what would you recommend for 29 yo female with Androgenetic Alopecia

[labellavita1985]

Hey guys, I just got back from the dermatologist who said he thinks I have Androgenetic Alopecia.

I've lost about 40-45% of my hair this year. I had some deficiencies, such as very significant iron deficiency (ferritin was 6.7) as well as Vitamin D, and a slight hormonal imbalance (elevated total testosterone.) I also became very thin at the end of 2014 from excessive dieting (anorexia.) So I thought (and a few doctors said) that I was having a Telogen Effluvium.

But the derm I just saw, who admittedly doesn't treat hair loss, said it looks like Androgenetic Alopecia.

He also seemed very very negative about possible treatment. He said minoxidil is a waste of money, might help me grow some peach fuzz, but that's it. He prescribed finestaride and said, basically, that if I was lucky, I'd keep what hair I have.

I'm already on Spironolatone, gradually increasing my dose to 200 mg. What else would you recommend?

Do you think this is a proper diagnosis?

 

[I.D WALKER]

Labellavita,

If you have pics we may be able to better assess what's going on.

If it is diet exclusively affecting your hair then there's no reason to be completely discouraged by this, for it typically corrects itself with little lifestyle modifications on your part.

Crash dieting has been associated with Telogen Effluvium symptom.

Certainly testosterone elevation is a common precursor to hair loss. Not sure why your levels are up/off?

So far minoxidil is the only approved treatment for women suffering from Androgenetic Alopecia or FPB. There is no cure. Resolve aforesaid issues before contemplating finasteride.

No more binge dieting and get your iron and vit. D levels right first.

Try to be patient as you know Telogen Effluvium hair loss can take several months to rebound.

Be kinder to yourself. Best of luck.

 

[labellavita1985]

Hey I.D.Walker,

thank you for your kind and thoughtful response. It means a lot to me.

Here are some pictures.

I think my elevated testosterone is a result of PCOS. Although I'm not 100% sure because my ob/gyn said PCOS is associated with elevated free testosterone, and my free testosterone is within range (actually low end of range,) but my total testosterone is elevated (54, with the range for premenstrual women being 2-45.) DHEA-S is well within range.

I'm also on the birth control pill Yaz, which contains .02 mg ethinyl estradiol. Lots of guys on this forum seem to think that estradiol is good for hair growth, so I'm hoping that's the case. I've only been on Yaz and spironolactone for a little over a month.

I'm just worried that hoping it's Telogen Effluvium and waiting for it to resolve on its own will lose me hair if it turns out it's Androgenetic Alopecia.

 

[dusty]

You could see a hair transplant surgeon and he could look at your scalp thoroughly to determine if there are any signs of Androgenetic Alopecia like miniaturized hairs.

 

[labellavita1985]

Thanks, dusty.

The problem with that is that hair loss from Telogen Effluvium can mimic miniaturization.

I'm losing shorter hairs that have obviously had their anagen phase compromised.

It's all so consuming.

 

[I.D WALKER]

Your worrying is perfectly understandable. After all you are clearly inundated with many legitimate stressors. I'm glad you included pics. Based on these and your medical

profile I would love to declare it is indeed Telogen Effluvium versus FPB but frankly I cannot tell. Thankfully you still have great coverage and no discernable signs of hair loss at present.

Like dusty suggests I think it may be well worth your while to arrange an appt. with a qualified and experienced hair transplant Doctor who has the skills and state of the art tools to make the proper diagnosis you deserve.

Please stay in contact and keep us current.

 

[labellavita1985]

Thanks again, ID Walker. I'm going to see a hair specialist next Wednesday. The dermatologist I saw yesterday referred me.

What are your thoughts on minoxidil for non Androgenetic Alopecia hair loss?

I'm seriously thinking about starting it. I am okay with being on it for the rest of my life.

I'm just worried about it making things worse.

 

[I.D WALKER]

Before considering min. you should know there is a running school of thought reporting min. loses it's efficacy over time (maybe 4-5 yrs.). Min. often compounds shedding so yes can at least temporarily make situation appear worse.

