A Guide to Hair Regrowth for Women

Losing hair at any age can be deeply distressing, but the degree of hair loss at some point in our lives. Hair loss can start early on in life, but most women find that hair thinning picks up as they approach menopause. 

Treatment options range from platelet rich plasma (PRP) injections to a plethora of over-the-counter hair vitamins and serums. However, only topical minoxidil (commonly known by the brand name Rogaine) and low-level laser therapy (LLLT) have specifically been FDA-approved for the treatment of female pattern hair loss. Finasteride and dutasteride, oral medications used to treat androgenic alopecia in men, are only used off-label when treating hair loss in women. 

What Causes Hair Loss in Women?

Hair loss in women can occur for a variety of different reasons. The most common cause of hair loss is due to your genes and certain hormonal factors. This type of hair loss is known as female pattern hair loss. 

Other causes of hair loss in women include autoimmune alopecias, like alopecia areata, and central centrifugal cicatricial alopecia, a multifactorial form of hair loss. The term alopecia is just a general term for hair loss of any cause. Alopecia can even be caused by external factors, like the way you style your hair or the use of chemical products.

1. Female Pattern Hair Loss

Female pattern hair loss, also called androgenic alopecia, causes gradual thinning of hair along the crown and midline that affects 40 percent of middle-aged women. (1) Androgenic alopecia is caused by a buildup of dihydrotestosterone (DHT), a hormone converted from free testosterone by the enzyme 5-alpha reductase.

DHT is a potent androgen with a higher affinity to hair follicles than testosterone. In the scalp, DHT binds to receptors on the hair bulb, causing hair follicles to shrink and the hair shaft to shed prematurely. DHT is also believed to shorten the growth phase of the hair cycle, which causes hair to grow back shorter, thinner, and sparser. (2)

Although DHT is primarily a male hormone, it is present in tiny amounts in women. In those with genetic predisposition, this is enough to trigger female pattern hair loss. Studies suggest that mutations in the androgen receptor gene makes hair follicles extra sensitive to circulating androgens. (3) On the other hand, women with polycystic ovarian syndrome produce more androgens, and are more likely to develop female pattern hair loss in young adulthood, even without the genetic predisposition.

2. Alopecia Areata

Alopecia areata is a type of nonscarring hair loss that affects 2 percent of the population. It has an autoimmune component wherein cells of the immune system surround and attack the hair follicles during the growth phase of the hair cycle. The attack on the hair follicle causes hair to fall out prematurely, but since the follicle stem cells are spared, the hair follicle still has a chance to regenerate and regrow hair. (4)

The precise event that triggers alopecia areata is unknown. Some possible triggers include physical and psychological stress, drugs, vaccines, and viral illness. (4)

3. Scarring Alopecias

Scarring alopecia, also known as cicatricial alopecia, is a group of disorders that cause irreversible scarring of the hair follicles.(5) In primary cicatricial alopecia, inflammatory cells attack stem cells and oil glands within the hair follicles. If the inflammatory process continues, the hair follicle could be irreversibly destroyed and replaced with scar tissue, leading to permanent hair loss. (6)

Scarring alopecias include lichen planopilaris (e.g. frontal fibrosing alopecia), central centrifugal cicatricial alopecia, and alopecia mucinosa, among others. Most primary cicatricial alopecias have no genetic basis, except for central centrifugal cicatricial alopecia, which primarily affects women of African descent in the same families. Treatment for primary cicatricial alopecia is targeted at stopping inflammation by using anti-inflammatories like steroids, hydroxychloroquine, or isotretinoin as early as possible. (6)

It’s also possible to experience secondary cicatricial alopecias. These scarring alopecias don’t involve inflammation and typically occur because of external reasons. Radiotherapy burns, chemical straightening, and chronic traction (e.g. tight braids) are known to contribute to these types of scarring alopecias.

How to Stop Hair Loss in Women

Hair loss treatment in women is geared toward stopping further hair loss and stimulating hair regrowth to achieve an acceptable level of scalp coverage. While over-the-counter hair loss remedies are affordable, easy solutions, FDA-approved treatment options for women’s hair loss are limited.

To date, topical minoxidil and laser hair therapy are the only FDA-approved treatments for women’s hair loss in the United States and many other countries. (8,17) These two treatments are meant to be used by people with female pattern hair loss. Finasteride is only approved for use in men, while dutasteride is only currently only approved for male pattern hair loss in Japan and Korea. 

