In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See "Life cycle of a hair.") That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called "follicular miniaturization." As a result, thicker, pigmented, longer-lived "terminal" hairs are replaced by shorter, thinner, non-pigmented hairs called "vellus."
Treatment options for AGA (Table 3)6 focus on decreasing androgen activity. Minoxidil (Rogaine) and finasteride (Propecia) are the only medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of AGA (Figure 4).6 Minoxidil is available without a prescription as a 2-percent topical solution that can be used by both men and women and as a 5-percent solution (Rogaine Extra Strength) that should be used by men only. The mechanism of action by which minoxidil promotes hair growth is unknown, but it appears to act at the level of the hair follicle. Minoxidil is an effective treatment for male and female AGA and is recommended as first-line treatment by the American Academy of Dermatology guidelines.5
According to practitioners of traditional Chinese medicine, hair health is tied to two things: kidney energy and the blood, which nourish the hair. The solution: acupuncture and Chinese herbs. While there isn't a lot of hard science to back this up, Maureen Conant, a TCM practitioner at Full Bloom Acupuncture in Seattle, says that she's seen women's hair stop falling out and then gradually regenerate after a few months of weekly treatments.
Re-growing hair: It is likely that the hair will grow back even without treatment. It may fall out again, though. Most patients lose their hair more than once before the disease goes away for good. Even people who lose all the hair on their scalp and body can have their hair grow back. When hair loss is widespread (lots of hair loss on the scalp and/or body), there is a greater chance that the hair will not re-grow.

In answer to which doctor should I see for my hair loss, my opinion is that you should probably see both. Most doctors don’t know enough about hair loss as it is, so seeing doctors in different specialties may actually help you get a better, more accurate diagnosis. I am sure there are various conditions of hair loss that might be better served by seeing one more than the other. Perhaps a dermatologist would be better suited in determining if the cause was an infectious skin condition such as ringworm or scaring alopecia, and an endocrinologist may be better at diagnosing hormone related hair loss. The truth is, any doctor whether it is an endocrinologist, dermatologist, or general practitioner with a strong interest and knowledge in hair loss can make a proper diagnosis and work with you on the the treatment they think will produce the best results. The operative words here are “interest and knowledge.”
In addition to diagnosing and treating any underlying disorder, treatments for alopecia areata include immunomodulating agents and biologic response modifiers (Table 5).6 Although topical and oral corticosteroids have been used, the treatment of choice in patients older than 10 years with patchy alopecia areata affecting less than 50 percent of the scalp is intralesional corticosteroid injections (Figure 8).6
The earlier you begin treating hair loss, the more effective the treatment will be. Androgenetic alopecia is a condition that gradually worsens over time, so the general rule is that the earlier you seek treatment, the better. “If you’re losing your hair and you have genetic hair loss, using medication such as Propecia or minoxidil is most effective when started early,” says Dr. Robert M. Bernstein, Dr. Wolfeld’s colleague at Bernstein Medical – Center for Hair Restoration. Because not everyone loses hair on the same timeline, you can’t rely on statistics to tell you when you should start treatment. Some men start to notice thinning in their early 20s, while others maintain a thick head of hair well into their 50s. If you suspect that you’re starting to lose your hair and want it to stop, act quickly.
There are numerous nonsurgical treatments that when combined, can offer significant hair improvements. Dr. Yaker’s TCHR Volumizing Glycolic Acid Shampoo and Conditioner help restore vitality to the hair by deep cleaning the scalp and reestablishing lost moisture content and physiological pH to the scalp and hair. Dr. Yaker has also formulated his own oral supplement, which is a blend of Aminoplex hair repair vitamins. This is made up of amino acids (building blocks of protein) that produce keratin, which makes up close to 97% of our hair. In addition, Dr. Yaker’s specially compounded FDA approved topical medication, Minoxidil (brand name: Rogaine®), is clinically proven to help slow down, stop and even reverse hair loss in women. Other nonsurgical therapies offered are Low Level Laser Therapy (LLLT) using the advanced LaserCap®, and Platelet Rich Plasma (PRP) with placenta-derived extracellular matrix therapy to help restore thinning hair. Lastly, Dr. Yaker offers scalp and facial micropigmentation where permanent ink is applied to the skin, creating micro dots that replicate the natural appearance of hair. This is used for the scalp and eyebrows.
