Physician Answered Q & As

64 Year Old Female Hair Transplant Patient – Concerns About Previous Procedure and Using Minoxidil

I am a female age 64 and had an 800 graft hair replacement done about 5 years ago. Since the thinning on the front and crown has become very noticeable, I wonder if there is any way to tell if these grafts actually worked? I really don’t see any difference. I have received HRT since I was 26 and it had both male and female hormones in the pill. I wrote and asked the drug maker if their pill could cause hair loss and they assured me that it could not. I now find out that it can and does along with facial hair. Would minoxidil work for me or not? And if so, what is the difference between the generic and the brand name if any. Thank you for any information that you can give me.

Thank you for your question and I will do my best to give you the best information that I can to assist you. I am going to assume that the 800 grafts you had done five years ago were placed in the front and the crown as these are the areas that you are concerned about. For starters I believe that it can be a great challenge for you yourself to be able to look at these area and tell what is transplanted and what is native hair, however a trained hair transplant surgeon should be able to tell the difference in the areas that you had worked on. I will assume that you have had continued thinning in the areas in question and this certainly can be made worse by the use of the hormone replacement therapy you described but there may also be a strong familial component to your hair loss problem IE familial female pattern hair loss that is simply progressive. I will make one point to you that I think is very important. 800 grafts is not a lot to transplant especially if they were follicular units, which I am guessing they were if the sx was 5 years ago. More importantly if that 800 grafts was used to cover areas in the front and back than I would not expect great coverage at all.

To give you an idea if I were working with a female pt and wanted to help her cover an area just in the front and middle area of her scalp to help her with some density change, I would typically not even start with less than 1200-1500 grafts and usually more like 1800 -2000 to really get some nice density changes. I believe that most surgeons these days are working towards fewer larger cases to get the job done. So in your case in may simply be that the case was too small to make a long term difference.

As a general rule regarding the Minoxidil if you don’t have any contraindications, and it doesn’t sound like you do, I believe that yes it is worth a try. I typically would have you start with the 2% Solution and generic is fine as long as it doesn’t bother your scalp. There is little difference between the generic and the brand name Rogaine except for the base that it is mixed in both are essentially either 2% or 5% Minoxidil. Be aware though that initially you can get some increased hair shedding with the Minoxidil and you must be OK with that and stick with it. You may not see results for at least 4-6 months and sometimes longer. I would tell you that if it doesn’t bother your scalp IE itching ect.. than you should try and continue it. The other point to be aware of is that if you stop the Minoxidil you can lose whatever you have gained so it does become a commitment on your part.

The last part of my answer to your question and this would require a knowledgeable hair surgeon to work with you, is this. If you are continuing your hormone replacement and it has some testosterone in it than you could be having some loss as a result of that which would almost be like that of a male pattern balding as a result of the exogenous testosterone. With that said in some rare cases with female patients that are beyond childbearing age we can use propecia to help and counter the effects of the testosterone. I have done this on occasion and had great results. I will tell you though you will meet with resistance with most doctors on this issue and you will need someone who has experience with using Propecia in this manner for this application.

Hope this helps.


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