There are also alternative options like PRP, microneedling, and hair transplants. Though not FDA-approved for female pattern hair loss, these treatments have shown varying levels of success in improving hair regrowth.

For scarring alopecias in women, it is most important to stop the inflammatory process that leads to scarring as early as possible to prevent permanent damage. Though no FDA-approved treatments are available, some women benefit from steroids. Women with advanced scarring could benefit from PRP injections, LLLT, and hair transplantation. (5)

There’s currently no FDA-approved treatment for hair loss in women with alopecia areata either. However, doctors often use steroid injections or prescribe topical minoxidil and steroid creams off-label for this condition. (4) Some women have also experienced some hair regrowth after trying microneedling.

Minoxidil for Women

Minoxidil is currently one of the best hair loss treatments for women. As a potent vasodilator, minoxidil works to widen blood vessels and increase blood and nutrient flow to the hair follicles.(7) This is believed to increase the size of the hair follicles, allowing hair to grow back thicker, fuller, and faster while also reducing hair loss in women who use it. (8)

Topical minoxidil (also known as Rogaine for women) is available in 2 percent and 5 percent foams and solutions. Both concentrations are FDA-approved for use in women. In some studies, 5 percent minoxidil was more effective for hair growth than the 2 percent formulation. (9) However, a large meta-analysis found no significant difference in efficacy. (8)

Using Minoxidil for Women

If you’re interested in using minoxidil, all you need to do is use 2 percent minoxidil twice daily. The appropriate dosages are 1 milliliter for solutions and half a cap for foams per application. Once applied, it should be left to dry for 4 hours. 

If you find twice daily applications too disruptive to your lifestyle, you can opt for the once-daily 5 percent formulation. Since minoxidil can take 2-4 months to produce noticeable improvements in hair growth, consistency with daily applications is key.

Minoxidil was originally used in pill form, but concerns about its systemic side effects, including fluid retention and increased heart rate limited its use. However, oral minoxidil is being tested in clinical trials and has been found to be equally effective for female pattern hair loss. (10) 

Is Minoxidil Safe for Women?

Topical minoxidil is safe and well-tolerated when used correctly. However, side effects like scalp irritation and hypertrichosis (excessive hair growth on areas other than the scalp) are more likely with 5 percent formulations. They are also much more likely with the oral version of the medication and higher-concentration topical products not approved by the FDA. (11)

Finasteride for Women

Finasteride was originally developed to treat benign prostatic hyperplasia in men. It was later found to significantly reduce hair loss and was approved to treat male pattern baldness in 1992. It works by blocking the conversion of free testosterone into DHT by the 5-alpha reductase enzyme, decreasing the levels of DHT in the body. (23)

Finasteride (commonly known by the brand name Propecia) produces dramatic reductions in hair loss and improvements in hair growth in men. There’s currently no version of Propecia for women, though the drug is sometimes prescribed off-label. Although finasteride isn’t FDA-approved for female pattern hair loss due to some safety concerns, recent studies are encouraging.

One study showed that 60 percent of postmenopausal and premenopausal women who took 2.5 milligrams of finasteride daily for 3 months experienced significant improvements in hair loss. (12) Another study reported that premenopausal women who took 5 milligrams of finasteride daily showed improvements in hair density. (13)

It’s worth noting that topical formulations of finasteride could be a potential alternative to the oral form. In fact, topical finasteride seems to be equally effective when compared to the oral version and has a better safety profile overall. (14) Despite the promising results, more clinical trials are needed for FDA approval of finasteride for hair loss in women.

Is Finasteride Safe for Women?

Finasteride side effects in women appear to be dose-dependent. Higher doses are associated with more frequent side effects, including decreased libido and hirsutism, which are fortunately temporary. (13)

The biggest downside to finasteride is its toxicity to pregnancies. Finasteride is dangerous to pregnant women and women who may become pregnant. If you’re considering using this drug off-label, make sure to take appropriate birth control measures before starting therapy. (23)  

Laser Hair Therapy for Women 

Laser hair therapy uses red light to promote hair growth. It is one of the few treatment modalities approved by the FDA for androgenic alopecia. LLLT may also have some benefit in managing scarring alopecia. (15) 

It is not clear how or why laser hair therapy works, but the most widely accepted theory is that when red light penetrates the scalp, it is absorbed into the hair follicles. Within the follicles, red light stimulates stem cells and jumpstarts biochemical processes and energy production, which kick the follicles from a dormant into an actively growing state. (16)

In a systematic review of 10 controlled trials involving both men and women with androgenic alopecia, laser hair therapy produced significant increases in hair count and hair growth. (17) LLLT can be used alone, but appears to be more effective when used in combination with other treatments like minoxidil.

