Hair Sciences: An Interview with Dr. Rodney Sinclair on Female Pattern Hair Loss

In this interview with dermatologist Dr. Rodney Sinclair, he discusses his opinions on female pattern hair loss (FPHL) and its treatment. Dr. Sinclair uses a clinical grading system to diagnose FPHL, which he believes is more comprehensive than the traditional Ludwig scale. His first-line treatment for FPHL is oral spironolactone, taken daily. He also recommends using 5% minoxidil solution twice a day for the first 6 months, then reducing to once daily. Dr. Sinclair acknowledges that minoxidil can cause itching and suggests using the 5% foam for men or the 2% solution, as well as topical steroids if necessary. He finds spironolactone to be equally effective as cyproterone acetate and more effective than finasteride. Dr. Sinclair does not recommend finasteride for premenopausal women due to the risk of birth abnormalities. He also discusses the role of vitamin supplements, ferritin levels, and low-level laser therapy in FPHL, stating that there is limited evidence for their effectiveness. Dr. Sinclair uses visual inspection and punch biopsies for examination of patients with hair loss. He believes that FPHL may involve both androgen and estrogen signaling, and that genetics play a role in the condition. Dr. Sinclair also mentions his treatment approach for frontal fibrosing alopecia and chronic telogen effluvium. Overall, his research interests include the biology of hair follicles, skin stem cell research, gene discovery, and cell-based therapy.