What is the evaluation approach for female androgenetic alopecia (Female Pattern Hair Loss)?

From the Guidelines

Evaluation of women with alopecia should begin with a thorough medical history, physical examination, and assessment using methods such as photography, trichoscopy, hair counts, hair diameter measurement, pull test, patient self-assessment questionnaire, trichogram, and in some cases, scalp biopsy, as outlined in the 2025 study on autologous platelet concentrates in esthetic medicine 1. To determine the pattern and extent of hair loss, a comprehensive evaluation is necessary. This includes:

• Blood tests: complete blood count, thyroid function tests, iron studies (ferritin, iron, TIBC), vitamin D levels, and hormonal assessments (testosterone, DHEAS, androstenedione, prolactin) to identify underlying causes.
• For suspected female pattern hair loss (androgenetic alopecia), first-line treatment is topical minoxidil 5% solution applied twice daily or 5% foam once daily.
• Oral minoxidil at low doses (0.25-2.5mg daily) may be considered for those who don't respond to topical treatment.
• For women with hormonal imbalances, spironolactone (50-200mg daily) can be effective by blocking androgen receptors.
• Finasteride (2.5-5mg daily) or dutasteride (0.5mg daily) may be options for postmenopausal women.
• For alopecia areata, topical or intralesional corticosteroids are typically used first, with systemic treatments like JAK inhibitors (tofacitinib, baricitinib) reserved for severe cases.
• Nutritional deficiencies should be corrected with appropriate supplements.
• Psychological support is important as hair loss can significantly impact quality of life.
• Treatment response should be monitored with standardized photographs every 3-6 months, and patients should understand that results typically take 3-6 months to become noticeable, as supported by the methods outlined in the study 1.

From the Research

Evaluation of Alopecia in Women

• The evaluation of hair loss in women includes a comprehensive clinical history and physical examination, as well as appropriate laboratory testing and scalp biopsy if indicated 2, 3.
• A careful history and thorough physical examination are usually sufficient to suggest the underlying cause of alopecia, but ancillary laboratory evaluation and scalp biopsy may be necessary to make or confirm the diagnosis 3.
• The differential diagnosis of hair loss includes a number of disorders causing cicatricial or noncicatricial alopecias, and an organized and systematic approach is needed to accurately address patients' complaints and achieve the correct diagnosis 4, 5.

Diagnostic Approaches

• A thorough history and examination, including specialist techniques, can give vital clues to the aetiology of hair loss 6.
• An algorithmic diagnostic approach based on the most recent knowledge about different types of alopecia can be useful in evaluating patients with hair loss 5.
• The evaluation of hair loss should also consider the potential for underlying systemic disease, as well as the significant impairment of quality of life associated with alopecia 2, 6.

Treatment Options

• Treatment methods for alopecia vary depending on the type of alopecia, and include watchful waiting, topical and systemic formulations, surgery, and treatment of any underlying or associated conditions 2.
• Early diagnosis and timely institution of appropriate treatment are helpful and comforting to those affected by this disease, and can help to alleviate the emotional, mental, and social distress caused by alopecia 2.