What are the treatment options for female hair loss, specifically androgenetic alopecia?

Treatment of Female Hair Loss (Androgenetic Alopecia)

Start with topical minoxidil as first-line therapy, and strongly consider adding platelet-rich plasma (PRP) injections for superior results, as combination therapy significantly outperforms minoxidil alone. 1

First-Line Treatment Approach

Topical minoxidil remains the cornerstone of treatment and must be continued indefinitely, as discontinuation reverses all hair growth benefits. 1 This is the most established treatment with the strongest evidence base for female androgenetic alopecia. 2

Minoxidil Protocol

• Apply minoxidil 5% solution, 1 mL twice daily to the affected scalp areas 1
• Expect 12-24 months before seeing meaningful results 3
• Understand this is lifelong therapy—stopping means losing all gains 1

Combination Therapy: The Superior Approach

PRP combined with minoxidil produces the highest increase in hair density compared to either treatment alone, making this the optimal strategy when resources permit. 1 The American Academy of Periodontology confirms this combination is more effective than minoxidil monotherapy. 1

PRP Treatment Protocol

• Initial phase: 3-5 treatment sessions spaced exactly 1 month apart 1
• Maintenance phase: 1 session every 6 months after completing initial treatments 1
• Dosing: 5-7 mL of PRP per session, injected at 0.05-0.1 mL/cm² 1
• Technique: Use 30-gauge × 4 mm needles at 90-degree angle, 2-4 mm depth, with injections spaced 1 cm apart 1
• Pain management: Apply pharmaceutical-grade topical anesthetic cream before injection—this is strongly recommended as the procedure causes significant pain 1

PRP Preparation Specifications

• Use manual double-spin method for preparation 1
• Target platelet concentration: 1 to 1.5 million platelets per µL 1
• Do NOT activate PRP—activation is unnecessary for androgenetic alopecia treatment 1

Patient Preparation

• Patient must shampoo and detangle hair before each session 1
• No hair products should be applied on treatment day 1

Alternative Physical Therapies

Low-level laser therapy (LLLT) at 655 nm is FDA-cleared and represents the only non-pharmaceutical option with regulatory approval for androgenetic alopecia. 4 Use three times per week for effectiveness. 1

Microneedling may be superior to injection techniques for some applications, though this is primarily studied in the context of PRP delivery. 5

Antiandrogen Therapy Considerations

While oral antiandrogens (spironolactone, cyproterone acetate) and finasteride are treatment options, 6 the guidelines prioritize topical minoxidil as first-line for women. 1 These systemic agents work best when initiated early and require ongoing use. 3, 6

Critical Treatment Principles

Timing Matters

• Start treatment as early as possible—all therapies are more effective at arresting progression than stimulating regrowth 3, 6
• Treatment efficacy decreases with severity and duration of alopecia 1
• Early intervention prevents progression to complete follicular miniaturization 6

Monitoring Treatment Response

Evaluate response using multiple objective measures rather than relying on patient perception alone: 1

• Standardized before-and-after photographs at consistent lighting and angles 5, 1
• Trichoscopy to measure hair density, diameter, and terminal/vellus hair ratio 5, 1
• Hair pull tests to assess fragility—fewer hairs pulled indicates improvement 5
• Patient self-assessment questionnaires for satisfaction scores 5, 1

Schedule formal evaluation at 12 months for PRP combination therapy. 1 For other treatments, assess at 3 months initially, though meaningful changes may take 12-24 months. 7, 3

Key Indicators of Positive Response

• Increased hair density per cm² 5
• Increased hair shaft diameter 5, 1
• Decreased proportion of telogen (resting phase) hairs 1
• Improved patient satisfaction scores 1

Common Pitfalls to Avoid

• Inadequate follow-up leads to suboptimal outcomes—regular monitoring is essential 1
• Stopping treatment prematurely before 12 months—patients must understand the delayed response 3
• Discontinuing successful therapy—all benefits reverse when treatment stops 1, 3
• Using unproven supplements without documented deficiencies—zinc and vitamin D supplementation should only occur if blood tests confirm deficiency 8

Adjunctive Measures

Address the significant psychological impact through counseling and cosmetic camouflage options. 7, 2 Hair transplantation should be considered for advanced cases resistant to medical treatment, provided the occipital donor area has well-preserved hair growth. 6