser RL, Dimitrakakis C, Messenger AG. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 2012 Feb;166(2):274-8.))

This retrospective analysis examined patients who had androgen deficiency. Of the 285 patients studied, 76 had some degree of hair loss prior to beginning treatment. At one year on testosterone replacement 63% reported an increase in hair regrowth on the scalp.

Traditionally, elevated levels of androgens, such as testosterone, are felt to be the primary cause for common hair loss in both men and women. This is due to the seemingly adverse effect of androgens on hair follicles. This has held true for most men with patterned hair loss in whom DHT-blockers, such as Propecia (finasteride) and Avodart (dutasteride), have proven to be a potent remedy.

Given this, it was surprising that none of the 285 women in the study who had been treated with testosterone reported any hair loss after one year. In fact, of the 76 women who initially reported hair loss before the study, 63% reported positive hair regrowth at one year.

The researchers noted that patients with a “significantly higher body mass index (BMI)” were in the subset of those who did not regrow any hair. This suggests that a higher dose might be needed in some patients. ((Kapp N1, Abitbol JL2, Mathé H2, Scherrer B2, Guillard H2, Gainer E2, Ulmann A2. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Contraceotion. 2015 Feb;91(2):97-104. doi: 10.1016/j.contraception.2014.11.001. Epub 2014 Nov 8.)), ((Lopez LM, Grimes DA, Chen M, Otterness C, Westhoff C, Edelman A, Helmerhorst FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD008452. DOI: 10.1002/14651858.CD008452.pub3)), ((Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2.))

Summary

By correlating higher levels of testosterone with more hair growth and/or retention in women, the study bolsters the idea that hair loss in men and women is caused by different mechanisms. Though not conclusive, the study opens the idea that testosterone implantation can effectively treat hair loss in women.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Survey Finds Red, Low-Level, Laser Light Therapy is an Effective, Alternate Treatment for Androgenic Alopecia

Currently, only two FDA approved medical treatments exist for androgenic alopecia — minoxidil (Rogaine) and finasteride (Propecia) — but these drugs are not effective in all individuals, and to remain effective, both require consistent, daily, life-long use. Additionally, finasteride is not FDA approved for use in women.

Because of the need for additional hair loss treatment options, researchers have begun to look at low-level light laser therapy (LLLT), specifically red and near-infrared LLLT, due to its ability to promote hair growth by stimulating hair follicle cells ((Mester E, Szende B, Tota JG. Effect of laser on hair growth in mice. Kiserl Orvostud 1967;19:628–631.)) — a process called cellular photo-biostimulatiostimulation.

While many studies have investigated the effects of red and near-infrared LLLT on hair loss, specifically in the ranges of 635 to 780nm, there’s been no comprehensive survey of these studies to see if this treatment option has a consistent, positive effect on androgenic alopecia (genetic balding) for men and women.

To answer this question, researchers from the Harvard Medical School surveyed ((Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med. 2014 Feb; 46(2):144-51.)) five clinical studies designed to measure the effects of LLLT on androgenic alopecia in both men and women. In each case, they found that red and near-infrared LLLT was a safe and effective treatment option for both men and women with genetic balding.

The authors propose that LLLT may work by supporting the anagen (growth) phase of the hair follicles affected by androgenic alopecia while also protecting them from alopecia’s inflammatory effects.

While the results in the studies were positive overall, the authors did note that the most therapeutic light wavelength and dosing remain to be determined.

Read more about Laser Therapy for Hair Loss

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can a Hair Transplant Treat an African-American Woman with Scarring Alopecia?

Q: I’m a 42 year old African-American woman and I’m losing hair on the crown of my head. Would I be a good candidate for a hair transplant? — E.E., Philadelphia, P.A.

A: Hair loss in the crown of an African American female can have several different etiologies, so the first thing to do is to make the right diagnosis. The most common causes of hair loss are androgenic alopecia (AGA) and scarring alopecia, also called ‘Central Centrifugal Cicatricial Alopecia,’ or CCCA. A biopsy is often useful to differentiate these two causes of hair loss when the diagnosis is unclear. A biopsy can also identify other, but less common, causes of crown hair loss.

AGA presents with a history of gradual thinning in the front and/or top of the scalp, a relative preservation of the frontal hairline, a positive family history of hair loss and the presence of miniaturization in the thinning areas. Miniaturization, the progressive decrease of the hair shaft’s diameter and length in response to hormones, can be identified using a hand-held device called a densitometer. If the diagnosis is AGA, then a hair transplant can be very successful provided there is enough donor hair.

