The Most Common Cause of Hair Loss in Women: Androgenetic Alopecia


Hair loss in women is one of the most emotionally traumatic conditions I deal with in my clinic. Many women are often concerned that will have a “monks” hairline by the time the condition burns itself out. Their hair is part of their femininity and identity, the crown of their womanhood. Nonetheless, hair thinning and loss can be a common and normal component of aging. Thankfully, there are ways to stop or drastically damper the mechanism which causes females to lose hair. This blog explores why you lose your hair and how to keep it.

It is normal to lose 100-150 hairs a day and that number goes up to 250 with hair washing. However, by the time most people notice significant hair-loss, beyond normal shedding, 50% of hair has fallen out. Thus, it is important to recognize hair-loss in its early stages and initiate treatment before it becomes permanent. Your first course of action should be scheduling an appointment with a dermatology provider. Second, as it is common that appointments can be scheduled weeks or months out, it’s essential to understand alopecia and what is available OTC to treat it.

Hair loss affects 50% of women to some degree, most often occurring with aging into the 3rd, 4th, or 5th decade of life. “Of all women who suffer from hair loss, 70% have no apparent cause other than heredity,” according to Dr. Craig Ziering, a hair restoration expert. This means that ONLY 30% of people will have hair loss from thyroid issues, anemia, or other diseases.

Normal Hair Cycle

Hair typically grows 6 inches a year. A normal cycle includes anagen, catogen, and telogen. Anagen is the active growth cycle which represents 90% of the hair environment at any given moment. Catogen is a 2-3 week transition phase where hair miniaturizes. Telogen is a 2-3 month resting phase.

Androgenetic Alopecia

This is the most common cause of hair loss (that 70% mentioned above) which is merely due to aging and genetics. In this condition, the anagen phase is shortened and mini, thinned, short hairs start growing instead of long, robust hair strands. This process is mitigated by an androgen (“male-hormone”) called testosterone being converted to dihydrotestosterone (DHT) by a chemical called 5-alpha-reductase. In people with androgenetic alopecia, there is increased 5-alpha reductase and thereby increased DHT, in addition to extra DHT receptors in the scalp. DHT binds to where its receptors are prominent in the mid frontal to occipital hairline, flips a switch, and turns on hair loss and thinning.

 All these events cause hair loss and over time can cause permanent loss of growth. The inheritance pattern is unknown, but it tends to run in families.

OTC Treatments


Saw Palmetto is touted as a natural supplement for hair loss, but research on this is limited, yet promising. It works by slowing production of 5-alpha reductase. Thus, it was originally utilized for enlarged prostates and thought to have similar properties of the prescription finasteride. Use of this supplement, along most herbals which lack vigorous clinical trials, should be discussed with your provider and you should learn further about possible interactions with current medications, conditions, and side effects. The Mayo Clinic gave it a “C” rating, advised as “unclear scientific evidence for this use.” Find further information on the National Institutes of Health’s website at


There are certain vitamins and minerals that are essential to skin, hair, and nail growth. Biotin and zinc are the two most commonly utilized vitamins for hair growth, as their deficiency can cause hair loss. However, according to U.S. studies, most adults are already receiving the recommended amount of these supplements in a regular diet. If diet is compromised, supplementation of up to 30 micrograms a day for adults is recommended (read more on biotin @ ). Nonetheless, Zinc for hair loss has been found inconclusive in studies with a “C” rating by Mayo Clinic. However, also per Mayo Clinic, if Zinc Supplementation is utilized it is advised that, “Zincomed, containing 220 milligrams of zinc sulfate, has been taken by mouth twice daily for three months,” for adults.

Viviscal is another popular supplement made with marine derived proteins and glycosaminoglycans along with other natural elements. In a 2015 JCAD Viviscal study, participants saw a significant increase in number and thickness of hair at 90-180 days of twice daily dosing.


OTC Nizoral 1% shampoo is targeted to treat severe “dandruff” or seborrheic dermatitis, which is caused by a yeast. However, the main ingredient of ketoconazole has been shown in past studies to have anti-androgenic effect, thereby being plausible to also help in hairloss.

