Hair loss treatments for women

Question
QUESTION: I have been dealing with hair loss for 20 years. My hair improved during my pregnancies, but since the birth of my last child 7 years ago, my hair is having a harder time recovering. I was put on a low estrogen dose bcp after my pregnancy and I started spironolactone (200mg) 5 years ago. I thought things were improving but I have noticed a gradual thinning after one ovary was removed 3 years ago. So I finally started Rogaine 3 months ago and asked my GYN to give me a higher estrogen dose bcp to help with the thinning. I see tons of growth, which gives me hope. My dermatologists wants to add propecia to see if that will help too, but I'm resistant to trying it.  My question is this:  Should I explore Avodart instead of Propecia and drop Sprio or should I try it in addition to the Spiro?  Thank you so much for your help!



ANSWER: The change to more estrogen was a good move. Being on spironolactone 200mg per day is also good for blocking (blocks androgen receptor sites) the hormones from telling the hairs to age. It is usually used as a diuretic to get rid of extra body fluid in women with high blood pressure. If your blood pressure tends to be high this is a double bonus. You should take in extra table salt with this dosage since it causes you to get rid of NaCl. Avodart is far superior to Propecia in blocking the Type I 5alpha reductase enzyme in the skin and hair. The only downside is that it stays in the body much longer and can be measured several months after stopping it. This is of concern in women who can still become pregnant. Avodart is the best medication we have to prevent DHT formation but there will still be some floating around. I would suggest continuing spironolactone 100 to 200 mg / day to block the receptor sites especially if you have some problems with high blood pressure, if not then 50 to 100 per day.



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QUESTION: Thank you for your time Dr. Panagotacos. I'll explore Avodart with my Dermatologist next appt., it shouldn't be a problem for me since I don't plan for anymore children. Just one more thing - since my hair loss became an issue, I have found the need to see many different types of doctors. My derm and endo are much more aggressive in treating this problem than my GP. My GP doesn't approve of Spiro long term and would like me to quit taking it - not for specific problems pertaining to my health, but b/c he believes that it could cause problems down the line. How do you feel about the safety of spiro?  Thank you again.  


Answer
I agree with your Derm and Endo. I do not think your GP has a good enough understanding of the hormonal interactions. Spironolactone is not a hormone. It blocks the androgen receptor sites and has not been implicated in any increase in breast cancer. Nevertheless there are warnings about its use and doctors who are afraid to use it because of the warnings which are unwarranted.