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[Yasmin]

Hi ladies,

I wonder if you can help pls. I’m 55 years old and recently (about 2 months ago) started HRT. I’m going through a late perimenapause and was put on the bio identical Estradot (Estradiol) oestrogen at 75mcg patches and Utrogestan (progesterone)100mg capsules. However, because I was experiencing  a lot of breast pain and not simply ‘tenderness’ I came off both after a week as I was concerned about the risk of breast cancer. However some of the benefits I noted even in that short space of a week were that my gums/teeth had stopped hurting/being sensitive, my libido had returned big time and my boobs were much firmer, plus my overactive bladder had settled, meaning that I was no longer getting up 3-4 times a night to go to the loo. 
Therefore after doing some further research, I decided to go back on it but this time more gradually, so I started at 35mcg for a week but felt no change, then I increased it to 50mcg for a week and again no change, then back to 75mcg for a week but still no change, so I upped it to 100mcg but again no change. My symptoms had come back but no benefits. On top of this disappointment my hair has thinned considerably, each strand is like gossamer, giving an overall awful ‘candyfloss’ appearance. I feel gutted and feel like giving up.
Has anyone else gone through this? Has anything else worked? Any ideas?
I won’t be seeing my GP for another week yet but even then she is pretty clueless. I’m sat here and going to try and do some online research but feel overwhelmed as lots of contradictory information...with so called ‘specialists’ seemingly copying blurb from each other and then setting up ‘practice’ and charging a fortune for it. I don’t have funds for the £200 per hour consultations, only no doubt to be told the same that I can gather online.
I spoke to my sister and she said she has been on Femoston Conti (combined pill) for a while and that that is not meant to cause hair loss and  added that she has not experienced any hair thinning or loss…which gave me a glimmer of hope… but then I saw a post from another woman on here who said she was experiencing hair loss due to Femoston Conti! Omg, what do I do??!!   
Any help/ideas would be greatly appreciated 
Many thanks and thankyou for sharing  on here x       

[Ana21]

Hi Yasmin,

A good place to start is with a visit to your GP or, even better, your dermatologist.  If you don't have a dermatologist, your GP will likely run a few basic blood tests while you wait for your referral, such as thyroid, ferritin, cholesterol, etc. Your GP may also suggest that you start using topical minoxidil (Rogaine/Regaine) in the interim.  Your dermatologist will take a complete history, run additional blood tests, and will examine your scalp with a dermatoscope.

List of blood tests for women with hair loss:
https://donovanmedical.com/blood-tests-women

In order to find an effective treatment, you need to know the underlying cause of your hair loss.  There may be multiple factors that will all need to be addressed.

I suffer from female pattern hair loss triggered by hormonal imbalance.  I've regained most of my density and my hair looks normal now.  My current treatment is 5% minoxidil foam (Regaine/Rogaine) and Finasteride 5 mg (DHT blocker), as well as systemic MHT (oral estradiol/micronized progesterone). 

Female pattern hair loss (FPHL) is very common.  It causes miniaturization of the hair follicles, the hair becoming thinner and sparser.  More info here:
https://static1.squarespace.com/static/5243dccde4b08fd9e4fc92ef/t/600e5c8ed9c8e22e3fd1e3c4/1611553934641/fphl+2021.pdf

There are so many potential causes of hair loss that you need an accurate diagnosis and you have to be patient with the process.

Some forms of hair loss are scarring, which means they result in permanent hair loss.  That's why it's important to see a dermatologist. 

You've been on and off hormone therapy.  My hair follicles are very sensitive to hormonal changes and that would trigger telogen effluvium (temporary hair loss) in me.   Every adjustment to my hormone therapy has resulted in temporary shedding.  Anything that has the potential to alter the hair growth cycle can trigger shedding.  So every hair loss treatment that I've trialed has caused temporary hair loss to some extent.  That's why you have to stick with a treatment for many, many months before you can determine whether it's working.

There's a lot of snake oil and snake oil salesmen out there.  For example, do not take mega doses of biotin.  Thyroid dysfunction can cause hair loss.  Large doses of biotin can interfere with blood testing.