Caffeine is also an unexpected but promising player in promoting hair growth research studies, which have found concentrations of 0.001%-0.005% to be anti-androgenic. Thereby, results show thickening of follicles, increased cell activity at follicle root, and increased hair growth. Hair Surge is one product that contains both caffeine and ketoconazole (the active ingredient in Nizoral shampoo mentioned above).

Follicure Shampoo (Pirocotone Olamine) was researched against Nizoral by International Journal of Cosmetic Science in 2002 and found Piroctone Olamine outperformed Nizoral and Head & Shoulders in its ability to increase hair thickness and decrease oil, proving antiandrogen effects.

Although lacking in independent research, Pura D’Or shampoo is a new heavy hitter in the hair loss market and provides company sponsored research of positive hair growth results.

Tricomin Shampoo also has been hailed as a great product, “In Phase II clinical studies, Tricomin had very positive results. It was tested on 36 men who applied the treatment topically twice/day for 6 months. It is one of the few treatments that have actually been shown to stimulate hair growth in intensive FDA trials,” according to

Scalp Solutions

Many of the brands above are accompanied by leave on product versions which tout natural or herbal ingredients. Ducray (alone or by Glytone) hair loss stimulants such as Creastim, Anastim, and Neoptide lotion are newer items on the market but hailing great remarks. Research statistics are provided on their website.

Qilib is also a brand that offers a revitalizing hair solution along with stronger medicaments. More information is available on their site at

Retress is a newer product developed by a Las Vegas dermatologist, which provides minoxidil-free scalp treatments, for those who get squeamish with that chemical ingredient. Research is posted on the site and can be found at


This medication was originally an oral prescription to treat high blood pressure when happenstance it was found to increase scalp hair growth. In alopecia, it is thought to increase blood flow to follicles thereby increasing oxygen and nutrients. It is available OTC in solutions or foams of 2% (for women) and 5% (for men) form in brands like Rogaine or Qilib. Although it is not FDA approved as a 5% in women, many clinicians will recommend the 5% to patients if used under their supervision. A few small research studies have found the 5% to be more effective than the 2% in women. Discuss this with your clinician to ensure you are a good candidate for such.

Light Therapy

Low level red light therapy (630-670 nm) is available in OTC combs, brushes, caps, and helmets. It works by emitting light of a specific spectrum that reaches hair follicles to stimulate growth and has proven results in several studies. However, a few individuals will have no response to light therapy and it is best used in conjunction with other methods. The most popular brands of such are the HairMax LaserComb, I-Grow Laser Helmet, and Capillus 272 Pro Laser Cap. Yet, this method of hair regrowth can be pricey in the range of $200-$3000.


Toppik is a hair building fiber spray that coats areas of hair loss with a color matching keratin fiber complex mimicking human hair. There are several brands of such sprays, yet quality of ingredients in some may appear more natural than others. Such sprays are of limited use in those with sever hair loss, as the keratin fibers need anchor hair to attach to.

Hair Styling

A savvy touch at the salon may help to decrease the appearance of thinning. Styling methods such as shoulder length cuts, blunt trims to scraggly ends, and using a hair dye (which plumps up the hair shaft) can help pump up the volume.


A thorough understanding of all of these methods is imperative for those with androgenetic alopecia, as there are minimal prescription medications available. The majority of treatments for this are OTC. As such, the importance of understanding this condition and how OTC products treat, is of great value. Patience is also of virtue as it will take at least 3-6 months before results from your efforts are seen. Nonetheless, with the time, effort, and expense needed, the importance of treating the right diagnosis is essential. Make sure to have an experienced dermatology professional examine your scalp, to ensure the hair loss you are having is of the 70% garden variety vs that caused by true disease, as will be discussed in the next blog.

*The information provided above or in any blogs on this site is for educational purposes. It does not replace advice or necessary examination and diagnosis from your healthcare clinician. Please see your healthcare provider for any and all concerns with changes in your health or treatment of disease.*

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