From the Guidelines
The first-line treatment for women with androgenetic alopecia is topical minoxidil 2% or 5% solution, applied twice daily to the affected areas of the scalp. The 5% formulation may be more effective but can cause more local irritation. Treatment should be continued indefinitely as hair loss will recur if the medication is stopped. Visible results typically take 3-6 months to appear, and patients should be counseled that initial shedding may occur in the first few weeks, which is a normal part of the treatment process. Minoxidil works by prolonging the growth phase of hair follicles and increasing follicular size, thereby promoting hair growth. It also improves blood flow to the scalp. For women who do not respond adequately to minoxidil alone, oral anti-androgens such as spironolactone (50-200 mg daily) may be added as a second-line treatment, particularly if there are signs of hyperandrogenism. However, these medications require monitoring and are contraindicated in pregnancy due to potential feminization of a male fetus.
Some studies suggest that autologous platelet concentrates, such as PRF, may be a safe and effective treatment option for androgenetic alopecia 1. However, the current evidence is not strong enough to recommend it as a first-line treatment.
Key points to consider when treating women with androgenetic alopecia include:
- The importance of continued treatment to maintain hair growth
- The potential for initial shedding and the need to counsel patients accordingly
- The consideration of oral anti-androgens as a second-line treatment for women who do not respond to minoxidil alone
- The need for monitoring and the contraindication of oral anti-androgens in pregnancy. Androgenetic alopecia can have a significant impact on a patient's quality of life, with potential detrimental psychological effects 1. Therefore, effective treatment is crucial to improve patient outcomes.
From the Research
First-Line Treatment for Women with Androgenetic Alopecia
The first-line treatment for women with androgenetic alopecia is typically topical minoxidil. This is supported by several studies, including one from 2002 2, which found that 2% minoxidil solution applied topically to the scalp over 6-12 months caused normalization of hair root condition and decrease of hair loss in some patients.
Treatment Options
Some of the treatment options for women with androgenetic alopecia include:
- Topical minoxidil, which has been shown to stimulate hair growth and decrease hair loss 2, 3
- Oral 5?-reductase inhibitors, which may be used in combination with topical minoxidil 4
- Oestroprogestative drugs with anti-androgen effects, which may be used in women with androgenetic alopecia 4
- Platelet-rich plasma (PRP) injections, which have been shown to be an effective treatment option for androgenetic alopecia 5
- Low-dose oral minoxidil, which has been compared to topical minoxidil in a randomized controlled trial 6
Efficacy of Treatment Options
The efficacy of these treatment options has been studied in several trials. For example, a study from 2019 found that PRP injections increased hair density and improved patient global assessment scores in women with androgenetic alopecia 5. Another study from 2024 found that low-dose oral minoxidil was as effective and safe as standard topical minoxidil in female and male pattern hair loss 6.
Key Findings
Some key findings from these studies include:
- Topical minoxidil is a effective treatment for androgenetic alopecia in women 2, 3
- PRP injections are a promising treatment option for androgenetic alopecia 5
- Low-dose oral minoxidil may be as effective and safe as standard topical minoxidil 6
- Treatment efficacy can be evaluated using measures such as hair diameter, photographic assessment, and patient self-assessment questionnaires 6