What are the treatment options for female androgenetic alopecia?

Treatment of Female Androgenetic Alopecia

Start with topical minoxidil 5% applied 1 mL twice daily as first-line therapy, and for patients with suboptimal response after 4-6 months, add monthly platelet-rich plasma (PRP) injections for at least 3 sessions. 1

First-Line Treatment

• Topical minoxidil is the primary recommended treatment by the American Academy of Dermatology for female androgenetic alopecia. 1
• Apply minoxidil 5% solution, 1 mL twice daily to the affected scalp areas. 1
• Treatment must be continued indefinitely—discontinuation leads to complete reversal of hair growth benefits within months. 1
• Evaluate response at 4-6 months using standardized photographs, trichoscopy for hair density and diameter assessment, and patient self-assessment questionnaires. 1

Advanced Treatment for Inadequate Response

• For patients who show suboptimal response to minoxidil monotherapy, combination therapy with PRP demonstrates superior efficacy compared to either treatment alone. 1
• PRP therapy works by inducing proliferation of dermal papilla cells, increasing vascularization of perifollicular tissue, and accelerating the telogen-to-anagen transition. 1

PRP Treatment Protocol

• Administer 3-5 treatment sessions spaced one month apart as the initial phase. 1
• Use 5-7 mL of PRP per session, injecting 0.05 to 0.1 mL/cm² at 1 cm intervals. 1
• Inject at a depth of 2-4 mm into the scalp. 1
• Apply pharmaceutical-grade anesthetic cream before injections, as the procedure is associated with significant pain. 1
• After the initial treatment phase, maintain with 1 session every 6 months. 1
• Continue topical minoxidil 5% twice daily throughout PRP therapy. 1

Alternative to PRP

• Platelet-rich fibrin (PRF) has theoretical advantages over PRP and can be used with the same protocol. 1
• PRF may be particularly useful as an adjunct to hair transplantation procedures. 2

Additional Treatment Option

• Low-level laser light therapy (LLLT) is an FDA-cleared non-pharmaceutical option with demonstrated efficacy in female androgenetic alopecia. 1, 3
• Recommended usage is three times per week. 1
• LLLT can be used as monotherapy or in combination with minoxidil. 3

Monitoring Treatment Efficacy

• Key indicators of positive response include increased hair density, increased hair shaft diameter, decreased proportion of telogen hairs, and improved patient satisfaction scores. 1
• Use multiple assessment methods: standardized before-and-after photographs taken under identical lighting conditions, trichoscopy to quantify hair density and diameter changes, and validated patient questionnaires. 1
• Inadequate follow-up leads to suboptimal outcomes—schedule regular monitoring appointments every 3-4 months during the first year. 1

Important Caveats

• Treatment efficacy decreases with increasing severity and duration of alopecia—earlier intervention yields better results. 1
• Neither oral finasteride nor dutasteride (commonly used in male pattern baldness) are mentioned in guidelines as first-line options for female androgenetic alopecia, though they may be considered in specific cases. 4, 5
• Spironolactone and other anti-androgens are not first-line therapies based on current evidence. 6
• All treatments require long-term commitment, as hair loss will resume upon discontinuation. 1