One is how much emphasis the company places on compliance, the major stumbling block in the efficacy of any treatment, said Dr. Senna, an author of studies on the subject. Prospective users are questioned about their ability to stick to a regimen because the extract must be applied every day, and they are told that the more conscientious they are, the better. Users are also reminded and encouraged with regular check-ins.
I was searching the internet and came across this wonderful site. I really appreciate you posting this article. I have always had a small bald patch on one side of my head. My mom told me it had always been there so I didn’t worry about it. Recently it has been getting larger and the hair around it is getting lighter. On the other side my hair is thinning and the color and texture is changing. It also seems to be falling out. I have excessive hair loss on a regular basis. I am only 24 years old and I can’t stand that my hair is falling out. I went to the dermatologist and he gave my injections but they didn’t work. He said I have alopecia areata and that the other side was a normal receding hairline. (He barely even looked at it) He then told me after the injections weren’t working to try Rogaine. I think it might be helpful to see an endrocrinologist as I have also been having problems with anemia. Again, thank you so much for the information you have provided.
The Rogaine rep we spoke to explained that the different packaging (and therefore different prices) has to do with the FDA-approval process: “We discovered in clinical trials that the hair loss patterns between men and women are different,” she said by way of explanation. “Men typically have that bald spot on the crown of their head, where women generally have a general thinning throughout, but concentrated more on the top of the head. So for FDA approval, we had to come up with two different, gender-specific products, so the directions were more explanatory.” 

Hi,this is really tough for me and I don’t know what to say. I have always lost a lot of hair but I had a ton of hair. However,my mom commented that she noticed that it has thinned out more than usual and it has. And today, I just took picture of the top of my head and see a spot. Like you Lisa, I am completely freaked out, I am two weeks away from my 34th birthday. Sorry, Lisa I don’t know of any doctors except for my dermatologist that I am calling tomorrow and I found an endocrinologist through United Healthcare that I will call. I’m so upset that the crying just won’t stop. What worries me is that I’ve been on aladactone for about a year for acne (but was only at 50 mg) BUT she did up the dosage about 5 months ago (but only consistently take at the 200 mg for 3 months). But my fear is that the aladactone didn’t help prevent it for me. But the thinning out has been noticeable since about May/June of this year so maybe there is hope. Now, I have to put in there I went through a very stressful period from March until now. And had a rapid weight loss of 35 pounds (went from 168 to 133) and I’ve been doing a lot of running. But my concern is my sister has female pattern balding and so does my mom so I am very worried. My sister said the doctor said to up her protein and get super b-12 complex which I started two weeks ago, my sister said she has seen some regrowth. Today, I went and got biotin, magnesium and iron. And bought Nioxin shampoo as i heard it help give the appearance of more hair. I am calling the doctors tomorrow in hopes that it really was just my rapid weight loss, I have to admit I was under a lot of stress and barely eating, I’m eating better now though but again it runs in my family and I am completely freaked out. Lisa if I have any success I will let you know who my doctors were. Know that I too, live in Phoenix and am going through the same thing. It is hard, now I am afraid my boyfriend will leave me. Keep faith.
Family history will often tell the doctor what type of alopecia a person has. Occasionally, a punch biopsy may be necessary to determine the type of hair loss. Looking at plucked hairs under a microscope can help to tell the difference between alopecia areata and androgenic alopecia. Other tests might be done to check for autoimmune diseases like lupus that can accompany alopecia.

Consider consultation with a dermatologist who has an interest in hair loss disorders. They can, admittedly, be difficult to find. Looks like you are about 3 hours away from a noted hair loss expert, Dr. Elise Olsen at Duke University. If it is very important to you, it may be worthwhile for you to travel. Hair loss cannot be appropriately diagnosed without a face-to-face consultation.
I too visited the infamous-overpriced Dr Redmond from NYC. I’m on spiro and all the meds for 7 months, going on 8. Forget regrowth, forget halting of shedding, the rate of hair shedding refuses to slow. (I’m also certain its PCOS and not lupus that causing my hairloss, thoroughly medically investigated my hairloss. ) At the start of my treatment, I cut my hair to bout 5 inch lenght, so I’d easily be able to tell thinning versus halt versus regrowth. And all I can say is, I have less hair than I started with. Unfortunately even a physicians intervention is incapable of helping me. To all those out there, atleast this approach before scratching it off your list, its the least you can do.
