There are more treatments than ever for hair loss in women. Experts weigh in

Hamilton Spectator

2 days ago

There's nothing quite like a good hair day, with that waterfall of shine befitting a Pantene commercial. But for the
up to 40 per cent of females
who experience thinning by age 50, those good hair days are harder to come by as we get older.
A bit of shedding every day is part of a normal hair cycle, but if you start to see an increase in the amount of hair caught in your hairbrush, or you have a widening part, recessed temples or bald patches, it might be worth making an appointment. 'Most patients don't present to their doctor until they've lost about 50 per cent of their hair,' says Dr. Michael Brandt, a facial plastic surgeon and hair restoration specialist at
Form Face + Body
. 'They just don't notice it.' A dermatologist, specialized doctor or certified trichologist can help you find the cause of your loss and provide treatment options, usually topicals and medications followed by in-clinic therapies as necessary.
Unfortunately, there is an element of trial and error with many hair loss treatments. 'Things like PRP and low-level laser therapy (LLLT) are second- or third-line options,' notes Caroline Ruggiero, IAT-certified trichologist and CEO of
Truly You Hair & Scalp Clinic
. 'Maybe they'll work, maybe they won't.' That's because the research on non-medical therapies often isn't as rigorous and may be funded by the companies creating the technology. Plus, they aren't subsidized by insurance. Many dermatology and trichology clinics still offer these solutions, though, because they can be very effective for some patients.
Another issue with hair loss treatments is the lack of research in women compared to men — especially women with darker skin tones. 'I'm tired of companies studying their devices with Fitzpatrick skin types I to IV,' says dermatologist Dr. Rénee A. Beach, founder of
DermAtelier on Avenue.
'Basically, they test on white people and maybe some East Asian people, not brown and Black people.'
Despite these ongoing issues in the industry, there are a wide range of treatment options — if you're willing to commit.
'There are easily 20 types of female hair loss, each with subtypes,' says Beach, noting that different types have different causes. Generally speaking, these types of alopecia (the medical term for hair loss) are grouped into two categories: non-scarring and scarring. In non-scarring hair loss, the follicles are not destroyed and can potentially regrow hair:
There are also several types of scarring alopecia, where the hair follicles are destroyed and replaced with scar tissue that prevents regrowth. The cause isn't always clear, but an autoimmune condition is often a factor. There are different types of scarring alopecia, in total affecting around
three per cent of people with hair loss
.
Yes, in many cases — especially if you catch it early. But an accurate diagnosis is key. 'I guarantee that there are people walking around with very complex disorders who think they have telogen effluvium or female pattern hair loss,' says Ruggiero. 'Without knowing what's happening, you don't know which treatments will work.'
To get a proper diagnosis, see a dermatologist or certified trichologist. Trichologists are not doctors, so they will have to work with your primary-care physician to order blood work or prescribe medications. Still, they can offer educated recommendations and may be easier to book than a dermatologist. According to
new research
, only 38 per cent of Ontario dermatologists are accepting OHIP referrals for hair loss.
Once you have your diagnosis, it's best to try just one treatment at a time. That way, you'll be able to pinpoint what's behind any improvements or, in some cases, side effects.
Keep in mind that most treatments take six months to show results (be wary of so-called quick fixes!) and may require lifelong upkeep. 'That's probably one of the most disappointing things that people hear when they come to see me,' says Beach. 'If you find something that works for you, expect to continue it indefinitely.'
Often, medications are the first-line response for female pattern hair loss, because they're backed by robust research (albeit primarily in men), help to retain existing hair and are often affordable. Minoxidil, whether in a topical like Rogaine or in prescription pill form, is a popular treatment that dilates the blood vessels, allowing more blood to reach the hair follicles. The pill is cheaper than the topical version and, for many people, is more convenient than rubbing Rogaine on the scalp twice per day.
