Lengthy reply alert:
1. Biotin as a hair growth supplement:
I would like to clarify a few points regarding biotin - firstly, biotin IS vital in the normal development of normal hair and nails (believed to be due to biotin's role in controlling keratin structure; keratin being the protein that is abundant in hair and nails). If you are looking for ingredients on your anti-hair loss supplement, biotin is also known as Vitamin B7 or Vitamin H.
A 2017 systematic review (a review of all published valid medical literature) of case reports published in the Journal of Skin and Appendage disorders showing that biotin was effective in the treatment of hair loss identified only 18 successful treatment cases - 17 of which had pre-existing medical conditions that explained the biotin deficiency.
Next, I agree with Dr Chua that there is no medical evidence that biotin is an effective standalone supplement for female hair loss. Biotin absorption and metabolism is a rather complex biochemical topic that we shall not go in depth into, but there are medical conditions e.g. brittle nail disease and uncombable hair syndrome that have shown response to biotin supplementation.
2: Medications used to treat 'Patterned Hair Loss'
Furthermore, I would like to agree again with Dr Chua that the US FDA approves topical Minoxidil 2% for Female Pattern Hair Loss, whereas DHT blockers e.g. finasteride, are not US FDA approved for female hair loss, despite its widespread off-label use, mainly in post-menopausal women.
The reason for US FDA disapproval is due:
1) to it's lack in clinical efficacy as supported by the 2018 Network Meta-Analysis done by Dr Gupta, published in the Journal of European Academy of Dermatology and Venereology (see attached table), as well as…
2) the risk of a young, child-bearing age female (like yourself), taking a DHT-blocker, having a male child that is delivered with birth defects.
There are other medications used off-label to treat female pattern hair loss such spironolactone.
3: Female Pattern Hair Loss is a Complex Topic
The International Society of Hair Restoration Surgeons (ISHRS), in its 2017 consensus meeting, decided to forgo the term 'androgenetic alopecia' when referring a female patient suffering from patterned hair loss.
This is due to the multitude of complex factors that could contribute to the characteristic features of miniaturization of hair follicles on the top of the scalp (i.e. hairs getting finer, shorter and less pigmented, with shrinking , i.e. the pathological process driving this phenomenon is not just due to 'androgens' and 'genetics'.
The complex pathology includes a stress hormone (cortisol) response, nutritional deficiencies or imbalances (Vitamin B12, folate, iron, zinc, copper and commonly, Vitamin D3), the traditional understanding of DHT and genetics and the existence of concomitant telogen effluvium (a condition where hair sheds excessively)
The end point of all these known contributors is MICROINFLAMMATION of the hair follicle and the resultant shortening of the 6th portion of the hair growth phase i.e Anagen 6, which is also, the final treatment target.
4. Treating Female Hair Loss, at 20 years old
I will summarise this portion as if you have read up till this point in my reply, you would probably have had an information overload. (This also depends alot on the stage of hair loss you are at)
1. History and clinical examination done by a doctor familiar with female hair loss conditions - this is to establish genetic, medical and nutritional links to the hair loss phenomenon and to confirm that the diagnosis is female pattern hair loss.
2. Consider a blood test - to assess for certain medical condition, or to confirm a nutritional link to hair loss
3. Treatment - recent advancements in understanding of female hair loss favours a approach that treats the underlying condition (medical conditions, nutritional abnormalities etc), blunting the stress response in female hair loss (preferably using a non-drug approach like a good quality hair supplement) or if those are excluded, using a regenerative medicine technique like Regenera Activa to reverse thinning of the hair.
Thank you for reading my very lengthy reply to this rather complex topic.
Thank you and I hope this helps you understand female hair loss a little better.
Sincerely,
Dr Joshua Chong
