What is the recommended work-up for female pattern hair loss (Androgenetic Alopecia)?

From the Guidelines

The recommended work-up for female hair loss should include a combination of trichoscopy, hair counts, hair diameter measurement, pull test, patient self-assessment questionnaire, and trichogram, as these methods provide a comprehensive assessment of hair growth and scalp health, as outlined in the 2025 study on autologous platelet concentrates in esthetic medicine 1. When evaluating female hair loss, it is essential to consider a multifaceted approach that incorporates various diagnostic tools. The following methods can be used to assess hair loss and monitor treatment response:

• Trichoscopy: involves using a specialized magnifying device to examine the scalp and hair follicles in detail, helping to identify signs of hair thinning, hair miniaturization, and the presence of vellus hairs 1.
• Hair counts and hair diameter measurement: provide objective data on hair growth and density, allowing for accurate monitoring of treatment response 1.
• Pull test and patient self-assessment questionnaire: offer additional insights into hair strength and patient satisfaction with treatment, respectively 1.
• Trichogram: involves analyzing photographs of the scalp using computer software to measure hair density, hair diameter, and T/V ratio, providing a comprehensive assessment of hair growth and scalp health 1. In some cases, a scalp biopsy may be necessary to examine the hair follicles under a microscope, particularly if the diagnosis remains unclear after initial evaluation 1. By utilizing these diagnostic tools, healthcare providers can develop an effective treatment plan tailored to the individual's specific needs, ultimately improving outcomes and quality of life for females experiencing hair loss.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Recommended Work-up for Hair Loss in Females

The recommended work-up for hair loss in females typically involves a comprehensive clinical history and physical examination, as well as targeted laboratory testing.

• A thorough medical history is essential to identify any underlying conditions that may be contributing to hair loss, such as hyperandrogenism, thyroid disorders, or nutritional deficiencies 2, 3, 4, 5, 6.
• A physical examination of the scalp and hair can help to identify patterns of hair loss, such as female pattern hair loss (FPHL) or alopecia areata 2, 3, 4, 5, 6.
• Laboratory tests, such as a complete blood count, ferritin, thyroid-stimulating hormone, and vitamin D 25OH, may be ordered to rule out underlying conditions that may be contributing to hair loss 5.
• A scalp biopsy may be performed in some cases to confirm a diagnosis, particularly in cases of cicatricial alopecia 2, 4, 5.

Diagnostic Considerations

When evaluating a female patient with hair loss, it is essential to consider the following:

• The patient's medical history, including any previous illnesses, medications, or hormonal imbalances 2, 3, 4, 5, 6.
• The patient's physical examination, including the pattern of hair loss and any other scalp or hair abnormalities 2, 3, 4, 5, 6.
• The results of laboratory tests, such as complete blood count, ferritin, thyroid-stimulating hormone, and vitamin D 25OH 5.
• The possibility of underlying conditions, such as hyperandrogenism, thyroid disorders, or nutritional deficiencies 2, 3, 4, 5, 6.

Treatment Options

Treatment options for hair loss in females depend on the underlying cause and may include:

• Topical minoxidil for FPHL 2, 3, 6.
• Oral antiandrogen therapies, such as cyproterone acetate and spironolactone, for FPHL 2.
• Treatment of underlying conditions, such as hyperandrogenism, thyroid disorders, or nutritional deficiencies 2, 3, 4, 5, 6.
• Hair systems and surgery for severe cases of FPHL 2.