I am a 38 year old woman experiencing generalized hair loss. What can I do about it and am I a candidate for hair transplant surgery.

There are many causes of hair loss in women. The first thing to do is have this worked up properly by your physician in Hong Kong. Hair loss in women is common after child birth because the hair becomes thicker during pregnancy. After pregnancy the hair will thin. Your situation sounds worse than this. Generalized hair loss is a common problem in women. In order to be a candidate for hair transplant surgery, you first need to have a donor supply. This means hair on the back and sides of your scalp. If you don’t have the donor area, you can’t have a hair transplant.

Again, the first thing you need to do is properly work up your hair loss to insure that it is female pattern loss and not due to some other cause. Those other causes include metabolic diseases such as thyroid disease and adrenal disease. You should have a TSH and T4 done to evaluate your thyroid. Both hypothyroidism and hyperthyroidism can cause hair loss. Make sure you are not producing too much male hormone. You should have a dihydroepiandrosterone or DHEA done. Also check your FSH and LH along with a free testosterone level. Then rule out syphylis with an RPR. Rheumatoid diseases can cause hair loss. Common ones are Lupus and Rheumatoid Arthritis. Do you have a skin rash or any joint pain? Finally, you should have a biopsy of your scalp done to make sure you do not have some other skin condition that is causing your hair loss. You should have two 4 mm punch biopsies done in the area of hair loss. It is of no value to take it where you are not loosing your hair. One biopsy should be read in vertical section and one in horizontal section by a pathologist experienced in reading biopsies related to hair diseases.

My office will send you an entire list of lab tests that I recommend for women experiencing hair loss.

I would say that over 95% of these work ups are negative and the diagnosis is female pattern hair loss. The reason you do these tests is to see if you have a treatable condition. Also, it is important to recognize that hair loss due to other conditions such as female pattern loss often do not respond to hair transplant surgery.

If you do not have a physician who can perform these tests for you, let me know. Female pattern loss does seem to have a common appearance. Usually, the frontal hair line remains in place while you begin to thin behind this. The crown area is usually affected later in the course of the hair loss. When you loose hair on the back and the sides, you really are not a very good candidate for the hair transplant. Loss is women can be frustrating in that it is progressive. You know that the donor area is finite. You only have so much hair in your donor area and the loss up top is progressive. Eventually, the amount of hair you have in your donor area may not be able to keep up with your hair loss.

Obviously, at age 38 it is important for you to have your hair so a hair transplant makes sense provided you are a suitable candidate. Regarding the graft count, you should be aware that a maximum of 800 to 1000 grafts up top in a single procedure is the most I would recommend in a woman. This is because higher densities are more likely to cause shock loss. This means that you could experience temporary loss that makes your appearance much worse. Eventually over several months the hair returns and your grafts grow, but I have found that women do not tolerate this temporary severe loss state well. It can be very depressing. Therefore, I recommend you have smaller sessions at a time to minimize the risk of shedding.

As far as physicians in your area, Dr. Tyng Tan is an affiliate physician with us. She is located in Singapore. Let me know if you have any more questions.

Will Acell/PRP help me stop loosing my hair and regrow hair? I am a 27 year old female.

A female has some options for the treatment of hair loss. The first step is to determine the origin of your hair loss. You do this by visiting your dermatologist for a medical work up of your hair loss and perhaps two 4mm skin biopsies in the affected area of hair loss. The biopsies are read in horizontal section and vertical section, and they must be evaluated by an experienced dermatopathologist, who has specific training in reading hair biopsies.

Female pattern hair loss is quite common and seems to affect about 10% of all women. The condition is treated with Rogaine 2% once or twice a day. You cannot take Finasteride as it might adversely affect the development of a male offspring.
PRP/Acell is used to treat female pattern hair loss. It does not work on all women, but can improve your coverage. You should consider giving it a try once you have documented the specific cause of your hair loss. There is not need to begin a treatment that will not work for you should the cause of your hair loss be due to some other medical condition. Female pattern hair loss does seem to run in families, which is what you have described. Other medical conditions can affect families too so you should have your condition evaluated properly prior to seeking any medical treatment.

