Female Pattern Hair Loss (FPHL)
- Haus Of Ästhetik
- Jan 8
- 7 min read
While often emotionally distressing, it is a biologically well‑described condition and, when identified early, can be effectively stabilised and managed with evidence‑based intervention.
What causes female pattern hair loss?
FPHL is driven by progressive follicular miniaturisation. Hair follicles remain alive but gradually shrink, producing shorter, finer hairs with each growth cycle. Over time, this leads to reduced density and visible scalp show rather than discrete bald patches.
Genetic and hormonal sensitivity
The dominant driver is inherited follicular sensitivity to androgens, particularly dihydrotestosterone. Crucially, most women with FPHL have normal circulating androgen levels. The pathology lies in increased follicular receptor sensitivity rather than systemic hormone excess.
Oestrogen plays a protective role in hair growth by prolonging the anagen phase. Periods of hormonal change or decline, including post‑partum states, perimenopause, menopause, and alterations in hormonal contraception, may therefore accelerate hair loss in genetically predisposed individuals.
Hair cycle dysregulation
Healthy hair cycles through anagen (growth), catagen (regression), and telogen (rest). In FPHL, the anagen phase progressively shortens while the telogen phase lengthens. The follicle spends less time producing visible hair and more time dormant, resulting in cumulative thinning despite continued follicular viability.
Contributing and aggravating factors
Although not primary causes, the following factors may worsen hair loss or reduce treatment response:
• Low ferritin levels, even without anaemia
• Thyroid dysfunction
• Polycystic ovary syndrome or insulin resistance
• Chronic psychological or physiological stress
• Rapid weight loss or inadequate protein intake
• Inflammatory scalp disease
Addressing these factors is essential for optimal outcomes.
Clinical presentation
FPHL classically presents with:
• Diffuse thinning over the crown and vertex
• Widening of the central parting
• Relative preservation of the frontal hairline
• Absence of scarring, scaling, or complete bald patches
This pattern differentiates FPHL from telogen effluvium and scarring alopecias, which require alternative diagnostic and treatment pathways.
Evidence‑based treatment strategy
Female pattern hair loss is treatable but not curable. The objective of treatment is to slow follicular miniaturisation, prolong the growth phase, and improve hair calibre and density. Benefits are maintained only with continued therapy. The strongest evidence supports early, combination‑based treatment.
Topical minoxidil
Topical minoxidil is first‑line therapy and the cornerstone of FPHL management.
How it works
Minoxidil acts as a potassium channel opener, improving follicular blood flow, prolonging the anagen phase, and increasing hair shaft diameter.
Recommended use
• Strength: 5 per cent foam or solution
• Dose: applied once daily to affected scalp areas
• Onset: reduced shedding by 3 months, visible improvement by 6–12 months
• Duration: ongoing, long‑term use required
An initial shedding phase within the first 8–12 weeks is common and reflects hair cycle synchronisation rather than deterioration.
Low‑dose oral minoxidil
Low‑dose oral minoxidil is used off‑label in specialist practice and may improve adherence where topical therapy is poorly tolerated.
How it works
Systemic vasodilation and follicular stimulation provide consistent exposure across the scalp.
Typical dosing
• 0.25–2.5 mg once daily, titrated cautiously
• Monitoring: blood pressure, heart rate, fluid retention
Clinical improvement is usually observed from 6 months, with maximal benefit by 12 months.
Anti‑androgen therapy
Anti‑androgens are indicated where androgen sensitivity plays a significant role.
How they work
Agents such as spironolactone competitively block androgen receptors at the follicle, reducing miniaturisation without lowering systemic androgen levels.
Typical dosing
• Spironolactone: 50–200 mg daily in divided doses
They are particularly beneficial in women with acne, hirsutism, or PCOS features and are most effective when combined with minoxidil.
Hormonal optimisation
Hormonal optimisation may stabilise hair loss in selected patients, particularly during perimenopause.
• Oestrogen replacement may reduce follicular sensitivity
• Certain progestins may worsen hair loss, others are neutral or protective
• Management must be individualised and medically supervised
Adjunctive clinic‑based treatments
Adjunctive therapies enhance follicular signalling and optimise outcomes when layered onto pharmacological treatment.
Platelet‑rich plasma
Mechanism
PRP delivers concentrated autologous growth factors that stimulate angiogenesis, cellular proliferation, and follicular signalling.
Protocol
• Induction: 3–4 sessions at 4‑week intervals
• Maintenance: 1–2 sessions annually
• Injection depth: intradermal to superficial subcutaneous
PRP improves hair shaft diameter and density but performs best alongside minoxidil‑based therapy.
Microneedling
Mechanism
Controlled micro‑injury triggers wound‑healing pathways, increasing growth factor release and enhancing topical absorption.
