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Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
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menapausal and suffering from hair loss on head and body..blood

Customer Question

I am menapausal and suffering from hair loss on head and body. I have had all the usual blood tests and there is no ther problem. I do understand that this happens at menapause sometimes. My skin where the hair loss is coming from is so sore and tender it is driving me mad and I am finding it impossible to sleep. There is nothing to be seen on my scalp. Any ideas? I can''t believe I am the only person in the world to suffer from this but the doctors I have seen have been dismissive.
Submitted: 8 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 8 years ago.

DearCustomer

In order to better address your concerns and question, I need to ask you a few additional questions:

  • May I ask your Age?
  • Have you lost all hair ... scalp, eyebrows, axillae, arms, legs, pubic region? If you haven't lost all hair completely, is it affecting all of these locations?
  • Can you tell me what blood tests you have had done?
  • Have you seen a Dermatologist? If so, what were you told?
  • What have the doctors told you?
  • Has anything been prescribed at all?
  • Are you on any medications? If so, please list them.
  • Do you have any medical conditions? If so, please list them.

Kindest Regards,
XXXXX XXXXX, MD

Expert:  Daniel Nelson, MD replied 8 years ago.

DearCustomer

It appears that you have gone offline, so I will go ahead and address the most common cause of hair loss (called alopecia) in women at the time of menopause. Androgenic Alopecia.

Androgenetic alopecia is the most common cause of hair loss in both men and women. It affects 30 to 40 percent of adult men and women, alike. The incidence of androgenic alopecia increases around the time of menopause. The mechanism is reduced estrogen, which in light of normal ongoing androgen production by the adrenal glands, leads to an androgen predominant state. Testosterone and other androgens from the adrenal glands are broken down into dihydrotestosterone, which travels to the hair follicles and activates a gene in the follicular cell DNA that leads to miniaturisation of the follicle itself ... and along with that miniaturisation process comes a reduced hair "growth phase" and extreme thinning of the hair shaft.

The only treatment approved in the US for Androgenic Alopecia in women is topical minoxidil. Studies suggest that 5% minoxidil is more effective than the 2% formulation. In women who do not respond to topical minoxidil therapy, there are case reports of success by adding 100mg to 200mg of spironolactone (a water pill = diuretic), a diuretic with anti-androgen properties.

This being said, alopecia has many different forms and causes. Androgenic alopecia is the most common, and for women is even more common at and following menopause. If you have not yet seen a Dermatologist, you should. Photographs of the scalp or hair loss regions are important to document progress.

Additional investigations that I routinely perform include:

  • CBC (complete blood count)
  • Vitamin B12 level
  • Complete metabolic panel
  • RPR - VDRL (tests for secondary syphilis)
  • Thyroid function studies (including TSH, free-T4, several tests for anti-thyroid antibodies if the TSH or free-T4 are abnormal)
  • Dermatology Consult - if not already done

I request a 1/4-inch punch biopsy of the affected scalp (and sometimes a draining lymph node if there is lymph node enlargement). This is not common. If a lymph node is biopsied, it is very important to give advanced notifice to the Pathologist that the biopsy is from an alopecia patient with lymph node enlargement, and I wish to have special testing performed on the lymph node ... this allows the Pathologist proper time to set up for the the proper stains, smears, and cultures. The Pathologist will additionally prepare for special studies (including immunohistochemical, cytogenetic, and molecular genetics) before the specimen arrives.

I have also created a PDF document for you as a Patient Handout. This is done with permission of the copyright holder, UpToDate, Inc.. Please save this document to your local hard drive once it is downloaded (it's a large file, 7 pages and nearly 0.5 megebytes, so it may take a while to download depending on your connection speed). I will remove this document from the Internet in a few days:

Thank you for visiting JustAnswer.com's Health Information. I hope that all of your concerns have been addressed and that your experience here was positive and helpful. Please press the ACCEPT BUTTON once your question has been addressed. Your positive feedback is greatly appreciated.

Kindest Regards,
XXXXX XXXXX, MD

Daniel Nelson, MD and 3 other Health Specialists are ready to help you
Customer: replied 8 years ago.
45, hair on head very thin and pubic hair. Plus eyes lashes.Others ok

Have had anemia, thyroid, diabetes. All negative. FSH test ( i think this was what it was) was positive. Have not seen a dermatologist. Doctors just say 'one of those things' hard to say the cause. Probably hormonal. Had a coal tar shampoo 'just in case' prescribed and a steriod hair lotion for the same reason Have no other medical problems other than the odd hot flush and dry eyes.No medications.
Expert:  Daniel Nelson, MD replied 8 years ago.

I think that the minoxidil +/- the spironolactone is the best option. I don't expect most primary care docs who shrug their shoulders and fatten their wallets to help much. A Dermatologist will hopefully understand Androgenic Alopecia, and know that the best two possible medications are as I have listed. Take care and be well. God Bless.

Kindest Regards,
XXXXX XXXXX, MD