I don't know if min. will do much long term if it is from PCOS complications. Are you seeing a respected/experienced endocrinologist who can instruct you on method options to reduce the androgen escalation and insulin issues due to PCOS. It sounds like you are already managing it to the best of your capacity.

As you know a consistent and proper diet can potentially help matters (low carbs, lean meat, etc..,.)

You are very intelligent so I'm pretty much telling you what you already understand.

 

[labellavita1985]

I'm seeing an endocrinologist next month.

My gynecologist didn't seem too interested in doing anything about my hormone imbalance other than putting me on birth control pills.

I'm not 100% sure I have insulin resistance, as I am thin, and my glucose levels stay around the same throughout the day (at home testing with my dad's blood glucose meter.) I have very extensive family history of diabetes, my father has been an insulin using diabetic for years, as are his parents and brother.

I've been to a PCP, two dermatologists, a gynecologist, a hematologist, and now a G.I. doctor (my hematologist thought I was having inflammation contributing to iron deficiency,) and no one has said anything about a full hormone workup or a fasting blood test.

I'm beginning to lose all hope in the medical profession.

Currently I'm taking the Spironolactone and the Yaz to manage the androgen excess (Yaz has anti-androgenic properties as well.)

I've read that PCOS isn't always caused by insulin resistance.

I try to eat healthy, not particularly conscious of the carbs since my doctors and I don't think I have insulin resistance. My diet is very Mediterranean in nature, a few nights ago I had eggplant for dinner, last night I had okra, etc. I try to make sure I get enough protein; if I'm not eating a lot on a given day I supplement with protein shakes.

When I look at my shed hairs, it is obvious that many of them have had their anagen phase compromised. They are shedding at varying lengths, starting at 3 inches, although I've found a couple that were about one inch.

This is why I'm thinking about trying minoxidil, as it is said to lengthen the anagen phase of hair. Is that right?

What do you think about skin changes attributed to minoxidil use (wrinkles, undereye puffiness, etc.)

About the minoxidil, is it thought that oral minoxidil (Loniten) also has this limited efficacy period?

Also, what are your thoughts on stemoxydine or Folligen for a case like mine?

I'm already using Nizoral 2% twice a week for seb derm (dermatologist said it's "mild".)

 

[I.D WALKER]

I googled this quickly :

http://www.medicinenet.com/minoxidil-oral/article.htm

http://www.ncbi.nlm.nih.gov/pubmed/21524889

You can also look into Setipiprant. There is some promise in terms of safety profile for starters.

http://www.ncbi.nlm.nih.gov/pubmed/24095247

 

[Joan]

Did your dermatologist do a scalp biopsy? Also, are the shorter hairs you're losing terminal, or are they intermediate and/or miniaturized? My stepdaughter (age 31) has had PCOS since her early teens, been on birth control since then and has a thick, full head of hair. Also, when my hair loss started three years ago, my ferritin was around 9, I brought it up considerably, and I am still shedding tons of hair. I don't buy into low ferritin alone causing hair loss. I would suggest having a scalp biopsy done if you haven't had one already to get a definitive diagnosis of whether or not you're dealing with Androgenetic Alopecia. Very low levels of Vitamin D and potassium can cause hair loss, so maybe have those levels checked. I've been to two dermatologists, and both suggested minoxidil; yet, yours is against it--go figure. I've been using Men's Rogaine 5% nightly for well over a year with no results. I have not experienced puffy eyes, dark circles or additional wrinkles (I'm 52). Your hair still looks good (mine looks a lot like yours). You need to give the spironolactone and Yaz some time, since you really haven't been on them long enough. If you can hang onto the hair you have now with treatments, I'd consider that a win.

 

[labellavita1985]

Joan,

thanks so much for responding.

Just to explain my situation a little more - about six months ago I used a color remover on my hair, when I was washing it out I noticed A LOT of hair coming out. I've always shed a lot, and didn't think much of this at the time, and figured it was just due to manipulation of my hair. Over the next few weeks, I used a color remover 3-4 more times, and then had allover highlights put in (my hair had been oversaturated with dark brown hair dye for years, and I wanted it lighter.) The stylist was inexperienced and may have left the bleach in too long, as I have tons of breakage where my highlights are.

