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Q: I have hypothyroidism and take Synthroid (0.25 mg.). My hair is thin in the front and back, as with a man who is beginning to become bald. I would like your opinion on Rogaine for women. Does the usual dose work, or is it true that only extra strength works? Also, I never heard of having a biopsy of the area where the hair is thinning. Can you tell me more?

-- P.L., New York City

A: Some degree of hair loss is inevitable in both men and women, but it is still understandably a source of anxiety and stress.

The type of hair loss you described is known as non-scarring alopecia, that is, not caused by trauma or injury to the skin. Hair loss caused by trauma like burns and scars is irreversible. Some women also have the pattern baldness experienced by men.

Both hyperthyroidism (too much thyroid activity) and hypothyroidism (too little) are known to be possible causes of non-scarring alopecia. In addition to experiencing the overall slowing down of bodily functions, many people with hypothyroidism note that hair can become sparse and dry.

However, non-scarring alopecia can also be caused by diseases, drugs, fever, stress and unknown causes. The onset of non-scarring alopecia is commonly associated with various systemic diseases (affecting the whole body), such as lupus, syphilis, anemia and pituitary insufficiency. Often, the only treatment needed to control hair loss caused by these diseases is prompt and effective control of that underlying problem.

This type of hair loss is also associated with quite a few drugs, especially cancer chemotherapy drugs. Here, too, the condition is often reversible.

In your case, the hair loss may be due to the hypothyroidism or to your body's response to the increased (hyper-) thyroid function promoted by the levothyroxine (Synthroid) medication. Or it may be due to something else entirely.

Premenopausal women can suffer from the most common alopecia in men, called androgenetic, or pattern, baldness.

Female androgenetic alopecia is more diffuse and less patterned than the form seen in men. Estrogens may protect the hair follicles from androgen effects, because an increased hair loss is often noted after menopause. This is the form of alopecia that is usually treated by minoxidil or Rogaine. But before you undertake the long therapy period required of Rogaine treatment, be sure you have identified the cause of your hair loss with your doctor, especially if you don't see any evidence of reversal of your alopecia soon.

Finding the cause may require further lab tests, including a complete blood cell count and measurement of thyroid hormones, serum iron levels and iron-binding capacity. A biopsy of the area where you are losing hair may also be recommended.

As with any recommended treatment, find out how effective that treatment is expected to be on the cause of your problem. Also make sure that you understand the possible side effects and what to do if one of them occurs.

Dr. Allen Douma welcomes questions from readers. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

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