The above are my pictures, one of the back of my head, one from the top, and a full frontal shot.  I use topical treatments, as well as scalp camouflage creams, which I have on in the face picture, that darken the scalp & help to conceal the hair loss. The other two pictures are with no camouflage creams & thickening sprays. I would rate my hair loss currently at the Ludwig 1-3 scale. Nothing really is working, and I am now considering hair transplants, including services in Mexico. What caught my eye is that you are also active in hair loss research. Here are my questions:

I am a 45 year old female, and started noticing consistent hair loss about 10 years ago. I have had all the appropriate blood testing, and beyond a slightly low-normal thyroid, and slightly low-normal red blood cell count, everything checks out just fine. I take a small dose of T3 thyroid supplement daily, but this has not improved my hair loss.

1.) If my hair loss is genetic, or from perimenopause, what are my best options? My hair was always less full on top, and even as a young adult, I could not really wear bangs. As I have grown older, the hair loss on top and in front has become worse. In my 20’s I noticed that my hair thinned a bit every time I tried birth control pills, so after a few attempts,  I stopped using birth control pills for this reason. I could never wear my hair parted in the middle past about age 24. My mother, by the time she finished menopause, had very, very thin hair all over her head, it was awful for her. I remember her hair thinning during her 40’s, and my hair loss is not this extreme nor does it seem to be as diffuse. My hair loss seems to be centered more on the top and front of my head, but I would say that my hair has also thinned all over as well.

Dr. Bazan:  Dear Joc, You wrote a pretty complete self assessment and description. What I read leads me to consider FAGA (Female AndroGenetic Alopecia) versus a few other conditions such as severe nutritional/chemical deficiencies (iron, biotin, scavenger minerals, DHT blocking metals, chronic telogen effluvium, etc, etc. Your written description points toward a long term condition versus a temporary effluvium, specially considering your mom's life-long alopecia. The emotional factors make the situation a burden, please take a moment to read my comments and never stop trying. Please consult other professionals as sometimes the truth is a combination of opinions and considerations. Good luck with your hair.

2.) What other treatments should I consider? I currently use minoxidil 5%, take a Chinese herb Fo Ti & take extra b-vitamins. I also use Nizoral shampoo. When I follow all of this, the shedding seems to stop, and the loss is stabilized, but nothing seems to make my hair grow in density. I also use a camouflage cream & powder that darkens my scalp so there is less contrast between my hair and scalp. This is very helpful, but time intensive, and comes off on everything. I still have to wear a low side part no matter what I do, and in certain lights, my scalp shows through like a beacon and it is pretty embarrassing.

Dr. Bazan:  I would suggest reassessing the need for IRON ! (iron and ferritin) and stronger T3 supplementation. Additionally it would be interesting to review your Testosterone levels. I think your medication/supplementation plan (as described) is well planned. I might be inclined to suggest adding Biotin 1,200 mcg per day for 9 months. Do not forget to explore primrose oil, flaxseed, l-lysine, iron, iron, iron, and a multivitamin containing decent amounts of metals and trace elements. It may be interesting to use the following measures: - restrain from using plastic combs or brushes. - use wood or cork only material with natural bristles (vg. ultra soft boar). - be extremely gentle with wet hair. - massage your scalp every night. Visit www.HerAlopecia.com

3.) Considering the above history and family tendency, am I a good candidate for hair transplants? I am willing to try anything, but don’t want to make the situation worse. I am particularly concerned about the post surgery hair loss that can occur. Any advice you have I would appreciate.

Dr. Bazan: The idea of a Hair Transplantation should be entertained, BUT, the main matter is to stop the excess shedding. If we (you) can stop the hairloss, then we can explore adding hair via a traditional hair transplantation or other methods. Post transplant shedding can be minimized nowadays with strong anti-shock protocols but no doctor can give a no-shock-hairloss guarantee just now. Even though we have great success preserving existing hair, individual results vary, this is the truth and is your right (and my obligation) to expose it.

4) Have you treated a lot of female patients with similar conditions?  

Dr. Bazan: Yes. We have a large number of females treated for hairloss. Medically-only, medically+surgically, and surgically only.

5) Please provide any additional comments you have about my condition.

Dr. Bazan:  Female Alopecia is a devastating condition. I undestand alopecia well since I lost most of my hair during my twenties. But I realize it is probably worse for a girl. Please let me know if I can be of any further help. Sincerely,

Carl Bazan, M.D., MTTS www.itzan.com Aguascalientes-Mexico