The shorter hairs that I'm losing for the most part look "terminal," most of the 3-6 inch ones appear to be the same thickness as the rest of my hair; although I've found a few 1-2 inch ones that appear to be thinner than the rest of my hair.

That is really disheartening that you haven't experienced any success with minoxidil in a year. Is there any sign of regrowth? Or decrease in shedding at least? I'd suggest upping your use to twice a day. Also, if you have confirmed Androgenetic Alopecia, my understanding is that you won't get far without an anti-androgen/DHT inhibitor in addition to the minoxidil. Are you using anything like this?

I'm also skeptical of the idea that low ferritin alone can cause hair loss. However, I've read that ferritin plays a role in regrowth. So if one has lost hair for any reason, and is attempting to regrow, ferritin levels of 80+ will maximize the potential of regrowth. This makes sense to me. Do you think that my weight loss (extreme dieting) could have been a factor? If I have/had Telogen Effluvium, I don't understand why I'm still losing short hairs, about 5-6 months into my hair loss experience, although I have read that this could be from "short cycling," where the hair goes through a few cycles before it returns to its previous, normal growth phase.

Maybe the birth control has helped your daughter keep her hair?

I really hope the birth control and spironolactone will help me. I'm seriously considering minoxidil though and am this close to placing an order for Lipogaine. I just can't stand not doing anything about this situation.

Do you have Androgenetic Alopecia? If so, how were you diagnosed? If you have Androgenetic Alopecia, maybe that's why your dermatologists recommended minoxidil. I don't know what the verdict is on minoxidil use for non Androgenetic Alopecia hair loss.

My dermatologist refused to do a biopsy, saying I need to get my iron and vitamin D levels up, and see where I'm at in six months. The second one I saw just said that he didn't deal with hair loss, but that it looks like Androgenetic Alopecia, and referred me to a derm who does, who I'm seeing next week.

If you have Androgenetic Alopecia, and my hair looks a lot like yours, that can't be a good thing.

Honestly, I really want to grow more hair. I never had tons of hair but I think I had 30% more volume. If I have Androgenetic Alopecia, do you think it's naive of me to hope I grow my hair back with aggressive treatments like spironolactone, finestaride, and minoxidil?

- - - Updated - - -

k9-

thanks for the feedback. If I find out with certainty that I have Androgenetic Alopecia, I won't even hesitate about going on minoxidil, and maybe also finestaride. I'm already on Spironolactone. I'm glad minoxidil has worked for you. I'm worried about the initial shed. Did you experience this? Have you experienced any side effects like aging skin/wrinkles, dark undereye circles and/or puffiness?

 

[Joan]

I agree with k9gatton. You'll never know if you're one of the lucky ones who will benefit from minoxidil unless you give it a try.

- - - Updated - - -

I googled this quickly :

http://www.medicinenet.com/minoxidil-oral/article.htm

http://www.ncbi.nlm.nih.gov/pubmed/21524889

You can also look into Setipiprant. There is some promise in terms of safety profile for starters.

http://www.ncbi.nlm.nih.gov/pubmed/24095247

I.D Walker, what's your Norwood? Just wondering if you're giving Seti a try.

- - - Updated - - -

Joan,

thanks so much for responding.

Just to explain my situation a little more - about six months ago I used a color remover on my hair, when I was washing it out I noticed A LOT of hair coming out. I've always shed a lot, and didn't think much of this at the time, and figured it was just due to manipulation of my hair. Over the next few weeks, I used a color remover 3-4 more times, and then had allover highlights put in (my hair had been oversaturated with dark brown hair dye for years, and I wanted it lighter.) The stylist was inexperienced and may have left the bleach in too long, as I have tons of breakage where my highlights are.

The shorter hairs that I'm losing for the most part look "terminal," most of the 3-6 inch ones appear to be the same thickness as the rest of my hair; although I've found a few 1-2 inch ones that appear to be thinner than the rest of my hair.

That is really disheartening that you haven't experienced any success with minoxidil in a year. Is there any sign of regrowth? Or decrease in shedding at least? I'd suggest upping your use to twice a day. Also, if you have confirmed Androgenetic Alopecia, my understanding is that you won't get far without an anti-androgen/DHT inhibitor in addition to the minoxidil. Are you using anything like this?

