A rundown of the latest treatments—plus what’s coming down the pike
by Linda Dyett
Updated April 28, 2023
Suffering from scrawny ponytail syndrome? Catching unseemly clumps of hair in your fingers when you shampoo?
Distressing, right? After all, not only does our hair frame and define our faces, it’s one of those obsessed-over secondary sex characteristics, whose purpose, it seems, is to be touchably alluring. Balding in men—well, that’s seen as a part of who they are. But women’s hair loss (better described as hair thinning, since few of us go bald) for centuries has carried a stigma, making it shameful to seek out remedies.
The good news? “It’s out of the closet. Women today are more comfortable talking about it,” notes Robert Bernstein, M.D. a hair loss expert and clinical professor of dermatology at Columbia University’s College of Physicians and Surgeons. They’re acting on it too, what with a growing number of treatments to curb hair thinning and spur new growth.
Hair loss can have many causes, including hypertension, iron deficiency, thyroid imbalance, and taking statins, antidepressants, and other medications. But in women over age 50, the most common form of hair loss is androgenic alopecia—also known as female-pattern or genetic hair loss. And once we reach age 65, it’s been estimated that 50-75 percent of us suffer from this condition, according to Noah Scheinfeld, M.D., assistant clinical professor of dermatology at Weill Cornell Medical College.
Hormone-driven loss is characterized by gradual diffuse thinning on the top and crown, with little or no hairline recession. Also typical, says Dr. Bernstein, who has a practice in Midtown Manhattan, is “a positive family history of hair loss and the presence of miniaturization in the thinning areas.” (Miniaturization refers to individual strands of hair growing in sparser and finer, usually in areas of diffuse thinning.)
But first, the condition needs to be diagnosed and those other causes ruled out. This is accomplished at Dr. Bernstein’s practice by taking a detailed medical history, checking blood counts, thyroid function and levels of ferritin (an iron-storing protein), and of course examining the scalp, typically via densitometry (use of a magnifying instrument that counts the number and diameter of hairs in a given area), hair-pulls (to test for shedding), and hair-plucks (to test for damage).
If genetic hair loss is indeed the culprit, these are the currently available and in-the-works medical treatments:
Widely known under the brand name Rogaine, the topical non-prescription drug minoxidil can re-grow hair in women as soon 12 weeks after starting this formula on a daily basis, typically at bedtime. Originally used to treat high blood pressure, minoxidil widens blood vessels, which in turn promotes follicle growth, while also strengthening and thickening existing hair.
Minoxidil doesn’t work for everyone who tries it, and it won’t restore a full head of hair. Some patients claim it only produces fuzz, rather than full-fledged strands of hair. That’s true for hair that been extremely miniaturized, says Dr. Bernstein. But in other cases, he maintains, it can increase the quality of hair that is just starting to thin.
Rogaine is available in 2 and 5 percent strengths. Dr. Bernstein, for one, generally recommends the 5 percent for women as well as men. And though it’s sold in separate packages for men and women, the formulas in both are essentially the same—that is, they’re interchangeable. The one difference is the package instructions, recommending that women apply Rogaine only once a day (not twice, as advised for men).
5 percent Rogaine is available in these two forms:
Men’s Rogaine Extra Strength Hair Regrowth Treatment, an alcohol-based liquid in a pipette dropper bottle. It definitely works, but can leave the hair matted down (not great for any coif) and can also cause scalp irritation. (Men’s Extra Strength Hair Regrowth Treatment: about $22 per bottle; generic formulations are available at lower prices.)
Women’s [or Men’s] Rogaine Hair Treatment Foam, by contrast, is “an elegant mixture, made for compliance,” says Dr. Bernstein. An aerosolized foam, it’s less irritating than liquid Rogaine, but can be more difficult to get directly on the scalp.” (Women’s Rogaine Hair Treatment Foam: $20-25 per month; again, generic formulations are available at lower prices.)
Both products should be applied to a dry scalp and, Dr. Bernstein advises, massaged in using the fingertips. Also keep in mind: Rogaine or any minoxidil product is a long-haul treatment; we’re talking lifetime here. If you stop treatment, your regrown hair will shed.
Rogaine liquid and foam aren’t the only minoxidil products available for women. This drug, proven to be synergistic, has been compounded with, for instance, tretinoin (the Retin-A drug) for better absorption, with cortico-steroids to minimize inflammation, and with estrogen to promote density and thickness. These formulations have a couple of other benefits. They’re non-greasy, and they’re sold in easy-to-wield squeeze-bottle drop-tainers or spray bottles, allowing for controlled, pinpoint application.
A couple of examples, both available via phone/Skype consultation, and, for non-patients, with approval from their physician, from Yael Halaas, M.D., a Midtown board-certified facial plastic surgeon and assistant clinical professor of otolaryngology at the Albert Einstein College of Medicine:
Formula 82M. Contains tretinoin as well as an androgen-blocker and anti-inflammatory agents. (Formula 82M 1-month supply, $75)
Formula YH Pink. Developed by Dr. Halaas. Contains minoxidil and tretinoin in higher concentrations than in the 82M preparation, as well as estradiol (a potent form of estrogen). This product doubles the effectiveness of Formula 82M, says Dr. Halaas. It isn’t advised for women with a history of estrogen-sensitive breast cancer. (Formula YH 1-month supply, $85).
