When surgeon Alan Bauman started his hair restoration practice in Boca Raton, Fla., in the late 1990s, about 10% of his patients were women. Now, he says, half are. Joseph Greco, a hair loss specialist in Sarasota, Fla., says his share of female patients has gone from 25% to 60% in the last decade alone.
There's no reason to think more women these days are losing hair. Almost all women lose some hair as they age and some women – just like some men – are genetically predisposed to lose a lot. Women rarely go bald, but what starts with a widening part, noticeable shedding or a shrinking pony tail can become significant, scalp-exposing hair thinning for about one third of women, studies show.
How women feel about that may be changing, says Melissa Piliang, a dermatologist specializing in hair loss at the Cleveland Clinic.
"I think there is an increased awareness and an increased interest in treatment," Piliang says. "For our grandmothers' generation, women over 50 were considered old. Now women that age are considered pretty young. Many also have jobs in which appearance is important."
And, it's fair to say, many also are seeing marketing for an increasing array of hair restoration products and procedures aimed at women – including a pricey but unproven treatment that both Bauman and Greco specialize in. It involves scalp injections with something called platelet-rich plasma (PRP).
Bauman, Greco and other practitioners – some of whom market PRP as a "vampire hair treatment," akin to the bloody "vampire facials" made famous by Kim Kardashian – say that substances in concentrated plasma, taken from a patient's own blood, can stimulate hair regrowth. They say the procedure is safe and produces noticeable results in most, but not all, male and female patients. A 20% to 25% increase in hair mass is typical, Bauman says.
But studies so far have been small and most have lacked the comparison groups that would show how PRP stacks up against other treatments or no treatment at all. "The early findings show promise, but more studies are needed to know whether this is a safe and effective treatment," the American Academy of Dermatology says.
Also, a lack of standardization – with each clinic using its own methods – "means it's buyer beware out there," Bauman says.
Those buyers are spending big bucks: Bauman charges $2,500 for a PRP treatment that he says needs to be repeated once a year on average. Greco says he repeats his version three times over the first 18 months for typical "female pattern hair loss" patients, charging $1,600 for the first treatment, $1,400 for the second and $1,000 for the third. Patients have an incentive to return because any new hair will fall out when treatment stops – just as it does with any treatment except for hair transplants.
But no one considers PRP the first-line treatment for women with hair loss.
That distinction goes to minoxidil, a liquid or foam applied to the scalp, available over the counter for years. The Food and Drug Administration approved a full-strength foam (a 5% solution) for women in 2014 and it is now sold as Women's Rogaine. The big advantage over older 2% versions is that it can be used once a day, instead of twice. It costs about $35 for a four-month supply.
Pililang says about 80% of women using minoxidil will stop losing hair and about half will regrow some. "It's not going to take someone who's 50 or 60 back to the hair they had at 20," she says.
"It doesn't work for everybody, but I tell my patients to use it diligently for six months and then look in the mirror and see how they feel," says Paradi Mirmirani, a dermatologist specializing in hair loss at Kaiser Permanente in Vallejo, Calif. Because hair loss caused by aging and genes gets worse over time, even maintaining hair "is a win," she says. "But patients have to decide whether it's worth the time and money."
The main side effects associated with minoxidil are scalp irritation and itching. And some women report unwanted facial hair growth – something that package instructions say might be prevented with careful application.
Another treatment that might work for some women: laser therapy with comb devices that sell for about $200 to $500 or caps that cost even more. These are FDA-approved for safety and recent studies suggest "a modest benefit," Mirmirani says.
Some women are candidates for hair transplant. But because women tend to lose hair all over their heads, not in the distinct bald spots common in men, finding lusher sections that can be moved to cover sparser areas is "more challenging," Piliang says.
Supplements such as biotin, marketed for hair health, are unproven, Piliang and Mirmirani say. But eating a healthy diet, protecting hair from the sun and not smoking can help, they say.
Also important to know: not all women's hair loss is the result of aging and genes. And some causes are treatable or temporary. Among them:
• Pregnancy. Many women see temporary hair loss after pregnancy.
• Stress. Hair also can shed after stressful or traumatic events.
• Iron deficiency, thyroid, hormone and immune disorders. Treating them can often stop any associated hair loss.
• Medications. Cancer drugs but also drugs used to treat acne, depression, blood clotting and other conditions can cause hair loss.
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