I'm also skeptical of the idea that low ferritin alone can cause hair loss. However, I've read that ferritin plays a role in regrowth. So if one has lost hair for any reason, and is attempting to regrow, ferritin levels of 80+ will maximize the potential of regrowth. This makes sense to me. Do you think that my weight loss (extreme dieting) could have been a factor? If I have/had Telogen Effluvium, I don't understand why I'm still losing short hairs, about 5-6 months into my hair loss experience, although I have read that this could be from "short cycling," where the hair goes through a few cycles before it returns to its previous, normal growth phase.

Maybe the birth control has helped your daughter keep her hair?

I really hope the birth control and spironolactone will help me. I'm seriously considering minoxidil though and am this close to placing an order for Lipogaine. I just can't stand not doing anything about this situation.

Do you have Androgenetic Alopecia? If so, how were you diagnosed? If you have Androgenetic Alopecia, maybe that's why your dermatologists recommended minoxidil. I don't know what the verdict is on minoxidil use for non Androgenetic Alopecia hair loss.

My dermatologist refused to do a biopsy, saying I need to get my iron and vitamin D levels up, and see where I'm at in six months. The second one I saw just said that he didn't deal with hair loss, but that it looks like Androgenetic Alopecia, and referred me to a derm who does, who I'm seeing next week.

If you have Androgenetic Alopecia, and my hair looks a lot like yours, that can't be a good thing.

Honestly, I really want to grow more hair. I never had tons of hair but I think I had 30% more volume. If I have Androgenetic Alopecia, do you think it's naive of me to hope I grow my hair back with aggressive treatments like spironolactone, finestaride, and minoxidil?

- - - Updated - - -

k9-

thanks for the feedback. If I find out with certainty that I have Androgenetic Alopecia, I won't even hesitate about going on minoxidil, and maybe also finestaride. I'm already on Spironolactone. I'm glad minoxidil has worked for you. I'm worried about the initial shed. Did you experience this? Have you experienced any side effects like aging skin/wrinkles, dark undereye circles and/or puffiness?

I've always shed a clump of hair when rinsing out hair dye, long before my hair loss started, so I really don't think that would cause prolonged shedding. Breakage can be fixed with a good trim and conditioning; hairs with bulbs are a different story.

It's a good sign that you're not noticing much miniaturization. Although I've read that some deficiencies can cause that, I don't buy into that either. I had a massive Telogen Effluvium shed three months after my older son was born (age 20), and I didn't notice miniaturization. All my hair grew back.

I do have regrowth, but it falls out and just can't keep up with my loss. It looks nothing like the thick regrowth I had after my Telogen Effluvium shed. You couldn't count the hairs because it looked like a thick fringe. Now I have to "hunt" for regrowth, which I rarely do anymore. Minoxidil has not decreased my shedding. I cannot even count the hairs I shed daily because it's an infinite number. It literally looks like a dead animal in my drain and sink every morning after I shampoo. My Androgenetic Alopecia diagnosis was confirmed by a scalp biopsy. I am finally going to try spironolactone this month. I'll get a script from my internist in a few weeks when I go for my physical. The reason I've been hesitant to try it is because of the risk of breast cancer. I have two sons, and I truly live my life for them. You think differently about what goes into your body when you have kids. When it's just you or you and your husband, you're more willing to take risks.

You can believe what you want about ferritin. How many success stories have you read from women bringing up their ferritin and regrowing their hair or at least stopping further hair loss? And how do you know it was raising the ferritin that really did it, if it was something else they were taking/doing, or if their hair loss was just going to resolve on its own? I've been reading about low ferritin ad nauseam for three years, and it's really getting old. You're still early into your hair loss, so there's still hope. If your doctor wants to wait until you raise your iron and Vitamin D levels before doing a scalp biopsy, then they must be very low (maybe caused by your dieting), so maybe once they're back in the normal range, your hair will begin to grow back. Time will tell.

