Female alopecia

Female androgenetic alopecia has a hormonal and genetic basis. Both androgen-dependent and androgen-independent mechanisms play a role in its development. When it appears before menopause, it is referred to as early-onset female androgenetic alopecia and often worsens during menopause due to the decline in oestrogen levels characteristic of this stage of life. When it develops after menopause, it is referred to as late-onset female androgenetic alopecia.

In some cases, this condition may begin during childhood, coinciding with adrenarche, the period when the adrenal glands begin hormonal activity.

In both early- and late-onset forms, androgen levels may be elevated; however, most women with androgenetic alopecia have normal circulating hormone levels. In these cases, the underlying mechanism is increased sensitivity of the hair follicle to normal androgen levels.

Androgens induce progressive miniaturisation of hair follicles, causing the hair shaft to become increasingly thinner. Without appropriate treatment, terminal hair may eventually be replaced by fine vellus hair.

As in male androgenetic alopecia, it is common to find affected family members, although the condition can also occur in the absence of a family history.

Unlike the male pattern, female androgenetic alopecia may coexist with other medical conditions, such as vitamin deficiencies, polycystic ovary syndrome, anorexia nervosa, restrictive diets, HAIR-AN syndrome, congenital adrenal hyperplasia, or adrenal and ovarian tumours.

All these conditions must be excluded to establish an accurate differential diagnosis.

Symptoms of female androgenetic alopecia

Female androgenetic alopecia most commonly affects the frontal, central and parietal regions of the scalp, while usually preserving the frontal hairline. However, hair loss in women does not follow the clearly defined pattern typically observed in men.

It is characterised by a generalised reduction in hair density, resulting in progressive widening of the central parting, thinning of the ponytail, or increased scalp visibility through the hair. Over time, diffuse thinning may affect the entire upper scalp.

Severity is commonly classified using the Ludwig or Olsen scales (three grades) or the Ebling scale (five grades), ranging from mild to advanced.

Not all patients progress to advanced stages. However, as with male androgenetic alopecia, the condition usually follows a slow but progressive course if left untreated, particularly during younger years.

Diagnosis of female androgenetic alopecia

Diagnosis is based on clinical examination and digital trichoscopy performed during consultation. This specialised digital microscopy technique allows assessment of hair density, variability in hair shaft diameter, measurement of hair thickness and evaluation of scalp sebum production.

As a non-invasive technique, trichoscopy enables early diagnosis and timely initiation of treatment.

Accurate digital monitoring with standardised photographs is essential for long-term follow-up and evaluation of treatment response.

In most cases, baseline laboratory testing is required to assess parameters influencing hair growth and to identify possible hormonal alterations associated with female androgenetic alopecia.

There is currently no curative treatment for androgenetic alopecia. Available therapies must therefore be maintained long term in order to preserve results and slow disease progression.

For this reason, it is essential to design a sustainable and well-tolerated treatment strategy, as therapy must often be continued for many years. Discontinuation of treatment typically leads to gradual loss of the improvement achieved.

At the Grupo Pedro Jaén Hair Disorders and Hair Transplant Unit, treatment is usually more intensive during the first two years. Clinical improvement generally becomes noticeable after six months and reaches its maximum effect between 12 and 18 months. Thereafter, treatment regimens may be adjusted to improve long-term adherence.

Afortunadamente, en la actualidad disponemos de multitud de alternativas que nos permiten introducir cambios que se ajusten a las necesidades de la paciente y a las características de su alopecia en cada momento. La mejoría obtenida se mide en función del aumento de la densidad capilar y en el engrosamiento del cabello fino existente.

Oral and topical medication

These objectives are achieved using medications that act selectively on the hair follicle, slowing or reversing follicular miniaturisation.

These treatments are generally well tolerated, allowing patients to maintain a normal lifestyle, including exercise, sun exposure and, where appropriate, alcohol consumption, in accordance with specialist advice. When indicated, they may be combined with therapies aimed at correcting associated hormonal alterations.

Women undergoing treatment with certain active agents must avoid pregnancy for a defined period after discontinuation, ranging from one to six months depending on the medication. Blood donation should also be avoided during this time.

Topical therapies may also be prescribed to promote hair shaft thickening.

