What are the treatment options for female pattern hair loss (androgenetic alopecia) in women?

Treatment for Thinning Hair in Women

For female pattern hair loss (androgenetic alopecia), topical minoxidil 2-5% applied twice daily is the first-line treatment and must be continued indefinitely, with combination therapy using platelet-rich plasma (PRP) showing superior results to minoxidil alone. 1, 2

First-Line Treatment: Topical Minoxidil

• Apply topical minoxidil 2-5% solution, 1 mL twice daily to the affected scalp areas 2
• Minoxidil is the only FDA-approved treatment specifically recommended by the American Academy of Dermatology for female androgenetic alopecia 1, 2
• Expect to see results after 32 weeks of consistent use, with an average increase of 23-33 nonvellus hairs per cm² compared to 11-19 hairs with placebo 3, 4
• Critical caveat: Treatment must continue indefinitely—discontinuation reverses all hair growth benefits 1, 2
• Women report new hair growth in 55-60% of cases versus 40-41% with placebo 3, 4

Enhanced Treatment: Combination Therapy with PRP

For women seeking optimal results, combine topical minoxidil 5% (1 mL twice daily) with monthly PRP injections for at least 3 sessions—this combination is significantly more effective than minoxidil alone. 1

PRP Treatment Protocol

• Initial phase: 3-5 sessions spaced 1 month apart 1
• Use 5-7 mL of PRP per session, injecting 0.05-0.1 mL/cm² at 1 cm intervals 1
• Inject at 90-degree angle, 2-4 mm depth using 30G × 4mm needles 1
• Maintenance phase: 1 session every 6 months after completing initial treatment 1
• Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain 1
• Patient must shampoo and detangle hair before each session with no hair products applied 1

PRP Preparation Specifications

• Use manual double-spin method with platelet concentration of 1-1.5 million platelets per µL 1
• PRP activation is NOT required for androgenetic alopecia 1

Monitoring Treatment Response

Evaluate treatment efficacy after one year using multiple objective measures: 1, 2

• Standardized before-and-after photographs taken at each visit 1, 2
• Trichoscopy to assess hair density and shaft diameter 1, 2
• Patient self-assessment questionnaires 1, 2
• Key positive indicators: increased hair density, increased hair shaft diameter, decreased proportion of telogen hairs, improved patient satisfaction scores 1

Alternative Treatment Options

Low-Level Laser Light Therapy (LLLT)

• Use three times per week for demonstrated efficacy in female androgenetic alopecia 1

Antiandrogen Therapy (Off-Label)

• Spironolactone, cyproterone acetate, or flutamide may help women with normal hormone levels, though evidence is limited primarily to postmenopausal women 5
• Finasteride 1 mg is ineffective, but doses of 2.5-5 mg have shown benefit in some open studies 5
• These remain off-label options with less robust evidence than minoxidil 5

Important Clinical Pitfalls

• Inadequate follow-up leads to suboptimal outcomes—schedule regular monitoring appointments 1
• Treatment efficacy decreases with severity and duration of alopecia, so early initiation is crucial 1, 6
• Oral minoxidil can cause dose-dependent hypertrichosis (unwanted body hair growth) if used systemically 2
• Combination therapy appears more efficacious than monotherapy across all treatment modalities 6

What NOT to Do

• Do not routinely test for iron deficiency—no published studies demonstrate treatment response to iron replacement therapy in androgenetic alopecia 7
• Do not confuse this condition with alopecia areata, which has different treatment algorithms involving intralesional corticosteroids 7, 8