The reason I mentioned my stepdaughter's PCOS is because I think you mentioned you might have it, and I didn't want you to worry that it's an automatic death sentence for hair, like some women experience. She has been off birth control for a couple of months (trying for a baby), and her hair still looks great. I had diffuse thinning like I have now when I had Telogen Effluvium, so don't worry that because my hair looks like yours, you definitely have Androgenetic Alopecia. My mother (81) started losing her hair in her 70s (lucky!), and she is losing it mainly in the crown area.

You are catching things early in the game, so you may regrow a good amount of hair with treatments. It's really a crap shoot, just like for the guys. My son was taking Propecia for 18 months, and his hairline continued to recede, and the shedding never decreased. Other guys have great results. You could be lucky too.

 

[I.D WALKER]

Joan,

I was hoping you'ld eventually intercede on Labellavita's behalf. As usual your perspective is particularly insightful.

I'm a Norwood 4a atm. ( nearly fully blown frontal/mid vertex). Also my crown is slowly beginning to break down.

To your Seti question: Not yet. Although Seti looks decent on paper I'm anticipating more positive feedback from those forum "testers" who are actively trialing it. Their efforts are commendable btw.

As you can see I've remained passive with starting "alternative" treatments insofar that the big 3 have proven unaffected. dutasteride. is also another option I may have to look into, but honestly my loss is so far advanced I'm not optimistic. Maintenance at best maybe?

 

[recedingyt]

Spironolactone, finasteride, and minoxidil are your best bet for regrowth. I'm using that combo too and have seen great regrowth so far. I am a trans woman so I don't know if the biology is different as a result but our hormonal profiles are likely very similar, so I doubt it. I think once you get your hormonal issues sorted with the help of your birth control, finasteride and spironolactone as well as fixing your vitamin D/iron deficiencies you should in theory see an improvement in your Androgenetic Alopecia. Maybe not regrowth, but at the very least I would think that should slow/halt you from losing more hair.

If you're okay with the prospect of being on minoxidil forever I see no reason not to start asap. Waiting only delays the possible regrowth it could offer and you may lose more hair in the meantime, so I see no downside really. You may lose some more hair at first because of shedding so tailor your expectations with that in mind. I'll let you know now that minoxidil is a bear to use with long hair though! It makes your hair really greasy and impossible to style for at least a few hours while it dries/absorbs into the scalp. I've found that using it once a day, a few hours before bed, so that you can just wash it out in the shower in the morning is much more manageable and still seems to produce results. Make sure you get the regular 5% strength minoxidil and not the women's 2% stuff, the 5% concentration is perfectly safe for women and it's been proven more effective. (Source: http://www.ncbi.nlm.nih.gov/pubmed/15034503)

Good luck!

 

[Joan]

Hi, I.D Walker!

I agree--these guys are truly soldiers. It's a shame that finding an effective treatment for hair loss has to come down to men acting as guinea pigs. They are always researching and finding new things and keeping up with latest meds, and I salute them. The women's forums are pretty much dead in that area. God, I hope we don't lose Hellouser for good. We need him--he's invaluable.

So then, viewing your regimen, you're not taking finasteride? Did you take it at one time and then discontinue? I ask this because you mentioned the big 3. Maintenance is all I'm hoping for too. I'd settle for thin hair as long as my scalp doesn't ever show. I will be totally dead inside when that happens. Have you ever considered a hair transplant?

Your advice to everyone is always helpful. I tend to be a downer, and I find your words much more uplifting (although I must admit you are far more intellectual than I'll ever be!).

- - - Updated - - -

I'll let you know now that minoxidil is a bear to use with long hair though! It makes your hair really greasy and impossible to style for at least a few hours while it dries/absorbs into the scalp.

I use the foam, and it doesn't make my hair greasy at all. I also style it immediately after applying it.

 

[I.D WALKER]

Thanx Joan, such a sweet prevaricator.

Yes I had a hair transplant that failed maybe due to present evidence retrograde alopecia ( self-diagnosis)?

Yes was on finasteride. for approx. 2 yr. without any discernible improvement. I should have committed longer, but at the time I was ignorant of it's potential maintenance value.

Also wore a partial hair piece/system for several years. This saved me from complete social anxiety ruin ( even though it took about 1 yr. of adjusting before the bugs were finally worked out).

Yeah so I can empathize with much of your fears anticipating your unknown future standing with hair loss.

