What is your experience treating women with androgenic alopecia using Vagifem?

Question

I'm a 55 year old female that has been diagnosed with androgenic alopecia. Currently using spiro 150mg daily and 5% rogaine. Hair loss is "normal". Due to menopause issues, family GP is suggesting Vagifem, however side effect is hair loss. Question; because of existing androgenic alopecia, could hair loss be significant? If so, would hair grow back if I stopped using Vagifem? What is your experience treating women with androgenic alopecia using Vagifem? Thank you,

Anil R. Shah, MD · Answer

Hello,Women are currently not FDA approved for the use of the ARTAS.  However, our use of the ARTAS does suggest that women who are experiencing androgenic alopecia may be good candidates.  As always, women should have a thorough workup including the following:
Trichoscopy- identify type of hair loss Extensive history and labs- rule out other forms of hair los As always, women should have a thorough workup including the following:
Trichoscopy- identify type of hair loss Extensive history and labs- rule out other forms of hair lossWe use ARTAS with regenerative techniques with women such as PRP and growth factors to help improve overall results.  Although ARTAS is not FDA approved, it can be used off label for this purpose.  
Best,
Anil Shah

Jae Pak, MD · Answer

Hair transplant doctors usually don't have experience with medications used for menopause.Ask your Ob/Gyn or family GP their experience in treating women with Vagifem or other hormone replacement drugs.  More specifically, ask your doctor if they noticed their patients complaining of hair loss after starting on the medication.Just because a drug has a potential side effect doesn't mean it will be a side effect you will experience.

Jeff Donovan, MD, PhD · Answer

The answer to your question is more complex than first glance. The starting or stopping of estrogen can give hair shedding. So yes, many women experience a temporary increase shedding. However, it's quite likely that the shed would occur once the vagifem is stopped rather than started.  The 10 micrograms of estradiol in vagifem is usually a bit growth stimulatory for many patients.  But, yes once it is stopped a shed "might" occur.   It's usually mild.  Estrogens are mildly helpful for post menopausal hair loss but only mildly. Other options appear superior. Speak to your dermatologist about low level laser therapy and platelet rich plasma.  Depending on a patient's response to spironolactone, options for other hormone blockers can also be discussed (finasteride, dutasteride).

R. Stephen Mulholland, MD (retired) · Answer

Dear LeslieAA,

Thank you for your clinical post and this is a very
frustrating common problem with women in my practice that have female pattern
alopecia more rarely women with androgenic alopecia.

The use of Spironolactone, vasodilators such as Rogaine and
low-level light therapy together with plasma rich protein are the mainstays of
non-surgical management of both female pattern hair loss, which is not
androgenic in origin and androgenic female pattern alopecia.  Symptoms of menopause can certainly be
improved with the use of Estrogen and Estradiol products such as Vagifem.  It’s been my experience that many female
pattern hair loss patients and androgenic female alopecia get a mild
stimulatory effect when on Estrogen.  If
you were to stop the Vagifem you may notice some loss of hair, but this is
usually only mild and stabilizes quite rapidly. 
You may seek out a dermatologist or knowledgeable non-surgical hair
transplantation physician for other non-hormonal manipulations such as the
aforementioned low-level light therapy, Rogaine or even the addition of
androgen blockers such as Propecia if you truly do have a diagnosis of
androgenic alopecia this may be a reasonable option.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Michael Meshkin, MD - Account Suspended · Answer

There are no scientific studies that show these products can be helpful for hair growth.  You can continue using minoxidil, you can also try vitamins and low level laser, sometimes they help.

What is your experience treating women with androgenic alopecia using Vagifem?

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