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Anti-Androgens

Most women who have Androgenetic Alopecia have normal androgen/hormone levels. Symptoms that could indicate high androgen levels include: excessive acne, facial hair, a rash called Seborrheic Dermatitis, cysts on your ovaries, and irregular menstrual cycles. If you suspect that you might have elevated androgen levels you should consult your physician.

Spironolactone, Cyproterone (by itself or in Diane-35), and Finasteride are anti-androgens that may be helpful in women with elevated androgen levels but they have not proven beneficial for the general female public. Anti-androgens are available only by prescription.

Spironolactone was originally used as a diuretic. It can lower blood pressure and can make the body retain potassium, so medical follow-up is essential. Spironolactone has anti-androgenic effects and can reduce facial hair and it is widely felt to reduce hair loss in women with elevated androgen levels. There have been mixed reviews about the use of Spironolactone in women who do not have elevated androgen levels. It has been used for a long time but there is not good scientific evidence to support its use.

Diane 35 is a birth control pill that contains Cyproterone, another anti-androgen. Diane 35 is mostly used to control acne in women who want birth control. It is unproven but Diane 35 is often prescribed for women with hair loss who do not want to conceive. A higher dose of Cyproterone is usually prescribed, either by itself or in addition to Diane 35, for women with elevated androgen levels.

Finasteride blocks the second of the two types of the enzyme called 5-alpha reductase and therefore reduces the conversion of testosterone to dihydrotestosterone (DHT). DHT leads to the miniaturization and loss of genetically sensitive hair on the top of the head, which is seen in the typical (Androgenetic) pattern of hair loss. It has been approved to treat hair loss in men since 1997 and it was expected to be helpful for all women but so far most women have had disappointing results. It is possible but not proven that Finasteride is more effective for women who have high androgen levels to start with. Whether or not more potent 5-alpha reductase blockers, such as Dutasteride, will prove more effective is still unknown. Dutasteride is not approved for use for hair loss or for women.

Finasteride should not be taken by pregnant women or by women who are trying to conceive since it could cause failure of development of normal genitalia in male fetuses.

There are other anti-androgens but these are the most commonly used ones. If anti-androgens are prescribed, and no side effects develop, they should be taken for at least six months before deciding whether or not they are effective. The benefits of anti-androgens last only as long as there is continuous use. Anti-androgens should therefore be regarded as a measure to slow down hair loss temporarily.

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