Low-level laser treatments can be done in both clinical settings and at home. Women who have mild hair loss can purchase at-home laser hair therapy devices in the form of caps, helmets, combs, and brushes. However, for moderate to severe hair loss, it is best to seek out professional services.

Is LLLT Safe for Women?

Laser hair therapy is safe and well-tolerated in both men and women. Mild side effects like itching, acne, and scalp tenderness are rare. When they do occur, they typically go away on their own within a few weeks. (17)

Other Hair Loss Treatments for Females

Women with advanced hair loss and scarring may benefit from hair transplantation, PRP, and microneedling. Over-the-counter supplements and shampoo are cheap and readily accessible, but many have questionable quality and variable efficacy.

Platelet-Rich Plasma Treatments

During a PRP treatment, a sample of blood is drawn and then processed in a centrifuge in order to separate platelets from other blood components. This produces  “platelet-rich plasma”. PRP is then injected into areas of hair loss across your scalp.

PRP is said to stimulate hair growth by prolonging the growth phase and secreting growth factors, which help specialized cells within the hair follicles to regenerate. Although it’s not yet an approved women’s hair loss treatment, PRP is shown to increase hair thickness in female androgenic alopecia and other types of hair loss, especially when combined with minoxidil and microneedling. (18)

Microneedling

Microneedling is a minimally invasive procedure that takes advantage of the skin’s innate ability to heal. The process involves sliding a dermapen or rolling a dermaroller containing very fine needles across your scalp. Microneedling creates hundreds of micro-tears across the surface of your skin.

As the skin or scalp is injured, it produces collagen and growth factors and increases blood flow to heal the injury, which in turn stimulates damaged or dormant hair follicles to start growing. The procedure can be used alone but appears to be more effective when combined with PRP or minoxidil. (19)

Nutraceutical Supplements

Most hair supplements contain high levels of vitamins and minerals that have important roles in hair metabolism, including vitamins A and C, iron, zinc, biotin, and sulfur. Deficiencies in these micronutrients can contribute to hair loss. However, it is not clear whether taking vitamins for hair loss (in women who are not deficient) can promote hair growth. Saw palmetto, a natural DHT-blocker, is also a common ingredient in hair supplements. (20)

Hair Loss Shampoos

Many over-the-counter shampoo products claim to increase blood flow to the scalp, block DHT, and promote hair growth. These products often contain nutraceutical ingredients like rosemary, argan, caffeine, and pumpkin seed, which have benefits for hair, but controlled trials on their efficacy are still lacking. 

There are a few hair loss shampoos for women that contain FDA-approved ingredients. For example, Nizoral, which contains the antifungal ketoconazole, is used off-label for female pattern hair loss, alopecia areata, and some scarring alopecias. (21) And prescription-only shampoo product Clobex, which contains Clobetasol propionate, has been used off-label to manage central centrifugal cicatricial alopecia. (22)

Hair Transplants

Hair transplantation is a minimally-invasive procedure involving the transplantation of healthy hair follicles from a donor site (usually located at the back of the head) to the balding areas. It works best for people with issues like androgenic alopecia and certain secondary cicatricial alopecias. It won’t work for autoimmune types of hair loss like alopecia areata, lichen planopilaris, or lupus-related hair loss, because these autoimmune conditions will cause the transplanted hair to also fall out.

If you have advanced hair loss and haven’t seen any improvement after trying minoxidil and laser hair therapy, hair transplantation may modestly improve coverage. Although 90 percent of transplanted hairs survive with modern transplant methods, this surgical procedure is still far from a complete solution for hair loss as hairs around the grafts will continue to shed. (24)

What Is the Best Hair Regrowth Treatment for Women?

The best hair loss treatment for women is one that is effective and has a good safety profile. Minoxidil and laser hair therapy have both undergone extensive evaluation by the FDA. Both are safe and have shown decent success in treating women’s hair loss from multiple angles. Although PRP is not yet FDA approved, it also shows modest improvements in several types of hair loss, especially when combined with minoxidil and other treatments.