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If a breezy day has you feeling nervous, we get ya. Even a slight wind can ruffle carefully manipulated strands that cover thinning.
Hair loss can be tough to deal with. If you’re experiencing thinning, you may have gone through a Google spiral of treatments to try, leading you to wonder, Are DHT blockers safe for females?
In this article, we’ll cover the different medications that decrease DHT, like finasteride and spironolactone, along with side effects and other treatments to consider.
First, let’s get into what DHT is. You’ve probably seen it mentioned when browsing hair loss treatments. But what is DHT and what exactly does it do?
DHT (dihydrotestosterone) is a hormone, and it plays a significant role in the sexual development of people assigned male at birth (AMAB). DHT is known as an androgen, a hormone that stimulates the development of male characteristics. Females also have DHT, but typically much smaller amounts.
Hormonal imbalances can create high DHT, as seen in women who may have polycystic ovarian syndrome (PCOS). PCOS can be tough to diagnose, but it can be quite common, affecting 5 to 15 percent of reproductive-aged females worldwide.
High DHT occurs when the ovaries create excess androgens. This includes testosterone, which then leads to increased DHT levels. Some are more sensitive to DHT than others, so how it affects you can really vary.
This leads us to the symptoms you may experience if you have high DHT.
Research shows that polycystic ovarian syndrome (PCOS) is the most common endocrinological abnormality associated with female pattern hair loss (FPHL). Hyperandrogenism is a feature between both female pattern hair loss and polycystic ovarian syndrome.
Male pattern hair loss is thought to be induced by an increased conversion of testosterone to DHT by the enzyme 5α-reductase. In some women with FPHL, there’s evidence of altered metabolism of androgens, but excessive androgen production isn’t present in all cases.
Increased DHT activity at your hair follicles is one of the causes of hair loss, alongside other factors like genetics. Some people are more sensitive to DHT than others.
And for those lucky people (sigh), high levels of DHT can shrink hair follicles and shorten the hair growth cycle. Over time, these smaller follicles produce thinner vellus hairs, creating hair thinning or loss.
Unlike men, women typically won’t go entirely bald, but they may see a wider part or a Christmas tree pattern of hair loss (wider at the front of the part line while remaining narrow near the back of the scalp).
Curious about hair loss in women? This guide tackles everything from root causes to treatments.
Now that you know DHT can wreak havoc on your hairline, you’re probably ready to fight DHT. This isn’t a bar fight, though — knuckles will do you no good.
Luckily, some medications and treatments can block DHT and help improve female hair loss.
Currently, the U.S. Food and Drug Administration (FDA) has only approved one DHT blocker for treating pattern hair loss, an oral medication called finasteride (commonly sold under the brand name Propecia®).
This medication works by inhibiting 5 alpha-reductase, the enzyme that converts testosterone to DHT within the body. While finasteride doesn’t lead to a 100 percent reduction in DHT, it slows down hair loss considerably.
However, finasteride is currently an FDA-approved medication for pattern hair loss in men, not women. Currently, there aren’t any DHT blockers for women with FDA approval. Most research on finasteride has focused on its benefits as a medication for male pattern baldness, not as a hair loss treatment option for women.
Finasteride is a teratogenic (previously category X) medicine; it might cause abnormalities in a male fetus if a woman is pregnant. Likewise, lactating patients are also recommended not to use this medication.
For these reasons, finasteride is only used off-label for hair loss, typically in postmenopausal women.
Want a deeper dive? We discuss finasteride and its side effects in our guide, Is Finasteride Safe for Women?
You may have seen “DHT-blocking” on the label of a shampoo bottle or hair-loss supplement. But there’s limited research suggesting that these types of shampoos or supplements may actually reduce DHT.
Ingredients like saw palmetto have risen in popularity in haircare products (becoming almost as popular as biotin) due to their purported antiandrogenic properties and hair regrowth benefits.
In five clinical trials and two cohort studies, patients with androgenetic alopecia (AGA) and telogen effluvium showed considerable improvements with the use of topical and oral supplements containing between 100 and 320 milligrams of saw palmetto. About 60 percent reported improvement in overall hair quality, and roughly 83 percent saw increased hair density.
Saw palmetto was well tolerated and not associated with serious adverse risks in alopecia patients, making this a potential treatment to try.
Learn more about saw palmetto for hair fall in our guide to saw palmetto shampoo for women.
Considerable research supports the efficacy of topical DHT blockers in treating women with hormonal hair loss. By inhibiting the 5a-reductase enzyme that converts testosterone into DHT, these treatments lead to decreased levels of DHT in certain parts of the body.
Translation: DHT blockers could potentially help treat hair loss in women. Let’s take a look at the research.
A small 2013 study published in the International Journal of Trichology found that oral finasteride produced improvements in hair density among postmenopausal women affected by pattern hair loss.
We should note that participants were given a 5-milligram dose versus the FDA’s approved 1-milligram dosage. Still, when women’s hair loss is caused by DHT, finasteride appears to be effective at either slowing it down or reversing it.
Topical finasteride has also been shown to increase hair count. While this form is generally well-tolerated, there have been limited studies looking at its effects on women.
In a placebo-controlled trial, 52 patients were given a 0.005% finasteride solution twice daily for 16 months. Those who took finasteride had substantially less hair shedding after six months and continued to improve throughout the duration of the study.
A combination of topical finasteride and minoxidil in this hair growth spray might be a good bet for postmenopausal women experiencing hormonal hair loss.
Additionally, our guide on finasteride for women is an excellent resource if you’re interested in this hair loss treatment.
