Treatment of Hair Loss in Women (Spironolactone)

Treatment of Hair Loss in Women - Spironolactone

Today we are going to explain receptor blockade, specifically looking at Spironolactone. We discuss how it works and where it fits in.

Typically we offer triple therapy to our patients, we do blockade and we do the stimulation. We often have two or three treatments in there, triple therapy means 3.

We’re going to talk about receptor blockers. We think that women with female pattern hair loss have different emphases or causes, sometimes we think it’s in the block in the receptor, sometimes we think it’s the enzyme, and sometimes we think it’s estrogen.

What are Receptor Blockers?

We’re going to explain what the receptor blockers are.

Basically a hormone inside the hair follicle that does not become biologically active until it binds to its own receptor. Binding it’s like a lock-and-key binding to the receptor. The issued receptor is great we’re not worried about that one, the one we’re worried about is the androgen receptor. Androgen is just another word for male hormones.

Basically, an androgen receptor will bind both testosterone and dihydrotestosterone. We know that dihydrotestosterone DHT and men cause hair loss and we think that’s implicated in some of our women with female pattern hair loss. We want to make that receptor less active, and that’s why we call them receptor blockers.

Spironolactone for hair loss

The first one I’m going to talk about is a drug that’s been around forever it’s called spironolactone. It was originally used as a diuretic making you pee more for high blood pressure but it also has some androgen receptor blocking qualities.

It’s very commonly prescribed in this condition. We started a low-dose try and built it up to block that receptor. Because it does make some women want to urinate more frequently probably better to take it in the morning or the evening.

Be mindful because it’s the directing diuretic as well can make you drop your blood pressure. If you’ve got low blood pressure to start with maybe this is not the perfect choice.

That’s why we start on a low dose and gradually build up but you want to try and hit a sweet spot, where you’ve got enough receptor blockade that you achieving the goal.

Cyproterone acetate (CPA)

Spironolactone is for women that have excess facial hair. For example, they can give some Cyproterone acetate to block the receptors so it’s not so active. In severe acne, you can do that as well but you can also do it in hair loss.

Interestingly contraceptive pills for women that are using them can have Cyproterone acetate in them. There are a couple of proprietaries, a combined contraceptive that has estrogen and Cyproterone acetate in it.

If we have a patient that we are worried about the family history or showing early signs of female pattern hair loss, we will direct them towards pills that we think are helpful.

In older style pills the progesterone content was high and also the progesterone was of the type that was similar to testosterone so we don’t really use those.

There are 3 or 4 different pills in the marketplace that we think are hair help helpful. Cyproterone acetate is certainly another one.

Flutamide for hair loss

Another one that’s beginning to be used more is called Flutamide. This has to be specifically prescribed but I mean all we really do talking about different medicines that actually block the androgen receptor.

The estrogen receptor can work with estrogen but that testosterone and DHT aren’t working on the estrogen receptor. Basically, we try and get a low dose and you have to stay on it. I’m sorry we are not curing anything here we’re treating it.

So, basically, we will give them some stimulation, whether it’s minoxidil and all those there, but we’ll give them some receptor blockade. We think that as long as we get the right dose of that going forward, two things will happen.

We’re going to prevent the normal progressive deterioration of the hairs. Firstly, the shaft diameters decrease and then the numbers decrease so we prevent that. In the early cases, we sometimes get a reversal and people get thicker hair and get better coverage.

Sometimes we see that women are on the pill and they say:

I’ve been on the pill for whatever reason I’ve come off the pill I’m losing more hair now. That’s not necessarily. It’s the estrogen in the pills that’s beneficial.

The pill has a protective effect on the hair and if you’re on the pill in essence what the contraceptive pill is giving you is a massive dose of estrogen and progesterone.

If you’ve got a high level of that estrogen and when you come off the pill for whatever reason the levels will decline or wash out of the system and decline and you find that that protective effect is not there.

I think that’s a clue when we talk about the fact that there are multiple factors involved in female pattern hair loss. In our test women may be up to 50% of women experience a shed after the birth of the baby because their estrogen went up during pregnancy the baby was born the engine went off a cliff.

If they are so sensitive to the estrogen in the system that they actually shed hairs, then maybe we have to be more careful about the estrogen levels. Same with our women who experience shedding after ceasing a pill because that’s a much lower dose of estrogen.

But if they’re taking estrogen in the pill and stopping the pill and experiencing hair shedding, that is a clue to us that their cycle is very estrogen insensitive. That gives us another insight into what is the predominant factor and why these women are losing hair.

Hair loss in pregnancy

Basically, women shed as I said just a minute ago after the baby is born because estrogen comes off a cliff. The reality is it’s only a correction because during pregnancy and the second half of the pregnancy as your estrogen level goes up the daily shedding rate goes down. After all, that’s the effect that estrogen exerts on the hair follicle.

When you’re pregnant you might notice that you have wonderful luscious hair. Or even hear that generally, women have wonderful hair during pregnancy then this effect goes out.

After pregnancy, women sometimes come in and say: I didn’t get full regrowth and that’s when they unmasked this early female pattern thinning they hadn’t been noticed before. This is the unmasking event that shows us there’s an underlying hair loss going on.

That’s why sometimes you can find in the first pregnancy some shedding is going on and the second pregnancy can be worse and get more aggressive shedding probably because you were unmasking something else that’s going on underneath.

Final point

The critical final point I’d make in this post is that we only treat our women when they’re not pregnant because we regard pregnancy as therapy.

I’m not saying go out and get pregnant, I’m saying that the estrogen levels go up during pregnancy and that’s protective of hair. During pregnancy, you don’t need other medications that pregnancy will do for you.