Protocol
• Needle depth: 0.5–1.5 mm depending on scalp thickness
• Frequency: every 2–4 weeks in clinic
Evidence demonstrates superior outcomes when combined with minoxidil or mesotherapy solutions.
Low‑level laser therapy
Mechanism
LLLT enhances mitochondrial activity and cellular energy production within follicular cells.
Protocol
• Frequency: 3–4 sessions per week
• Duration: minimum 6 months before reassessment
The benefit is modest but may be useful where medication options are limited.
Mesoestetic hair and scalp solutions
Mesoestetic products can be incorporated as supportive, evidence‑aligned adjuncts within a comprehensive FPHL treatment plan.
Hair Plus
An intradermal mesotherapy solution designed to support follicular metabolism and hair shaft quality.
How it works
Delivers biotin, dexpanthenol, organic silica, amino acids, and trace elements directly to the follicular environment, supporting keratin synthesis and cellular function.
Protocol
• Induction: 4–6 sessions
• Interval: every 7–14 days
• Maintenance: monthly to quarterly, depending on stability
Hair Plus supports hair quality and density but does not replace pharmacological therapy.
Hair Loss Solution
A topical scalp solution formulated to improve microcirculation and scalp environment.
Use
• Applied once daily to affected areas
• Used between clinic treatments to support ongoing follicular activity
Microneedling synergy
Mesoestetic scalp solutions may be applied immediately post‑microneedling to enhance dermal penetration and biological activity. Combined protocols demonstrate improved density and hair calibre compared with topical use alone.
Treatments with limited evidence
Biotin supplementation without documented deficiency, growth supplements as monotherapyTopical oils or massage alone, stopping treatment once improvement occurs
Diagnostic assessment and clinical work‑up
The diagnosis of female pattern hair loss is primarily clinical and based on history, pattern recognition, and examination of the scalp. In most cases, invasive investigations are not required.
Clinical assessment
Assessment focuses on:
• Pattern and duration of hair thinning
• Family history of androgenetic alopecia
• Presence of associated features such as acne, hirsutism, or menstrual irregularity
• Scalp health, including evidence of inflammation, scaling, or scarring
Dermoscopic examination may demonstrate hair shaft diameter variability and follicular miniaturisation, supporting the diagnosis.
Laboratory investigations
Blood tests are not routinely required but may be indicated where clinical features suggest contributory pathology. These may include:
• Ferritin and full blood count where iron deficiency is suspected
• Thyroid function tests
• Androgen profile where hyperandrogenism is clinically suggested
Scalp biopsy is rarely necessary and reserved for diagnostic uncertainty or suspected scarring alopecia.
Treatment sequencing and clinical pathway
Management of FPHL follows a staged, rational approach designed to stabilise loss, optimise follicular function, and maintain long-term results.
Stabilisation phase
The primary aim is to arrest progressive follicular miniaturisation.
• Initiation of topical or oral minoxidil
• Introduction of anti-androgen therapy where indicated
• Correction of contributory medical or nutritional factors
This phase typically spans the first 6–12 months and forms the foundation of long-term management.
Optimisation phase
Once shedding stabilises, adjunctive therapies may be layered to enhance hair calibre and density.
• Platelet-rich plasma
• Microneedling protocols
• Mesotherapy using mesoestetic Hair Plus
These interventions amplify follicular signalling but do not replace pharmacological therapy.
Maintenance phase
Long-term maintenance focuses on preserving gains and preventing relapse.
• Continued minoxidil therapy
• Periodic procedural treatments as indicated
• Regular clinical review and treatment adjustment
Long-term management and review
Female pattern hair loss is a chronic condition requiring ongoing management rather than finite treatment. Regular review allows treatment to be adjusted in response to age, hormonal change, or disease progression.
• Clinical review is typically undertaken every 6–12 months
• Treatment intensity may be escalated or de-escalated based on stability
• Discontinuation of therapy commonly results in a gradual reversal of benefit
Clear communication regarding long-term expectations is central to patient satisfaction and adherence.
Prescribing governance and safety considerations
All treatment decisions are individualised following a comprehensive consultation. Where medications are prescribed outside their licensed indication, this is undertaken in line with established clinical evidence and accepted dermatological practice.
• Risks, benefits, and alternatives are discussed as part of informed consent
• Appropriate monitoring is implemented where required
• Treatment plans are documented and reviewed regularly
This approach ensures safe, ethical, and proportionate care consistent with professional and regulatory standards.
Prognosis and expectations
Female pattern hair loss requires long‑term management rather than short‑term correction. Early intervention offers the greatest chance of stabilisation and cosmetic improvement. Later treatment can still slow progression, though regrowth is less predictable.
The most reliable outcomes arise from combination therapy, correction of contributory factors, and realistic expectations. When managed appropriately, most patients achieve stable, cosmetically acceptable hair density.
References
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