There's also a category of medications called 5-alpha reductase inhibitors. They help to block a hormone called DHT from shrinking the hair follicles, which is a significant factor in female pattern hair loss and can be a problem for women with Polycystic Ovary Syndrome. These medications work for many people, but can come with side effects (breast tenderness, headaches and decreased sex drive) and are contraindicated for anyone who has had breast cancer or a first-degree relative (mom or sister) who has had breast cancer. They may also impact egg quality, so it's rare to prescribe this medication to premenopausal women who hope to conceive. In this age group, a hormone blocker like spironolactone may be an option.
For alopecia areata, one of the most effective treatments is a class of medications called JAK inhibitors, which can help to reduce inflammation. However, it has side effects and isn't typically covered by insurance. The exorbitant cost? Around $20,000 per year.
Procedures like PRP, microneedling, light therapy and transplants are commonly used as adjunct therapies to oral medication. However, if someone doesn't want to risk the side effects of medication or has a contraindication, they may be the first approach.
What it is:
Commonly used for androgenetic alopecia and telogen effluvium, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) can be injected into the scalp to stimulate hair follicles with growth factors spun from your own blood. Scalp Botox — yes, the wrinkle-freezer — is also a newer option for treating these types of hair loss by reducing inflammation and oil production while stimulating blood flow to the follicles.
What's involved in treatment:
For PRP or PRF, your provider will first draw a small amount of blood from your arm and place it in a centrifuge to separate out the plasma and/or fibrin, then draw that substance up into a syringe. Numbing cream can be used before injecting PRP, PRF or Botox to reduce discomfort, which can feel like a sharp pressure. You may experience bruising, itching, redness or swelling that lasts for a few days.
How many treatments are needed:
For PRP and PRF, three treatments spaced four to six weeks apart, then maintenance treatments every three or four months; for scalp Botox, just like getting it in your forehead or around your eyes — about every three to four months.
How much does it cost:
$600 to $1,200 per session (though there are often discounts for packages).
What it is:
This hair loss treatment involves puncturing the scalp with tiny needles to create microchannels, which attracts oxygenated blood to the surface. These pathways allow growth-enhancing topicals like PRP, exosomes (derived from stem cells or placenta cells), or customized serums to better penetrate. There is also new regenerative technology out of Canada's own
Acorn Biolabs
that uses stem cells processed from 50 of your hair follicles to create a personalized secretome serum for application after microneedling.
For all types of microneedling, the provider will apply an anesthetic cream to numb the area, then they'll create micro-injuries in the scalp with a dermaroller or dermapen — hand-held devices with tiny needles. You may experience some mild discomfort. Next, it's time for the chosen topical treatment, which will need to stay on for 12 or more hours. You'll be able to resume normal activities in a day or two, and may experience some redness and swelling for a couple days.
How many treatments are needed:
Three treatments spaced four to six weeks apart, then maintenance treatments every three or four months.
How much does it cost:
$500 to $1,000 per session with discounts on packages. For microneedling with a secretome serum, there's also a one-time cost of about $5,000 for stem cell collection and the production of 12 vials of serum.
What it is:
A device like the Alma TED uses ultrasound waves and air pressure to improve blood flow and absorption of a hair serum containing growth factors and peptides.
What's involved in treatment:
Your provider will apply the serum to your scalp, then will move a hand-held device over your head. It's painless and with no downtime but you'll have to leave the serum on your head for 24 hours.
How many treatments are needed:
Four treatments spaced one month apart, then maintenance treatments every four to six months.
How much does it cost:
$800 to $1,200 per session with discounts on packages.
What it is:
The most common laser for hair loss right now is low-level laser therapy (LLLT). It uses diffused red and near-infrared light to increase blood flow and stimulate the hair follicles. Some people — typically with short, straight hair — have good results, while others don't see a difference. On the more aggressive side of the laser spectrum, Health Canada recently cleared a non-ablative fractional laser called
FoLix
. It promises to stimulate hair growth by creating micro-wounds in the scalp with its tiny beams of energy, though its adoption into Canadian clinics hasn't picked up steam yet.
