What medication is recommended for a 45-year-old female patient with female pattern hair loss?

Medication Recommendations for Female Pattern Hair Loss

Start with topical minoxidil 5% applied once daily as first-line therapy, and strongly consider adding platelet-rich plasma (PRP) injections for superior results, particularly if initial response is suboptimal. 1

First-Line Treatment: Topical Minoxidil

• Minoxidil 5% is the American Academy of Dermatology's recommended first-line treatment for female pattern hair loss and must be continued indefinitely to maintain results, as discontinuation reverses hair growth benefits 1

• Apply 1 mL of 5% minoxidil solution twice daily (or once daily foam formulation) directly to the affected scalp areas 1, 2

• The 5% concentration demonstrates superior efficacy compared to 2% formulation, with significantly better patient-assessed treatment benefit at 48 weeks 2

• Expect to see initial results within 4-6 months of consistent use 3

Common Side Effects to Monitor

• Local irritation, pruritus, and facial hypertrichosis occur more frequently with 5% versus 2% concentration 2
• These effects are generally mild and do not require treatment discontinuation in most cases 2

Advanced Combination Therapy: PRP with Minoxidil

For optimal outcomes, combine topical minoxidil with PRP therapy, as this combination is significantly more effective than minoxidil monotherapy. 1

PRP Treatment Protocol

• Initial phase: 3-5 treatment sessions spaced exactly 1 month apart 1
• Dosing: 5-7 mL of PRP per session, injected at 0.05 to 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
• Maintenance phase: 1 session every 6 months after completing initial treatment 1

PRP Preparation Specifications

• Use manual double-spin method with platelet concentration of 1 to 1.5 million platelets per µL 1
• Do NOT activate PRP before injection - non-activated PRP shows superior results 4, 1

Pain Management for PRP

• Apply pharmaceutical-grade topical anesthetic cream before injection - this is strongly recommended as PRP injections cause significant pain 1
• Patient must shampoo and detangle hair before session with no hair products applied 1

Expected Outcomes with Combination Therapy

• 83% of patients achieve negative hair pull test (indicating reduced hair fragility) after PRP combined with minoxidil 1
• Increased hair density, increased hair shaft diameter, and decreased proportion of telogen (resting phase) hairs 1
• Hair density improvements are typically visible by 2-3 months, with optimal results at 6 months 4

Monitoring Treatment Response

Evaluate treatment efficacy using multiple objective measures 1:

• Standardized before-and-after photographs at consistent lighting and angles
• Trichoscopy to quantify hair density and diameter changes
• Patient self-assessment questionnaires for satisfaction scores

A 25% improvement in hair density at 2 months predicts sustained response at 6 months 4

Treatment Algorithm

1. Start immediately with minoxidil 5% twice daily (or once daily foam) 1
2. Evaluate response at 4-6 months 3
3. If suboptimal response, add PRP therapy with the protocol outlined above 1, 3
4. Continue both treatments indefinitely - discontinuation leads to reversal of benefits 1

Critical Pitfalls to Avoid

• Do not delay treatment initiation - efficacy decreases with severity and duration of alopecia 1
• Do not use minoxidil 2% concentration - the 5% formulation shows superior patient-reported outcomes 2
• Do not activate PRP before injection - this reduces efficacy 4, 1
• Do not skip the maintenance PRP phase - hair loss will recur without ongoing treatment 1
• Inadequate follow-up assessment leads to suboptimal outcomes - regular monitoring every 2-3 months is essential 1