Alopecia from hormonal therapy
Thank you to I.M. of California who wrote with the following question:
Dear Dr Kefford,
I am 66 years old, and I have been taking Femara since early April. I have noticed a great deal of hair loss during the past several months. When I learned that hair thinning is one of the side effects of Femara, I quit taking it with my oncologist's blessing in early November. I have lost about 1/3 of the hair on the top of my head. Is estrogen production permanently halted by 7 to 8 months of Femara, or dare I hope that the condition may be reversible? What would you recommend to one of your patients in this situation?
Thank you for any advice you may have.
This prompted me to research the matter.
Compared to men, women have even higher levels of the aromatase enzyme in hair follicles in parts of the scalp. In women of certain genetic makeup (as yet poorly understood,) inhibition of this enzyme with the aromatase inhibitors probably alters the balance of hormones, leading to a slight overbalance of androgens, or male hormones, both circulating, and produced locally in the scalp tissue. It is well known that hair follicles on the scalp respond to androgens, and probably to estrogen deprivation, by a transformation that produces finer, thinner hair texture. (This is complicated: the follicles on the remainder of the body behave quite differently to the sex hormones, and for this reason, some women may experience an increase in body hair “hypertrichosis” in other parts of the body on these medications and during the menopause in general).
Overall, the incidence of alopecia on the aromatase inhibitors is between 1-10% and is generally mild. (Very few of my patients have experienced it). It is probably reversible on ceasing the drug, but there is little clinical information on this. Generally, after ceasing drugs that cause hair loss, the hair grows back at the rate of about 0.5-1 cm per month.
Topical minoxidil solution (Regaine for wome) is the only drug available for promoting hair growth in women. Efficacy has been shown in double-blind studies using hair counts and hair weight. There is minimal reliable data on its use in women on aromatase inhibitors however we have had some women use it with good results.
Alopecia may also be increased by smoking – yet another reason to give up!
Alopecia also occurs in 1-5% of women taking tamoxifen.
Tip: Be careful to seek expert medical advice in person about any treatment for alopecia and before considering changing your breast cancer medication for any reason.
Compared to men, women have even higher levels of the aromatase enzyme in hair follicles in parts of the scalp. In women of certain genetic makeup (as yet poorly understood,) inhibition of this enzyme with the aromatase inhibitors probably alters the balance of hormones, leading to a slight overbalance of androgens, or male hormones, both circulating, and produced locally in the scalp tissue. It is well known that hair follicles on the scalp respond to androgens, and probably to estrogen deprivation, by a transformation that produces finer, thinner hair texture. (This is complicated: the follicles on the remainder of the body behave quite differently to the sex hormones, and for this reason, some women may experience an increase in body hair “hypertrichosis” in other parts of the body on these medications and during the menopause in general).
Overall, the incidence of alopecia on the aromatase inhibitors is between 1-10% and is generally mild. (Very few of my patients have experienced it). It is probably reversible on ceasing the drug, but there is little clinical information on this. Generally, after ceasing drugs that cause hair loss, the hair grows back at the rate of about 0.5-1 cm per month.
Topical minoxidil solution (Regaine for wome) is the only drug available for promoting hair growth in women. Efficacy has been shown in double-blind studies using hair counts and hair weight. There is minimal reliable data on its use in women on aromatase inhibitors however we have had some women use it with good results.
Alopecia may also be increased by smoking – yet another reason to give up!
Alopecia also occurs in 1-5% of women taking tamoxifen.
Tip: Be careful to seek expert medical advice in person about any treatment for alopecia and before considering changing your breast cancer medication for any reason.