What's involved in treatment:
LLLT and FoLix each take about 30 minutes per treatment and are generally pain-free with no downtime. For LLLT, you sit with a helmet on your head and can read a book or scroll your phone. For FoLix, you lie down and your provider moves a hand-held device over your scalp, using the laser to target thinning areas.
How many treatments are needed:
Two to three weekly LLLT treatments for four to six weeks, then maintenance treatments every week; monthly FoLix treatments for four to six months.
How much does it cost:
$70 to $150 per LLLT treatment, with discounts on packages (some people choose to buy their own device [$1,500 to $5,000] if LLLT works for them); expect FoLix to ring in significantly higher per treatment.
What it is:
A hair transplant removes follicles from one area of the scalp (often the back of the head where hair is thicker or hair loss is less noticeable) and implants them in another. 'If there's global thinning, a hair transplant is not the answer,' notes Brandt. For candidates that have enough transplantable hair for the procedure, the follicles are traditionally harvested and implanted manually, but new technology is changing the process — and results. For example, the
Artas iXi Robotic Hair Restoration
system uses a robotic arm, multiple high-tech cameras and AI to improve the rate of successful transfer from 80 per cent in skilled human hands to more than 90 per cent.
What's involved in treatment:
Small strips of your hair are shaved at the back of your head so that the robot (or your provider) can access the follicles in the area. For women with long hair, these strips usually can't be noticed. As you lie face down, the follicles are then grafted with a scalpel, needle, or the Artas iXi, which acts kind of like a hole punch to harvest the follicles over the course of three hours. After a short break, the grafts are reinserted into the scalp's thinned-out areas, one by one. Altogether, the procedure takes six to 10 hours and nerve blocks and Ativan are used to manage pain and anxiety. After two weeks, the donor area should be fully healed, but it takes at least a year to see the full results.
How many treatments are needed:
One, in most cases (however, hair loss tends to be progressive and will likely continue with age).
How much does it cost: $8,000 to $15,000 on average, depending on how many follicles are harvested.
Recently, there's been a scalp-care boom, popularizing new serums, shampoos and conditioners designed to hydrate the scalp and strengthen hair roots to help minimize shedding. Some lean on peptides and antioxidants like you'd find in skin care, while others use ingredients like Aminexil, which is chemically similar to the tried-and-true minoxidil. You've likely also spotted caffeine-spiked serums and scalp massage tools, both designed to stimulate blood flow to hair follicles. For Ruggeiro and Beach, these products are fine complements to a treatment plan, but the pros note that there's a lack of third-party research to support the effectiveness. 'I don't think there's anything wrong with treating scalp care like skin care, but if you have a serious condition, disorder of the scalp, progressive form of hair loss or autoimmune form of hair loss, you need proper diagnosis and treatment,' says Ruggeiro.
Maintaining existing hair is easier than growing new hair, so it's always a good idea to take care of your mane — just don't expect a miracle shampoo to overdeliver, says Beach. 'I don't have a problem with people using shampoos that they think are helpful, but how long do you leave your shampoo on your head? A minuscule amount of time. I have Afro-textured hair and wash it once a week. How am I going to expect a shampoo alone to stop hair thinning? The math doesn't math.'
Maintenance is crucial for good long-term results. That means that the best hair restoration treatment is the one you can afford and are willing to stick with forever. 'If you have unlimited time and money, you could probably layer all of these treatments,' says Ruggiero. 'But if you can't spend $20,000 or $30,000 on your hair every year, then don't start.' Instead, pick one or two therapies — say, oral medication and PRF injections three times per year — and stick with them.
For female pattern hair loss, you'll often want to start with topicals and medications. Then, if you're not satisfied with your results or don't want to take medication, you might consider PRP with or without microneedling as the next step.
If you have telogen effluvium, finding and resolving the trigger is essential. That may mean changing your diet, working to minimize stress, correcting thyroid concerns or waiting out the postpartum period. To jump-start the hair growth phase, you can try PRP, microneedling, ultrasound or lasers — but you first need to treat the underlying cause of your hair loss or you're wasting your time and money.