Three prescription medications prevent the conversion of testosterone to dihydrotestosterone—the hormone responsible for hereditary hair loss. Finasteride (brand name, Propecia) and more powerful dutasteride (Avodart) work by blocking the enzyme that triggers this conversion, and are primarily prescribed to men for treating men’s hair loss and prostate conditions. Since they may cause breast tenderness and a possibly higher risk of breast cancer, the FDA does not approve their use in women. But some doctors prescribe these drugs off-label to their women hair-loss patients anyway. (The price for a one-month supply of Propecia varies from pharmacy to pharmacy, but is generally in the $50-120 range. Avodart is priced from $15-38. Neither is eligible for insurance coverage when prescribed for women.)
Aldactone (Spironolactone) is a diuretic and blood pressure medication that helps hair growth slightly differently, by blocking overall androgen production. Side effects may include weight gain, loss of libido, depression, and fatigue. (The monthly price, generally under $16, is often covered by medical insurance.)
It may take a year of use or even longer before any of these drugs show results on their own, though there is evidence that all three anti-androgens help reduce shedding and stimulate new growth when combined with minoxidil.
Another view of hormonal hair loss is that it’s caused by prostaglandins—cell-function modulators that affect the hair follicles’ growth phase in both positive and negative ways. Indeed, “prostaglandins have emerged as a whole new field of hair growth drugs,” says Dr. Halaas.
One prostaglandin drug that’s already in wide use is Latisse—for growing longer, thicker, darker eyelashes—and for growing brows (as Dr. Bernstein was the first to point out). A sizable clinical study testing Latisse for hair growth has recently been completed, and results are currently awaited regarding its efficacy on the scalp. (A 5ml bottle lasts 10 to 12 weeks and is likely to cost around $135. It’s wise to check online for special offers.)
Meanwhile, a second prostaglandin drug, Setipiprant, while not yet on the market (originally it was investigated as an allergy and asthma treatment; now it’s being tested for its effectiveness on the scalp) is poised to emerge in several years as a major oral treatment that activates hair growth on a cellular level.
Low-Level Laser Therapy
Several home-use appliances—a variety of laser caps (generally priced from $600-700) and laser combs ($200), as well as the new HairMax LaserBand 82 (a hair band with hair-parting teeth; $500-800)—are FDA-approved for treating hair loss, especially the diffuse kind that women have. Used for 30 minutes several times a week, their low-level lasers decrease follicular inflammation, stimulating more and thicker strands of hair.
For many women, the cap is both easier to wield and “more effective for very thin hair, due to the greater number of lasers in it,” says Dr. Bernstein. But for higher-density hair, “a laser comb or the LaserBand82 may be more effective, as it’s probably better at getting the beam to the scalp.”
New growth from low-level lasers is apparent in 3 to 4 months. Mary Wendel, M.D., a Wellesley, Massachusetts, internist who runs what may be the world’s first non-surgical women’s hair loss clinic, has found that her laser-cap and –comb patients show “a significant decrease in shedding. But regrowth takes longer,” and she urges her patients to combine laser use with minoxidil. Dr. Bernstein recommends low-level lasers as a second line of treatment and notes that they’re safe for use without medical approval.
A relatively recent breakthrough, platelet-rich plasma therapy involves spinning the patient’s own blood (preferably twice) in a centrifuge to separate out the solids, which are then enhanced with platelet activators such as thrombin, calcium chloride, and collagen, according to Dr. Bernstein. The resulting PRP is injected just under the scalp into thinning hair sites.
Treatments are typically repeated at intervals of 1½ to 6 months, with improvement evident around 3 to 6 months.
While some doctors have yet to notice significant results, Dr. Wendel points to “fairly impressive research, showing up to 75 percent improvement to slow down loss and stimulate regrowth,” adding that “even a 10% increase is an improvement.”
In the New York area, PRP treatments range from about $750-1,250; doctors performing a double centrifuge tend to charge at the high end of this range.
(Also see NYCitywoman’s article on Top Wig Boutiques in New York City.)
For decades, transplants involved strips of harvested hair placed in sparse areas of the scalp—not ideal. Today we’ve got a subtler technique, Follicular Unit Transplantation, in which tiny units of 1 to 3 follicles are harvested, usually from the back and sides of the scalp, where hair tends to be healthiest and most plentiful. These grafts are then placed in equally tiny recipient sites that have been prepped with a fine needle-point instrument. “Generally single graft units are placed at the hairline, 2-hair grafts a little further back and so on,” explains Dr. Halaas. It’s this pinpoint technique “that allows many women to have a completely natural hair restoration, producing a dramatic change in their appearance,” says Dr. Bernstein.
At Dr. Bernstein’s practice, advanced robotics is used to extract the follicular unit grafts. This, he says, “allows for unparalleled precision, without any line scars in the donor area and no post-operative limitations on physical activity.”
In the New York area, transplants range from $5,000-15,000, depending on the number of grafts.
Stem cell studies in human hair are under way, with experts predicting that minimally invasive cloning will become available in 10 to 15 years, producing a full head of hair.
How might this work? A punch biopsy from the back of the scalp will yield healthy cells responsible for hair growth. These are then dissected, reproduced, and injected into the scalp, where they will induce new hair growth.
Okay, definitely yes to cloned hair, but we’ve got questions: Won’t these new tresses also be subject to genetic hair loss? Will they be in better shape than our current hair? Can they, like extensions, add density to the hair we already have? And won’t we need facelifts to go with our full new head of hair?
Robert Bernstein, M.D.: bernsteinmedical.com, 212-826-2400
Meditresse, Mary Wendel, M.D., founder. meditresse.com, 347-704-2370, in NYC
Dr. Halaas, drhalaas.com, 332-239-6439
Linda Dyett’s articles on fashion, beauty, health, home design, and architecture have appeared in The New York Times, Washington Post, Monocle, Afar, New York magazine, Allure, Travel & Leisure, and many other publications.