Also, re: the Proscar, I think that it may already be helping some as I think my shedding may be tapering off a bit more. I am losing a few less hairs Per day now. Maybe? I don’t know, but I am trying to stay positive!! I have no real regrowth. Just wisps, extremely fine hair, almost hard to see. Kind of transparent. I am not expecting miracles, but trust me…. THe moment I feel I have any true results to share with you girls, I will definitely be posting them! There aren’t many success stories out here. We need more. I guess people don’t come out here as much if they are experiencing good things w their hair?
You can buy minoxidil over the counter, for about $25 for a three-month supply. But you’ll also need to invest some patience. Minoxidil can take six months or even a year to work. Dr. Avram estimates that the drug, which must be applied twice a day, stops hair loss in 80 percent of the women who use it properly and it can actually stimulate hair regrowth in about half the users.
I have had thin, fine and ugly hair since I had a hysterectomy in my 20’s. I am 73 now. My mother had very sad hair as did my grandmother. My hair was thick and good until my surgery. I went to 3 dermatologists and they seemed almost embarrassed to look at my hair. I have tried men’s Rogaine but do not see any improvement. I take lots of vitamins and health aids but they don’t seem to help. I also take Premarin and blood pressure meds which may add to the problem. I wear a hair piece which clips into my hair and the lower back and sides and bangs are my real hair. It all mixes together. It is human hair and has a mono scalp which has a part and looks real. It is not a perfect solution but helps me go in public. As you can tell I have pretty much given up on a good solution and from reading what everyone has to say I am afraid that some of us are just destined to have bad hair.
It is perfectly normal for people to shed 50 to 100 hairs per day. This generally doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time that hair is shedding. However, hair loss occurs when this hair growth cycle and shedding is disrupted or when the hair follicle becomes destroyed and replaced with scar tissue. Female pattern hair loss (androgenetic alopecia) is the most common form of hair loss in women. This occurs gradually and is caused by genetics (from either side of the family), age, and the action of a specific male hormone, dihydrotestosterone (DHT). This hormone is found in lesser amounts in women and it preys on the hair follicles, preventing them from receiving vital nutrients for proper hair follicle growth, leading to the hairs shrinking, and resulting in a shorter lifespan. Interestingly, DHT does not need to be elevated to generate hair loss. Estrogen, when lowered as commonly seen in menopause, creates a change in the ratio of male to female hormones, giving an edge to these male hormones. Compounded with the sensitivity of DHT to the hair follicles, heredity can affect the age at which a woman begins to lose her hair, as well as the rate of hair loss and the extent of baldness. 
How to use minoxidil: Be sure that your hair and scalp are dry. Using the dropper or spray pump that's provided with the over-the-counter solution, apply it twice daily to every area where your hair is thinning. Gently massage it into the scalp with your fingers so it can reach the hair follicles. Then air-dry your hair, wash your hands thoroughly, and wash off any solution that has dripped onto your forehead or face. Don't shampoo for at least four hours afterwards.
Men may also experience some sexual and emotional side effects while taking it: In a study published in the June 2011 issue of The Journal of Sexual Medicine, Dr. Michael Irwig of George Washington University found as many as 92 percent of test subjects reporting problems in the bedroom. The study also reported that “the mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months,” meaning that side effects lingered long after subjects stopped taking the pill.
Finally people who understands what I am going through …I am in a desperate search for doctors in the Miami/Boca Raton, Florida area. Can anyone help? I dont know yet what has been causing my hair loss…I had been loosing some hair throighout the years, and sometimes it gets lees severe but lately has just gotten worse and there is no stopping it seems. I had mt Tyroid checked by PCP a coulpe months ago and my iron level also looked normal …getting desperate. Would appreciate some help.
What’s important to know: the cause of hair loss is specific to each individual, which is why it is so important to have a board-certified dermatologist examine, diagnose, and treat your condition. DR.DENNIS GROSS will review your symptoms, examine your scalp, perform a possible scalp biopsy, and/or order medical and blood tests if an underlying medical condition (like thyroid disease, diabetes, or autoimmune diseases like lupus) is suspected.
