The effects of hormones on alopecia and treatments

Female pattern alopecia is often diagnosed in patients complaining of thinning. You will generally hear “my hair stopped growing”, patients cannot achieve the same length as before.

This condition needs to be differentiated from the telogen effluvium when patients see “hair everywhere”.

In making a diagnosis it is important to examine the hair shaft, their fragility, caliber and shape.

The lab work is necessary and will include an assessment of the ferritin level, as well as hormones,  like thyroid hormones.

There is no clear evidence that high levels of ferritin are necessary but for patients who are contemplating a transplant it is important to supplement the Fe and bring the levels in the range of 30-40ng/ml.

Androgens however are found within normal range in most cases. If androgen excess is suspected as the cause it is important to check the total and free testosterone as well as dehydroepinadrosterone sulfate and sex hormone binding globulin.

Medical treatment in female pattern alopecia will include Minoxidil. The mechanism of action is not fully understood and patients need to be counseled on the method of use and the fact that telogen shed can occur at the beginning of the treatment.

Finasteride does not seam to benefit women in this category unless they have documented androgen elevation.

In terms of surgical approach, the strip technique and the follicular unit extraction techniques are the most widely utilized.

In order to achieve good results I is important to chose the technique correctly and not everybody is eligible for the same procedure.

In the strip technique an elliptical piece of skin is removed from the back of the head, where the hairs are very dense and not programmed to fall.

The follicular unit extraction techniques have gained a lot of popularity in the last years. There is no scar and a good number of grafts can be isolated in a shorter period of time. With automated devices like the Neograft the procedure is safe and fast with excellent results. The health of the transplanted grafts is well preserved giving a high yield compared to other FUE techniques. The costs however may be higher with this technique as compared to FUE using other devices, because of the cost of the equipment but the results well warrant the choice of this treatment versus the less expensive hand held devices. The size of the punch is well controlled so that there is no excessive scarring leaving that punch out appearance. The follicles are removed intact so there is no loss of healthy hairs during the procedure.

This treatment is adequate for both females and males and is performed under local anesthesia with minimal or no downtime.

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