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

Treatment for Thinning Hair in Women

Start with topical minoxidil 2-5% solution (1 mL twice daily) as first-line therapy, and strongly consider adding monthly platelet-rich plasma (PRP) injections for superior results—this combination increases hair density 1.74 times more than minoxidil alone. 1, 2

First-Line Treatment: Topical Minoxidil

• Apply topical minoxidil 2-5% solution, 1 mL twice daily to affected scalp areas—this is the only FDA-approved treatment specifically recommended by the American Academy of Dermatology for female androgenetic alopecia. 1
• Minoxidil must be continued indefinitely; discontinuation reverses all hair growth benefits. 1, 2
• Expect modest results with monotherapy: an average increase of 23-33 nonvellus hairs per cm² compared to 11-19 hairs with placebo after 32 weeks. 3, 4
• Over 60% of patients report satisfaction with minoxidil treatment, though objective improvements may be more modest. 5

Enhanced Treatment: Combination Therapy (Minoxidil + PRP)

The combination of topical minoxidil 5% with monthly PRP injections is significantly more effective than minoxidil alone—hair density increases 1.74 times and hair diameter increases 14.3 times compared to monotherapy. 2

PRP Treatment Protocol

Initial Phase: 1, 6

• Perform 3-5 sessions spaced 1 month apart (at months 0,1, and 3)
• Use 5-7 mL of PRP per session
• Inject 0.05-0.1 mL/cm² at 1 cm intervals
• Insert needle at 90-degree angle, 2-4 mm depth
• Use 30G × 4 mm needles to minimize discomfort 6

Maintenance Phase: 1, 6

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

Critical Technical Details: 2

• Do NOT activate PRP before injection—nonactivated PRP demonstrates 31% greater increases in hair count compared to activated PRP
• Target platelet concentration: 1 to 1.5 million platelets per µL 6
• Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain 6

Expected Outcomes with Combination Therapy

• 83% of patients achieve a negative hair pull test (indicating reduced hair fragility) 6
• A 25% improvement in hair density at 2 months predicts sustained response at 6 months 2
• PRP shows particular value in mild-to-moderate cases when applied as early as possible 2

Monitoring Treatment Response

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

• Standardized before-and-after photographs for visual comparison 1, 2
• Trichoscopy to evaluate hair density, diameter, and terminal/vellus hair ratio 1, 2
• Hair pull tests to evaluate hair fragility 6
• Patient self-assessment questionnaires 1, 2

Alternative Treatment Option: Low-Level Laser Therapy

• Low-level 655-nm laser devices demonstrate efficacy in female androgenetic alopecia 7
• Recommended usage: 3 times per week 6
• Requires continuous use similar to minoxidil 7

Critical Pitfalls to Avoid

Timing and Follow-Up Issues: 1, 2

• Treatment efficacy decreases with severity and duration of alopecia—early initiation is crucial
• Inadequate follow-up leads to suboptimal outcomes; schedule regular monitoring appointments
• Patients often discontinue treatment prematurely, not understanding the indefinite commitment required

Medication-Related Pitfalls: 2

• Oral minoxidil can cause dose-dependent hypertrichosis (unwanted body hair growth) if used systemically
• Do not confuse androgenetic alopecia with alopecia areata, which requires completely different treatment (intralesional corticosteroids) 1, 2

Testing Pitfalls: 1

• Do NOT routinely test for iron deficiency—no published studies demonstrate treatment response to iron replacement therapy in androgenetic alopecia

Inappropriate Treatments: 2

• Do NOT use contact immunotherapy (DPCP/SADBE), PUVA photochemotherapy, dithranol, systemic immunosuppressants (ciclosporin, methotrexate), or prostaglandin analogues—these address completely different pathophysiology

Treatment Algorithm

1. Start all patients on topical minoxidil 2-5% (1 mL twice daily) 1
2. For patients seeking optimal results or with mild-to-moderate disease, add monthly PRP injections (3-5 initial sessions, then every 6 months) 1, 6, 2
3. Counsel patients that treatment must continue indefinitely 1
4. Evaluate response at 2 months (early predictor) and definitively at 12 months 1, 2
5. If inadequate response at 12 months, reassess diagnosis and consider hair transplantation for permanent solution 8