What are the treatment options for female pattern hair loss?

Treatment Options for Female Pattern Hair Loss

Start with topical minoxidil 5% solution, 1 mL applied twice daily to the affected scalp areas, as this is the only FDA-approved treatment specifically recommended by the American Academy of Dermatology for female androgenetic alopecia. 1

First-Line Treatment: Topical Minoxidil

• Minoxidil 5% solution is superior to 2% formulation, demonstrating better patient-assessed treatment benefit at 48 weeks, though both concentrations show efficacy in promoting hair growth 2
• Apply 1 mL twice daily directly to dry scalp in affected areas 1
• Treatment must continue indefinitely—stopping minoxidil reverses all hair growth benefits 1, 3
• Expect to see results after 12-24 weeks of consistent use 4
• Common side effects include pruritus, local irritation, and hypertrichosis (unwanted facial/body hair growth), which occur more frequently with 5% versus 2% concentration 2

Alternative Minoxidil Formulation

• Once-daily 5% minoxidil foam is available and may improve adherence, though it did not meet prespecified noninferiority criteria compared to twice-daily 2% solution in clinical trials 4, 5

Enhanced Treatment: Combination Therapy with PRP

For patients seeking better results than minoxidil alone, combine topical minoxidil 5% with monthly platelet-rich plasma (PRP) injections for at least 3 sessions, as this combination is significantly more effective than monotherapy. 1, 3

PRP Treatment Protocol

Initial Phase: 1, 3

• Perform 3-5 sessions spaced 1 month apart
• Use 5-7 mL of PRP per session
• Inject 0.05-0.1 mL/cm² at 1 cm intervals
• Inject at 90-degree angle, 2-4 mm depth 3
• Use 30G × 4 mm needles to minimize discomfort 3

Maintenance Phase: 1, 3

• Continue with 1 session every 6 months after completing initial treatment

PRP Preparation and Administration

• Use manual double-spin method with platelet concentration of 1 to 1.5 million platelets per µL 3
• PRP activation is NOT required for androgenetic alopecia 3
• Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain 3
• Patient must shampoo and detangle hair before session, with no hair products applied 3

Expected Outcomes with Combination Therapy

• 83% of patients achieve a negative hair pull test after PRP combined with minoxidil, indicating reduced hair fragility 3
• Combination therapy shows the highest increase in hair density compared to either treatment alone 3

Monitoring Treatment Response

Evaluate treatment efficacy after one year using multiple objective measures: 1, 3

• Standardized before-and-after photographs
• Trichoscopy to evaluate hair density and diameter
• Patient self-assessment questionnaires

Key indicators of positive response include: 3

• Increased hair density
• Increased hair shaft diameter
• Decreased proportion of telogen hairs
• Improved patient satisfaction scores

Additional Treatment Option

• Low-level laser light therapy (LLLT) three times per week is another option with demonstrated efficacy in female androgenetic alopecia 3

Critical Clinical Pitfalls to Avoid

• Start treatment early—efficacy decreases with severity and duration of alopecia 1, 3
• Schedule regular monitoring appointments, as inadequate follow-up leads to suboptimal outcomes 1, 3
• Do NOT routinely test for iron deficiency—no published studies demonstrate treatment response to iron replacement therapy in androgenetic alopecia 1
• Do NOT confuse female pattern hair loss with alopecia areata, which presents with patchy hair loss and requires different treatment (intralesional corticosteroids) 1
• Warn patients about dose-dependent hypertrichosis with oral minoxidil if considering systemic therapy 1

Important Counseling Points

• Early initiation of treatment and combination of various modalities are more efficacious than monotherapy 6
• Female pattern hair loss has a strikingly overwhelming psychological effect, making successful treatment crucial for quality of life 7
• The aim of therapy is to slow or stop disease progression—manage expectations regarding permanent hair regrowth 7