Keep us posted and let us know what works for you.

[sheila99]

I can't help with the hair loss but if you're going to try hrt again you really need to stick one dose for much longer. The usual starting dose in peri is 50mcg, 75 is unusually high to start on. They say you should try it for 3 months to get the full benefits of it, the worst thing you can do is to keep changing it. I think this is right as it took 3 months for my anxiety and insomnia to go completely. If you're peri you'd normally use a sequi regime so 2x100mg utrogestan x 12 days ( days 15-26). Apologies for the waffle if you have no intention of trying it again   .

[Bungo]

Hi Yasmin,

A good place to start is with a visit to your GP or, even better, your dermatologist.  If you don't have a dermatologist, your GP will likely run a few basic blood tests while you wait for your referral, such as thyroid, ferritin, cholesterol, etc. Your GP may also suggest that you start using topical minoxidil (Rogaine/Regaine) in the interim.  Your dermatologist will take a complete history, run additional blood tests, and will examine your scalp with a dermatoscope.

List of blood tests for women with hair loss:
https://donovanmedical.com/blood-tests-women

In order to find an effective treatment, you need to know the underlying cause of your hair loss.  There may be multiple factors that will all need to be addressed.

I suffer from female pattern hair loss triggered by hormonal imbalance.  I've regained most of my density and my hair looks normal now.  My current treatment is 5% minoxidil foam (Regaine/Rogaine) and Finasteride 5 mg (DHT blocker), as well as systemic MHT (oral estradiol/micronized progesterone). 

Female pattern hair loss (FPHL) is very common.  It causes miniaturization of the hair follicles, the hair becoming thinner and sparser.  More info here:
https://static1.squarespace.com/static/5243dccde4b08fd9e4fc92ef/t/600e5c8ed9c8e22e3fd1e3c4/1611553934641/fphl+2021.pdf

There are so many potential causes of hair loss that you need an accurate diagnosis and you have to be patient with the process.

Some forms of hair loss are scarring, which means they result in permanent hair loss.  That's why it's important to see a dermatologist. 

You've been on and off hormone therapy.  My hair follicles are very sensitive to hormonal changes and that would trigger telogen effluvium (temporary hair loss) in me.   Every adjustment to my hormone therapy has resulted in temporary shedding.  Anything that has the potential to alter the hair growth cycle can trigger shedding.  So every hair loss treatment that I've trialed has caused temporary hair loss to some extent.  That's why you have to stick with a treatment for many, many months before you can determine whether it's working.

There's a lot of snake oil and snake oil salesmen out there.  For example, do not take mega doses of biotin.  Thyroid dysfunction can cause hair loss.  Large doses of biotin can interfere with blood testing.

Keep us posted and let us know what works for you.

Am also suffering severe hair loss, scalp is very visible and dramatically .so in last 6months waiting for biopsy. Am reluctant to take medication for it, did you notice side effects from the finasteride? Im worried about.losing strength and muscle as I'm a powerlifter . Also have dogs so worried about using regain as apparently can be toxic to them? Does the regain also make your hair more frizzy/worse condition have you noticed?

[Yasmin]

Hi ladies,

Many thanks for your thoughts...sorry I don't know how to reply on the forum...there doesn't seem to be a clear link? Have replied to one or two individually but as I'm busy with this nightmare I can't reply to all.

Your comments are appreciated and being noted though, so thankyou for taking the time and trouble, much appreciated.

Yasmin x 

[Ana21]

Hi Bungo!

My hair loss journey started with rapid hair loss unmasking FPL/AGA.  Miniaturization of the follicles became obvious. My hair loss was front and centre, including both temples, so there was no way to disguise it.  I had to wear head coverings for 6 months.  This is how I discovered that I was not absorbing transdermal estrogen.  Blood testing detected no estradiol.  I was switched to oral estrogen.

