Female pattern hair loss (FPHL) is the most common cause of gradual hair thinning in women. It often starts subtly, and many women notice it first as a widening part or a thinner ponytail. This guide covers causes, symptoms, diagnosis and treatment options.
What it looks like
- A widening part, often described as a "Christmas tree" pattern toward the front
- Thinning over the top and crown of the scalp
- Finer hairs and a thinner ponytail
- The front hairline is usually preserved
Unlike stress-related shedding, FPHL is usually gradual rather than sudden.
Causes
FPHL is thought to involve genetics, hormones and age. Androgens are thought to contribute to follicles gradually shrinking in women who are sensitive, and the hormonal shift around menopause can make it more noticeable. Not every woman with FPHL has abnormal hormone levels. See hormonal hair loss in women and menopause hair loss.
Diagnosis
A clinician diagnoses FPHL from the pattern of thinning, history and exam. They may order blood tests for iron, thyroid function and, when there are signs such as irregular periods, acne or excess facial hair, hormone levels. Other causes that can look similar or coexist include telogen effluvium, iron deficiency, thyroid problems and traction alopecia. See TE vs androgenetic alopecia.
Treatment options
- Minoxidil. Topical minoxidil is FDA-approved for hereditary hair loss in women and is often a first step. See minoxidil for women.
- Anti-androgens. Spironolactone is used off-label, with screening, and must not be used during pregnancy. See spironolactone for women's hair loss.
- Compounded topical formulas that combine ingredients, when a provider judges it appropriate. Compounded medications are prepared by a licensed pharmacy for an individual patient and are not FDA-approved.
- Other options such as low-level laser devices, or in-office procedures with a dermatologist.
The most consistent benefit of treatment is slowing or stopping further thinning, and some women see increased density. Change is slow, and treatment usually needs to continue to maintain benefits.
When to see a dermatologist in person
See a dermatologist for sudden or patchy loss, scalp pain or redness, or a receding band at the front hairline, which can signal a scarring condition.
Next step
If you want a licensed provider to review your thinning, start your online consultation.
Prescription required for prescription treatment. A licensed provider decides whether treatment is appropriate. Compounded medications are prepared by a licensed pharmacy for an individual patient and are not FDA-approved. Individual results vary. Prescribed Essence currently serves patients in California, Colorado, Florida and New York.
