I have been busy with reading academic articles on hairloss in women for the past 2-3 days. Dr. Sara from the network suggested two important publications - “Hair Loss in Women" by Jerry Shapiro, M.D. published in New England Journal of Medicine in 2007 and "Medical Treatments for male and female pattern hair loss" by Nicole E. Rogers, MD, and Marc R. Avram, MD published in the Journal of the American Academy of Dermatology in Oct 2008. Fortunately I have access to those articles through the electronic databases of my university. It's educating to read them but to be honest my experience with visits to dermatologists shows that most doctors do not follow the current literature in the field because I was never diagnosed according to the methodologies recommended in those publications. I never had a clear long-term treatment plan and none of the doctors used methods to measure progress, ex. by taking pictures at the beginning. This is quite disappointing. I am also disappointed because it seems to me that hair loss research still revolves around checking for significant difference in the condition of minoxidil treated and placebo patients. Topical minoxidil has been used since the 80's - what has happened in the last 30 years in this field?? According to an article by Francisco M. Camacho-Martínez called “Hair Loss in Women” (Seminars in Cutaneous Medicine and Surgery 2009): “Because FPHL (female pattern hair loss) is a biological process determined by a sensitivity to androgens that is genetically mediated, we use 3 treatments to interrupt its course: (1) modification of the biological response through nonhormonal mechanisms; (2) modification of the androgen action by altering the production, transport, or metabolism of androgens, such as preventing binding to androgenic receptors; and (3) transplanting follicles to balding areas by surgical procedures.” A lot of studies check for the effect of intake of anti-androgenic agents such as cyproterone acetate (CA), spironolactone, drospirenone, flutamide, finasteride or dutasteride. It looks like both minoxidil and anti-androgens treatments show significant difference compared to the control groups so there is indeed a proof for some treatment effect but the magnitude of the treatment effect is far from the desired one. In those publications I did not see even one picture of a woman where normal hair coverage is observed after relatively lengthy treatment periods of 6 months to several years. The problem is that improvement is very slow and eventually only in very rare cases leads to the stage of actually having normal hair coverage which will discourage most of the patients to be perseverant with such a treatment. Also the side effects of intake of anti-androgens are quite worrying especially for women in childbearing age. We can only afford to experiment with finasteride and dutasteroids after menopause or if we definitely do not want to have children. I am 29 now and I don’t want to wait another 20 years to do something about my hair. I do not find it comforting to be dependent on minoxidil for a lifetime either - moreover it seems like there is a pick in its action and then its effectivenss decreases as well. Several years ago when I still did not pay so much attention to my thinning hair I had the idea that if nothing else works hair transplantation can be the solution to the problem. But transplantation of hair follicles does not seem to give the desired results especially for women with diffuse hair loss. So after reading a pile of scientific articles I still could not see where the science of trichology is heading to and what our perspectives for reversing hair loss are. I have the feeling that the focus is on treating female hairloss as a symptom only without delving into the actual causes and how to eliminate them. The knowledge about the human endocrine system and the way hormones are involved with hairloss seems to touch the surface only – if androgen action is the problem what causes the onset? I’m convinced that the triggers of hairloss and its progression involve a lot of hormonal processes for which medicine has not filled in all the gaps. I could not find answers about the consequences of insulin resistance and the related hormonal disbalances for example. When malfunction of the thyroid gland is involved the picture becomes even more complicated. From my blood tests there is an evidence for slightly underactive thyroid and some doctors have doubts about insulin resistance and others about the function of my ovaries. Other doctors say that I am completely healthy. Everything seems almost normal but a lot of hormones are in the upper levels. So the question is from where does the problem originate and which function exactly goes out of order first and drags all the rest down? Then why are some follicles sensitive to those processes and others not – can this sensitivity be modified? There are so many unanswered questions which is very frustrating for all of us. I’m sure that this is valid not only for the field of trichology but I hope to see more profound research going on because hair loss puts an enormous pressure on us not only because it ruins our self esteem and quality of life – it is quite disturbing to live in fear that the problem is not only cosmetic but hints other underlying conditions dangerous for our health. And when medical science cannot provide the answers we feel lost and helpless.