Hello,

I have some questions. I am a 36 year old female who has had hair shedding since my 20’s (my dad lost his hair at 21). I have all the signs of androgenic alopecia. However, I use to have alot of hair so it didn’t cause me much concern until the last few years. At the age of 30, I lived overseas and took the Birth Control Pill, Diane 35 which was wonderful for hair, but when I moved back to the US I stopped it since it was not available here. 3 weeks after I stopped, I noticed a large amount of increased shedding that went on for months until my thinning was very noticeable. I tried 2 % Rogaine and saw even MORE excessive shedding. I lost a huge amount of hair and it was very noticeable and devastating. Finally, I was able to stabilize my hairloss with 100 mg of spironlactone and have been on it for a year. I started also using 5% rogaine after stabilization and I also saw an improvement. I was basically content.

Well 3 months ago, I took Plan B the backup emergency contraceptive. 3 weeks later, I started noticing a large increase in shedding again. This time I was on 100 mg of Spirolactone and it didn’t stop it (I even saw myself develop acne.) I tried 5% Rogaine to only see my hair fall out even for excessively like before. My doctor has now put me on Propecia. I am worried about this “hyperandrogenicity”. I do not have much hair left and I hope the propecia does not make it worse since I am obviously going through some type of “withdrawal” from the hormones in the birth control. However, nothing seems to stop this withdrawal anymore. I’m very worried and sad. Any feedback would be very helpful.

Thank You

Your treatment plan doesn’t make complete sense to me. I don’t follow why you are taking all these medications and doing what you are doing.

Lets start with the facts:

Hair loss from Plan B (progestin) is a less common, but known side effect (see here).

Rogaine can cause initial shedding which scares people into stopping the medication. If you continue on with Rogaine the shedding will eventually stop and hair will grow. 2% Rogaine is same as 5% Rogaine — the only difference is the concentration. So I don’t understand why you would say you lost so much hair on 2% Rogaine then started 5% Rogaine to have the hair loss stabilize. Then later start the 5% Rogaine and have more hair loss. Maybe you are not using the medication correctly. Once you start the medication, you need to use it for life. If you stop it, the hairs that grew or the hair that were stabilized will fall out. And if you restart it, you risk the initial shedding (the way you saw with the 2% Rogaine a long time ago) all over again. Could the Rogaine be working for you, but you aren’t using it consistently?

Spironolactone is a blood pressure medication that has an effect on blocking androgens, but it has never been proven to grow hair or slow down hair loss unless you had an excess of androgens like women with polycystic ovarian disease (PCOS). I realize many patients use it and doctors prescribe spironolactone, but I would need more information on your hormone analysis. If you are using Rogaine and spironolactone, how do you know which is working or not?

Finally, Propecia only works for androgenic alopecia (more specifically, hair loss related to DHT hormone). I do not know if you are one of the very rare women who have male pattern baldness, and even if you do, I do not know that Propecia would work for you. Regardless, Propecia is NOT recommended for women because it can cause birth defects if you are or may become pregnant. I see you are of child bearing age, and you are obviously sexually active (as you had to take the Plan B “morning after pill”). I personally would never recommend Propecia to young women who can get pregnant. If you must take it, you need to be on a birth control pill, but this is something you and your doctor need to talk about.

Unless you have strong male features, I would think that hyperandrogenicity would not be something you should worry about. My point being that hair loss is not the only symptom of hyperandrogenicity. But that’s just my guess.

You have a complex problem and even the cursory discussion I gave here will not really help you. You need to have a doctor who is focused on hair loss and if your doctor has such an interest, then you need to know why he is doing what you described here. Sometimes, hair loss is self limiting and whatever you are doing or NOT doing may or may not stop the hair loss.

My final thought is you should see your doctor for a good diagnosis and a comprehensive treatment plan.