An update on the treatment of female alopecia and the introduction of a potential novel therapy.

PURPOSE: To review treatment options for hair loss in women. MATERIALS AND METHODS: Suggestions for treatment were based on a thorough literature search plus the present authors' experience. RESULTS: There are controlled studies that support the present authors' typical treatment regimen of identifying if there are increased androgens, and if so, identify the source (ovary and/or adrenal) and then suppress with drugs, e.g., oral contraceptives or glucocorticoids. If serum androgens are normal, agents that block dihydrotestosterone at the hair shaft level, e.g., spironolactone or 5a reductase inhibitors seem to be effective. However, a recent Cochrane systematic review concludes that the only drug proven to improve alopecia by randomized controlled studies using rigorous criteria is minoxidil. CONCLUSIONS: The present authors will add minoxidil to their normal treatment paradigm based on this later study. The previous reasons for it was the quality of the hair produced (generally much shorter than other head hair). For alopecia related to inflammation, the present authors may have discovered a novel therapy--dextroamphetamine sulfate.