Other therapies for female androgenetic alopecia

Additional treatments may be useful in selected cases, including microneedling, low-level laser therapy or mesotherapy with specific active substances

The specialists at Grupo Pedro Jaén are also involved in clinical studies investigating regenerative medicine therapies. However, further research is required before these approaches can be routinely recommended.

When necessary, complementary medical treatment may be initiated based on laboratory findings or coexisting conditions, with support from the Gynaecology or Endocrinology Units.

Hair transplantation for female androgenetic alopecia

Hair transplantation using micrograft techniques is a minimally invasive surgical option that may complement medical treatment by significantly improving hair density in affected areas. Contrary to common belief, this procedure can also be performed in women.

Current techniques provide fully natural results. Surgery may be performed using FUE with shaving or using strip (FUSS) techniques without shaving.

The procedure is carried out on an outpatient basis and does not require hospital admission. Recovery is gradual and usually complete within seven to eight days.

New hair growth typically becomes visible after six months, with maximal results observed between 12 and 15 months

More information about androgenetic alopecia

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.

References on female alopecia:

1. New Treatments for Hair Loss. Vañó-Galván S, Camacho F. Actas Dermosifiliogr. 2017 Apr; 108(3):221-228. doi: 10.1016/j.ad.2016.11.010.

2. Safety and Tolerability of the Dual 5-Alpha Reductase Inhibitor Dutasteride in the Treatment of Androgenetic Alopecia. Choi GS, Kim JH, Oh SY, Park JM, Hong JS, Lee YS, Lee WS. Ann Dermatol. 2016 Aug;28(4):444-50.

3. The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia. Boersma IH, Oranje AP, Grimalt R, Iorizzo M, Piraccini BM, Verdonschot EH. Indian J Dermatol Venereol Leprol. 2014 Nov-Dec;80(6):521-5.

4. Mesotherapy with dutasteride in the treatment of androgenetic alopecia. Saceda-Corralo D, Rodrigues-Barata AR, Vano-Galvan S, Jaen-Olasolo P. Int J Trichol 2017;9:143-5.

5. Mesotherapy using dutasteride-containing preparation in treatment of female pattern hair loss: photographic, morphometric and ultrustructural evaluation. Moftah N, Moftah N, Abd-Elaziz G, Ahmed N, Hamed Y, Ghannam B, Ibrahim M. J Eur Acad Dermatol Venereol. 2013 Jun;27(6):686-93.

6. Oral bicalutamide for female pattern hair loss: A pilot study. Fernandez-Nieto D, Saceda-Corralo D, Rodrigues-Barata R, Hermosa-Gelbard A, Moreno-Arrones O, Jimenez-Cauhe J, Ortega-Quijano D, Vano-Galvan S. Dermatol Ther. 2019 Nov;32(6):e13096.

7. Safety of oral bicalutamide in female pattern hair loss: a retrospective review of 316 patients. Ferial Ismail F, Meah N, de Carvalho LT, Bhoyrul B, Wall D, Sinclair R. J Am Acad Dermatol. 2020 Mar 22:S0190-9622(20)30452-7.8.

8. Sinclair, Rodney D. “Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.” International journal of dermatology 57.1 (2018): 104-109.

9. Low-Dose Oral Minoxidil for Female Pattern Hair Loss: A Unicenter Descriptive Study of 148 Women. Rodrigues-Barata R, Moreno-Arrones OM, Saceda-Corralo D, Jiménez-Cauhé J, Ortega-Quijano D, Fernández-Nieto D, Jaén Olasolo P, Vaño-Galvan S. Skin Appendage Disord. 2020 Jun;6(3):175-176

10. Safety of low-dose oral minoxidil treatment for hair loss. A systematic review and pooled-analysis of individual patient data. Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, Moreno-Arrones OM, Ortega-Quijano D, Fernandez-Nieto D, Jaen-Olasolo P, Vaño-Galvan S. Dermatol Ther. 2020 Aug 5. doi: 10.1111/dth.14106.

The Grupo Pedro Jaén Hair Disorders and Hair Transplant Unit, in collaboration with the Hair Disorders Unit of Ramón y Cajal University Hospital, is currently conducting several scientific studies to advance knowledge of female alopecia. If you are interested in participating in any of these studies, please discuss this with your physician.