Best Treatment for Androgenetic Alopecia in Women
Start with topical minoxidil 5% applied 1 mL twice daily to the affected scalp areas, which is the only FDA-approved treatment and must be continued indefinitely to maintain results. 1, 2
First-Line Treatment: Topical Minoxidil
Minoxidil 5% is superior to 2% concentration and should be your default choice, as once-daily 5% foam formulation is noninferior to twice-daily 2% solution while offering better tolerability and less interference with hair styling. 3
The 5% concentration applied twice daily demonstrates significantly greater efficacy than 2% solution in meta-analyses, with all minoxidil formulations proving superior to placebo (P < 0.00001). 4
Critical pitfall: Discontinuation reverses all hair growth benefits, so counsel patients upfront that this is a lifelong commitment. 1, 2
Expect a mean increase of 33 nonvellus hairs per cm² with 2% minoxidil (significantly better than 19 hairs with placebo), with 55% of women reporting subjective improvement. 5
Enhanced Treatment: Combination Therapy with PRP
For patients seeking superior results, combine topical minoxidil 5% (1 mL twice daily) with monthly platelet-rich plasma (PRP) injections for at least 3 sessions. 1, 2
PRP Treatment Protocol
Initial phase: 3-5 sessions spaced exactly 1 month apart, using 5-7 mL of PRP per session. 1, 2
Injection technique: Use 30G × 4 mm needles at 90-degree angle, 2-4 mm depth, injecting 0.05-0.1 mL/cm² at 1 cm intervals apart. 1
Maintenance phase: 1 session every 6 months after completing initial treatment. 1, 2
Pain management: Apply pharmaceutical-grade topical anesthetic cream before injection—this is strongly recommended as the procedure causes significant pain. 1
Patient preparation: Have patient shampoo and detangle hair before session with no hair products applied. 1
Expected Outcomes with Combination Therapy
PRP combined with minoxidil increases hair density 1.74 times and hair diameter 14.3 times compared to baseline. 6
83% of patients achieve a negative hair pull test after combination treatment, indicating reduced hair fragility. 1
The combination shows the highest increase in hair density in comparative studies versus either treatment alone. 1
Alternative and Adjunctive Options
Low-Level Laser Therapy (LLLT)
655-nm laser devices demonstrate efficacy in female androgenetic alopecia with recommended usage of 3 times per week. 1, 2
Like minoxidil, requires continuous use to maintain benefits. 2
Topical Antiandrogens (Off-Label)
Topical flutamide 2% plus minoxidil 5% combination is significantly more effective than minoxidil alone for hair density, hair thickness, and patient satisfaction (p < 0.05). 7
This represents an off-label option when standard treatments prove insufficient. 7
Monitoring Treatment Response
Evaluate treatment efficacy after one year using multiple objective measures: 2
Standardized before-and-after photographs taken at each visit. 1, 2
Trichoscopy to evaluate hair density and diameter changes. 1, 2
Hair pull tests to assess hair fragility. 1
Patient self-assessment questionnaires for subjective improvement. 1, 2
Key Response Indicators
Increased hair density and shaft diameter. 6
Decreased proportion of telogen (resting phase) hairs. 6
Improved patient satisfaction scores. 6
Critical Clinical Pitfalls to Avoid
Inadequate follow-up leads to suboptimal outcomes—schedule regular monitoring appointments every 3-6 months. 2
Treatment efficacy decreases with severity and duration of alopecia, so initiate treatment early rather than waiting for extensive hair loss. 1, 2
Do not routinely test for iron deficiency—no published studies demonstrate treatment response to iron replacement therapy in androgenetic alopecia. 2
Do not confuse with alopecia areata, which requires completely different treatment (intralesional corticosteroids for limited patches, contact immunotherapy for extensive disease). 8, 2
Oral minoxidil causes dose-dependent hypertrichosis (unwanted body hair growth) if used systemically, so stick with topical formulations. 2