Female Pattern Hair Loss, What to Do?

Heather Hydzik, ND | August 3, 2021

Androgenetic alopecia is the most common form of hair loss in both men and women and affects 38% of women over age 70. It is caused by androgens in genetically susceptible individuals, often those who have a family history of hair loss. Females with androgenetic alopecia (female pattern hair loss) experience gradual onset of diffuse thinning of the vertex (where the scalp transitions from a horizontal to a vertical plane, a.k.a. posterior hairline) with sparing of the frontal hairline and in some cases this can result in complete baldness. Women experiencing alopecia also often suffer from anxiety, depression, low self-confidence and negative social interactions as a result. As hair health impacts a person’s identity and quality of life, it is imperative to correctly diagnose, identify contributing factors and promptly apply effective therapies when a female patient presents with thinning hair.

Medical conditions that can underlie hair loss include thyroid disorders, vitamin D or iron deficiency, insulin resistance, recent pregnancy, severe stressful events (sudden onset of hair shedding in clumps), and febrile illness including Covid-19. Testing to help determine contributing factors can include thyroid hormones, vitamin D, ferritin, fasting glucose, insulin, salivary sex hormones and diurnal cortisol.

Numerous medications can cause hair loss as a side effect, which usually occurs within 3 months of starting the medication and presents as thinning on the top of the scalp. Some common alopecia-promoting medications include: amphetamines, ACE inhibitors, antidepressants, antifungals, anti-seizure, beta-blockers, OCPs, blood thinners, cholesterol lowering meds (clofibrate, gemfibrozil), thyroid medications, famotidine, isotretinoin, levodopa, NSAIDS, and steroids.

Once the diagnosis of androgenetic alopecia has been established and other etiological factors have been addressed (see Hair Loss: Common Causes and Treatment below for more detailed information) conventional treatment is usually topical minoxidil 2% solution, which is continued indefinitely as hair loss returns with discontinuation. Side effects include hypertrichosis and contact dermatitis. Improvement is seen in 6 to 12 months, and it is more effective at preventing further loss rather than promoting new growth so earlier treatment will have a better outcome. Oral dutasteride, which is not yet FDA-approved for this condition, has been prescribed off-label, and one study promisingly showed improved hair thickness in women under age 50 with 3 years of use. Dutasteride is pregnancy category X and it should be noted that the side effect profile in women is not well-studied. A few small studies have shown that higher doses of finasteride (2.5mg and 5mg) were effective for female androgenetic alopecia, but there is a theoretical increased risk of breast cancer as it may leave more testosterone available to convert to estrogens.

A few natural therapies, mostly aimed at 5-alpha reductase inhibition, have been studied for female androgenetic alopecia including green tea, saw palmetto, topical rosemary and melatonin, and platelet-rich plasma. In general, the evidence is not as strong as for the conventional treatments, but patients may prefer this approach and some of these may be combined with pharmaceuticals for more benefit after checking for drug-herb interactions.

  • The epigallocatechins in green tea decrease the production of DHT and green tea can also increase sex hormone binding globulin helping to reduce free androgens.
  • Saw palmetto has been shown to inhibit 5-alpha-reductase, decrease DHT binding to androgen receptors and increase DHT breakdown to a weaker metabolite.
  • Topical rosemary oil 3.7mg/ml daily resulted in a significant increase in hair count at 6 months and was “noninferior” to topical 2% minoxidil (Note: this study was on males). The most common side effect was localized itching, but this was more frequent in minoxidil users. Rosemary inhibits 5α-reductase, and also decreases the binding of DHT to androgen receptors.
  • Five clinical studies showed that topical melatonin resulted in a significant reduction in hair loss in women and had good tolerability.
  • Injecting platelet-rich plasma (PRP) into the scalp might promote hair growth and prevent further loss. A review of the literature in 2021 involving 8 studies totaling 197 subjects found that PRP was well tolerated and showed promising results and concluded that “PRP may be proposed in patients who did not respond or did not tolerate topical minoxidil, as well as in combination with topical and oral treatments.”
  • Oral zinc supplementation may promote regrowth and thicker hair shafts.

In conclusion, to best help your female hair loss patients, address causative factors and initiate effective therapies – whether those be pharmaceutical or botanical—as early on as possible. The likelihood of achieving the desired outcome should be discussed when weighing treatment options. Since underlying hormonal imbalance has wide-ranging effects beyond hair thinning, salivary hormone testing may be clinically beneficial, especially to assess androgen levels and target hormone balancing treatment to the individual. Diurnal cortisol testing will reveal abnormalities in HPA axis function which may contribute to the case. Balancing these hormones while improving the alopecia can have a positive impact on quality of life.



Starace M, Orlando G, Alessandrini A, Piraccini BM. Female Androgenetic Alopecia: An Update on Diagnosis and Management. Am J Clin Dermatol. 2020;21(1):69-84. doi:10.1007/s40257-019-00479-x

Grant Phillips A, Slomiany P, Allison R. Hair Loss: Common Causes and Treatment. Am Fam Physician. 2017 Sep 15;96(6):371-378.

Dresden D. What medications cause hair loss? MedicalNewsToday. November 11, 2019. Available at https://www.medicalnewstoday.com/articles/326955. Accessed 7/26/21.

Prager N, Bickett K, French N, Marcovici G: A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-α-reductase in the treatment of androgenetic alopecia. J Altern Complement Med 2002; 8: 143–152.

Mercuri SR, Paolino G, Di Nicola MR, Vollono L. Investigating the Safety and Efficacy of Platelet-Rich Plasma (PRP) Treatment for Female Androgenetic Alopecia: Review of the Literature. Medicina (Kaunas). 2021;57(4):311. Published 2021 Mar 25. doi:10.3390/medicina57040311

Fischer TW, Trüeb RM, Hänggi G, Innocenti M, Elsner P. Topical melatonin for treatment of androgenetic alopecia. Int J Trichology. 2012;4(4):236-245. doi:10.4103/0974-7753.111199

Hosking A.-M, Juhasz M, Atanaskova Mesinkovska N. Complementary and Alternative Treatments for Alopecia: A Comprehensive ReviewSkin Appendage Disord 2019;5:72–89

Practical and Applicable Neuroendocrine Training for your Clinical Practice

August 20-22, 2021 | Online Only

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A Spoonful of Sugar: The Impact of Blood Sugar Imbalance

on Adrenal and Hormone Health

Krista Anderson Ross, ND

August 4, 2021 at 9:30 AM and 12 PM Pacific

Each session is approximately 60 minutes with Q&A

  1. Review the rise of sugar consumption globally and associated health burdens
  2. Compare the biochemical makeup of sucrose, fructose and glucose
  3. Examine the role that excess dietary sugar plays in glucose metabolism, insulin resistance, adrenal health and obesity
  4. Consider sugar's role in addiction
  5. Define metabolic syndrome including its impact on sex hormones and the HPA Axis
  6. Discuss laboratory testing to identify insulin resistance and hormone imbalance
  7. Explore dietary, nutritional, and herbal treatments for blood sugar management

Disclaimer: All information given about health conditions, treatment, products, and dosages are for educational purposes only and do not constitute medical advice.



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