Recently, the New England Journal of Medicine published an article on finasteride and dustasteride, whose brand names are Propecia, Proscar, and Avodart. The article may be summarized as follows. An analysis of trials evaluating finasteride and dutasteride indicate that the reduction in prostate cancer risk with both finansteride and dutasteride was limited to tumors with a modified Gleason Score of 6 or lower. Therefore, the trade off inherent in using a 5 alpha reductase inhibitor for prostate cancer prevention is the acceptance of one additional high grade cancer in order to avoid three to four theoretically clinically pertinent lower grade cancers.
The supposition drawn by the advisory committee in December was that finasteride and dutasteride do not have a advantageous risk-benefit profile for the propositioned use of chemoprevention of prostate cancer in healthy men. The FDA agrees with this assessment.

A new study by Sharon Keene and Andy Goren examined hair loss in women.  Previous studies appeared to indicate that postmenopausal women with hair loss did not respond to finasteride, a 5 alpha reductase inhibitor commonly prescribed for hair loss in men.  These findings led researchers to question whether women were actually disposed to androgenetic alopecia, more commonly referred to as pattern baldness.  Recently published reports of finasteride response in some women with hair loss, however, indicate an androgenic mechanism may indeed be present.

Keene and Goren’s study was undertaken in an effort to determine whether variant repeat nucleotide sequences in exon 1 of the androgen receptor gene may help determine which women are likely to respond to finasteride therapy.  A 6-month pilot study was undertaken with 13 patients.  They found that women with greater androgen sensitivity were likely to have a significant response to finasteride compared with those treated with a placebo and those with normal androgen sensitivity.  These results indicated that AR-CAG repeats, in conjunction with epigenetic factors, may in fact help determine which women with hair loss will respond to finasteride therapy.

Women suffering with hair loss can purchase genetic tests, such as HairDX, which may indicate whether their hair loss has an androgenetic basis and predict their response to finasteride.  This is helpful for women struggling to find a cause for their hair loss and is a way to “test the waters” before diving into a finasteride regime.

I am a 22 year old female and 6 months ago I moved into a house that is on well water. My hair has thinned a ton, and I’ve been to the doctor to test my iron levels, thyroid levels, and hormones (including testosterone). All the levels are normal. The dermatologist said I might have mild alopecia. I KNOW that is not the case. I had a beautiful head of hair up until I moved into this house. When I pull my hair back I can see through to my scalp. Should I get a Reverse Osmosis water filter? The doctors said that well water wouldn’t cause hair loss, but I have found so much evidence that says otherwise. Please help me, the thought of loosing my hair is consuming my life.

The main thing to do is to first identify the cause of your hair loss.
There are many medical illnesses that can cause hair loss in women. The lab tests you have done are helpful, but usually they are all normal. One should evaluate you for chronic inflammatory diseases such as Lupus, as well. Have your DHEA level checked if this has not been done, but it is usually normal. As you mentioned, iron deficiency anemia can cause hair loss so you should check your ferritin level if you have anemia. You need to do more than look at your iron level if you have a microcytic hypochromic anemia. One should also check for Syphilis, but this is unlikely.

The next step is to have two 4 mm scalp biopsies done. They should be done in the area where you are loosing your hair and they should include intact hair follicles. One biopsy should be for vertical sectioning and the other should be for a lateral sectioning. These should be read by someone experienced in reading scalp hair biopsies such as David Whiting at Baylor.
This will probably give you the diagnosis.

You mention well water. The thing to look for here is heavy metals. These can cause hair loss, but usually this is not present.

Female pattern hair loss is the most common cause and the two biopsies will confirm or rule out this diagnosis. If this is what you have, you should then consider treatment options to include Rogaine for women.