I knew I would have a long wait to see a derm, so my GP suggested I start Rogaine (topical minoxidil) right away.  Rogaine caused mild headache during the adjustment phase.  It didn't cause any frizziness.  My hair condition and texture improved.  My hair started to grow back and I could leave the house without a scalp covering.

In terms of Rx meds, I initially tried spironolactone, an anti-androgen, at various doses.  I wasn't able to tolerate it.  Then I tried finasteride 1 mg.  No side effects.  My hair loss was not progressing, but not improved beyond the gains from minoxidil.  My derm agreed to increase the finasteride to 2.5 mg and my hair density improved noticeably with no side effects.  I wanted to continue experimenting and my derm agreed to increase the finasteride to 5 mg.  That's where I am now.  On 5 mg, my hair density has continued to increase and the thickness of the individual strands has increased.  No side effects.

You're a power lifter and concerned about loss of strength and muscle mass.  In women, finasteride does not cause the same side effects that men experience.  Finasteride does not reduce testosterone.  It inhibits the conversion of testosterone to dihydrotestosterone (DHT).  In women, the reduction in DHT production can lead to higher levels of circulating testosterone without causing hyperandrogenism.

The more commonly prescribed spironolactone reduces testosterone.

If you're concerned about exposing your dog to topical minoxidil, you can also take minoxidil orally.  Some pet owners using topical minox cover their hair with a bonnet.  It doesn't need to be on your scalp 24 hrs a day.

I hope that answers your questions.  If you have any others, I'll try my best to answer them.  Keep us posted on your biopsy results.

[Bungo]

Thanks Ana, this is really helpful. I didn't think finasteride was prescribed to women? Are you  in the UK? I'm in Ireland and could be waiting for a year before see a dermatologist ,even privately , so my chances of getting a prescription in the medium term are low anyway. Interesting that it was that which caused the new hair growth. I've have high blood pressure and high cholesterol from meds I took 15 years ago for acne so I'm very reluctant to take new meds as you can imagine. 
Did you increaseyour Hrt and oestrodial levels? Did that make any difference?
Was it regain lotion or foam that you used?
 I hadn't realized how bad my thinning was until someone mentioned and I took a photo and realized I was almost 50% scalp visible on top. So I'm still on the early days of this new journey, thank you menopause!
Sorry, this post is hopping all over the place😃

[Ana21]

Bungo,

I'm in Canada.  Long waits here too.  I requested referral to the dermatology clinic of a teaching hospital, hoping the doctors would be more familiar with the latest research.

Studies on the use of finasteride to treat FPHL span more than two decades.  Other 5-alpha reductase inhibitors (DHT blockers) are also used off-label.

If used during pregnancy, antiandrogen drugs such as finasteride carry the risk of birth defects, so many doctors will only prescribe them to postmenopausal women.

My hair loss was triggered by hormonal imbalance.  Postmenopause, my estrogen plummeted while my androgen levels remained in the normal premenopausal range.  Not uncommon.  Unfortunately, my hair follicles are sensitive to androgens.  I started taking oral estradiol and using minoxidil foam at the same time, so I can't attribute hair regrowth to either one.  It was an effective combination for me.

You asked whether I used Regain lotion or foam.  I've always used the 5% foam.  The liquid contains propylene glycol, a common cause of irritant contact dermatitis, and the foam does not. Some women warm the foam to turn it into a liquid which they can apply with a brush.  I have always applied the foam with gloved hands, as this is what my GP advised to reduce the risk of side effects.  There is a 2% foam marketed to women at greater cost.  Don't bother with it.  Doctors always recommend the more effective 5% foam.

I understand that you do not want to take any new drugs.  Fortunately, topical minoxidil and topical finasteride are effective treatments for FPHL.  Your biopsy may indicate another cause for your hair loss and require different treatment, but it's good to know there are many different topical options.

If Regain is something you want to try but you are concerned about your dog, you may want to visit r/FemaleHairLoss. There are many posts on reddit from pet owners who have used topical minox for years.

Hair loss is so stressful.  I'm sorry you're going through this.  If you have any additional questions, don't hesitate to ask.