What is the treatment for androgenic (male/female pattern hair loss) alopecia in women?

Treatment of Androgenic Alopecia in Women

Topical minoxidil 5% applied twice daily is the first-line treatment for female androgenic alopecia, and for optimal results, combine it with platelet-rich plasma (PRP) therapy consisting of three monthly sessions. 1, 2

First-Line Pharmacologic Treatment

• Topical minoxidil 5% (1 mL twice daily) is the American Academy of Dermatology's recommended first-line treatment and must be continued indefinitely, as discontinuation reverses all hair growth benefits. 1, 2

• The 5% concentration is superior to 2% minoxidil for all primary efficacy measures including nonvellus hair count, patient assessment, and investigator assessment of hair growth and scalp coverage at 48 weeks. 3

• Women using 5% minoxidil achieve a mean increase of 33 nonvellus hairs compared to 19 hairs with placebo, with 55% of patients reporting new hair growth versus 41% with placebo. 4

• Common side effects with 5% minoxidil include pruritus, local irritation, and hypertrichosis, but no systemic adverse effects occur. 3

Advanced Combination Therapy for Enhanced Results

The combination of topical minoxidil 5% with topical finasteride 0.25% demonstrates significantly superior efficacy compared to either monotherapy and represents the most effective medical treatment approach. 2

Platelet-Rich Plasma (PRP) Protocol

• PRP combined with topical minoxidil is significantly more effective than minoxidil monotherapy, with 83% of patients achieving a negative hair pull test (indicating reduced hair fragility) after combination treatment. 1, 2

• The combination increases hair density 1.74 times and hair diameter 14.3 times compared to baseline, with hair density increases of 27.7-45.9/cm². 2

Treatment Protocol:

• Use the manual double-spin method for PRP preparation with platelet concentration of 1 to 1.5 million platelets per µL (activation is NOT required for androgenic alopecia). 1
• Perform 3-5 sessions at 1-month intervals using 5-7 mL PRP at 0.05 to 0.1 mL/cm², injected at 90-degree angle, 2-4 mm depth, with injections 1 cm apart. 1
• Use 30G × 4 mm needles to minimize discomfort. 1
• Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain. 1
• Maintenance phase consists of 1 session every 6 months after initial treatment. 1

Platelet-Rich Fibrin (PRF) as Alternative

• PRF represents a promising alternative to PRP with theoretical advantages including longer growth factor release and may be more cost-effective, showing particular efficacy in mild androgenic alopecia cases. 2

• PRF functions as both scaffold and reservoir for growth factors with prolonged release. 2

Monitoring Treatment Response

Evaluate treatment efficacy using multiple objective methods at regular intervals:

• Standardized before-and-after photographs (essential baseline documentation). 1, 2
• Trichoscopy to evaluate hair density and diameter. 1, 2
• Hair pull tests to evaluate hair fragility. 1, 2
• Patient self-assessment questionnaires. 1, 2

Key indicators of positive response include:

• Increased hair density and shaft diameter. 2
• Decreased proportion of telogen hairs. 2
• Improved patient satisfaction scores. 2
• Negative hair pull test after treatment. 2

Important Clinical Considerations

• Treatment efficacy decreases with the severity and duration of alopecia, so earlier intervention yields better outcomes. 1

• Inadequate follow-up to assess treatment response leads to suboptimal outcomes, highlighting the importance of regular monitoring. 1

• Low-level laser light therapy (LLLT) three times per week is another option with demonstrated efficacy in female androgenic alopecia. 1

• Topical minoxidil significantly improves quality of life even in the absence of visible hair regrowth. 5