CCCA presents as a progressive form of scarring alopecia that occurs almost exclusively in African American women. The onset of CCCA is very slow, typically developing over the course of years. CCCA starts near the vertex or top of the scalp and spreads in an outward direction. The involved area is usually smooth and shiny with decreased hair density.

Central Centrifugal Cicatricial Alopecia is diagnosed with a scalp biopsy performed in the area of hair loss. Those patients with CCCA are generally not candidates for a hair transplant procedure since the body may reject the transplanted hair. This condition is better treated with oral and injectable anti-inflammatory medications. Surgical treatment for cosmetic benefit may be an option in some cases after the disease has been inactive for many years.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Bernstein Medical Patient Writes About Female Hair Loss in Cosmopolitan Magazine

Thinning Hair Nightmare - Cosmopolitan Magazine - January 2014

A patient who visited Dr. Bernstein to learn about her hair loss authored an article on her experiences which appeared in the January 2014 issue of Cosmopolitan Magazine. In an article titled, “Thinning Hair Nightmare,” the patient wrote about her struggle in coping with thinning hair, the taboo of talking about women’s hair loss, and ways in which she attempted to overcome these physical and emotional difficulties.

On visiting Bernstein Medical – Center for Hair Restoration:

I dialed up New York dermatologist and hair transplant surgeon Robert Bernstein, MD — I’d just seen him on Oprah talking about hair loss, so he had to be good — and booked an appointment.

Dr. Bernstein ordered a blood test to rule out common hair loss causes, like thyroid disorders and hormone abnormalities, and he made sure my diet and any medications weren’t to blame. Everything came back normal.

On the diagnosis of hair loss in women:

During a follow-up visit, the doc broke out a densitometer — a crazy flashlight-looking tool that measures the changes in diameter between hair — dove into my mane, resurfacing moments later with a diagnosis: mild androgenetic alopecia, aka female pattern hair loss (FPHL). “It’s the most common type of hair loss in women, affecting perhaps one-third of the adult female population,” he explained. It occurs when a woman’s hair follicles shrink in response to her body’s own hormones.

On the taboo of female hair loss:

In search of solutions, I turned to the blogosphere… While the topic of female hair loss feels taboo, here were thousands of women talking openly — not just about the physicality of the issue but also its psychological toll. […] Whenever any conversation turns to hair, I push myself to talk openly about my issue. I’m determined not to let this condition make me feel ashamed. With more than 30 million U.S. women affected by FPHL, we should find strength in our numbers.

Dr. Bernstein was the featured guest on the Doctor Oz Show, where they discussed women’s hair loss and how the subject is often, unfortunately, considered taboo.

Consultations for female hair loss patients

Video: watch Dr. Bernstein and Dr. Mehmet Oz discuss the taboo of female hair loss

View before & after hair transplant photos of some of our female patients

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Female Androgenetic Alopecia?

Q: What is female androgenetic alopecia?

A: Female androgenetic alopecia, also called female pattern hair loss, is caused by the shrinking of susceptible hair follicles in response to normal levels of hormones (androgens). It is the most common type of hair loss in women, affecting perhaps 1/3 of the adult female population. It is seen as a general thinning over the entire scalp, but can also present in a more localized pattern i.e. just limited to the front and top. The condition is characterized by a gradual thinning and shortening (miniaturization) of individual hair follicles, rather than their complete loss and, although the condition tends to be progressive, it rarely leads to complete baldness.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Latisse Drug as Hair Loss Treatment? Trials Under Way on New Formulation of Bimatoprost

Latisse, the brand name for the drug bimatoprost, is commonly used to promote eyelash growth in women who want their eyelashes to be longer, thicker, and darker, typically for cosmetic reasons. It is also used to promote growth of eyebrow hair.

In a publication on ClinicalTrials.gov titled, “Safety and Pharmacokinetics Study of New Formulation of Bimatoprost in Patients With Alopecia,” Allergan, the pharmaceutical company that produces Latisse, has announced a new study on the safety and efficacy of a new formulation of bimatoprost for use as a topical hair loss treatment for general baldness.

The study, based out of Tempe, Arizona, will test two different formulations of bimatoprost in men who suffer from moderate male pattern baldness and women who have moderate female patterned alopecia.

