"In the light of this favourable effect of estrogen on senile skin, the obvious supposition is that these steroids also have a similarly favourable effect on hair follicles. Estrogens prolong the growth period of hair (Taubert 1976, Winkler 1969) and, in addition, inhibit mitosis (Stuuttgen and Schaefer 1977). Some investigations point, that systemic estrogens increase the proliferation rate, slow down differentiation and, thus, postpone fallout of telogen hairs (Moretti et al. 1977).
"Orentreich (1969) observed a decrease in daily hair fall-out during therapy with systemic doses of estrogen...Lubowe saw good results in androgenetic alopecia by means of the conjugated estrogen Presomen (Lubowe 1972). It can be assumed that the semi-synthetic estrogens, like mestranol and ethinylestradiol, have a stronger effect on hair growth than conjugated estrogens.
"In the treatment of hair diseases, there have been few reports on systemic estrogen. But some authors have been using estrogens for topical treatment of hair diseases for many years (e.g. Funk as long ago as 1951).
"Androgenetic Alopecia, which in many cases causes great suffering, is of particular significance for topical use of estrogens... Topical estrogen treatment can be considered particularly in those cases in which systemic antiandrogen therapy...is not possible.
"According to Zondek, topical use of estrogen solutions is almost as effective as systemic administration of this hormone. Wendker et al. (1976) have demonstrated the good penetration of estradiol solutions right into the cutis. However, no reports of concentration in the subcutis and, thus, at the hair follicle are available.
"Estrogen solutions exist in West Germany as commercial products, but they can also be made up as a prescription. The commercial products are: Alpicort F, Crinohermal-fem and Ell-Cranell. [...]
"We carried out investigations into the effect of estradiol benzoate, incorporated in isopropyl alcohol, on androgenetic alopecia... We selected 35...patients with androgenetic alopecia in whom typical androgenetic alopecia was also present on the basis of history and clinical findings. We treated these patients for at least 6 months with the above-mentioned estrogen solution, in some cases for a year, and in some cases for even longer. Every day a few drops of the prescribed solution were applied to the scalp...
"Trichogram investigations according to the standardized method of Meiers (1975) were carried out on the 5th day after the last hair wash and after withdrawal of all topical therapeutic agents; this was done prior to therapy and 6 to 8 months later during therapy. During the treatment, the patients were only allowed to use a mild shampoo to wash their hair.
"The therapeutic results were evaluated on the basis of the trichogram findings, corresponding to the change in the telogen rate (TR). A decrease in the telogen rate of more than 20% was rated as improvement, values of +/-20% as no improvement, and an increase in the telogen rate of more than 20% as deterioration. The results are summarized in the Table 1.
Table
1. A decrease in the telogen rate of more than 10% was seen in a total of 22 patients = 63%
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Evaluation ..... Telogen rate (TR) ...... No. of patients (35 = 100%)
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improvement ..... >20% decrease ......... 18 = 51.5%
no improvement +/-20% ...................... 12 = 34.2%
deterioration ...... >20% increase ........... 5 = 14.3%
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"Here you can see two particularly good examples of therapeutic success in a woman and a man: a 51-year-old woman patient, telogen rate in the frontal area prior to treatment 42.9%, after treatment 18.0%; a 33-year-old man, telogen rate in the frontal area prior to treament 46.6%, after treatment 20.0%.
"The deterioration of androgenetic alopecia in five patients had to be attributed partly to very irregular use of, and partly to premature withdrawal of, the estrogen tincture. For example, one patient who initially noticed a subjective improvement after 3 months' regular use of the estrogen spirit discontinued treatment on the advise of his general practitioner, who did not consider the therapy meaningful...
"Our results have confirmed the studies by Wustner and Orfanos (1974), who saw an improvement, that is, a decrease of the telogen-rate in 52% of androgenetic alopecia treated with Alpicort-F and Crinohermal-fem. These authors did not find side effects when their preparations were used.
"Our patients too did not report any side effects. [...] Hence, we can say topical use of estrogen is a suitable therapy for androgenetic alopecia. We cannot say whether the hair follicles become accustomed to estrogen application after 10 or more years because the observation period was not longer than 2 years."