have something to say that sounds alarming: I came to the Texas to live 10 weeks ago from the UK. Within only 2 weeks of being here my hair started falling out dramatically, I would lose around 500 to 700 hairs every time I washed my hair, this would also include hair lost through blow drying as I got to the point I would sweep it up off the floor too. Before I left the UK my hair was beautifully silky and shiny and looked so healthy. Over the following 8 weeks the hair loss worsened to the extent I started getting so dramatically thin all over the top of my head that I got myself into a panic every time I would do out as I didn’t want anyone to see me this way as I am quite an attracted woman 38 years of age. My periods are normal and my health appears good, just now I am suffering from depression because of this. The point I am making here is, I never had this in my life before, sure I have had bouts of hair fall from stress but never has it ever got to the point I can no-longer go out ever. I see so many things about this on the TV here in Dallas always advertising women’s hair loss? I also see too much of this on the net also from the US that now I am really getting worried about ever coming here and if this continues I’m going to leave the US and never come back. The people here are so lovely so please don’t get me wrong just that my health and my hair come first. I have visited the US many times and been to many States over the recent years from California to FL to Chicago and each time I come over I start to lose my hair. Bit this time is the worst ever! When I Skype my family back home they are shocked of course and we are all wondering if it is the food chain, the water, the air, pollution, I mean it’s got to be something right? I also spent years over in Brasil and also Lima Peru but never had anything like this, in fact my hair got even better over there than from when I was in the UK last. I’ve got a strong suspicion the doctor’s over here know more than they are letting on and have done for a long time but just making money out of peoples misery. I saw a doctor here who did some blood works and charged me $800 and he didn’t even do a hormone profile or (Ferritin) as checking iron is a total waste of time, Ferritin is the end response of iron absorption. Checking iron in the blood is what is floating around and not what has been absorbed. He wanted to then send me onto an Endo who wanted to charge me another $400. for a consult plus she said anything from $600. for additional blood works. I Lima Peru I can get 10 x more blood works done for no more than $120. Be cheaper for me to get a return flight and have all the tests done over there. Sorry to say this but, the US is a total rip-off when it comes to this sort of thing. Everyone back home thinks the whole thing stinks and sounds very suspect. If my hair gets any worse I’m defo going leave and most likely head on to Lima for a while and then go set my roots in Brasil. I really wanted to be here in the US as I have so many lovely friends over here and could really see a future for me here. I am gutted. Anyways I’m going to do some research to see if I can find a good Endo myself as well as a dermatologist. Maybe it is all to I do with all the nuclear testing they did years ago? they say radiation remains for a 100 years and what with weather conditions, wind, rain, crops, livestock, water supply? Now we have phytoestrogens and now we have this other thing to worry about frankenfoods. Us women have a more complex hormone system than males and this has got to wreak havoc on our endocrine system our glands and of course our hormones. I believe whatever is causing this must be doing something to us internally that is the cause. So lotions and potions working from the outside is not the answer or a permanent solution. I think something is disrupting us from the inside and screwing with our hormones be it thyroid, sex hormones or whatever. So stop sugar drinks, artificial foods and water from plastic bottles, microwave foods and start to clean up your health from the inside and perhaps try find organic meat, vegetable, fruit, fish suppliers. Maybe little more costly, but far cheaper than giving the money to a bunch of quacks? I guess thank goodness for European rules and regulations on food compared to here. Like to hear peoples thoughts.
Alopecia areata is characterized by a localized area of complete hair loss (Figure 5). This may extend to the entire scalp (alopecia totalis) or the entire body (alopecia universalis)12,13 (Figure 6). Alopecia areata is probably secondary to an autoimmune reaction involving antibody, T-cell, and cytokine-mediated losses.14–16 The trait appears to be polygenic, affecting 0.1 to 0.2 percent of the population, with men and women equally affected.14 On microscopic evaluation, “exclamation-point” hairs are found, in which the proximal hair shaft has thinned but the distal portion remains of normal caliber (Figure 7). Spontaneous recovery usually occurs within six to 12 months, with hair in areas of re-growth often being pigmented differently.1,13 Prognosis is not as good if the condition persists longer than one year, worsens, or begins before puberty. Persons with a family history of the disorder, atopy, or Down syndrome also have a poorer prognosis.1 The recurrence rate is 30 percent, and recurrence usually affects the initial area of involvement.12 Thyroid abnormalities, vitiligo, and pernicious anemia frequently accompany alopecia areata.1,12,14
I took spironolactone several years ago, and after 3 days got tinnitus (ringing in ears) permanently. Quit using it. Now, I take Fo-ti, Beta sitosterol, saw palmetto, and black cohosh. Also don’t use commercial hair dyes, as they made more hair fall out and if you have a yeast infection, take yeast defense as an itchy scalp from yeast (think too much sugar in diet) will make your hair fall out. Fructis has come out with a shampoo called Fall Fight that seems to help. My hair loss has stopped, although the volume has not come back. Look for solutions on your own, plenty of articles on the internet. Good luck!
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