According to the details of the study, the test involves, “One mL dose applied evenly onto pre-specified balding area on scalp – single dose in the am followed by multiple doses daily in the am for 14 days.” The goal of the testing is to measure the results of a single dose of bimatoprost, as well as multiple doses over time. The completion date of the study is February 2011, so we will look for the results and share them with you when they are available.

Update:

The results of the study have been published and it did not result in the FDA approving Latisse for hair loss on the scalp. Latisse was found to be not nearly as effective in treating hair loss as the control group that used minoxidil 5% solution. See the results of the study on ClinicalTrials.gov.

Visit our page on Latisse/Bimatoprost for more information on the drug and its off-label use. View the publication on ClinicalTrials.gov for more specifics on the study. Read about other medical hair loss treatments on our page on medications.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Is Hair Loss In Women Harder To Treat With A Hair Transplant Than Hair Loss In Men?

Q: Why is hair loss in women harder to treat with hair transplants than hair loss in men?

A: The majority of women present with diffuse hair loss (i.e. thinning all over) rather than the patterned hair loss seen in men (where the hair loss is localized to the front and top of the scalp).

Diffuse thinning presents two problems for a potential hair transplant candidate.

The first is that there is no permanent area where the hair can be taken from. If hair is taken from an area that is thinning, the transplanted hair will continue to thin after the procedure, since moving it doesn’t make it more permanent.

The second problem is that since the areas to be transplanted are thin, rather than completely bald, the existing hair in the area of the hair transplant is at some risk to shedding as a result of the procedure.

When women have a more defined pattern (i.e. more localized thinning on the front part of the scalp with a stable back and sides), they can make excellent candidates for surgery. This pattern occurs in about 20% of women. A small percentage of men have diffuse thinning and are, therefore, poor candidates for a hair restoration surgery as well.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can a Woman be a Candidate for a Hair Transplant?

Q: I am female and thinning can I be a candidate for a Follicular Unit Hair Transplant?

A: If it turns out that you have female pattern hair loss, you may be a candidate a hair transplant, but would need to be evaluated by a doctor who specializes in surgical hair restoration.

In the evaluation, you should have your degree of hair loss assessed and donor supply measured, using an instrument called a densitometer, to be certain that you have enough permanent donor hair to meet your desired goals. For more information about hair loss in women, please see the Diagnosis of Hair Loss in Women page of the Bernstein Medical – Center for Hair Restoration website.

If you are thinking about your hair loss and would like to be evaluated, go to the physician consult page to schedule a consultation.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why is there a Different Consultation Fee for Diffuse Thinning versus Patterned Hair Loss?

Q: Why is the consult fee more for diffuse thinning than for a regular visit? — B.F., Altherton, CA

A: Diffuse hair loss, more common in women, can be the result of a number of underlying medical conditions and therefore it usually requires an extended medical evaluation.

If you are a male or female with obvious diffuse thinning from androgenetic alopecia (common baldness), or if you have patterned hair loss where the diagnosis is straightforward, the fee is less because an extensive evaluation is not required.

Please visit our Hair Transplant Costs & Consultation Fees page for more information.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Transplant Treat Hair Loss from Traction Alopecia?

Q: I am a Caucasian female that has experienced hair loss on the sides of my head from the height of the eyebrow to the ear due to traction. The hair loss has been present since my teen years. My job requires me to wear my hair up most of the time. Although I don’t wear it nearly as tight, I seem to continue to lose my hair in the front and on the top of my head. My hair also used to be very thick as a child and is now quite thin. I’m not sure if this is normal or something else is going on, but I am definitely interested in a hair transplant. — M.H., Larchmont, NY

A: It sounds like you are experiencing continued traction alopecia. Unless the underlying cause is corrected (the traction), you can expect to continue to lose your hair. People that have traction alopecia can have thinning even from mild pulling that might not be a problem for others. Once you stop the pulling, it can take up to two years for the hair to return, although there may be permanent hair loss.

Surgical hair restoration is the treatment of choice for permanent hair loss from traction. If you have significant thinning on the sides, you may not be a candidate for hair transplantation since in this procedure we often need to harvest hair from the permanent area in the sides of the scalp as well as the back.

An additional problem (that you allude to) is that you may have underlying female pattern hair loss. This would further complicate the surgical treatment.

A careful examination (including densitometry) can sort these problems out and allow for more specific recommendations.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Loss in Women be Caused by Pregnancy, Prozac, or Hyperactive Thyroid?

