From the Guidelines
The initial workup for female androgenetic alopecia (FAGA) should include a detailed medical history, family history, medication review, and physical examination focusing on the scalp and hair loss pattern, as well as laboratory testing to assess thyroid function, iron status, and hormonal evaluation in cases with signs of hyperandrogenism. This comprehensive approach is crucial for identifying underlying causes and guiding treatment decisions 1.
Key Components of Initial Workup
- Detailed medical history
- Family history
- Medication review
- Physical examination focusing on the scalp and hair loss pattern
- Laboratory testing:
- Thyroid function (TSH)
- Iron status (ferritin, CBC)
- Hormonal evaluation in cases with signs of hyperandrogenism (total testosterone, free testosterone, DHEAS, and prolactin)
Treatment Options
First-line treatment is topical minoxidil 5% solution or foam applied twice daily to the affected areas, which works by prolonging the anagen phase of hair follicles and increasing follicular size 1. Oral minoxidil at low doses (0.25-2.5 mg daily) may be considered for patients who don't respond to topical therapy. For women without contraindications, anti-androgens like spironolactone (50-200 mg daily) can be added, which blocks androgen receptors and decreases testosterone production. Finasteride (2.5-5 mg daily) or dutasteride (0.5 mg daily) may be considered off-label in postmenopausal women.
Additional Considerations
- Nutritional deficiencies should be corrected, particularly iron (aim for ferritin >40 ng/mL) and vitamin D.
- Patients should understand that treatment requires at least 6-12 months for visible results, and therapy must be continued indefinitely to maintain benefits, as discontinuation leads to reversal of gains within 3-6 months.
- The use of platelet-rich fibrin (PRF) as an adjuvant treatment for androgenetic alopecia shows promise, particularly in mild cases, and may be considered as part of a comprehensive treatment plan 1.
Monitoring Response to Treatment
Response to treatment can be assessed using various methods, including:
- Photography: Before-and-After Photos
- Trichoscopy
- Hair Counts
- Hair Diameter Measurement
- Pull Test
- Patient Self-Assessment Questionnaire
- Trichogram
- Global Physician Assessment (GPA)
- In some cases, a Scalp Biopsy may be performed to examine the hair follicles under a microscope 1.
From the Research
Initial Workup for Female Androgenetic Alopecia
- The initial workup for female Androgenetic Alopecia typically involves a thorough medical history and physical examination to rule out other potential causes of hair loss 2.
- A scalp examination and hair pull test may be performed to assess the extent of hair loss and determine the presence of any other scalp conditions 3.
- Laboratory tests, such as hormone level checks, may be ordered to rule out underlying hormonal imbalances that could be contributing to hair loss 4.
Treatment Options for Female Androgenetic Alopecia
- Topical minoxidil solution is a commonly used treatment for female Androgenetic Alopecia, with studies showing significant increases in non-vellus hair count and hair density 2, 5.
- Platelet-rich plasma (PRP) injections have also been shown to be an effective treatment option, with improvements in hair density, terminal to vellus hair ratio, and patient global assessment scores 4, 3.
- Low-dose oral minoxidil has been used off-label with good clinical efficacy and safety, although more research is needed to fully understand its effects 6.
- Other treatment options, such as oral 5?-reductase inhibitors and oestroprogestative drugs with anti-androgen effects, may also be considered, although their effectiveness and potential side effects should be carefully evaluated 4.
Monitoring and Follow-up
- Regular follow-up appointments are necessary to monitor the effectiveness of treatment and make any necessary adjustments 2, 5.
- Photographic and video-trichoscopic assessments may be used to track changes in hair density and growth over time 5.
- Patient self-assessment questionnaires and global assessment scores can also provide valuable feedback on treatment efficacy and patient satisfaction 3, 6.