We must try better to learn how to adapt to this intimidating disease. While we still have our faculties and commitment to our daily responsibilities. Giving up on what remains of our joyful sense of self must not be an option for surviving this.

In spite of any stoic impression (my brave game face) I may leave you I promise you after you saw me you would see that I'm still reeling from the aftershock.

I wish I could offer you a more practical form of comfort. -)

 

[labellavita1985]

Hey Joan,

thanks for your thoughtful and detailed response. Yes, my ferritin and vitamin D were extremely low. Ferritin was 6.7 and vitamin D was in the mid 20's. I was just wondering if you could clarify the following - you initially said you don't believe ferritin causes hair loss, then you said my hair might grow back when I increase the ferritin and vitamin D.

What concerns me is maintenance on any hair loss treatment. Doesn't Androgenetic Alopecia usually "win out" in the end? Like ID Walker said, it is thought that minoxidil stops being effective after 4-5 years. After that, do you guys think spironolactone, finestaride, and Nizoral will be enough to maintain whatever gains one has made? I can also stay on birth control pills, virtually indefinitely. Will I be able to keep my hair? Wouldn't any hair loss on this regimen be somewhat self-limiting, as androgen numbers will be drastically decreased, and stay that way?

I'm attaching some pictures. In the picture of my hair line, do you think that looks like regrowth?

The other picture is some hairs I found on my shirt today. There is a hair in the middle of the others that is about one inch and thinner. It's also got an "S" shape. Does this appear to be Androgenetic Alopecia related miniaturization, according to your knowledge and experience? I've only found a few of these so far, and the overwhelming majority of the hairs I lose are terminal, even the 3-5 inch ones. Of course, these little ones would be much easier to miss.


recedingyt,

thanks for sharing your experience. How long have you been on this combination treatment? How much hair had you lost and how much would you say you've regrown?

 

[recedingyt]

recedingyt,

thanks for sharing your experience. How long have you been on this combination treatment? How much hair had you lost and how much would you say you've regrown?

I've been on spironolactone & finasteride since 1/1/15. I started estrogen 2/1/15. As for minoxidil, I started it around 12/20/14 (give or take a week or two) and continued to use it until 3/15/15. I stopped using it because I had achieved great results, going from NW5 (nearly fully bald on top) to around a NW2.5-3 and I honestly didn't think it was minoxidil that caused the success (I attributed it more to spironolactone/finasteride/estrogen at the time). I believed that since my testosterone and DHT were basically zero that even if minoxidil was the main contributor I'd keep the results I had gained. About 2 months later in May I started to notice more hair fall than usual. It got gradually worse until I was in a full blown shed that lasted until around the end of June. I was basically back to square one (NW5) at this point, so I restarted minoxidil around the start of July. By the end of July I had regrown most of the hairs I had lost. Today I sit in a better place than I did before the major shed with a pretty strong/dense NW2. I have a lot of vellus hairs on my temples that I'm waiting on right now and if they do fill in like I'm hoping they will, I'll be a NW1 (basically no easily visibly detectable hair loss).. so I think at least in my case, minoxidil is a very important part of my success.

Here's some pics to help you visualize how bad it was/how much I recovered. The June 30th picture is pretty close to how bad it was back in December before I started doing anything to treat my Androgenetic Alopecia and the August 26th picture is slightly better in terms of density and hairline than it was before the major shed occurred.



Anything is possible it seems.

 

[labellavita1985]

Recedingyt,

thank you so much for taking the time to share your experience and your photos. Your results are absolutely incredible and soo inspiring. I can't say how happy I am for you. I really hope you are out there, living and enjoying your life, as you deserve to, now that hair loss is pretty much not an issue anymore! Honestly, that's what it looks like. Just a bit of recession at the temples, but to be honest, from the perspective of a 29 year old female, I pretty much expect guys to have that going on by their mid-late 20's. It's a complete non-issue for me.

What is your spironolactone dose? I'm slowly going to increase mine to 200, and I am also taking some estradiol, as it's in my birth control, so I'm hoping that my hair gets better. I'm pretty sure I'll be adding minoxidil soon, too.

Thanks, again!