Q: I had a baby 12 weeks ago and have recently been diagnosed with a hyperactive thyroid, although only slightly. I was also taking Prozac for 7-10 days. I am 27 and have been experiencing a significant amount of hair loss from all over my scalp. What are the chances that this would be permanent?

A: Based upon your history, you have three possible reasons for having a type of hair loss called telogen effluvium; thyroid disease, medication induced (Prozac) and pregnancy.

Telogen effluvium is diagnosed by a hair pull test and observing club hairs under the microscope. It is generally a reversible condition, regardless of the cause. Telogen effluvium most often occurs 2-3 months after the inducing event, so your pregnancy is the most likely cause. Prozac would less likely be the problem since you have only been on it for a short time. Besides causing Telogen effluvium, thyroid disease can also alter your hair characteristics, which can make your hair appear thinner.

Other causes of hair loss, such as genetic female pattern hair alopecia, must be ruled out. Please see the Hair Loss in Women page on the Bernstein Medical – Center for Hair Restoration website for more information.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Transplant Treat Diffuse Hair Loss in Women?

Q: My hair loss resembles the grade I female hair loss scale, but none of the male hair loss patterns. It has been relatively stable for the past five years and only recently has it begun to progress further. I began both Propecia and Rogaine two months ago, but the hair loss still continues at the same pace. I’m really worried. Does a hair transplant work in such a diffuse hair loss? — D.D., Park Slope, Brooklyn

A: If your hair loss is diffuse only on top, then a hair transplant will be effective. This condition is called Diffuse Patterned Alopecia or DPA.

If the diffuse pattern of hair loss affects the back and sides as well, then surgical hair restoration should be avoided. In this case (called Diffuse Unpatterned Alopecia or DUPA) the donor area is not permanent and the transplanted hair will continue to thin over time.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

U.K. Invests in Hair Cloning Research

The British government has awarded Intercytex a grant to automate the production of their new hair regeneration therapy. Intercytex is a cell therapy company that develops products to restore and regenerate skin and hair. Intercytex has partnered with a private company, The Automation Partnership (TAP), to develop an automated manufacturing process for their novel hair multiplication treatment.

The hair multiplication product, ICX-TRC, has been submitted as a hair regeneration therapy that uses cells cloned from one’s own scalp. It is intended for the treatment of male pattern baldness (androgenetic alopecia) and female pattern hair loss. The key researcher, biochemist Dr. Paul Kemp, founder of Intercytex, is developing the hair multiplication treatment at their Manchester facility. This investment in hair cloning research is spearheaded by UK Science Minister, Lord Sainsbury.

The government grant will be used mainly to develop a robotic system specifically designed to support the commercial-scale production of their hair cloning product ICX-TRC, at a scale that can handle a large number of people. The company is currently in Phase II clinical testing.

How Intercytex’s Hair Cloning Product Works

Intercytex’s method of hair regeneration involves removing a slice of the scalp, complete with hairs and follicles, from the back of the head. Hair follicles from this area are most resistant to typical hereditary baldness. The sample is taken to a laboratory where the hair producing dermal papilla (DP) cells are extracted and multiplied in flasks. After eight weeks, the DP cells should have cloned into millions of hair cells.

To complete the hair cloning process, the new cells are injected back into the patient’s scalp under a local anesthetic. These cultured cells should then develop into brand new hair follicles.

Intercytex

Intercytex is a 6-year-old company with its main office is in Cambridge, UK and has a clinical production facility and research and development laboratories in Manchester, UK. Additional laboratories are located in Boston, Massachusetts. TAP, founded in 1988, is a private company with headquarters near Cambridge, UK. Intercytex is publicly traded on the London Stock exchange (LSE: ICX).

Additional information about this hair cloning product can be found at www.intercytex.com.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can a Hair Transplant Restore Frontal Hair Loss in Women?

Q: Although I read that women are supposedly protected from hair loss in the frontal hairline by the enzyme aromatase that is exactly where I am losing hair. My hairline has receded and I have developed a widow’s peak. What can be causing this, and how can I fix it? It seems to have been happening gradually for a few years.

A: Less than 10% of female hair loss is in a frontal pattern that is similar to the pattern of genetic hair loss seen in men.

Women with this pattern can often be good candidates for hair transplant surgery, particularly if the donor area is stable. View our Women’s Hair Transplant Gallery for some examples of the kind of results we can achieve for women at Bernstein Medical – Center for Hair Restoration.

Posted by Robert M. Bernstein M.D.



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(212) 826-2400

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Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.

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