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What women can do about thinning hair

Bonnie Miller Rubin, Chicago Tribune reporter

March 7, 2012

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No one wants to lose their hair, but for a woman it is particularly distressing. While men can look perfectly presentable — even sexy — with their exposed scalp, no such options exist for the 30 million American women who grapple with thinning tresses. Dr. Maria Colavincenzo, a dermatologist at Northwestern University Feinberg School of Medicine, has a practice that specializes in preserving those precious strands — especially in cases of androgenetic alopecia, a hereditary condition that causes hair loss, mainly on the top and crown of the scalp. Without an appointment, she answered some of our questions:

Q. Why does it seem like we're seeing more of this problem? Is it because of all the aging boomers and menopause? Stress?

A. Hormonal shifts can make thinning more prominent — but for some with a more significant problem, it started way before that. And while stress can play a role, I just think there's a lot more awareness today … and more people are seeking help.

Q. There are tons of "volumizing" products out there, but from a science standpoint it seems like very few stimulate new growth. What ingredient should a consumer look for if she wanted to make sure she wasn't throwing out money?

A. I can't say that there's a strong body of medical literature that supports any product. When patients ask, "What shampoo should I use?" I don't have a great answer.

Q. Minoxidil (Rogaine) is the only topical product that has been effective, but lots of women who try it see no results. What is the success rate?

A. I'd say 25 percent get very good results. For another group, it just means that the situation is not getting worse, which no one ever considers a success. If you are thinking about it, you should start early. Minoxidil is not for everyone. … It can take at least six months to work — which doesn't fit most patients' time frames. It can stimulate facial hair or cause a rash on the scalp. It's not a miracle, but it's the only FDA-approved medication we have and it's been that way for 30 years. These are things we struggle with.

Q. What do you think of hormone replacement therapy? Iron supplements?

A. I would never recommend HRT for hair loss. If you're shedding, it might warrant investigation to check a patient's iron stores. If your iron is low, some kind of supplement can be helpful. But I'd need to know where you are and what you need.

Q. How about other interventions, such as steroid injections or laser combs?

A. Steroids are not for female pattern hair loss but are sometimes used for alopecia areata (spotty hair loss that is different than hair loss due to genetics and aging). Laser combs? There are some reports that low-level light therapy could stimulate hair growth in some people. It's something to try when people feel like they have no other good options. At $350, it's expensive and I'm not sure it's worth the money, but it is safe.

Q. What about Latisse, the prescription drug for growing eyelashes? Why can't we just put it on the scalp and grow hair?

A. It's very interesting. … It started as a drug for glaucoma and then people who used it found that their lashes were thicker … a happy accident. As for hair loss, it's still an unknown that's being studied.

Q. Medical reasons aside — hypothyroidism, for example — if your shedding is genetic, what are the options? Like men, are women relegated to camouflage with hair pieces and wigs?

A. I think it's a personal preference, but why is a cosmetic solution such a big deal? To use sprays, powders and hair extensions? It doesn't address the problem, but it can do wonders for your self-esteem. I see patients who are extremely depressed, and this is ruining their life. We always have hope for that miracle solution, but it's very hard to do research studies. … As much as this affects people's mentality, there's not a lot of (National Institutes of Health) funding because hair loss isn't killing anyone.

Q. What do you think about hair transplants?

A. It certainly is an option for women, although it's very expensive and not covered by insurance. I'd make sure the surgeon does women patients, because … their thinning pattern is a little different so a different strategy is needed and familiarity with how women thin is important. Again, if you're going to pursue this, don't wait until you're hair loss is really bad.

Q. What would you do?

A. I'm in my mid-30s — but if I was definitely done with having children, I'd start with the Rogaine.… Then I'd look into the anti-androgen meds — finasteride or spironolactone — which is not FDA-approved for women but sometimes helpful. Then, I'd get myself a good hairpiece. … You've got to do the best with what you have.

brubin@tribune.com