Another possible concern when using finasteride treatment is a slight rise in estrogen levels. For this reason, the treatment isn’t advisable in females with a family or personal history of breast cancer.
Our article on finasteride side effects in women is another excellent resource if you want to learn more.
Finasteride isn’t your only choice when it comes to treating hair loss in women. Other treatment options include minoxidil, spironolactone, reducing DHT and healthy lifestyle changes.
Commonly sold under the brand name Rogaine®, minoxidil is a topical or oral medication that helps stimulate hair growth. Though the science isn’t exactly clear on how it works, it’s thought to encourage your hairs to enter into the anagen phase (aka growth stage) of the hair growth cycle.
There are a few varieties of Hers minoxidil you can try:
Minoxidil drops. This is a 2% strength formulation with an easy-to-use dropper.
Minoxidil foam. The 5% foam version of minoxidil can be easily worked through hair.
Oral minoxidil. This once-daily pill is a nice option for those who may not have had much success with topical minoxidil.
Spironolactone is a once-daily pill that helps target hormones (like testosterone) that cause excess hair shedding. Androgen binding leads to hair loss, and spironolactone helps inhibit this process. This makes it a potentially effective treatment for female pattern hair loss, especially for those with signs of hyperandrogenism.
While there isn’t definitive research, a healthier lifestyle is generally a good idea for better health and (hopefully) healthy hair growth. You probably already know what this entails, even if you’re not living it yet on the day-to-day.
One cross-sectional study on males with AGA reported that those with a higher BMI (body mass index) had more severe hair loss. While a similar study hasn’t been done on women, we’re betting a strength training sesh or pilates class isn’t a bad idea.
And if you’re a fan of cigarettes, you should know that smoking has been linked to accelerated hair loss in the form of androgenetic alopecia.
There are many ways to come up with a game plan to attack a receding hairline and get thicker hair.
But due to the potential side effects of DHT blockers in women, it’s crucial you talk with a healthcare provider first. They’ll be able to give you the best medical advice if you’re considering this type of medication to prevent hair loss or promote hair growth.
Here’s what you need to remember:
DHT blockers like finasteride haven’t been approved by the FDA as treatments for hair loss in women. However, topical finasteride can be used off-label to treat hair loss in women who’ve already been through menopause.
Before menopause, medications like spironolactone — which work by limiting all androgens, not just DHT — can also help treat female pattern hair loss.
If you’re nervous about taking an oral medication, you might consider the topical route for thinning hair. Hers offers both topical minoxidil and topical finasteride to help you find the right hair loss treatment. You’ve got options, baby.
Need some assistance with your game plan? Get a hair loss consultation today to help stop hair loss and gain control over your hair health.
Want to learn more about female pattern hair loss? Our guide gives you a broader insight into what causes it and how to treat it.
Sara Harcharik Perkins, MD, FAAD is a board-certified dermatologist and Assistant Professor in the Department of Dermatology at the Yale School of Medicine. She is the director of the Teledermatology Program, as well as the Associate Program Director of the Yale Dermatology Residency Training Program. Her research focuses on telemedicine and medical education. Her practice includes general medical dermatology, high-risk skin cancer, and procedural dermatology.
Dr. Perkins completed her undergraduate education at the University of Pennsylvania and obtained her medical degree at the Icahn School of Medicine at Mount Sinai. She completed her medical internship at the Massachusetts General Hospital, followed by residency training in dermatology at Yale University, after which she joined the faculty.
Ahmad, M., Christensen, S. R., & Perkins, S. H. (2023). The impact of COVID-19 on the dermatologic care of nonmelanoma skin cancers among solid organ transplant recipients. JAAD international, 13, 98–99. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518328/
Ahmad, M., & Perkins, S. H. (2023). Learning dermatology in medical school: analysis of dermatology topics tested in popular question banks. Clinical and experimental dermatology, 48(4), 361–363. https://academic.oup.com/ced/article-abstract/48/4/361/6869515?redirectedFrom=fulltext&login=false
Belzer, A., Leasure, A. C., Cohen, J. M., & Perkins, S. H. (2023). The association of cutaneous squamous cell carcinoma and basal cell carcinoma with solid organ transplantation: a cross-sectional study of the All Of Us Research Program. International journal of dermatology, 62(10), e564–e566. https://onlinelibrary.wiley.com/doi/10.1111/ijd.16700
Ahmad, M., Marson, J. W., Litchman, G. H., Perkins, S. H., & Rigel, D. S. (2022). Usage and perceptions of teledermatology in 2021: a survey of dermatologists. International journal of dermatology, 61(7), e235–e237. https://onlinelibrary.wiley.com/doi/10.1111/ijd.16209
Asabor, E. N., Bunick, C. G., Cohen, J. M., & Perkins, S. H. (2021). Patient and physician perspectives on teledermatology at an academic dermatology department amid the COVID-19 pandemic. Journal of the American Academy of Dermatology, 84(1), 158–161. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491373/
Belzer, A., Olamiju, B., Antaya, R. J., Odell, I. D., Bia, M., Perkins, S. H., & Cohen, J. M. (2021). A novel medical student initiative to enhance provision of teledermatology in a resident continuity clinic during the COVID-19 pandemic: a pilot study. International journal of dermatology, 60(1), 128–129. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753449/
Cohen, J. M., Bunick, C. G., & Perkins, S. H. (2020). The new normal: An approach to optimizing and combining in-person and telemedicine visits to maximize patient care. Journal of the American Academy of Dermatology, 83(5), e361–e362. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316470/
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