Hair Today, Gone Tomorrow

June 2, 2023

By: Rachel Noonan, PharmD

The distress of thinning hair is beyond compare. Patients are deeply affected by hair loss. It’s unsettling; hair loss can negatively impact a person’s well-being by aging them prematurely. Studies suggest the stress of hair problems may contribute to deepening anxiety and depression during midlife. For perspective, George Costanza was only in his mid-thirties. For all we know, his premature baldness may have magnified the neurotic behavior that helped Seinfeld become a household name. 

Jokes aside, hair health matters. And not just to men. Hormonal changes during menopause may alter the hair cycle. Characterized by reduced scalp hair growth, female pattern hair loss is often coupled with thinner, drier hair (not to mention facial hair your patients wish wasn’t there). Progesterone and estrogen appear to have a protective effect, while androgens like testosterone inhibit scalp hair follicles. Data about menopausal hair disorders is scarce and further investigation is needed. 

The mechanics behind hair loss can differ from person to person. Multiple mechanisms may be required to combat the condition, as active pharmaceutical ingredients (APIs) promote hair growth in unique ways. Minoxidil stimulates resting hair follicles into a growth state by scalp vasodilation. Tretinoin can create a favorable scalp environment by regulating skin cells. The two appear to work synergistically and penetrate the hair follicle better when applied together. Finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT), a very potent androgen. Lower DHT levels can translate to less hair loss in patients with androgenic alopecia.  

Topical corticosteroids like betamethasone or antibacterial/antifungal agents (ketoconazole or metronidazole) can help target underlying scalp conditions contributing to your patients’ hair problems. Many of these drugs aren’t readily available in a formulation fit for scalp application, making customized compounds a desirable choice.  

Despite the advantages of a multi-medication approach, current hair formulations are limited. Single-ingredient options stack the shelves. Managing a slew of topicals is exhausting and not sustainable. Supporting hair growth while limiting thinning and loss can take weeks to reach maximum effect. If your patients stop using their hair formulations, the benefit disappears. Finding a topical option that supports your patients’ hair health and easily complements their daily routine is a winning combination. 

It’s hard to know where to begin. There are many elements at play dictating individual hair response, and understanding genetic factors can save you and your patient base valuable time. Clinical resources facilitated by Belmar’s expert staff streamline medication options and may prevent future frustration. 

Let’s get to the root of the problem.  


  1. Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jul;77(1):136-141.e5. doi: 10.1016/j.jaad.2017.02.054. Epub 2017 Apr 7. PMID: 28396101. 
  1. Bazzano GS, Terezakis N, Galen W. Topical tretinoin for hair growth promotion. J Am Acad Dermatol. 1986 Oct;15(4 Pt 2):880-3, 890-3. doi: 10.1016/s0190-9622(86)80024-x. PMID: 3771854. 
  1. Clinical Resource, Treatment and Prevention of Hair Loss. Pharmacist’s Letter/Prescriber’s Letter. November 2021. 
  1. Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018 Jun 19;4(4):203-211. doi: 10.1016/j.ijwd.2018.05.001. PMID: 30627618; PMCID: PMC6322157. 
  1. Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 1: hair disorders. Clin Exp Dermatol. 2022 Dec;47(12):2110-2116. doi: 10.1111/ced.15327. Epub 2022 Oct 28. PMID: 35796569; PMCID: PMC10092469. 
  1. Lee SW, Juhasz M, Mobasher P, Ekelem C, Mesinkovska NA. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. J Drugs Dermatol. 2018 Apr 1;17(4):457-463. PMID: 29601622; PMCID: PMC6609098. 
  1. Ring CM, Finney R, Avram M. Lasers, lights, and compounds for hair loss in aesthetics. Clin Dermatol. 2022 Jan-Feb;40(1):64-75. doi: 10.1016/j.clindermatol.2021.08.013. Epub 2021 Aug 8. PMID: 35190067. 
  1. Zouboulis CC, Blume-Peytavi U, Kosmadaki M, Roó E, Vexiau-Robert D, Kerob D, Goldstein SR. Skin, hair and beyond: the impact of menopause. Climacteric. 2022 Oct;25(5):434-442. doi: 10.1080/13697137.2022.2050206. Epub 2022 Apr 4. PMID: 35377827. 

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