What are the treatment options for female hair loss?

Treatment Options for Female Hair Loss

For female pattern hair loss (FPHL), topical minoxidil 2-5% applied twice daily is the first-line treatment with the strongest evidence for efficacy. 1, 2

Types of Female Hair Loss

• Androgenetic alopecia (female pattern hair loss) is the most common cause, affecting over 50% of postmenopausal women and up to 40% of women beginning around reproductive age 3
• Other types include alopecia areata, telogen effluvium, and scarring alopecias 3
• In females, FPHL typically presents as central region thinning with a preserved frontal hairline 4

Diagnostic Approach

• Clinical diagnosis is usually sufficient in most cases, with careful assessment of pattern of hair loss 1
• Laboratory tests may be needed when androgen excess is suspected, including androgenic determinations 1
• Differential diagnosis includes alopecia areata, telogen effluvium, tinea capitis, and scarring alopecia 4
• Dermoscopy can aid in diagnosis by revealing characteristic patterns 4

Treatment Options for Female Pattern Hair Loss

First-Line Therapy

• Topical minoxidil 2-5% applied twice daily is the mainstay of treatment 1, 2
• Early diagnosis and treatment initiation is crucial as treatments are more effective at arresting progression than stimulating regrowth 5
• Treatment response often takes 12-24 months, requiring patient patience and monitoring 5

Hormonal Treatments (for FPHL with androgen excess)

• Antiandrogens may be considered when FPHL is associated with high androgen levels 1
• Options include:
  • Cyproterone acetate (with oral contraceptives) 1
  • Spironolactone 2
  • Finasteride or dutasteride (2.5mg daily, particularly for postmenopausal women) 1, 2
• Oral contraceptives containing ethinylestradiol and a progestogen can help with ovarian androgen suppression 1

Emerging Treatments

• Platelet-rich plasma (PRP) injections have shown promise in some studies, with increased hair density and thickness 4
• Low-level laser and light therapies are increasingly used, though benefits may be modest 2

Non-Pharmaceutical Approaches

• Natural 5α-reductase inhibitors like saw palmetto, horsetail, and pumpkin seed oil show some promise 3
• Addressing nutritional deficiencies, particularly iron, vitamin D, and essential minerals 3
• Curcumin has demonstrated anti-inflammatory effects that may contribute to improved scalp health 3

Treatment for Alopecia Areata

• Limited patchy hair loss: Intralesional corticosteroid injections 4
• Extensive patchy hair loss: Contact immunotherapy (though this has limitations and side effects) 4
• For many patients with alopecia areata, especially those with limited patches, spontaneous remission occurs in up to 80% of cases within one year 4

Cosmetic Solutions

• Wigs or hairpieces are effective solutions for many women with extensive hair loss 4
• Hair transplantation is the only current successful permanent option, but requires surgical procedures 2

Important Considerations

• Hair loss treatments need to be continued long-term to maintain effects, as they do not provide permanent cures 2, 5
• Psychological impact of hair loss can be significant, and counseling may be beneficial 4
• Management of expectations is crucial - current therapies aim to slow or stop progression rather than achieve complete regrowth 2
• Weight loss can improve hair loss in hyperandrogenic women 1

Treatment Algorithm

1. Confirm diagnosis and rule out other causes of hair loss
2. For FPHL without androgen excess: Start with topical minoxidil 2-5% twice daily
3. For FPHL with androgen excess: Add appropriate antiandrogen therapy based on hormonal profile
4. Consider adjunctive treatments like PRP or low-level laser therapy if initial response is inadequate
5. Discuss cosmetic options like wigs or hair transplantation for significant hair loss
6. Address any nutritional deficiencies and provide psychological support